Successful treatment with baloxavir marboxil of a patient with peramivir-resistant influenza A/H3N2 with a dual E119D/R292K substitution after allogeneic hematopoietic cell transplantation: a case report
Abstract Background Extended use of oseltamivir in an immunocompromised host could reportedly induce neuraminidase gene mutation possibly leading to oseltamivir-resistant influenza A/H3N2 virus. To our knowledge, no report is available on the clinical course of a severely immunocompromised patient w...
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| Format: | Article |
| Language: | English |
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BMC
2020-07-01
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| Series: | BMC Infectious Diseases |
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| Online Access: | http://link.springer.com/article/10.1186/s12879-020-05205-1 |
| _version_ | 1828467517876600832 |
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| author | Naonori Harada Wataru Shibata Hideo Koh Emi Takashita Seiichiro Fujisaki Hiroshi Okamura Satoru Nanno Koichi Yamada Hirohisa Nakamae Masayuki Hino Hiroshi Kakeya |
| author_facet | Naonori Harada Wataru Shibata Hideo Koh Emi Takashita Seiichiro Fujisaki Hiroshi Okamura Satoru Nanno Koichi Yamada Hirohisa Nakamae Masayuki Hino Hiroshi Kakeya |
| author_sort | Naonori Harada |
| collection | DOAJ |
| description | Abstract Background Extended use of oseltamivir in an immunocompromised host could reportedly induce neuraminidase gene mutation possibly leading to oseltamivir-resistant influenza A/H3N2 virus. To our knowledge, no report is available on the clinical course of a severely immunocompromised patient with a dual E119D/R292K neuraminidase mutated-influenza A/H3N2 during the administration of peramivir. Case presentation A 49-year-old male patient was admitted for second allogeneic hematopoietic cell transplantation for active acute leukemia. The patient received 5 mg prednisolone and 75 mg cyclosporine and had severe lymphopenia (70/μL). At the time of hospitalization, the patient was diagnosed with upper tract influenza A virus infection, and oseltamivir treatment was initiated immediately. However, the patient was intolerant to oseltamivir. The following day, treatment was changed to peramivir. Despite a total period of neuraminidase-inhibitor administration of 16 days, the symptoms and viral shedding continued. Changing to baloxavir marboxil resolved the symptoms, and the influenza diagnostic test became negative. Subsequently, sequence analysis of the nasopharyngeal specimen revealed the dual E119D/R292K neuraminidase mutant influenza A/H3N2. Conclusions In a highly immunocompromised host, clinicians should take care when peramivir is used for extended periods to treat influenza virus A/H3N2 infection as this could potentially leading to a dual E119D/R292K substitution in neuraminidase protein. Baloxavir marboxil may be one of the agents that can be used to treat this type of mutated influenza virus infection. |
| first_indexed | 2024-12-11T04:08:35Z |
| format | Article |
| id | doaj.art-64ff82206ad94f1a82f4178f199f41be |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-11T04:08:35Z |
| publishDate | 2020-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-64ff82206ad94f1a82f4178f199f41be2022-12-22T01:21:28ZengBMCBMC Infectious Diseases1471-23342020-07-012011510.1186/s12879-020-05205-1Successful treatment with baloxavir marboxil of a patient with peramivir-resistant influenza A/H3N2 with a dual E119D/R292K substitution after allogeneic hematopoietic cell transplantation: a case reportNaonori Harada0Wataru Shibata1Hideo Koh2Emi Takashita3Seiichiro Fujisaki4Hiroshi Okamura5Satoru Nanno6Koichi Yamada7Hirohisa Nakamae8Masayuki Hino9Hiroshi Kakeya10Hematology, Graduate School of Medicine, Osaka City UniversityDepartment of Infection Control Science, Graduate School of Medicine, Osaka City UniversityHematology, Graduate School of Medicine, Osaka City UniversityInfluenza Virus Research Center, National Institute of Infectious DiseasesInfluenza Virus Research Center, National Institute of Infectious DiseasesHematology, Graduate School of Medicine, Osaka City UniversityHematology, Graduate School of Medicine, Osaka City UniversityDepartment of Infection Control