Thread by @TheIDtrivia

🧵1/3 #IDtwitter first trivia of 2023!#TxID

45 F w/Hx of hypertensive nephropathy complicated by ESDR s/p kidney transplant 7 mo ago, on tacrolimus & MMF. CMV D+R-, who after completing prophylaxis w/ valganciclovir for 6mo is admitted with 3 wks of watery diarrhea

2/3 Colonoscopy findings consistent with CMV colitis. Initial CMV DNAemia 800 IU/mL. Patient’s immunosuppressive regimen is reduced, and she is treated with ganciclovir 5 mg/kg IV every 12 hours.

3/3 After one week, despite medical treatment diarrhea persists, with up to 6-8 episodes daily.

A repeated CMV DNAemia is 805 IU/mL. What would you do next? 🤔 #IDboardreview

🪡 1/4 #IDTwitter
Answer: A) Continue with the same therapy

-Refractory CMV disease progresses despite antiviral agents and reduction of immunosuppression and can be due to ganciclovir resistance😷

2/4
-Ganciclovir resistance should be suspected in patients who have rising or persistently elevated viral loads despite treatment with appropriately dosed ganciclovir for more than two weeks 🗓️

3/4
-It occurs in 1 to 2% of kidney transplant recipients with CMV infection or disease and typically develops in CMV D+/R- patients
 
Genotype testing should be performed to identify specific resistance mutations 🧪

4/5
-Thank you everyone for participating! And thanks to @KottonNelson for this amazing material.

link.springer.com/referenceworke…