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Volume 17, Number 4—April 2011

CME ACTIVITY

H275Y Mutant Pandemic (H1N1) 2009 Virus in Immunocompromised Patients

Christian Renaud, Alexandre A. Boudreault, Jane Kuypers, Kathryn H. Lofy, Lawrence Corey, Michael J. Boeckh, and Janet A. EnglundComments to Author 
Author affiliations: Author affiliations: Fred Hutchinson Cancer Research Center, Seattle, Washington, USA (C. Renaud, A.A. Boudreault, L. Corey, M.J. Boeckh, J.A. Englund); Seattle Children’s Hospital, Seattle (C. Renaud, J.A. Englund); University of Washington, Seattle (J. Kuypers, L. Corey, M.J. Boeckh, J.A. Englund); Washington State Department of Health, Shoreline, Washington, USA (K.H. Lofy)

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Table 2

Clinical characteristics and outcomes of 8 patients with H275Y mutation of pandemic (H1N1) 2009 virus, Seattle Cancer Care Alliance, Seattle, Washington, USA, May 1, 2009–April 30, 2010*

Patient no. Symptoms of URTI Signs of LRTI Radiology results Antiviral drug therapy before resistance Co-pathogens Outcome
1
24 h before diagnosis: congestion, headache
Hypoxemia; positive BAL result on d 5
Bilateral ground glass opacity
Oseltamivir 150 mg 2×/d followed by peramivir
None
Death related to influenza
2
48 h before diagnosis: congestion, wet cough, sore throat, fever (24 h)
Hypoxemia; positive BAL result on d 25
Bilateral ground glass opacity
Oseltamivir 150 mg 2×/d +
rimantadine 100 mg 2×/d
Pneumocystis spp.
(DFA + in BAL)
Alive
3
5 d before diagnosis: fever (24 h), wet cough
Hypoxemia;
positive BAL result on d 2
Multiple nodules with halo sign
Oseltamivir 150 mg 2×/d
Aspergillus
(PCR and GM result positive in BAL sample); Staphylococcus aureus; PIV3
Alive
4
<24 h before diagnosis: fever (5 d), cough
Hypoxemia
Bilateral infiltrates
Oseltamivir 2 mg/kg 2×/d
None
Alive
5
<24 h before diagnosis: cough, rhinorrhea, congestion
No
Bronchial thickening
Oseltamivir 150 mg 2×/d
None
Alive
6
<24 h before diagnosis: rhinorrhea, fever (24 h), cough
No
None
Oseltamivir 150 mg 2×/d
None
Alive
7
24 h before diagnosis: sore throat, fever (24 h), cough
No
CXR stable
Oseltamivir 75 mg 2×/d +
rimantadine 100 mg 2×/d
Rhinovirus
(PCR result positive in NW sample)
Alive
8 24 h before diagnosis: sore throat, fever (24 h), chills No CXR normal Prophylaxis: oseltamivir 45 mg 2×/d for 10 d, ended 3 d before influenza diagnosis None Alive

*URTI, upper respiratory tract infection; LRTI, lower respiratory tract infection; BAL, bronchoalveolar lavage; DFA, direct immunofluorescence assay; GM, galactomanane; PIV3, parainfluenza virus 3; NW, nasal wash; CXR, chest radiograph.

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