S2135 CMV Esophagitis in Immunocompetent Person Treated With Oral Valganciclovir

This case report discusses the rare presentation of cytomegalovirus (CMV) pneumonitis in a young patient with moderately severe Crohn’s disease managed with low dose azathioprine. CMV pneumonitis was initially suspected on CT chest images and confirmed by PCR for CMV. She was treated with intravenous ganciclovir and later stepped down to oral valganciclovir. Although this patient had a prolonged and complicated hospital admission, a good clinical outcome was achieved. CMV infection was raised as an early differential and antiviral treatment was started without delay. This case study, therefore, makes the case for increased awareness of the possibility of, and recognition of CMV pneumonitis among healthcare professionals as a way of preventing significant morbidity and mortality. It also raises awareness of checking for slow metabolisers of azathioprine before initiation to look for individuals who may be at increased risk of azathioprine’s adverse effects.

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Incidence of UL97 Resistance Mutations in Infants with Congenital Cytomegalovirus Disease Receiving 6 Months of Oral Valganciclovir Therapy

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx162.058 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S23-S23 ◽

Cited By ~ 1

Author(s):

Scott H James ◽

Ra’Shun L Conner ◽

David W Kimberlin ◽

Richard Whitley ◽

Mark N Prichard

Keyword(s):

Antiviral Therapy ◽

Antiviral Resistance ◽

Sequence Variants ◽

Resistance Mutations ◽

Phase 3 ◽

Congenital Cytomegalovirus ◽

Study Population ◽

Oral Valganciclovir ◽

Cmv Disease ◽

Ul97 Gene

Abstract Background A recently completed Phase 3 randomized, controlled, double-blind, multicenter study of infants with symptomatic congenital cytomegalovirus (CMV) disease receiving 6 months of oral valganciclovir (VGCV) therapy represents the largest such population in which to evaluate treatment-emergent antiviral resistance. The most common mechanism of CMV antiviral resistance occurs through mutations in the CMV UL97 gene that confer resistance to ganciclovir (GCV). Genotypic resistance analyses were performed on infants receiving 6 months of VGCV to assess the incidence of antiviral resistance due to UL97 sequence variants. Methods Resistance analyses were performed by conventional DNA sequencing of the UL97 gene at multiple time points. Following CMV DNA extraction from frozen whole blood specimens, the UL97 gene was amplified with a double nested polymerase chain reaction method and sequenced to identify polymorphisms and mutations that might confer GCV resistance. Results Forty-six infants with symptomatic CMV disease who received a 6-month course of VGCV underwent resistance analysis to identify UL97 sequence variants. In addition to a range of natural polymorphisms known to have no effect on antiviral susceptibility, 2 subjects developed UL97 mutations known to confer resistance to GCV (A594V and G598S detected in one subject; E596G detected in another), yielding an incidence of 4%. Each of these resistance mutations occurred in specimens collected after at least 4 months of antiviral therapy. As evaluated in the original Phase 3 trial, neither of these infants showed an improvement in hearing outcome. Conclusion The development of treatment-emergent UL97 resistance mutations was determined in a controlled study population of infants with congenital CMV disease receiving 6 months of VGCV. This targeted resistance analysis demonstrated an incidence approaching the total incidence of antiviral resistance for CMV disease in some immunocompromised populations, such as solid-organ transplant recipients. Further studies within this study population are warranted to elucidate the risk of emerging antiviral resistance and to assess clinical impact as well as the potential need for combination antiviral therapy. Disclosures All authors: No reported disclosures.

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Primary cytomegalovirus infectious colitis complicating Crohn's disease successfully treated with oral valganciclovir

Journal of Crohn s and Colitis ◽

10.1016/j.crohns.2009.11.004 ◽

2010 ◽

Vol 4 (2) ◽

pp. 199-202 ◽

Cited By ~ 7

Author(s):

Venkataraman Subramanian ◽

Caroline Finlayson ◽

Thomas Harrison ◽

Phillip Rice ◽

Richard Pollok

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Infectious Colitis ◽

Oral Valganciclovir

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Antibiotic-Resistant Cytomegalovirus Infection Following Oral Valganciclovir Prophylaxis in Lung Transplant Recipients

CHEST Journal ◽

10.1378/chest.10964 ◽

2010 ◽

Vol 138 (4) ◽

pp. 546A

Author(s):

Linda J. Stuckey ◽

Anish Wadhwa ◽

Daniel Kaul ◽

Kristy Bauman ◽

Vibha N. Lama ◽

...

Keyword(s):

Cytomegalovirus Infection ◽

Lung Transplant ◽

Transplant Recipients ◽

Antibiotic Resistant ◽

Oral Valganciclovir ◽

Lung Transplant Recipients

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Efficacy, safety, and pharmacokinetics of oral valganciclovir in patients with congenital cytomegalovirus infection

Journal of Infection and Chemotherapy ◽

10.1016/j.jiac.2020.08.019 ◽

2020 ◽

Author(s):

Eisuke Suganuma ◽

Hideaki Sakata ◽

Nodoka Adachi ◽

Satoshi Asanuma ◽

Mihoko Furuichi ◽

...

