Antiviral Drug-Resistance Typing Reveals Compartmentalization and Dynamics of Acyclovir-Resistant Herpes Simplex Virus Type-2 (HSV-2) in a Case of Neonatal Herpes

Abstract

A neonate suffering from herpes simplex virus type 2 disease with central nervous system involvement developed an early recurrence under acyclovir therapy. Isolates from the cerebrospinal fluid and skin lesions were acyclovir resistant, while viruses from blood and trachea were not. Acyclovir combined with foscavir followed by long-term suppressive acyclovir therapy supported normal neurological development.

Persistent primary cytomegalovirus infection in a kidney transplant recipient: Multi-drug resistant and compartmentalized infection leading to graft loss

“…Although the A594V UL97 was found in blood (RV-1103) and kidney (CS_3_7), the Δ 981-982 and P522S DNA polymerase mutants were present in blood and the T503A mutation in the kidney, indicating that the T503A, detected as a minor population in blood at day 152 by NGS had the ability to infect and replicate in the kidney. Our findings clearly indicate a compartmentalized evolution of the viral subpopulations as highlighted in our previous studies (Bache et al, 2014;Bauters et al, 2016), which warrants genotyping of tissue-specific specimens together with blood in patients unresponsive to antiviral therapy. Because different viral mutants can be selected at relatively low amounts in blood where high levels of viral replication take place and some minor viral variants have the ability to invade the graft causing disease, their rapid detection by NGS should be beneficial.…”

Anti‐HSV‐1 and HSV‐2 Flavonoids and a New Kaempferol Triglycoside from the Medicinal Plant Kalanchoe daigremontiana

“…HSV‐1 and HSV‐2 are usually associated with orolabial and genital lesions, respectively . HSV can also cause deadly infections of the central nervous system and disseminated disease in immune‐compromised adults and newborns . Antiviral therapies for HSV are only partially effective since the virus can ascend along neuronal axons to establish latent infections that last a lifetime …”

Neonatal Herpes Simplex Viral Infections and Acyclovir: An Update

“…36 Specific recommendations outline management of asymptomatic infants born to mothers with active lesions regardless of method of delivery. 37 The approach to management of these infants depends on the presence or absence of maternal history of genital HSV infection prior to the pregnancy. Infants born to mothers with a prior history should have surface cultures (with or without HSV PCR) and blood HSV PCR testing at 24 hours of life.…”

“…37 In addition to surface cultures (with or without HSV PCR) and blood HSV PCR testing at 24 hours of life, infants should have an alanine aminotransferase (ALT) and also undergo a lumbar puncture to obtain CSF cell count, chemistries, and HSV PCR. Maternal type-specific serologies should be sent if available at the delivery hospital.…”

“…The prevalence of resistance in the neonatal population is unknown but has been reported. 37 The prevalence of acyclovir resistance is greater in immunocompromised patients compared with immunocompetent ones. 38,39 Of note, one of the infants in the aforementioned case series evaluating maternal antiviral suppressive therapy was infected with a resistant organism.…”