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

Prolonged shedding of pandemic influenza A (H1N1) 2009 virus in a pancreas-after-kidney transplant recipient

“…Prolonged shedding of influenza may result in repeated exposures to oseltamivir and lead to the development of drug resistance in immunocompromised individuals [6]. Interestingly, our patient's most recent isolates (Sample 5 and 6) were analyzed by pyrosequencing and determined to be wild type (H275).…”

“…Patients with delayed viral clearance are more likely to develop lower respiratory tract disease and may develop more serious complications [5]. Furthermore, prolonged shedding has been associated with the emergence of drug-resistance mutations in experimental and clinical settings [6,7]. We report a case of a pancreas-after-kidney transplant recipient who had detectable influenza A virus for 12 months.…”

Multiple Influenza A (H3N2) Mutations Conferring Resistance to Neuraminidase Inhibitors in a Bone Marrow Transplant Recipient

“…Despite reduced susceptibility to zanamivir, Q136K alone was reported to have no effect on susceptibility to oseltamivir (22,25). Of import, although there is a stable rate of oseltamivir and zanamivir resistance among circulating influenza A viruses, a higher prevalence of resistance has been documented in immunocompromised patients following antiviral administration (4,5,18,26,27,49,50).…”

Persistent Infection of Drug-resistant Influenza A Virus during Chemotherapy for Malignant Lymphoma

“…Furthermore, prolonged viral shedding and the long-term administration of anti-viral drugs may have provided a conductive growth environment for the drug-resistant viral strains (14)(15)(16). Thus, the NA inhibitor-resistant influenza A (H3N2) virus possessing an R292K substitution in the NA protein might have thus selectively survived in the present case with malignant lymphoma undergoing multiple chemotherapies.…”