A Case of Oseltamivir-Resistant Pandemic Influenza (H1N1 2009) in a Patient with Acute Myeloid Leukemia

Yo Han Lee; Hyo Youl Kim; Hyun Soo Kim; Young Uh; Young Keun Kim; Bo Ra Kim; Ho Yeon Jung; Woo Taek Kim; Hwajung Yi

doi:10.3947/ic.2010.42.2.107

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Lee, Kim, Kim, Uh, Kim, Kim, Jung, Kim, and Yi: A Case of Oseltamivir-Resistant Pandemic Influenza (H1N1 2009) in a Patient with Acute Myeloid Leukemia

Case Report

Infection & Chemotherapy

Infection & Chemotherapy 2010; 42(2): 107-111.

Published online: 30 April 2010

DOI: https://doi.org/10.3947/ic.2010.42.2.107

A Case of Oseltamivir-Resistant Pandemic Influenza (H1N1 2009) in a Patient with Acute Myeloid Leukemia

Yo Han Lee¹, Hyo Youl Kim¹, Hyun Soo Kim¹, Young Uh², Young Keun Kim¹, Bo Ra Kim¹, Ho Yeon Jung¹, Woo Taek Kim¹, Hwajung Yi³

¹Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.

²Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.

³Division of Influenza Virus, Center for Infectious Diseases, National Institute of Health, Korea Centers for Disease Control and Prevention, Seoul, Korea.

Corresponding author: Hyo Youl Kim, M.D., Ph.D. Division of Infectious Diseases, Department of Internal Medicine, Yonsei University Wonju College of Medicine, 162, Ilsan-dong, Wonju 220-701, Korea. Tel: +82-33-741-1206, Fax: +82-33-748-1206, hyksos@yonsei.ac.kr

Received 11 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

Oseltamivir is the drug of choice for patients with pandemic influenza (H1N1 2009). However, sporadic cases of oseltamivir resistance have been described worldwide. Up to March 2010, a total of 11 strains (2.2% of tested isolates) of oseltamivir-resistant pandemic influenza (H1N1 2009) have been discovered in South Korea. We report a case of 46-year-old man with acute myeloid leukemia in whom an oseltamivir-resistant pandemic (H1N1) 2009 virus was isolated. Despite high dose oseltamivir therapy for 10 days he had persistent symptoms and showed positive results in repeated real-time RT-PCR for pandemic influenza (H1N1 2009) virus from nasopharyngeal specimen. The patient improved eventually after oseltamivir was replaced by zanamivir inhalation.

Keywords: Pandemic influenza (H1N1 2009), Oseltamivir, Antiviral resistance, Leukemia

Figures and Tables

Figure 1

Chest radiograph (left) and contrast-enhanced CT scan (right) show a focal consolidation on middle lobe area of right lung (arrow) on the 5th day of admission

Figure 2

Body temperature changes according to hospitalization days and treatment.

Figure 3

Oseltamivir resistant genetic substitution in NA (neuraminidase) of pandemic influenza A (H1N1 2009) viruses from the patient's nasopharyngeal specimen on hospital day 17. NA gene sequence product was generated by RT-PCR and directly sequenced. Nucleotide sequence TAC (encoding tyrosine) in box exhibits that the viruses contain oseltamivir resistant maker (Y275) on their NA. In the figure, single letters and numbers denote abbreviations of individual amino acids and amino acid sequences numbering, respectively.

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