Influenza virus reactivation after remission with oseltamivir treatment in a patient undergoing nonmyeloablative bone marrow transplantation

Kobayashi, Shinichi; Kimura, Fumihiko; Kobayashi, Ayako; Sato, Ken; Motoyoshi, Kazuo

doi:10.1007/s10156-008-0615-2

Cited by 14 publications

(6 citation statements)

References 17 publications

(15 reference statements)

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“…Kobayashi et al described a patient who developed influenza A 5 days prior to hematopoietic cell allografting. Interestingly, despite oseltamivir treatment at a dose of 75 mg twice a day for 5 days, the patient had recurrence of influenza A (by rapid diagnostic test) on post-transplant day ?7 manifesting as upper respiratory symptoms accompanied by fever [17]. Subsequent treatment with oseltamivir for seven additional days resulted in resolution of symptoms and a negative influenza A rapid diagnostic test.…”

Section: Discussionmentioning

confidence: 97%

“…Subsequent treatment with oseltamivir for seven additional days resulted in resolution of symptoms and a negative influenza A rapid diagnostic test. The authors suggest that patients who develop influenza infections during the immediate pre-transplant period should be treated with antiviral therapy at least until successful engraftment is achieved [17].…”

Section: Discussionmentioning

confidence: 99%

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Influenza A/pandemic 2009/H1N1 in the setting of allogeneic hematopoietic cell transplantation: a potentially catastrophic problem in a vulnerable population

et al. 2009

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We describe Influenza A/pandemic 2009/H1N1 in two allogeneic hematopoietic cell transplantation recipients. The main presentation in both cases consisted of flu-like symptoms manifesting as, fever, arthralgias and myalgias. The virus was isolated in one case from a throat swab and in another case following a bronchoalveolar lavage. Both patients received oseltamivir at a dose of 75 mg orally twice day. The dose of oseltamivir was increased to 150 mg twice per day due to the lack of improvement or progression of symptoms. In one case, clinical symptoms resolved without sequelae. In the second case, pulmonary symptomatology continued to deteriorate, despite aggressive polymicrobial treatment, requiring mechanical ventilation and ultimately the patient died from respiratory failure. These cases highlight the potentially serious effect of the ongoing Influenza A/pandemic 2009/H1N1 pandemic in this very vulnerable population and the urgent need to establish emergency preparedness strategies by oncology and bone marrow transplantation staff to face this serious healthcare challenge.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Influenza A/pandemic 2009/H1N1 in the setting of allogeneic hematopoietic cell transplantation: a potentially catastrophic problem in a vulnerable population

et al. 2009

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“…Influenza viruses resistant to antiviral drugs have been reported in immunocompromised patients, [21,40] and this resistance might be associated with prolonged viral shedding [41,42]. Notably, five isolates from two patients had high IC 50 values to neuraminidase inhibitors (NAIs).…”

Section: Discussionmentioning

confidence: 99%

H1N1pdm Influenza Infection in Hospitalized Cancer Patients: Clinical Evolution and Viral Analysis

et al. 2010

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BackgroundThe novel influenza A pandemic virus (H1N1pdm) caused considerable morbidity and mortality worldwide in 2009. The aim of the present study was to evaluate the clinical course, duration of viral shedding, H1N1pdm evolution and emergence of antiviral resistance in hospitalized cancer patients with severe H1N1pdm infections during the winter of 2009 in Brazil.MethodsWe performed a prospective single-center cohort study in a cancer center in Rio de Janeiro, Brazil. Hospitalized patients with cancer and a confirmed diagnosis of influenza A H1N1pdm were evaluated. The main outcome measures in this study were in-hospital mortality, duration of viral shedding, viral persistence and both functional and molecular analyses of H1N1pdm susceptibility to oseltamivir.ResultsA total of 44 hospitalized patients with suspected influenza-like illness were screened. A total of 24 had diagnosed H1N1pdm infections. The overall hospital mortality in our cohort was 21%. Thirteen (54%) patients required intensive care. The median age of the studied cohort was 14.5 years (3–69 years). Eighteen (75%) patients had received chemotherapy in the previous month, and 14 were neutropenic at the onset of influenza. A total of 10 patients were evaluated for their duration of viral shedding, and 5 (50%) displayed prolonged viral shedding (median 23, range = 11–63 days); however, this was not associated with the emergence of a resistant H1N1pdm virus. Viral evolution was observed in sequentially collected samples.ConclusionsProlonged influenza A H1N1pdm shedding was observed in cancer patients. However, oseltamivir resistance was not detected. Taken together, our data suggest that severely ill cancer patients may constitute a pandemic virus reservoir with major implications for viral propagation.

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“…The recommended duration of therapy with neuraminidase inhibitors in leukemic and HSCT patients may be 10 days, as reoccurrence may develop with the 5‐day course recommended for immune‐competent hosts . Longer therapy is necessary when symptoms do not resolve and viruses are not cleared from respiratory secretions .…”

Section: Antiviral Treatmentmentioning

confidence: 99%

European guidelines for prevention and management of influenza in hematopoietic stem cell transplantation and leukemia patients: summary of ECIL‐4 (2011), on behalf of ECIL, a joint venture of EBMT, EORTC, ICHS, and ELN

Engelhard

Mohty

Cámara

et al. 2013

Transplant Infectious Dis

101

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Influenza may cause severe disease and mortality in leukemia patients and in hematopoietic stem cell transplantation recipients. The 4th European Conference of Infections in Leukemia (ECIL‐4) has developed evidence‐based guidelines for prevention and management of influenza infections in these patients. Real‐time reverse‐transcription polymerase chain reaction is the diagnostic test of choice, as it is the most sensitive and specific test for influenza. The risks for severe influenza and fatal outcome include lymphopenia, older age, influenza soon after transplantation or chemotherapy, steroid treatment, and lack of early antiviral therapy. Neuraminidase inhibitors (oral oseltamivir or inhalation of zanamivir) are currently the most effective therapeutic agents for influenza. Main preventive measures include annual vaccination of patients, household contacts, and hospital staff. This review summarizes ECIL‐4's main recommendations.

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Influenza virus reactivation after remission with oseltamivir treatment in a patient undergoing nonmyeloablative bone marrow transplantation

Cited by 14 publications

References 17 publications

Influenza A/pandemic 2009/H1N1 in the setting of allogeneic hematopoietic cell transplantation: a potentially catastrophic problem in a vulnerable population

Influenza A/pandemic 2009/H1N1 in the setting of allogeneic hematopoietic cell transplantation: a potentially catastrophic problem in a vulnerable population

H1N1pdm Influenza Infection in Hospitalized Cancer Patients: Clinical Evolution and Viral Analysis

European guidelines for prevention and management of influenza in hematopoietic stem cell transplantation and leukemia patients: summary of ECIL‐4 (2011), on behalf of ECIL, a joint venture of EBMT, EORTC, ICHS, and ELN

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