Abstract
Recent case reports describe multidrug-resistant influenza A pandemic (H1N1) 2009 virus infection in immunocompromised patients exposed to neuraminidase inhibitors because of an I223R neuraminidase mutation. We report a case of multidrug-resistant pandemic (H1N1) 2009 bearing the I223R mutation in an ambulatory child with no previous exposure to neuraminidase inhibitors.
Highlights
Recent case reports describe multidrug-resistant influenza A pandemic (H1N1) 2009 virus infection in immunocompromised patients exposed to neuraminidase inhibitors because of an I223R neuraminidase mutation
We report a case of infection by multidrug-resistant pandemic (H1N1) 2009 virus bearing the I223R mutation in an ambulatory child with no previous exposure to neuraminidase inhibitors (NAIs)
Apart from I201V, which is of unknown significance and has not been previously documented in pandemic (H1N1) 2009, these mutations were detected in 22% to 72% of pandemic (H1N1) 2009 strains circulating in Ontario at the same time that underwent whole genome sequencing
Summary
Recent case reports describe multidrug-resistant influenza A pandemic (H1N1) 2009 virus infection in immunocompromised patients exposed to neuraminidase inhibitors because of an I223R neuraminidase mutation. Immunocompromised patients exposed to oseltamivir and zanamivir because of an I223R (isoleucine to arginine) mutation in NA [4,5,6]. We report a case of infection by multidrug-resistant pandemic (H1N1) 2009 virus bearing the I223R mutation in an ambulatory child with no previous exposure to NAI.
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