• Title/Summary/Keyword: ganciclovir

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Severe Cytomegalovirus Infection in a Late-Preterm Infant at 2 Months of Age (후기 미숙아에서 생후 2개월에 진단된 중증 거대 세포바이러스 감염)

  • Choi, Seo Yeol;Lee, Kun Song
    • Pediatric Infection and Vaccine
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    • v.23 no.2
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    • pp.137-142
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    • 2016
  • Severe cytomegalovirus (CMV) infection involving multiorgan is very rare except in very low-birth weight infants, or in immunocompromised pediatric patients. We report an unusual case of severe CMV infection involving multiple organs including the central nervous system, liver, lung, and gastrointestinal tract in a late-preterm infant at 2 months of age.

Substrate Specificity of Protein Kinase UL97, an antiviral target, on Mutant Peptide Substrates Derived from a Peptide, KESYSVYVYKV (KESYSVYVYKV로부터 변형된 펩타이드 기질을 이용한 항바이러스제의 타깃이 되는 UL97 단백질 인산화 효소의 기질 특이성)

  • Baek, Moon-Chang
    • YAKHAK HOEJI
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    • v.52 no.6
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    • pp.466-470
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    • 2008
  • Human cytomegalovirus expresses an unusual protein kinase UL97, a member of ${H_V}{U_L}$ family of protein kinase. UL97 can phosphorylate nucleoside analogs such as ganciclovir as well as protein/peptide. It has previously been reported that UL97 is able to phosphorylate a KESYSVYVYKV peptide and that P+5 position (K) is important. We examined the extent of contribution of other positions (P-4 through P+6) of the peptide to be substrate of UL97 using alanine substituted peptides (Ala scanning) and deleted peptides. The result suggested that the E (P-2) is negative effect and P+5 (K) is still important. The peptide YSVYVYK is the shortest substrate enough to show high activity, which could be a starting point to develop peptidomimetic drug. This study would give important information to deeply understand the substrate specificity of UL97 and develop an antiviral drug using the small peptide identified here.

CMV antigenemia following pediatric hematopoietic stem cell transplantation : risk factors and outcomes (소아 조혈모세포 이식 후 거대세포 바이러스 항원혈증 발생 : 위험인자와 임상 경과)

  • Cho, Eun-Young;Park, Young-Shil;Lee, Dae-Hyung;Park, Ji Kyoung;Choi, Sangrhim;Kim, Sun Young;Jang, Pil-Sang;Lee, Dong-Gun;Chung, Nak-Gyun;Kim, Jong-Hyun;Jeong, Dae-Chul;Cho, Bin;Hur, Jae Gyun;Kang, Jin Han;Kim, Hack Ki
    • Clinical and Experimental Pediatrics
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    • v.49 no.2
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    • pp.173-180
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    • 2006
  • Purpose : Cytomegalovirus(CMV) infection still remains as a major cause of morbidity and mortality after stem cell transplantation. In this study, we analyzed the results of antigenemia-guided preemptive therapy among children with allogeneic hematopoietic stem cell transplantation to determine the incidence and risk factors associated with CMV antigenemia, and evaluated the efficacy of the CMV antigenemia based preemptive therapy. Methods : We enrolled 213 pediatric patients following allogeneic hematopoietic stem cell transplantation(HSCT), at the Catholic HSCT center between October 1998 and December 2003. Pre-emptive ganciclovir was started when more than 5 CMV Ag-positive cells were detected in matched sibling HSCT, and when any Ag-positive cells were seen in unrelated allogenic HSCT. Results : CMV antigenemia was observed in 88(41.3 percent) of 213 patients on median day 28(day 11-99). In univariated analysis, use of unrelated donors(other than siblings), age of recipient(more than 5 years at transplant) at transplantation, the presence of recipient CMV-IgG before transplantation, TBI-based conditioning regimen and the presence of acute GvHD(grade ${\geq}II$) were the risk factors for positive CMV antigenemia. In multivariate analysis, unrelated bone marrow transplantation, positive recipient CMV serology and acute GvHD(grade ${\geq}II$) were the independent risk factors for positive CMV antigenemia. Conclusion : Risk factors of CMV infection in children were CMV serostatus of the recipient, the source of stem cells, and acute graft-versus-host disease. The pre-emptive therapy based on CMV antigenemia was effective in the prevention of CMV disease.