Science, Graduate School of Medicine, Osaka City UniversityHematology, Graduate School of Medicine, Osaka City UniversityHematology, Graduate School of Medicine, Osaka City UniversityDepartment of Infection Control Science, Graduate School of Medicine, Osaka City UniversityAbstract Background Extended use of oseltamivir in an immunocompromised host could reportedly induce neuraminidase gene mutation possibly leading to oseltamivir-resistant influenza A/H3N2 virus. To our knowledge, no report is available on the clinical course of a severely immunocompromised patient with a dual E119D/R292K neuraminidase mutated-influenza A/H3N2 during the administration of peramivir. Case presentation A 49-year-old male patient was admitted for second allogeneic hematopoietic cell transplantation for active acute leukemia. The patient received 5 mg prednisolone and 75 mg cyclosporine and had severe lymphopenia (70/μL). At the time of hospitalization, the patient was diagnosed with upper tract influenza A virus infection, and oseltamivir treatment was initiated immediately. However, the patient was intolerant to oseltamivir. The following day, treatment was changed to peramivir. Despite a total period of neuraminidase-inhibitor administration of 16 days, the symptoms and viral shedding continued. Changing to baloxavir marboxil resolved the symptoms, and the influenza diagnostic test became negative. Subsequently, sequence analysis of the nasopharyngeal specimen revealed the dual E119D/R292K neuraminidase mutant influenza A/H3N2. Conclusions In a highly immunocompromised host, clinicians should take care when peramivir is used for extended periods to treat influenza virus A/H3N2 infection as this could potentially leading to a dual E119D/R292K substitution in neuraminidase protein. Baloxavir marboxil may be one of the agents that can be used to treat this type of mutated influenza virus infection.http://link.springer.com/article/10.1186/s12879-020-05205-1Allogeneic hematopoietic cell transplantationBaloxavir marboxilNeuraminidase mutationDual E119D/R292K substitutionPeramivir resistanceImmunocompromised host |
| spellingShingle | Naonori Harada Wataru Shibata Hideo Koh Emi Takashita Seiichiro Fujisaki Hiroshi Okamura Satoru Nanno Koichi Yamada Hirohisa Nakamae Masayuki Hino Hiroshi Kakeya Successful treatment with baloxavir marboxil of a patient with peramivir-resistant influenza A/H3N2 with a dual E119D/R292K substitution after allogeneic hematopoietic cell transplantation: a case report BMC Infectious Diseases Allogeneic hematopoietic cell transplantation Baloxavir marboxil Neuraminidase mutation Dual E119D/R292K substitution Peramivir resistance Immunocompromised host |
| title | Successful treatment with baloxavir marboxil of a patient with peramivir-resistant influenza A/H3N2 with a dual E119D/R292K substitution after allogeneic hematopoietic cell transplantation: a case report |
| title_full | Successful treatment with baloxavir marboxil of a patient with peramivir-resistant influenza A/H3N2 with a dual E119D/R292K substitution after allogeneic hematopoietic cell transplantation: a case report |
| title_fullStr | Successful treatment with baloxavir marboxil of a patient with peramivir-resistant influenza A/H3N2 with a dual E119D/R292K substitution after allogeneic hematopoietic cell transplantation: a case report |
| title_full_unstemmed | Successful treatment with baloxavir marboxil of a patient with peramivir-resistant influenza A/H3N2 with a dual E119D/R292K substitution after allogeneic hematopoietic cell transplantation: a case report |
| title_short | Successful treatment with baloxavir marboxil of a patient with peramivir-resistant influenza A/H3N2 with a dual E119D/R292K substitution after allogeneic hematopoietic cell transplantation: a case report |
| title_sort | successful treatment with baloxavir marboxil of a patient with peramivir resistant influenza a h3n2 with a dual e119d r292k substitution after allogeneic hematopoietic cell transplantation a case report |
| topic | Allogeneic hematopoietic cell transplantation Baloxavir marboxil Neuraminidase mutation Dual E119D/R292K substitution Peramivir resistance Immunocompromised host |
| url | http://link.springer.com/article/10.1186/s12879-020-05205-1 |
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