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首页> 外文期刊>BMC Pediatrics >Emerging (val)ganciclovir resistance during treatment of congenital CMV infection: a case report and review of the literature
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Emerging (val)ganciclovir resistance during treatment of congenital CMV infection: a case report and review of the literature

机译：在先天性巨细胞病毒感染治疗期间出现新的（val）更昔洛韦耐药性：病例报告和文献复习

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Background Congenital cytomegalovirus (cCMV) infection is an important illness that is a common cause of hearing loss in newborn infants and a major cause of disability in children. For that reason, treatment of symptomatic patients with either ganciclovir or its pro-drug valganciclovir is recommended. Treatment duration of 6?months has been shown to be more beneficial than shorter courses; however, there is uncertainty regarding emergence of resistance strains, secondary effects and long term sequelae. Case presentation Here we present a female infant with symptomatic cCMV who was treated from day 5 of life with oral valganciclovir. In spite of close monitoring of her drug levels and increments of her treatment dose according to weight gain, she developed ganciclovir resistance after 4?months of treatment, with increasing viraemia and petechiae. Adherence to treatment was assessed and felt to be good. Clinically, although she had marked developmental delay, she was making steady progress. In view of the development of resistance treatment was stopped at 5?months of age. No secondary effects of ganciclovir were noted during the whole course. Conclusions There were few cases in the literature reporting resistance to ganciclovir for cCMV before the new recommendations for a 6?months treatment course for this infection were published. As demonstrated in our patient, surveillance with periodic viral loads and drug monitoring are vital to identify emerging resistance and optimise antiviral dosing according to weight gain.
机译：背景技术先天巨细胞病毒（cCMV）感染是一种重要疾病，是新生儿听力损失的常见原因，也是儿童残疾的主要原因。因此，建议用更昔洛韦或其前药缬更昔洛韦治疗有症状的患者。研究表明，持续6个月的治疗比缩短疗程更有益;但是，关于耐药菌株的出现，次级效应和长期后遗症尚不确定。病例介绍在这里，我们介绍一例有症状的cCMV的婴儿，该婴儿从生命的第5天开始接受口服缬更昔洛韦治疗。尽管根据体重增加密切监测药物水平和治疗剂量的增加，但在治疗4个月后，她对更昔洛韦产生了耐药性，并伴有病毒血症和瘀斑的增加。评估对治疗的依从性并认为是良好的。临床上，尽管她明显地延迟了发育，但是她正在稳步发展。鉴于抗药性的发展，在5周龄时停止治疗。在整个疗程中未观察到更昔洛韦的次要作用。结论在文献中很少有报道对更昔洛韦耐药的cCMV，然后才发布了针对该感染6个月疗程的新建议。正如我们的患者所证明的那样，定期进行病毒载量监测和药物监测对于确定新出现的耐药性并根据体重增加优化抗病毒剂量至关重要。

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