Chonnam Med J.  2011 Aug;47(2):127-129. 10.4068/cmj.2011.47.2.127.

First Fatal Oseltamivir-Resistant 2009 Pandemic Influenza A (H1N1) Case in an Adult in Korea

• Hong SD
• Park SH
• Kang SJ
• Kwon YS
• Kee SJ
• Park KH
• Jung SI
• Jang HC

• KMID: 2048798
• DOI: http://doi.org/10.4068/cmj.2011.47.2.127

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.

Keyword

Influenza A virus, H1N1 subtype; Pandemics; Oseltamivir; Drug resistance, viral

MeSH Terms

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
Anti-Bacterial Agents
Neuraminidase
Oseltamivir
Zanamivir

Figure

• 

  FIG. 1 Results of the chest radiography and computed tomography performed at the time of admission. Cardiomegaly and pulmonary infiltration in both lungs are evident with predominance in the lower lobes.

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