在接受异构血型造血干细胞移植的儿科患者中,抗环维尔的简单疹病毒:一系列病例
Jenna Nunn1, Ahmed Ahmed1, Srividhya Senthil1
1Department of Paediatric Haematology and Bone Marrow Transplant, Manchester University Foundation Trust, Manchester, UK.
概括
在小儿干细胞移植患者中,抗乙克洛维尔的简单疹病毒 (HSV) 感染导致高死亡率和有限的治疗选择. 早期耐药性测试和迅速的二线治疗对于更好的结果至关重要.
科学领域:
- 儿科血液瘤学
- 传染性疾病 传染性疾病
- 移植免疫学 移植免疫学
背景情况:
- 简单疹病毒 (HSV) 感染对血造干细胞移植 (HSCT) 接受者来说是一个显著的风险.
- 在这种脆弱人群中,HSV的抗病毒耐药性带来了重大的临床挑战.
研究的目的:
- 为了分析临床特征,治疗结果,并发症的阿西克洛维尔耐药HSV感染在儿科HSCT接受者.
- 确定管理这些具有挑战性的感染的关键因素.
主要方法:
- 八名儿科患者的回顾性病例系列,他们接受了全基性HSCT,基因型确认了抗阿西克洛维尔的HSV感染.
- 对HSCT,HSV表现,抗病毒治疗和相关并发症的患者适应症的分析.
主要成果:
- 最常见的突变是提米丁激酶 (TK). 感染呈现变化,包括粘膜皮肤疾病,肺炎和病毒病.
- 大多数患者需要二线或三线抗病毒药物,观察到显著的毒性 (37.5%).
- 发现高死亡率 (37.5%) 和继发性并发症,如移植相关的血栓性微血管病变和异常性肺综合征.
结论:
- 儿科HSCT接受者的抗阿西克洛维尔HSV与高发病率,死亡率和治疗毒性有关.
- 早期识别,耐药性测试,及时的二线治疗和免疫抑制管理至关重要.
- 新兴疗法看起来很有前途,但需要更多的儿科数据和更好的准入.
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