{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T05:35:11Z","timestamp":1792128911677,"version":"4.4.0"},"reference-count":17,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T00:00:00Z","timestamp":1768262400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T00:00:00Z","timestamp":1768262400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transplant Infectious Dis"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Herpes simplex virus (HSV) infection is a significant risk in hematopoietic stem cell transplant (HSCT) recipients, and antiviral resistance poses many clinical challenges.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective case series of eight pediatric patients with acyclovir\u2010resistant HSV infection, determined via genotypic sequencing, post allogeneic HSCT between 2012 and 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Indications for HSCT included primary immunodeficiency, sickle cell disease, myelodysplastic syndrome (MDS), and relapsed\/refractory leukemia. All patients received acyclovir prophylaxis. TK mutations were most common (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a07, 87.5%). Infections manifested as mucocutaneous disease, pneumonitis, keratitis, enterocolitis, and blood viremia. A total of 87.5% of patients (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a07) were treated with second\u2010line antivirals (foscarnet and\/or cidofovir), and three patients were treated with third\u2010line antivirals (pritelivir). Treatment was complicated by nephrotoxicity (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a03, 37.5%). Adjunct treatments included intravenous immunoglobulin (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a03, 37.5%) and donor lymphocyte infusion (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a01, 12.5%). Poor outcomes were seen across the cohort, including death (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a03, 37.5%). T\u2010cell depletion was used in 50% of patients (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a04). Concomitant immunosuppressive therapy was used in 100% of patients (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a08) and high\u2010dose steroids were used in 50% of patients (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a04). Graft versus host disease occurred in four patients (50%). Secondary complications included transplant\u2010associated thrombotic microangiopathy (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a03, 37.5%), idiopathic pulmonary syndrome (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a03, 37.5%), and graft failure (\n                      <jats:italic>n\u00a0<\/jats:italic>\n                      =\u00a01, 12.5%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Acyclovir\u2010resistant HSV infection in pediatric HSCT recipients is associated with high morbidity and mortality, limited therapeutic options, and significant treatment\u2010related nephrotoxicity. Early recognition, early resistance testing, prompt initiation of second\u2010line therapy, and weaning of immunosuppression are critical. Emerging therapies, such as helicase\u2010primase inhibitors and adoptive T\u2010cell therapy, hold promise but remain limited by access and pediatric data.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/tid.70162","type":"journal-article","created":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T07:30:05Z","timestamp":1768375805000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Acyclovir\u2010Resistant Herpes Simplex Virus in Pediatric Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplant: A Case Series"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7790-9955","authenticated-orcid":false,"given":"Jenna","family":"Nunn","sequence":"first","affiliation":[{"name":"Department of Paediatric Haematology and Bone Marrow Transplant Manchester University Foundation Trust  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9964-4209","authenticated-orcid":false,"given":"Ahmed","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Paediatric Haematology and Bone Marrow Transplant Manchester University Foundation Trust  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0892-6858","authenticated-orcid":false,"given":"Srividhya","family":"Senthil","sequence":"additional","affiliation":[{"name":"Department of Paediatric Haematology and Bone Marrow Transplant Manchester University Foundation Trust  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oana","family":"Mirci\u2010Danicar","sequence":"additional","affiliation":[{"name":"Department of Paediatric Haematology and Bone Marrow Transplant Manchester University Foundation Trust  Manchester 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of Paediatric Haematology and Bone Marrow Transplant Manchester University Foundation Trust  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malcolm","family":"Guiver","sequence":"additional","affiliation":[{"name":"Department of Virology Manchester University Foundation Trust  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramya","family":"Nataraj","sequence":"additional","affiliation":[{"name":"Department of Paediatric Haematology and Bone Marrow Transplant Manchester University Foundation Trust  Manchester 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