We present an unusual case of serial CMV antiviral drug resistance, first to ganciclovir (GCV), and then to maribavir (MBV) in a D+/R- CMV renal transplant patient, who received standard post-transplant valganciclovir (vGCV) prophylaxis, but developed breakthrough CMV drug resistance during this post-transplant prophylaxis period. Eventually the CMV levels were brought under control by CMV IVIG, which also adds to the relatively scarce data around this immuno-therapeutic intervention.
Bundibugyo virus disease (BVD) is a severe filovirus infection caused by Bundibugyo virus (BDBV), an orthoebolavirus with diagnostic and countermeasure implications distinct from Ebola virus (EBOV). The ongoing outbreak in the Democratic Republic of the Congo (DRC) has expanded substantially, with 7890 confirmed cases and 3799 deaths reported across 63 health zones in seven provinces as of 23 September 2026. BVD usually presents as a nonspecific febrile and gastrointestinal illness; haemorrhagic manifestations are uncommon at presentation. Early outbreak investigation also showed that EBOV-oriented testing can fail to detect BDBV, making species-appropriate molecular testing essential when BDBV is epidemiologically plausible. Supportive care remains the standard of management, but what can be delivered safely differs between peripheral facilities and dedicated filovirus treatment centres. First-contact facilities should prioritise recognition, separation, protected sampling, treatment of immediately life-threatening or common treatable conditions, and early referral; treatment centres can provide closer monitoring, advanced supportive care, and access to approved research protocols. Insecurity, displacement, laboratory and transport constraints, and delayed presentation continue to limit implementation. No vaccine or specific therapeutic has established clinical efficacy against BDBV in humans; Ervebo is being evaluated within research protocols and the PARTNERS trial is evaluating MBP134 and remdesivir-based regimens. This review synthesises historical and current evidence on recognition, diagnosis, clinical care, infection prevention, referral, and emerging countermeasures in outbreak-affected settings.
