Oseltamivir-resistant 2009 H1N1 influenza pneumonia during therapy in a renal transplant recipient.

Abstract:

:The emergence of oseltamivir-resistant 2009 H1N1 influenza virus (conferred by the H275Y substitution in NA) during therapy or prophylaxis in immunocompromised patients is a serious concern. The optimal therapy for immunosuppressed patients with oseltamivir-resistant 2009 H1N1 influenza virus is unknown and few options exist. We report a 10-yr-old recipient of kidney transplant who was hospitalized with oseltamivir-resistant 2009 H1N1 influenza pneumonia complicated by severe respiratory failure, ARDS, and renal failure requiring institution of ECMO and CRRT. On presentation, treatment with oseltamivir (second course) and broad-spectrum antibiotics was initiated. Immunosuppressive agents were stopped on hospital day (d) 2. On hospital d 7, given his critical status, immunocompromised state, and difficulty in obtaining intravenous zanamivir, after obtaining ethical approval and parental consent, he was treated with intravenous peramivir (through an Emergency Investigational New Drug Application) for two wk. He tolerated the regimen well and his clinical status improved gradually. Several factors may have contributed to virus clearance and survival including recovery of the immune system, aggressive critical care support, and administration of peramivir. Ongoing surveillance is essential to monitor how oseltamivir-resistant H275Y mutant viruses may evolve in the future.

journal_name

Pediatr Transplant

authors

Shetty AK,Ross GA,Pranikoff T,Gubareva LV,Sechrist C,Guirand DM,Abramson J,Lin JJ

doi

10.1111/j.1399-3046.2011.01489.x

subject

Has Abstract

pub_date

2012-08-01 00:00:00

pages

E153-7

issue

5

eissn

1397-3142

issn

1399-3046

journal_volume

16

pub_type

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