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Volume 17, Number 4—April 2011
CME ACTIVITY - Research

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)

Main Article

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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Page created: September 01, 2011
Page updated: September 01, 2011
Page reviewed: September 01, 2011
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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