A Case of Posttransplant Lymphoproliferative Disease(PTLD) Following Renal Transplantation in a Child (소아에서 신이식후 발생한 Posttransplant Lymphoproliferative Disease(PTLD) 1례)

  • Eun, Byung-Wook;Park, Eun-Sil;Lee, Seong-Yong;Hahn, Hye-Won;Jang, Ju-Young;Park, Kyung-Mi;Kim, Chul-Woo;Kang, Gin-Han;Ko, Jae-Seong;Ha, Il-Soo;Lee, Hoan-Jong;Cheong, Hae-Il;Seo, Jeong-Kee
    • Childhood Kidney Diseases
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    • v.6 no.1
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    • pp.123-130
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    • 2002
  • Posttransplant lymphoproliferative disease (PTLD) represents a diverse lymphoproliferative disorder ranging front nonspecific reactive hyperplasia to malignant immunoblastic sarcoma developed in a setting of immunosuppression following organ or cellular transplantation. It is often associated with Epstein-Barr virus (EBV) infection and high dose immunosuppression. PTLD after renal transplantation was reported at first in adult in Korea in 1997. In children there have been several cases of PTLD after liver transplantation but PTLD after renal transplantation has not been reported. This is a case report of PTLD developed 4 months after renal transplantation in a 9-year-old boy. The major clinical manifestations were fever, multiple lymph nodes enlargement and blood-tinged stool. EBV was detected by in-situ hybridization in the enlarged cervical lymph node and the colonic tissue. Histological examination revealed B-cell lineage. Use of ganciclovir and reduction of the immunosuppression level resulted in complete remission of PTLD. This is the first pediatric case report of PTLD following renal transplantation in Korea. (J Korean Soc Pediatr Nephrol 2002 ; 6 : 123-30)

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Discordant Congenital Cytomegalovirus Infection in Twins (쌍생아에서 선천 거대세포바이러스 감염 증례)

  • Kim, Yi-Seul;Kang, Ji-Man;Lee, Ji-Hoon;Chang, Yoon Sil;Park, Won Soon;Kim, Yae-Jean
    • Pediatric Infection and Vaccine
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    • v.24 no.1
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    • pp.65-70
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    • 2017
  • Cytomegalovirus (CMV) infection is one of the most common congenital infections. The first case of discordant congenital CMV infection in twins occurred in Korea. A 31-year-old woman became pregnant with twins (dichorionic-diamniotic). An elective caesarean section was performed at 37 weeks. The first baby was male, weighing 2,410 g with an Apgar score of 8/9. The second baby was female, weighing 1,380 g with an Apgar score of 5/8. She had experienced intrauterine growth retardation, and presented with microcephaly, micrognathia, and joint stiffness. During the work-up for discordant twins, the second baby's serum test was positive for CMV immunoglobulin M. Her urine, blood, and cerebrospinal fluid (CSF) were CMV polymerase chain reaction positive. The first baby's CMV tests were negative. Ophthalmologic exam and audiometry performed on the second baby showed CMV retinitis and bilateral sensorineural hearing loss. She was treated with intravenous ganciclovir. Currently, she is bed-ridden and has significant developmental delay. Although the causes of discordant congenital CMV infection in twins are unclear, this case shows that discordant congenital CMV infection should be considered in twins with significant differences in intrauterine growth or clinical symptoms after birth.

Combined Effect of Ganciclovir and Vidarabine on the Replication, DNA Synthesis, and Gene Expression of Acyclovir-resistant Herpes Simplex Virus (Acyclovir저항성 Herpes Simplex Virus의 복제, DNA합성 및 형질 발현에 미치는 Ganciclovir 및 Vidarabine의 병용효과에 관한 연구)

