A Case of Oseltamivir-Resistant Pandemic Influenza (H1N1 2009)

Hyo Lim Hong; Ji Hun Kim; Hwa Jung Yi; Hyun Hee Kwon

doi:10.3947/ic.2010.42.2.103

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Hong, Kim, Yi, and Kwon: A Case of Oseltamivir-Resistant Pandemic Influenza (H1N1 2009)

Case Report

Infection & Chemotherapy

Infection & Chemotherapy 2010; 42(2): 103-106.

Published online: 30 April 2010

DOI: https://doi.org/10.3947/ic.2010.42.2.103

A Case of Oseltamivir-Resistant Pandemic Influenza (H1N1 2009)

Hyo Lim Hong¹, Ji Hun Kim¹, Hwa Jung Yi², Hyun Hee Kwon¹

¹Department of Internal Medicine, Catholic University of Daegu, School of Medicine, Daegu, Korea.

²Division of Influenza Virus, Center for Infectious Diseases, National Institute of Health, Centers for Disease Control and Prevention, Seoul, Korea.

Corresponding author: Hyun Hee Kwon, M.D. Department of Internal Medicine, Catholic University of Daegu, School of Medicine, 3056-6 Daemyung 4-Dong, Namgu, Daegu 705-718, Korea. Tel: +82-53-650-4859, Fax: +82-53-629-8248, heeya0035@cu.ac.kr

Received 10 April 2010 Accepted 22 April 2010

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

In April 2009, the first swine origin pandemic influenza (H1N1 2009) infection was reported in Mexico and United states and has since spread rapidly worldwide. Finally on June 11, 2009, WHO officially declared the first pandemic of the 21st century. Until March 2010, more than 213 countries reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 16,931 deaths. The drug of choice for treatment and prophylaxis of pandemic (H1N1) 2009 influenza are the neuraminidase inhibitor (oseltamivir and Zanamivir). However, increased use of these drugs lead to the emergence of oseltamivir-resistant strains. We report a case of oseltamivir-resistant pandemic influenza (H1N1 2009) virus infection in a patient who were initially started with oseltamivir for laboratory-confirmed influenza. Patient's symptoms worsened despite the use of high-dose oral oseltamivir, and antiviral susceptibility test showed oseltamivir resistance (H275Y mutation). The patient resolved after treatment with zanamivir.

Keywords: Pandemic, Influenza A, Oseltamivir, Resistance

Figures and Tables

Figure 1

Serial chest radiograph findings. (A) normal chest radiograph at admission, (B) right middle lobe consolidation appears at pandemic influenza (H1N1 2009) diagnosis, (C) sustained right middle lobe consolidation with aggravated right loculated pleural effusion and new patchy consolidation in left upper lobe after 9 day oseltamivir use (D) improved chest radiograph at discharge.

Figure 2

Constrast-enhancing chest CT scan at the 9th day of oseltamivir use shows patchy consolidation with centrilobular nodule in right upper lobe, right lower lobe and bilateral pleural effusion.

Figure 3

Oseltamivir and amantadine resistant genetic substitution in M2 and NA of pandemic influenza (H1N1 2009) viruses from the patient. (A) Nucleotide sequence TAC (encoding tyrosine) in box exhibits that the viruses contains oseltamivir resistance maker (Y275) on their NA. (B) Nucleotide sequence AAT (coding asparagine) in box exhibits that infected viruses form the patient contains amantadine resistance maker (N31) on their M2. In A and B, single letters and numbers denote abbreviations of individual amino acids and amino acid sequences numbering. respectively.

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