tetano
Editor, Senior Moderator
Int J Antimicrob Agents
. 2024 Jul 22:107281.
doi: 10.1016/j.ijantimicag.2024.107281. Online ahead of print. Zanamivir and Baloxavir Combination to cure Persistent Influenza and Coronavirus Infections after Hematopoietic Stem Cell Transplant
Victor Euzen[SUP] 1 [/SUP], Aliénor Xhaard[SUP] 2 [/SUP], Samar Berreira-Ibraim[SUP] 3 [/SUP], Laure Deville[SUP] 4 [/SUP], Aude Quentin[SUP] 5 [/SUP], Pedro Hendrique DE Lima Prata[SUP] 2 [/SUP], Viviane Gournay[SUP] 2 [/SUP], Matthieu Prot[SUP] 6 [/SUP], Yannis Rahou[SUP] 3 [/SUP], Marion Barbet[SUP] 3 [/SUP], Séverine Mercier-Delarue[SUP] 1 [/SUP], Régis Peffault DE LA Tour[SUP] 2 [/SUP], Etienne Simon-Loriere[SUP] 7 [/SUP], Jérôme Legoff[SUP] 8 [/SUP]
Affiliations
Objectives: . Immunocompromised patients may experience prolonged shedding of influenza virus potentially leading to severe infections. Alternatives to monotherapy with neuraminidase inhibitors should be evaluated to entirely suppress viral replication and prevent drug-resistant mutations.
Methods: . We investigated the clinical and virological evolution in a case of persistent influenza A and human coronavirus OC43 (HCoV-OC43) coinfection in a hematopoietic stem cell transplant recipient after different therapeutic strategies.
Results: . Successive oseltamivir and zanamivir monotherapies failed to control both infections, with positive results persisting for over 110 days each. This led to the emergence of highly resistant oseltamivir strains due to neuraminidase mutations (E119V and R292K) followed by a deletion (del245-248), while maintaining sensitivity to zanamivir. The intra-host viral diversity data showed that the treatments impacted viral diversity of influenza virus, but not of HCoV-OC43. Considering the patient's underlying condition and the impact of prolonged viral shedding on pulmonary function, eradicating the influenza virus was necessary. A 10-day regimen combining zanamivir and baloxavir-marboxil effectively controlled influenza virus replication and was associated with the clearance of HCoV-OC43, finally resulting in comprehensive respiratory recovery.
Conclusion: These observations underscore the importance of further investigating combination treatments as the primary approach to achieve influenza eradication in immunocompromised patients.
Keywords: Baloxavir-marboxil; Neuraminidase inhibitor; Transplantation; drug-resistant; influenza.
. 2024 Jul 22:107281.
doi: 10.1016/j.ijantimicag.2024.107281. Online ahead of print. Zanamivir and Baloxavir Combination to cure Persistent Influenza and Coronavirus Infections after Hematopoietic Stem Cell Transplant
Victor Euzen[SUP] 1 [/SUP], Aliénor Xhaard[SUP] 2 [/SUP], Samar Berreira-Ibraim[SUP] 3 [/SUP], Laure Deville[SUP] 4 [/SUP], Aude Quentin[SUP] 5 [/SUP], Pedro Hendrique DE Lima Prata[SUP] 2 [/SUP], Viviane Gournay[SUP] 2 [/SUP], Matthieu Prot[SUP] 6 [/SUP], Yannis Rahou[SUP] 3 [/SUP], Marion Barbet[SUP] 3 [/SUP], Séverine Mercier-Delarue[SUP] 1 [/SUP], Régis Peffault DE LA Tour[SUP] 2 [/SUP], Etienne Simon-Loriere[SUP] 7 [/SUP], Jérôme Legoff[SUP] 8 [/SUP]
Affiliations
- PMID: 39047913
- DOI: 10.1016/j.ijantimicag.2024.107281
Objectives: . Immunocompromised patients may experience prolonged shedding of influenza virus potentially leading to severe infections. Alternatives to monotherapy with neuraminidase inhibitors should be evaluated to entirely suppress viral replication and prevent drug-resistant mutations.
Methods: . We investigated the clinical and virological evolution in a case of persistent influenza A and human coronavirus OC43 (HCoV-OC43) coinfection in a hematopoietic stem cell transplant recipient after different therapeutic strategies.
Results: . Successive oseltamivir and zanamivir monotherapies failed to control both infections, with positive results persisting for over 110 days each. This led to the emergence of highly resistant oseltamivir strains due to neuraminidase mutations (E119V and R292K) followed by a deletion (del245-248), while maintaining sensitivity to zanamivir. The intra-host viral diversity data showed that the treatments impacted viral diversity of influenza virus, but not of HCoV-OC43. Considering the patient's underlying condition and the impact of prolonged viral shedding on pulmonary function, eradicating the influenza virus was necessary. A 10-day regimen combining zanamivir and baloxavir-marboxil effectively controlled influenza virus replication and was associated with the clearance of HCoV-OC43, finally resulting in comprehensive respiratory recovery.
Conclusion: These observations underscore the importance of further investigating combination treatments as the primary approach to achieve influenza eradication in immunocompromised patients.
Keywords: Baloxavir-marboxil; Neuraminidase inhibitor; Transplantation; drug-resistant; influenza.