Aidan at 00:28, 7 August 2020

2020-08-07T00:28:49Z

← Older revision		Revision as of 00:28, 7 August 2020
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	== Background ==		==Background==

			* Inherent resistance to [[acyclovir]]
			* Acquired resistance to [[ganciclovir]], [[foscarnet]], [[cidofovir]], and [[letermovir]] is possible

	{\| class="wikitable"		{\| class="wikitable"
	!Gene		!Gene
Line 65:		Line 69:
	\|}		\|}

	== Clinical Manifestations ==		==Clinical Manifestations==

	* CMV viral load increasing or failing to decrease after 2 weeks of appropriate antiviral therapy		*CMV viral load increasing or failing to decrease after 2 weeks of appropriate antiviral therapy
	* Failure to improve clinically after 2 weeks of appropriate antiviral therapy		*Failure to improve clinically after 2 weeks of appropriate antiviral therapy

	== Diagnosis ==		==Diagnosis==

	* Genotyping for resistance alleles		*Genotyping for resistance alleles

	== Management ==		==Management==

	* Decrease immunosuppression, if possible		*Decrease immunosuppression, if possible
	* If switching to foscarnet or cidofovir, monitor closely for renal toxicity		*If switching to foscarnet or cidofovir, monitor closely for renal toxicity

	[[Category:Infectious diseases]]		[[Category:Infectious diseases]]

Aidan: Created page with "== Background == {| class="wikitable" !Gene !Product !Mutations !Resistance !Notes |- | rowspan="4" |''UL97'' | rowspan="4" |kinase |M460V, H520Q, A594V, L595S, C603W, L595F |..."

2020-08-07T00:25:53Z

Created page with "== Background == {| class="wikitable" !Gene !Product !Mutations !Resistance !Notes |- | rowspan="4" |''UL97'' | rowspan="4" |kinase |M460V, H520Q, A594V, L595S, C603W, L595F |..."

New page

== Background ==
{| class="wikitable"
!Gene
!Product
!Mutations
!Resistance
!Notes
|-
| rowspan="4" |''UL97''
| rowspan="4" |kinase
|M460V, H520Q, A594V, L595S, C603W, L595F
|high-level ganciclovir
|most common (0-3% of transplant recipients)
|-
|M460I, C592G, L595W
|low-level [[ganciclovir]]
|
|-
|L405P, M460T, V466G, A594T/P/G/E, L595S, E596G, G598S, K599T, C603W/R/S, C607Y/F, Δ591-594, Δ591-607, Δ595, Δ595-603, Δ600, Δ601, Δ601-603
|[[ganciclovir]]
|
|-
|V353A, L397R, T409M, H411Y/N/L
|[[maribavir]]
|
|-
| rowspan="5" |''UL54''
| rowspan="5" |DNA polymerase
|D301N, N408D/K, N410K, F412C/V, D413A/E, L501I, T503I, K513E/N, L516R, I521T, P522A/S, L545S, A987G
|[[ganciclovir]] and [[cidofovir]]
|
|-
|N495K, D588E, E756D/Q, T700A, V715M, T838A
|foscarnet
|
|-
|L776M, V781I, V787L, L802M, A809V
|[[foscarnet]] and [[ganciclovir]]
|
|-
|D588N, E756K, V812L, T813S, A834P, G841A, Δ981-2
|[[foscarnet]], [[ganciclovir]], and [[cidofovir]]
|
|-
|K805Q
|[[cidofovir]]
|
|-
|''UL56''
|terminase complex
|mutations in the codon range 231-369
|[[letermovir]]
|
|-
|''UL51''
|terminase complex
|
|[[letermovir]]
|
|-
|''UL89''
|terminase complex
|
|[[letermovir]]
|}

== Clinical Manifestations ==

* CMV viral load increasing or failing to decrease after 2 weeks of appropriate antiviral therapy
* Failure to improve clinically after 2 weeks of appropriate antiviral therapy

== Diagnosis ==

* Genotyping for resistance alleles

== Management ==

* Decrease immunosuppression, if possible
* If switching to foscarnet or cidofovir, monitor closely for renal toxicity

[[Category:Infectious diseases]]
[[Category:Immunocompromised hosts]]
[[Category:Transplant patients]]

Antiviral resistance in CMV - Revision history

Aidan at 00:28, 7 August 2020

Aidan: Created page with "== Background == {| class="wikitable" !Gene !Product !Mutations !Resistance !Notes |- | rowspan="4" |''UL97'' | rowspan="4" |kinase |M460V, H520Q, A594V, L595S, C603W, L595F |..."