title: Neuraminidase H275Y and hemagglutinin D222G mutations in a fatal case of 2009 pandemic influenza A (H1N1) virus infection.
abstract: Oseltamivir-resistant 2009 H1N1 influenza virus infections associated with neuraminidase (NA) H275Y have been identified sporadically. Strains possessing the hemagglutinin (HA) D222G mutation have been detected in small numbers of fatal 2009 H1N1 cases. We report the first clinical description of 2009 H1N1 virus infection with both NA-H275Y and HA-D222G mutations detected by pyrosequencing of bronchioalveolar lavage fluid obtained on symptom day 19. The 59-year-old immunosuppressed patient had multiple conditions conferring higher risk of prolonged viral replication and severe illness and died on symptom day 34. Further investigations are needed to determine the significance of infection with strains possessing NA-H275Y and HA-D222G.
authors.affiliation: Infectious Disease Epidemiology, Prevention and Control Division, Minnesota Department of Health, Saint Paul, MN 55164, USA. aaron.devries@state.mn.us
authors.forename: Aaron
authors.initials: A
authors.lastname: DeVries
authors.forename: Jason
authors.initials: J
authors.lastname: Wotton
authors.forename: Christine
authors.initials: C
authors.lastname: Lees
authors.forename: David
authors.initials: D
authors.lastname: Boxrud
authors.forename: Timothy
authors.initials: T
authors.lastname: Uyeki
authors.forename: Ruth
authors.initials: R
authors.lastname: Lynfield
mesh_terms: D019943:Amino Acid Substitution; D000998:Antiviral Agents / Q000494:pharmacology; D001992:Bronchoalveolar Lavage Fluid / Q000821:virology; D024882:Drug Resistance, Viral; D017809:Fatal Outcome; D019267:Hemagglutinin Glycoproteins, Influenza Virus / Q000235:genetics*; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000235:genetics* / Q000302:isolation & purification*; D007251:Influenza, Human / Q000821:virology*; D008297:Male; D008875:Middle Aged; D020125:Mutation, Missense; D009439:Neuraminidase / Q000235:genetics*; D053139:Oseltamivir / Q000494:pharmacology; D012367:RNA, Viral / Q000235:genetics; D017422:Sequence Analysis, DNA; D014764:Viral Proteins / Q000235:genetics*
chemical_list: D000998:Antiviral Agents; D019267:Hemagglutinin Glycoproteins, Influenza Virus; D012367:RNA, Viral; D014764:Viral Proteins; D053139:Oseltamivir; C487630:NA protein, influenza A virus; D009439:Neuraminidase