title: 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.
authors: Department of Surgery, Wake Forest University School of Medicine and Brenner Children's Hospital, Winston Salem, NC, USA. ashetty@wfubmc.edu
authors: Avinash K
authors: AK
authors: Shetty
authors: Gregory A
authors: GA
authors: Ross
authors: Thomas
authors: T
authors: Pranikoff
authors: Larissa V
authors: LV
authors: Gubareva
authors: Catherine
authors: C
authors: Sechrist
authors: Derek M
authors: DM
authors: Guirand
authors: Jon
authors: J
authors: Abramson
authors: Jen-Jar
authors: JJ
authors: Lin
mesh_terms: D000998:Antiviral Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002648:Child; D024882:Drug Resistance, Viral; D006801:Humans; D016867:Immunocompromised Host; D053118:Influenza A Virus, H1N1 Subtype / Q000187:drug effects* / Q000302:isolation & purification; D007251:Influenza, Human / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology* / Q000821:virology; D016030:Kidney Transplantation; D008297:Male; D053139:Oseltamivir / Q000494:pharmacology / Q000627:therapeutic use*; D011024:Pneumonia, Viral / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology* / Q000821:virology; D011183:Postoperative Complications / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology* / Q000821:virology
chemical_list: D000998:Antiviral Agents; D053139:Oseltamivir