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

• Published in: BMC infectious diseases Vol. 20; no. 1; pp. 1 - 5
• Main Authors: Harada, Naonori, Shibata, Wataru, Koh, Hideo, Takashita, Emi, Fujisaki, Seiichiro, Okamura, Hiroshi, Nanno, Satoru, Yamada, Koichi, Nakamae, Hirohisa, Hino, Masayuki, Kakeya, Hiroshi
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 06.07.2020; BioMed Central; BMC
• Subjects: Allogeneic hematopoietic cell transplantation; Analysis; Antigens; Antiviral drugs; Baloxavir marboxil; Binding sites; Care and treatment; Case Report; Case reports; Cyclosporins; Development and progression; Diagnostic systems; Disease; Drug dosages; Dual E119D/R292K substitution; Exo-a-sialidase; Gene mutation; Genetic aspects; Glucocorticoids; Health aspects; Hematopoietic stem cell transplantation; Hospitals; Immunocompromised host; Immunomodulators; Infections; Influenza; Influenza A; Influenza viruses; Leukemia; Lymphopenia; Mutation; Neuraminidase mutation; Oseltamivir; Patients; Peramivir; Peramivir resistance; Point mutation; Prednisolone; Risk factors; Sequence analysis; Stem cell transplantation; Substitutes; Transplantation; Transplants & implants; Vincristine; Viral infections; Viruses; Japan
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-020-05205-1

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. 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.