  • Yang, Young-Tai;Cheong, Dong-Kyun;Mori, Masakazu
    • The Korean Journal of Pharmacology
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    • v.25 no.1
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    • pp.115-134
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    • 1989
  • Combined effects of ganciclovir (GCV) and vidarabine (ara-A) on the replication, DNA synthesis, and gene expression of wild type-1 herpes simplex virus (HSV-1) and three acyclovir (ACV)-resistant HSV-1 mutants were studied. These mutants include a virus expressing no thymidine kinase $(ACV^r)$, a virus expressing thymidine kinase with altered substrate specificity $(IUdR^r)$, and a mutant expressing altered DNA polymerase $(PAA^r5)$. GCV, an agent activated by herpesvirus specific thymidine kinase, showed potent antiviral activity against the wild type HSV-1(KOS) and DNA polymerase mutant $(PAA^r5)$. The ACV-resistant mutants with thymidine kinase gene $(ACV^r\;and\;IUdR^r)$ were resistant to GCV. All tested wild type HSV-1 or ACV-resistant HSV-1 mutants did not display resistance to vidarabine (are-A). Combined GCV and ara-A showed potentiating synergistic antiviral activity against wild type KOS and $PAA^r5$, and showed subadditive combnined ativiral activity against thymidine kinase mutants. Combined GCV and ara-A more significantly inhibited the viral DNA synthesis in wild type KOS and $PAA^r5-infected$ cells to a greater extent than either agent alone, but the synergism was not determined in $ACV^r$ or $IUdR^r-infected$ cells. These data clearly indicate that combined GCV and ara-A therapy might be useful for the treatment of infections caused by wild type HSV-1 or ACV-resistant HSV-1 with DNA polymerase mutation. ACV-resistant viruses with the mutation in thymidine kinase gene are also, resistant to GCV, but susecptible to ara-A, indicating that ara-A would the drug of choice for the treatment of ACV-resistant HSV-1 which does not express thymidine kinase or expresses thymidine kinase with altered substrate specificity. While the synthesis of viral ${\alpha}-proteins$ of wild type HSV-1 was not affected by ACV, GCV, ara-A, or combined GCV and ara-A, the synthesis of ${\beta}-proteins$ was slightly but significantly increased at the later stage of viral infection by the antiviral agents. The synthesis of ${\gamma}-proteins$ of wild type HSV- 1 was significantly inhibited by ACV, GCV, ara-A, and combined GCV and ara-A. Combined GCV $(5-{\mu}M)$ and ara-A $(100-{\mu}M)$ also significantly altered the expression of viral ${\beta}-and$ ${\gamma}-proteins$, of which efffct was similar to that of GCV $(10-{\mu}M)$ alone. Although ACV at the concentration of $10-{\mu}M$ did not alter the expression of ${\alpha}-$, ${\beta}-$, and ${\gamma}-proteins$ of ACV-resistant $PAA^r5$, GCV and ara-A significantly alter the epression of ${\beta}-and$ ${\gamma}-proteins$, not ${\alpha}-protein$, as same manner as they altered the expression of those proteins in cells inffcted with wild type HSV-1. Combined GCV $(5-{\mu}M)$ and ara-A $(100-{\mu}M)$ altered the expression ${\beta}-and$ ${\gamma}-proteins$ in $PAA^r5$ infected cells, and the effect of combined regimen was comparable of that of GCV $(10-{\mu}M)$. These data indicate that the alteration in the expression of ${\beta}-and$ ${\gamma}-proteins$ in wild type HSV-1 or $PAA^r5$ infected cells could be more significantly affected by combined GCV and are-A than individual GCV or ara-A. In view of the fact that (a) viral ${\alpha}-$, ${\beta}-$, and ${\gamma}-proteins$ are synthesized in a cascade manner; (b) ${\beta}-proteins$ are essential for the synthesis of viral DNA; (c) the synthesis of ${\beta}-proteins$ are inhibited by ${\gamma}-proteins$; and (d) most ${\gamma}-proteins$ are made from the newly synthesized progeny virus, it is suggested that GCV and ara-A, alone or in combination, primarily inhibit the synthesis of viral DNA, and by doing so might exhibit their antiherpetic activity. The alteration in viral protein synthesis in the presence of tested antiviral agents could result from the alteration in viral DNA synthesis. From the present study, it can be concluded that (a) combined GCV and ara-A therapy would be beneficial for the control of inffctions caused by wild type HSV-1 or ACV-resistant DNA polymerase mutants; (b) the combined synergistic activity of GCV and ara-A is due to further decrease in the viral DNA by the combined regimen; (c) ara-A is the drug of choice for the infection caused by ACV-resistant HSV-1 with thymidine kinase mutation; and (d) the alteration in viral protein synthesis by GCV and ars-A, alone or in combination, is mostly due to the decreased synthesis of viral DAN.

