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

Avinash K. Shetty, Gregory A. Ross, Thomas Pranikoff, Larissa V. Gubareva, Catherine Sechrist, Derek M. Guirand, Jon Abramson, Jen Jar Lin

Research output: Contribution to journalArticle

11 Citations (Scopus)

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.

Original languageEnglish
JournalPediatric Transplantation
Volume16
Issue number5
DOIs
Publication statusPublished - 01-08-2012
Externally publishedYes

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Oseltamivir
Human Influenza
Pneumonia
Kidney
H1N1 Subtype Influenza A Virus
Orthomyxoviridae
Investigational New Drug Application
Zanamivir
Parental Consent
Viruses
Therapeutics
Immunocompromised Host
Critical Care
Immunosuppressive Agents
Respiratory Insufficiency
Renal Insufficiency
Immune System
Emergencies
Transplant Recipients
Anti-Bacterial Agents

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Transplantation

Cite this

Shetty, A. K., Ross, G. A., Pranikoff, T., Gubareva, L. V., Sechrist, C., Guirand, D. M., ... Lin, J. J. (2012). Oseltamivir-resistant 2009 H1N1 influenza pneumonia during therapy in a renal transplant recipient. Pediatric Transplantation, 16(5). https://doi.org/10.1111/j.1399-3046.2011.01489.x
Shetty, Avinash K. ; Ross, Gregory A. ; Pranikoff, Thomas ; Gubareva, Larissa V. ; Sechrist, Catherine ; Guirand, Derek M. ; Abramson, Jon ; Lin, Jen Jar. / Oseltamivir-resistant 2009 H1N1 influenza pneumonia during therapy in a renal transplant recipient. In: Pediatric Transplantation. 2012 ; Vol. 16, No. 5.
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Shetty, AK, Ross, GA, Pranikoff, T, Gubareva, LV, Sechrist, C, Guirand, DM, Abramson, J & Lin, JJ 2012, 'Oseltamivir-resistant 2009 H1N1 influenza pneumonia during therapy in a renal transplant recipient', Pediatric Transplantation, vol. 16, no. 5. https://doi.org/10.1111/j.1399-3046.2011.01489.x

Oseltamivir-resistant 2009 H1N1 influenza pneumonia during therapy in a renal transplant recipient. / Shetty, Avinash K.; Ross, Gregory A.; Pranikoff, Thomas; Gubareva, Larissa V.; Sechrist, Catherine; Guirand, Derek M.; Abramson, Jon; Lin, Jen Jar.

In: Pediatric Transplantation, Vol. 16, No. 5, 01.08.2012.

Research output: Contribution to journalArticle

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