• Diagn. Microbiol. Infect. Dis. · Nov 2010

    Case Reports

    Selection and viral load kinetics of an oseltamivir-resistant pandemic influenza A (H1N1) virus in an immunocompromised patient during treatment with neuraminidase inhibitors.

    • Andrés Antón, Ana Alicia López-Iglesias, Teresa Tórtola, Isabel Ruiz-Camps, Pau Abrisqueta, Lluís Llopart, María Ángeles Marcos, Miguel Julián Martínez, Griselda Tudó, Francesc Bosch, Albert Pahissa, María Teresa Jiménez de Anta, and Tomàs Pumarola.
    • Microbiology Department, Hospital Clínic and Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain. ananton@clinic.ub.es
    • Diagn. Microbiol. Infect. Dis. 2010 Nov 1; 68 (3): 214-9.

    AbstractProlonged viral excretion in immunocompromised hosts leads to long oseltamivir treatment and to the subsequent development of oseltamivir-resistant pandemic influenza virus selection. We report the selection and nasopharyngeal shedding kinetics of an oseltamivir-resistant strain in a hospitalized immunocompromised patient with prolonged influenza illness. Viral load quantification and genotyping methods were performed from 7 serial nasopharyngeal samples. Before initial oseltamivir treatment, the viral load was 5.78 log(10) copies/mL of sample and only wild-type virus population was detected. The nasopharyngeal viral load remained above the detection limit although there was a second course of oseltamivir treatment. Twelve days after the onset of symptoms, an oseltamivir-resistant strain was selected. After 12 days of inhaled zanamivir treatment, the patient was discharged asymptomatic. The study emphasizes the importance of viral load quantification and surveillance of emergence of resistant strains prospectively because the information provided has important implications in the clinical management of the patient.Copyright © 2010 Elsevier Inc. All rights reserved.

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