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Inhibition Effect of Human Cytomegalovirus Replication by Peptide nucleic acids (PNA)

  • Park, Young-Doo;Eum, Jin-Seong;Paik, Soon-Young;Hong, Seong-Karp
    • Proceedings of the Korean Institute of Information and Commucation Sciences Conference
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    • 2008.05a
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    • pp.971-975
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    • 2008
  • Human cytomegalovirus (HCMV) provokes fatal infections in AIDS patients that have deficient immune functions and patients that have cellular immune responses repressed after bone marrow transplantation. A new candidate for therapeutic against HCMV is needed because conventional treatments as ganciclovir, acyclovir, cidofovir, and foscarnet cytosine used currently are improper due to their side effects and advent of resistant HCMV. In this study, peptide nucleic acids (PNAs) against UL54 (DNA polymerase) and UL97 (phosphotransferase) that were essential in replication of HCMV were applied in inhibition of replication of HCMV. From the results of this study, 4 PNAs $_{PNA}UL97-1$, $_{PNA}UL97-2$, $_{PNA}UL54-3$, and $_{PNA}UL54-4$ showed 3.7, 3.1, 1.7, and 1.6 folds of inhibition effect against replication of HCMV in the human fibroblast cells. These PNA suggest a novel possibility as therapeutic against HCMV.

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Conservative treatment of cytomegalovirus colitis with bowel perforation in an immunocompetent patient: case report and review of literature

  • Nam, Kyoung Sik;Park, Hee Ug;Park, Min Gi;Park, Su Ho;Hwang, Ji Yeon;Kim, Dong Kyu;Kim, Sung Jun
    • Journal of Yeungnam Medical Science
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    • v.34 no.1
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    • pp.75-79
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    • 2017
  • Cytomegalovirus (CMV) colitis, which is rare in an immunocompetent patient, was encountered in a 67-year-old man who was admitted due to persistent diarrhea. The first diagnostic tool was colonoscopy, which showed multiple ulcers from cecum to rectum. The secondary tool was CMV polymerase chain reaction, and CMV colitis was diagnosed. Intravenous ganciclovir therapy was administered, which resulted in improvement of diarrhea and ulcers throughout the colon were healed. Asymptomatic colon perforation was detected during diagnostic testing, which improved over the conventional treatment. CMV colitis is rare in immunocompetent patients, but it is essential for the differential diagnosis.

Congenital and perinatal cytomegalovirus infection

  • Kim, Chun Soo
    • Clinical and Experimental Pediatrics
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    • v.53 no.1
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    • pp.14-20
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    • 2010
  • Cytomegalovirus (CMV) is currently the most common agent of congenital infection and the leading infectious cause of brain damage and hearing loss in children. Symptomatic congenital CMV infections usually result from maternal primary infection during early pregnancy. One half of symptomatic infants have cytomegalic inclusion disease (CID), which is characterized by involvement of multiple organs, in particular, the reticuloendothelial and central nervous system (CNS). Moreover, such involvement may or may not include ocular and auditory damage. Approximately 90% of infants with congenital infection are asymptomatic at birth. Preterm infants with perinatal CMV infection can have symptomatic diseases such as pneumonia, hepatitis, and thrombocytopenia. Microcephaly and abnormal neuroradiologic imaging are associated with a poor prognosis. Hearing loss may occur in both symptomatic and asymptomatic infants with congenital infection and may progress through childhood. Congenital infection is defined by the isolation of CMV from infants within the first 3 weeks of life. Ganciclovir therapy can be considered for infants with symptomatic congenital CMV infection involving the CNS. Pregnant women of seronegative state should be counseled on the importance of good hand washing and other control measures to prevent CMV infection. Heat treatment of infected breast milk at $72{^{\circ}C}$ for 5 seconds can eliminate CMV completely.