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Related Experiment Videos

Acyclovir-resistant herpes simplex virus causing pneumonia after marrow transplantation.

P Ljungman1, M N Ellis, R C Hackman

  • 1Program in Infectious Diseases, Fred Hutchinson Cancer Research Center, Seattle, WA 98104.

The Journal of Infectious Diseases
|July 1, 1990
PubMed
Summary

Acyclovir-resistant herpes simplex virus (HSV) caused severe pneumonia in three immunocompromised patients. Alternative antivirals like foscarnet are crucial when HSV develops resistance to acyclovir.

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Area of Science:

  • Virology
  • Immunology
  • Oncology

Background:

  • Hematopoietic stem cell transplantation (HSCT) patients are highly susceptible to opportunistic infections.
  • Herpes simplex virus (HSV) infections are common in immunocompromised individuals, typically managed with acyclovir.

Observation:

  • Three HSCT recipients developed fatal pneumonia attributed to thymidine kinase-deficient, acyclovir-resistant HSV type 1.
  • Autopsy revealed HSV pneumonia in all three cases, with virus isolated from lung tissue.
  • Two patients had concurrent pulmonary infections, while one had HSV pneumonia as the sole identified cause of death.

Findings:

  • The acyclovir-resistant HSV strains remained sensitive to foscarnet and vidarabine but not ganciclovir.
  • These resistant strains acted as primary or significant co-pathogens in severe visceral disease.

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  • This challenges the notion that acyclovir-resistant HSV is always less virulent.

    • Implications:

    • Highlights the critical need for routine antiviral sensitivity testing in immunocompromised patients with suspected HSV infections.
    • Underscores the importance of considering alternative antiviral therapies, such as foscarnet, for acyclovir-resistant HSV.
    • Emphasizes the potential severity of acyclovir-resistant HSV in severely immunocompromised populations, necessitating vigilant monitoring and tailored treatment strategies.