Morillo-Gutierrez Beatriz, Waugh Sheila, Pickering Ailsa, Flood Terence, Emonts Marieke
Paediatric Infectious Diseases and Immunology Department, Great North Children's Hospital, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK.
Microbiology Department, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK.
BMC Pediatr. 2017 Aug 22;17(1):181. doi: 10.1186/s12887-017-0933-6.
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.
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.
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.
先天性巨细胞病毒（cCMV）感染是一种重要疾病，是新生儿听力丧失的常见原因，也是儿童残疾的主要原因。因此，建议对有症状的患者使用更昔洛韦或其前体药物缬更昔洛韦进行治疗。已证明6个月的治疗疗程比更短疗程更有益；然而，关于耐药菌株的出现、副作用和长期后遗症仍存在不确定性。
我们在此报告一名有症状的cCMV感染女婴，从出生第5天开始接受口服缬更昔洛韦治疗。尽管密切监测她的药物水平并根据体重增加增加治疗剂量，但她在治疗4个月后出现了更昔洛韦耐药，病毒血症增加且出现瘀点。评估了她对治疗的依从性，认为依从性良好。临床上，尽管她有明显的发育迟缓，但仍在稳步进步。鉴于耐药的出现，在5个月大时停止了治疗。在整个疗程中未发现更昔洛韦的副作用。
在关于这种感染的6个月治疗疗程的新建议发布之前，文献中很少有cCMV对更昔洛韦耐药的病例报告。正如我们的患者所示，定期监测病毒载量和药物监测对于识别新出现的耐药性并根据体重增加优化抗病毒药物剂量至关重要。
