Success and failure of artesunate treatment in five transplant recipients with disease caused by drug-resistant cytomegalovirus

R Germi; C Mariette; S Alain; J Lupo; A Thiebaut; J P Brion; O Epaulard; C Saint Raymond; P Malvezzi; P Morand

doi:10.1016/j.antiviral.2013.10.014

Success and failure of artesunate treatment in five transplant recipients with disease caused by drug-resistant cytomegalovirus

Antiviral Res. 2014 Jan:101:57-61. doi: 10.1016/j.antiviral.2013.10.014. Epub 2013 Nov 1.

Authors

R Germi¹, C Mariette², S Alain³, J Lupo⁴, A Thiebaut⁵, J P Brion², O Epaulard⁶, C Saint Raymond⁷, P Malvezzi⁸, P Morand⁴

Affiliations

¹ Department of Virology, University Hospital, Grenoble, France; Unit of Virus Host Cell Interactions UMI 3265 UJF-EMBL-CNRS, B.P. 181, 6, rue Jules Horowitz, 38042 Grenoble Cedex 9, France. Electronic address: rgermi@chu-grenoble.fr.
² Department of Infectious diseases, University Hospital, Grenoble, France.
³ Department of Virology, French National Cytomegalovirus Reference Center, University Hospital, Limoges, France.
⁴ Department of Virology, University Hospital, Grenoble, France; Unit of Virus Host Cell Interactions UMI 3265 UJF-EMBL-CNRS, B.P. 181, 6, rue Jules Horowitz, 38042 Grenoble Cedex 9, France.
⁵ Department of Hematology, University Hospital, Grenoble, France.
⁶ Department of Virology, University Hospital, Grenoble, France; Unit of Virus Host Cell Interactions UMI 3265 UJF-EMBL-CNRS, B.P. 181, 6, rue Jules Horowitz, 38042 Grenoble Cedex 9, France; Department of Infectious diseases, University Hospital, Grenoble, France.
⁷ Department of Pneumology, University Hospital, Grenoble, France.
⁸ Department of Nephrology, University Hospital, Grenoble, France.

PMID: 24184983
DOI: 10.1016/j.antiviral.2013.10.014

Abstract

Cytomegalovirus (CMV) strains resistant to ganciclovir, cidofovir and/or foscarnet were genotypically and phenotypically characterised in two haematopoietic stem cell transplant recipients and three solid-organ transplant recipients with CMV disease. The anti-malaria drug artesunate led to a favourable virological and clinical response in three cases with mild CMV diseases (fever and neutropaenia) but was ineffective in two fatal CMV diseases with lung involvement in spite of a decrease in the CMV DNA load in blood and bronchoalveolar fluid.

Trial registration: ClinicalTrials.gov NCT01008540.

Keywords: Artesunate; Cytomegalovirus; Multidrug resistance; Transplantation.

Publication types

Case Reports

MeSH terms

Antiviral Agents / therapeutic use*
Artemisinins / therapeutic use*
Artesunate
Cytomegalovirus / drug effects*
Cytomegalovirus / genetics
Cytomegalovirus / isolation & purification
Cytomegalovirus Infections / drug therapy*
Cytomegalovirus Infections / virology
Drug Resistance, Viral*
Female
Hematopoietic Stem Cell Transplantation / adverse effects
Humans
Male
Middle Aged
Organ Transplantation / adverse effects
Transplantation
Treatment Outcome
Viral Load

Substances

Antiviral Agents
Artemisinins
Artesunate

Associated data

ClinicalTrials.gov/NCT01008540