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Acyclovir-resistant herpes simplex virus infections in a bone marrow transplant population
J M Darville1, B E Ley, A P Roome
1Department of Pathology and Microbiology, University of Bristol, UK.
Abstract:
Over a 3-month period, four patients who had received unrelated donor (UD) bone marrow transplants (BMT) presented with severe mucocutaneous herpes simplex virus (HSV) infection while receiving acyclovir (ACV) prophylaxis. Sensitivity testing of the isolates revealed three to be acyclovir-resistant and in one patient the infection was also characterised by a marked failure to respond to foscarnet (phosphonoformic acid). The emergence of ACV-resistant HSV infections in themselves is a new and challenging problem, and yet a far greater problem will become evident if these infections develop resistance to non thymidine kinase dependent therapy.
Insights
Severe herpes simplex virus (HSV) infections emerged in bone marrow transplant patients despite acyclovir (ACV) prophylaxis. Some infections were resistant to both acyclovir and foscarnet, posing a significant treatment challenge.
Area of Science:
- Hematology
- Virology
- Infectious Diseases
Background:
- Bone marrow transplantation (BMT) is a critical procedure for various hematologic malignancies and other conditions.
- Patients undergoing BMT are immunocompromised, increasing their susceptibility to opportunistic infections.
- Herpes simplex virus (HSV) infections are common in BMT recipients, necessitating prophylactic antiviral therapy.
Observation:
- Four patients who received unrelated donor (UD) BMT developed severe mucocutaneous HSV infections.
- These infections occurred despite receiving acyclovir (ACV) prophylaxis.
- Clinical observation noted a significant failure to respond to standard antiviral treatments.
Findings:
- Isolates from three patients demonstrated acyclovir resistance.
- One patient's infection was also refractory to foscarnet (phosphonoformic acid) treatment.
- This indicates the emergence of drug-resistant HSV strains in the post-BMT setting.
Implications:
- The rise of acyclovir-resistant HSV poses a new challenge in managing BMT patients.
- Further resistance to non-thymidine kinase dependent therapies like foscarnet could lead to untreatable infections.
- Development of novel antiviral strategies and resistance monitoring is crucial for improving outcomes in immunocompromised hosts.