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

• Published in: Antiviral research Vol. 101; pp. 57 - 61
• Main Authors: Germi, R., Mariette, C., Alain, S., Lupo, J., Thiebaut, A., Brion, J.P., Epaulard, O., Saint Raymond, C., Malvezzi, P., Morand, P.
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier B.V 01.01.2014; Elsevier; Elsevier Masson
• Subjects: Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiviral Agents; Antiviral Agents - therapeutic use; Artemisinins; Artemisinins - therapeutic use; Artesunate; Biochemistry, Molecular Biology; Biological and medical sciences; Cytomegalovirus; Cytomegalovirus - drug effects; Cytomegalovirus - genetics; Cytomegalovirus - isolation & purification; Cytomegalovirus Infections; Cytomegalovirus Infections - drug therapy; Cytomegalovirus Infections - virology; Drug Resistance, Viral; Female; Hematopoietic Stem Cell Transplantation; Hematopoietic Stem Cell Transplantation - adverse effects; Humans; Infectious diseases; Life Sciences; Male; Medical sciences; Middle Aged; Multidrug resistance; Organ Transplantation; Organ Transplantation - adverse effects; Pharmacology. Drug treatments; Structural Biology; Transplantation; Treatment Outcome; Viral diseases; Viral Load; Cytomegalovirus; Transplantation; Multidrug resistance; Artesunate; Antimalarial; Treatment resistance; Disease; Herpesviridae; Homotransplantation; Betaherpesvirinae; Human cytomegalovirus; Infection; Virus; Treatment; Multiple resistance; Viral disease; Parasiticide; Failure
• ISSN: 0166-3542; 1872-9096
• DOI: 10.1016/j.antiviral.2013.10.014

•Clinical efficiency of artesunate in resistant CMV infections is controversial.•We describe 5 cases of multidrug-resistant CMV infections treated with artesunate.•Clinical outcomes was favourable in 3 cases and unfavourable in 2 cases.•Artesunate was useful in decreasing CMV DNA load in multidrug-resistant CMV strains.•Artesunate was insufficient for the treatment of severe illness with organ injury. 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.