H275Y mutant pandemic (H1N1) 2009 virus in immunocompromised patients

Emerg Infect Dis. 2011 Apr;17(4):653-60; quiz 765. doi: 10.3201/eid1704.101429.

Abstract

Most oseltamivir-resistant pandemic (H1N1) 2009 viruses have been isolated from immunocompromised patients. To describe the clinical features, treatment, outcomes, and virologic data associated with infection from pandemic (H1N1) 2009 virus with H275Y mutation in immunocompromised patients, we retrospectively identified 49 hematology-oncology patients infected with pandemic (H1N1) 2009 virus. Samples from 33 of those patients were tested for H275Y genotype by allele-specific real-time PCR. Of the 8 patients in whom H275Y mutations was identified, 1 had severe pneumonia; 3 had mild pneumonia with prolonged virus shedding; and 4 had upper respiratory tract infection, of whom 3 had prolonged virus shedding. All patients had received oseltamivir before the H275Y mutation was detected; 1 had received antiviral prophylaxis. Three patients excreted resistant virus for >60 days. Emergence of oseltamivir resistance is frequent in immunocompromised patients infected with pandemic (H1N1) 2009 virus and can be associated with a wide range of clinical disease and viral kinetics.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Antiviral Agents / therapeutic use
  • Child
  • Drug Resistance, Viral / genetics
  • Female
  • Humans
  • Immunocompromised Host*
  • Influenza A Virus, H1N1 Subtype / drug effects
  • Influenza A Virus, H1N1 Subtype / genetics
  • Influenza A Virus, H1N1 Subtype / physiology*
  • Influenza, Human / complications
  • Influenza, Human / drug therapy
  • Influenza, Human / virology*
  • Male
  • Middle Aged
  • Mutation*
  • Respiratory Tract Infections / etiology
  • Respiratory Tract Infections / virology
  • Young Adult

Substances

  • Antiviral Agents