Journal Article

Common Emergence of Amantadine- and Rimantadine-Resistant Influenza A Viruses in Symptomatic Immunocompromised Adults

Janet A. Englund, Richard E. Champlin, Philip R. Wyde, Hagop Kantarjian, Robert L. Atmar, Jeffrey Tarrand, Hassan Yousuf, Helen Regnery, Alexander I. Klimov, Nancy J. Cox and Estella Whimbey

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 26, issue 6, pages 1418-1424
Published in print June 1998 | ISSN: 1058-4838
Published online June 1998 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/516358
Common Emergence of Amantadine- and Rimantadine-Resistant Influenza A Viruses in Symptomatic Immunocompromised Adults

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The importance and significance of amantadine- or rimantadine-resistant influenza viruses in immunocompromised patients was studied in a population of adult bone marrow transplant (BMT) recipients and patients with leukemia prospectively cultured for respiratory viruses. Influenza A viruses were isolated from 29 patients with acute respiratory illness (14 BMT recipients and 15 patients with leukemia). Fifteen patients (52%) received amantadine (n = 4) or rimantadine (n = 11) therapy. All influenza isolates recovered from six patients shedding virus for ⩾3 days were screened for antiviral susceptibility; resistant isolates were further genetically characterized. Initial influenza isolates were susceptible to amantadine or rimantadine, but subsequent isolates from five of six patients were resistant. Influenza-associated mortality was similar among patients with and without documented antiviral resistance (2 of 5 vs. 5 of 24). We conclude that development of antiviral resistance in immunocompromised individuals should be considered when they have been treated with antivirals and have shed influenza virus for a prolonged period. Isolation procedures should be instituted for all immunocompromised patients with influenza, both during and after therapy with amantadine or rimantadine.

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Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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