Keyword(s):

Cytomegalovirus Infection ◽

Congenital Cytomegalovirus Infection ◽

Congenital Cytomegalovirus ◽

Oral Valganciclovir

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A Nationwide Survey of Cytomegalovirus Prevention Strategies in Kidney Transplant Recipients in a Resource-Limited Setting

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz322 ◽

2019 ◽

Vol 6 (9) ◽

Cited By ~ 1

Author(s):

Jackrapong Bruminhent ◽

Asalaysa Bushyakanist ◽

Surasak Kantachuvesiri ◽

Sasisopin Kiertiburanakul

Keyword(s):

Kidney Transplant ◽

Nationwide Survey ◽

Preemptive Therapy ◽

Prevention Strategies ◽

Kidney Transplant Recipients ◽

Infectious Disease Physician ◽

Hybrid Approaches ◽

Resource Limited ◽

Oral Valganciclovir ◽

Main Barrier

Abstract Objective Strategies to prevent cytomegalovirus (CMV) infection in resource-limited settings have been under-explored. We investigated CMV prevention strategies utilized among transplant centers in Thailand. Method A questionnaire on CMV prevention strategies for kidney transplant (KT) recipients was developed using a web-based electronic survey website (www.surveymonkey.com). The survey was delivered to 31 transplant centers in Thailand. One infectious disease physician (ID) and 1 nephrologist (NP) from each center were included. Results There were 43 respondents from 26 of the 31 transplant centers (84%), including 26 (60%) IDs and 17 (40%) NPs. Forty-one 95% (41/43) physicians agreed on the necessity of CMV prevention. Of these, 77% (33/43) physicians implemented prevention strategies for their patients. Interventions included preemptive approaches (48%), prophylaxis (45%), hybrid approaches; surveillance after prophylaxis (3%), and CMV-specific immunity-guided approaches (3%). For CMV-seropositive KT recipients, use of preemptive approaches (84%) exceeded prophylaxis (12%). However, 81% of the former preferred targeted prophylaxis in patients receiving antithymocyte globulin therapy. Sixty-five percent and 93% of physicians started preemptive therapy when plasma CMV DNA loads reached 2000 and 3000 copies/mL (1820 and 2730 IU/mL), respectively. A significantly greater percentage of NPs initiated preemptive therapy at a plasma CMV DNA load of 1820 IU/mL compared with IDs (88% vs 50%; P = .02). The most common barrier to prevention strategy implementation was financial inaccessibility of oral valganciclovir (67%) and quantitative CMV DNA testing (12%). Conclusions Most physicians agreed on a need for preemptive approaches, although prophylaxis was targeted in those receiving intense immunosuppression. The financial implication is the main barrier for CMV prevention in Thailand.

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Pharmacokinetic and Pharmacodynamic Assessment of Oral Valganciclovir in the Treatment of Symptomatic Congenital Cytomegalovirus Disease

The Journal of Infectious Diseases ◽

10.1086/528376 ◽

2008 ◽

Vol 197 (6) ◽

pp. 836-845 ◽

Cited By ~ 165

Author(s):

David W. Kimberlin ◽

Edward P. Acosta ◽

Pablo J. Sánchez ◽

Sunil Sood ◽

Vish Agrawal ◽

...

Keyword(s):

Cytomegalovirus Disease ◽

Congenital Cytomegalovirus ◽

Oral Valganciclovir

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Cytomegalovirus Retinitis in an ALL Child during Maintenance Therapy Treated Successfully with Intravenous Ganciclovir

Case Reports in Ophthalmological Medicine ◽

10.1155/2014/294238 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Hande Celiker ◽

Ayse Karaaslan ◽

Eda Kepenekli Kadayifci ◽

Serkan Atici ◽

Ahmet Soysal ◽

...

Keyword(s):

Anterior Chamber ◽

Lymphoblastic Leukemia ◽

Maintenance Phase ◽

Cytomegalovirus Retinitis ◽

Intravenous Ganciclovir ◽

Hematopoietic Stem ◽

Normal Limits ◽

Retinal Examination ◽

Oral Valganciclovir ◽

The Right

Purpose.In here we described cytomegalovirus retinitis (CMVR) in 12-year-old male patient with acute lymphoblastic leukemia (ALL) who was on maintenance phase therapy.Methods.He was referred to our clinic for seeing of spots with the right eye for 3 days. At presentation, his best corrected visual acuity was 20/20 in the right eye and 20/20 in the left eye. Slit-lamp biomicroscopic examination of the anterior chamber of the left eye was within normal limits, whereas we observed 3+ anterior chamber cellular reaction in the right eye. On retinal examination, we found active retinitis lesions (cream-colored lesions associated with hemorrhages) and perivascular cuffing in the retinal periphery in the right eye. Left eye was normal.Results.On the basis of clinical picture, we made the diagnosis of CMVR in the right eye. Vitreous aspiration was performed and 23096 copies/mL of CMV DNA was detected by polymerase chain reaction (PCR) technique. The patient was successfully treated with intravenous ganciclovir for two weeks and discharged with oral valganciclovir prophylaxis.Conclusion.CMVR should be in mind in children with ALL on maintenance phase therapy even in those without hematopoietic stem cell transplantation. These patients can be treated successfully by intravenous ganciclovir alone.

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