Brincidofovir clearance of acyclovir-resistant herpes simplex virus-1 and adenovirus infection after stem cell transplantation

Transpl Infect Dis. 2016 Oct;18(5):791-794. doi: 10.1111/tid.12582. Epub 2016 Sep 16.

Abstract

Infections with adenovirus (AdV) and herpesviruses can result in considerable morbidity and mortality in pediatric hematopoietic stem cell transplant (SCT) recipients. Herpes simplex virus (HSV) reactivations are usually prevented by acyclovir (ACV) prophylaxis, whereas cidofovir (CDV) has been used off indication to manage AdV infections. We report a child with myelodysplastic syndrome undergoing multiple SCT, who experienced HSV-1 disease including severe mucositis and herpetic whitlow, as well as high viral load AdV DNAemia. Both ACV and CDV were ineffective; however, viral loads were decreased with brincidofovir, resulting in viral clearance. A subsequent Epstein-Barr virus disease with relevant meningoencephalitis responded to rituximab.

Keywords: Epstein-Barr virus; adenovirus; brincidofovir; hematopoietic stem cell transplantation; herpes simplex virus.

Publication types

  • Case Reports

MeSH terms

  • Acyclovir / administration & dosage
  • Acyclovir / therapeutic use
  • Adenoviridae / isolation & purification
  • Adenoviridae / physiology*
  • Adenovirus Infections, Human / blood
  • Adenovirus Infections, Human / drug therapy*
  • Adenovirus Infections, Human / virology
  • Antibiotic Prophylaxis
  • Antiviral Agents / administration & dosage
  • Antiviral Agents / therapeutic use*
  • Child, Preschool
  • Cidofovir
  • Cytosine / administration & dosage
  • Cytosine / analogs & derivatives*
  • Cytosine / therapeutic use
  • DNA, Viral / blood
  • Drug Resistance, Viral
  • Epstein-Barr Virus Infections / blood
  • Epstein-Barr Virus Infections / drug therapy*
  • Epstein-Barr Virus Infections / virology
  • Female
  • Foscarnet / administration & dosage
  • Foscarnet / therapeutic use
  • Hematopoietic Stem Cell Transplantation / adverse effects*
  • Herpes Simplex / drug therapy*
  • Herpes Simplex / virology
  • Herpes Zoster / drug therapy*
  • Herpes Zoster / virology
  • Herpesvirus 1, Human / isolation & purification
  • Herpesvirus 3, Human / isolation & purification
  • Herpesvirus 4, Human
  • Humans
  • Immunocompromised Host
  • Meningoencephalitis / drug therapy*
  • Meningoencephalitis / virology
  • Mucositis / drug therapy*
  • Mucositis / virology
  • Myelodysplastic Syndromes / surgery*
  • Organophosphonates / administration & dosage
  • Organophosphonates / therapeutic use*
  • Rituximab / administration & dosage
  • Rituximab / therapeutic use
  • Viral Load

Substances

  • Antiviral Agents
  • DNA, Viral
  • Organophosphonates
  • Foscarnet
  • Rituximab
  • brincidofovir
  • Cytosine
  • Cidofovir
  • Acyclovir