First Fatal Oseltamivir-Resistant 2009 Pandemic Influenza A (H1N1) Case in an Adult in Korea
10.4068/cmj.2011.47.2.127
- Author:
Seung Dok HONG
1
;
Seong Hwan PARK
;
Seung Ji KANG
;
Yong Soo KWON
;
Seung Jung KEE
;
Kyung Hwa PARK
;
Sook In JUNG
;
Hee Chang JANG
Author Information
1. Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea. haroc153@naver.com
- Publication Type:Case Report
- Keywords:
Influenza A virus, H1N1 subtype;
Pandemics;
Oseltamivir;
Drug resistance, viral
- MeSH:
Adult;
Anti-Bacterial Agents;
Cardiomyopathy, Dilated;
Chest Pain;
Diabetes Mellitus;
Drug Resistance, Viral;
Dyspnea;
Hospitalization;
Humans;
Hypertension;
Influenza A Virus, H1N1 Subtype;
Influenza, Human;
Korea;
Male;
Middle Aged;
Neuraminidase;
Orthomyxoviridae;
Oseltamivir;
Pandemics;
Pneumonia;
Polymerase Chain Reaction;
Renal Insufficiency, Chronic;
Viruses;
Zanamivir
- From:Chonnam Medical Journal
2011;47(2):127-129
- CountryRepublic of Korea
- Language:English
-
Abstract:
It has been suggested that oseltamivir-resistant influenza viruses harboring the H274/275Y mutation are less virulent than are those that are oseltamivir-sensitive, and fatality attributed to infection with an oseltamivir-resistant virus is very rare. Here we report the first fatal adult case of oseltamivir-resistant 2009 pandemic influenza A (H1N1) in Korea. A 60-year-old Korean male who had hypertension, diabetes mellitus, chronic kidney disease, and dilated cardiomyopathy visited Chonnam National University Hospital because of a 7-day history of chest pain and dyspnea. The patient was at another clinic and had been medicated with oseltamivir (75 mg twice daily) beginning 7 days before admission. Empirical antibiotics were started on the first day of hospitalization. Reverse-transcriptase polymerase chain reaction for 2009 pandemic influenza A (H1N1) was reported to be positive, and a double dose of oseltamivir (150 mg twice per day) was started on day four of hospitalization. However, the pneumonia worsened and the patient died, despite 3 days of high-dose antiviral therapy and 6 days of antibacterial therapy. An H275Y mutation was detected in the neuraminidase gene sequence. This case shows that oseltamivir resistance after short-term drug exposure is possible and can be fatal, emphasizing that early use of zanamivir should be considered in suspicious cases.
