title: Cytomegalovirus ventriculoencephalitis in a peripheral blood stem cell transplant recipient.
abstract: Cytomegalovirus encephalitis occurs rarely in transplant recipients. We describe a patient with cytomegalovirus ventriculoencephalitis who had a very high CSF viral load but a low peripheral blood viral load. No resistance mutations were present in cerebrospinal fluid viral DNA, whereas DNA from blood showed a resistance mutation in the UL54 gene but not in the UL97 gene. Viral replication was intense in the brain ependyma and periventricular areas without evidence of peripheral cytomegalovirus disease. The data provide evidence for compartmentalization of cytomegalovirus infection. Levels of ganciclovir and foscarnet in the cerebrospinal fluid may be inadequate for treatment, even for some drug-susceptible strains, and, together with periventricular replication, may explain the disparity between cerebrospinal fluid viral load and peripheral blood viral load.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA. geraldine.miller@vanderbilt.edu
authors.forename: Geraldine G
authors.initials: GG
authors.lastname: Miller
authors.forename: Guy
authors.initials: G
authors.lastname: Boivin
authors.forename: J Stephen
authors.initials: JS
authors.lastname: Dummer
authors.forename: Thomas
authors.initials: T
authors.lastname: McConnell
authors.forename: Mark W
authors.initials: MW
authors.lastname: Becher
authors.forename: Adetola
authors.initials: A
authors.lastname: Kassim
authors.forename: Yi-Wei
authors.initials: YW
authors.lastname: Tang
mesh_terms: D000208:Acute Disease; D000998:Antiviral Agents / Q000627:therapeutic use; D001921:Brain / Q000821:virology; D003587:Cytomegalovirus / Q000235:genetics* / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000097:blood / Q000134:cerebrospinal fluid / Q000188:drug therapy / Q000821:virology*; D004279:DNA, Viral / Q000097:blood* / Q000134:cerebrospinal fluid*; D004259:DNA-Directed DNA Polymerase / Q000235:genetics; D024882:Drug Resistance, Viral / Q000235:genetics; D018792:Encephalitis, Viral / Q000097:blood / Q000134:cerebrospinal fluid / Q000188:drug therapy / Q000821:virology*; D006801:Humans; D016867:Immunocompromised Host / Q000276:immunology*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007951:Leukemia, Myeloid / Q000276:immunology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009154:Mutation; D036102:Peripheral Blood Stem Cell Transplantation; D019562:Viral Load; D014764:Viral Proteins / Q000235:genetics
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D007166:Immunosuppressive Agents; C109367:UL54 protein, Human herpesvirus 5; D014764:Viral Proteins; D004259:DNA-Directed DNA Polymerase