"Influenza virus infection is very common and although usually self-limiting, it remains a significant cause of morbidity in specific vulnerable populations like immunocompromised patients  . Treatment with neuraminidase inhibitors is recommended, but viral mutations that reduce susceptibility to oseltamivir occur more often in this group of patients  . We report our experience with a combination therapy consisting of oseltamivir, zanamivir, and amantadine. "
[Show abstract][Hide abstract] ABSTRACT: Immunocompromised patients are at increased risk of complications of influenza virus infection. We report on two critically ill patients on immunosuppressive medication with influenza pneumonia. In both patients, oseltamivir monotherapy did not result in clearance of the virus after 18 and five days, respectively. After adding zanamivir and amantadine to the treatment, PCRs on pharyngeal and/or plasma specimens turned negative in both patients after four and three days, respectively. We suggest, that in critically ill patients with influenza A H1N1 infection, treatment efficacy should be monitored closely and treatment with a combination of antiviral drugs should be considered.
"The pandemic influenza A (H1N1) 2009 virus (H1N1pdm09) broke out in Mexico and USA during the late spring and early summer of 2009. Due to its rapid widespread transmission, H1N1pdm09 virus was declared as novel influenza pandemic virus in June 2009 by the World Health Organization (WHO) [1-6]. Indeed the genomic analysis of this new 2009 influenza virus indicated a genetic viral reassortment and it contained genes of influenza A virus strains that are endemic in swine, avian and human species [7,8]. "
[Show abstract][Hide abstract] ABSTRACT: Background
The pandemic influenza A (H1N1) 2009 (H1N1pdm09) virus infection caused illness and death among people worldwide, particularly in hematologic/oncologic patients because influenza infected individuals can shed virus for prolonged periods, thus increasing the chances for the development of drug-resistant strains such as oseltamivir-resistant (OST-r) variant.
The aim of our study was to retrospectively evaluate the clinical importance of OST-r variant in circulating strains of the pandemic H1N1pdm09 virus. By means of RT-PCR and Sanger sequencing we analysed the presence of OST-r variant in 76 H1N1pdm09 laboratory-confirmed cases, hospitalized at the hematologic/oncologic ward at Spedali Civili of Brescia –Italy.
Out of 76 hospitalized hematologic/oncologic patients, 23 patients (30.2%) were infected by H1N1pdm09 virus. Further investigation revealed that 3 patients were positive for the OST-r variant carrying the H275Y mutation. All the 23 infected patients were immuno-compromised, and were under treatment or had been treated previously with oseltamivir. Three patients died (13%) after admission to intensive care unit and only one of them developed H275Y mutation.
Our retrospective observational study shows that pandemic influenza A (H1N1) 2009 virus can cause significant morbidity and even mortality in hematologic/oncologic patients and confirms the high rate of nosocomial transmission of pandemic H1N1pdm09 virus in these critical subjects. Indeed, the reduction in host defences in these hospitalized patients favoured the prolonged use of antiviral therapy and permitted the development of OST-r strain. Strategies as diagnostic vigilance, early isolation of patients and seasonal influenza A(H1N1) vaccination may prevent transmission of influenza in high risk individuals.
"Patients with malignancies can have more serious manifestations, including respiratory failure. Prolongation of viral shedding has been observed in immunosuppressed patients; therefore, treatment of infection can be a major problem . Oseltamivir and zanamivir have been approved for the treatment of influenza. "
[Show abstract][Hide abstract] ABSTRACT: The clinical course of influenza A (H1N1) infection in allogeneic hematopoietic stem cell transplantation (AHSCT)recipients is not clearly known. We report 3 AHSCT recipients that were infected with influenza A (H1N1). Each of thepatients had a different hematological disease and was at a different post-transplantation stages. All the patients weretreated with oseltamivir, and zanamivir was switched to oseltamivir in 1 patient. All the patients survived without anycomplications. The course of swine flu can vary and progress with bacterial or other viral infections in immunosuppressedpatients.
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