tetano
Editor, Senior Moderator
Clinical Infectious Diseases 2010;50:e47?e49
? 2010 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2010/5007-00E2$15.00
DOI: 10.1086/651166
BRIEF REPORT
Possible Neuropsychiatric Reaction to High‐Dose Oseltamivir during Acute 2009 H1N1 Influenza A Infection
Kenta Nakamura,1
Brian S. Schwartz,2
Niklas Lindeg?rdh,4
Chris Keh,2 and
B. Joseph Guglielmo3
1School of Medicine, 2Division of Infectious Diseases, and 3Department of Clinical Pharmacy, University of California, San Francisco, California; and 4Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
The safety of high‐dose oseltamivir during treatment of 2009 H1N1 influenza A infection for critically ill patients is unknown. Here we report on a case patient with severe, delayed‐onset neuropsychiatric symptoms after administration of high‐dose oseltamivir. Clinicians should be vigilant to the possible increased risk of complications associated with high‐dose oseltamivir therapy for 2009 H1N1 influenza A infection.
Received 9 November 2009; accepted 30 December 2009; electronically published 1 March 2010.
Reprints or correspondence: Dr Brian S. Schwartz, Div of Infectious Diseases, University of California, San Francisco, 513 Parnassus Ave, S‐380, San Francisco, CA 94143‐0654 (brian.schwartz@ucsf.edu).
Oseltamivir is widely prescribed to prevent and treat influenza infection [1, 2]. During the present 2009 H1N1 influenza A pandemic, increased oseltamivir use is expected, and clinicians may administer higher doses to critically ill patients on the basis of expert recommendations [3]. Neurologic complications have been attributed to infection with influenza A and B viruses [4] and, more recently, to infection with 2009 H1N1 influenza A virus [5]. Sudden‐ and delayed‐onset adverse neuropsychiatric reactions to oseltamivir have also been reported after standard and high dosing for patients infected with influenza, resulting in several deaths [6?8].
Case report.In July 2009, a previously high‐functioning 43‐year‐old Vietnamese man developed a fever, cough, and sinus congestion 4 days after undergoing an autologous stem cell transplant for acute promyelocytic leukemia. Computed tomography scans of the chest and sinuses revealed ground‐glass opacities throughout the lungs and bilateral mastoid and sphenoid sinus opacification consistent with pneumonia and sinusitis, respectively. On day 6 after the onset of fever, a direct fluorescent‐antibody assay of respiratory viruses was positive for influenza A virus, which was later subtyped as novel 2009 H1N1. High‐dose oseltamivir (150 mg orally twice daily) was started on the evening of day 6 after onset of fever. On day 8 after onset of fever, the patient became disoriented in time and place, had visual hallucinations, and was transferred to the intensive care unit for closer monitoring. Arterial blood gases, electrolytes, and renal function were normal, blood and urine cultures were negative, and review of his other medications (cefepime, acyclovir, entecavir, filgrastim, heparin, pantoprazole, docusate, and senna) failed to reveal any likely cause of his altered mental status. Neuroimaging was not obtained because of his inability to lay still for the study, and a lumbar puncture was not performed because of thrombocytopenia.
full article
http://www.journals.uchicago.edu/do...%7Cany%3A+influenza+h1n1%5D&searchHistoryKey=
? 2010 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2010/5007-00E2$15.00
DOI: 10.1086/651166
BRIEF REPORT
Possible Neuropsychiatric Reaction to High‐Dose Oseltamivir during Acute 2009 H1N1 Influenza A Infection
Kenta Nakamura,1
Brian S. Schwartz,2
Niklas Lindeg?rdh,4
Chris Keh,2 and
B. Joseph Guglielmo3
1School of Medicine, 2Division of Infectious Diseases, and 3Department of Clinical Pharmacy, University of California, San Francisco, California; and 4Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
The safety of high‐dose oseltamivir during treatment of 2009 H1N1 influenza A infection for critically ill patients is unknown. Here we report on a case patient with severe, delayed‐onset neuropsychiatric symptoms after administration of high‐dose oseltamivir. Clinicians should be vigilant to the possible increased risk of complications associated with high‐dose oseltamivir therapy for 2009 H1N1 influenza A infection.
Received 9 November 2009; accepted 30 December 2009; electronically published 1 March 2010.
Reprints or correspondence: Dr Brian S. Schwartz, Div of Infectious Diseases, University of California, San Francisco, 513 Parnassus Ave, S‐380, San Francisco, CA 94143‐0654 (brian.schwartz@ucsf.edu).
Oseltamivir is widely prescribed to prevent and treat influenza infection [1, 2]. During the present 2009 H1N1 influenza A pandemic, increased oseltamivir use is expected, and clinicians may administer higher doses to critically ill patients on the basis of expert recommendations [3]. Neurologic complications have been attributed to infection with influenza A and B viruses [4] and, more recently, to infection with 2009 H1N1 influenza A virus [5]. Sudden‐ and delayed‐onset adverse neuropsychiatric reactions to oseltamivir have also been reported after standard and high dosing for patients infected with influenza, resulting in several deaths [6?8].
Case report.In July 2009, a previously high‐functioning 43‐year‐old Vietnamese man developed a fever, cough, and sinus congestion 4 days after undergoing an autologous stem cell transplant for acute promyelocytic leukemia. Computed tomography scans of the chest and sinuses revealed ground‐glass opacities throughout the lungs and bilateral mastoid and sphenoid sinus opacification consistent with pneumonia and sinusitis, respectively. On day 6 after the onset of fever, a direct fluorescent‐antibody assay of respiratory viruses was positive for influenza A virus, which was later subtyped as novel 2009 H1N1. High‐dose oseltamivir (150 mg orally twice daily) was started on the evening of day 6 after onset of fever. On day 8 after onset of fever, the patient became disoriented in time and place, had visual hallucinations, and was transferred to the intensive care unit for closer monitoring. Arterial blood gases, electrolytes, and renal function were normal, blood and urine cultures were negative, and review of his other medications (cefepime, acyclovir, entecavir, filgrastim, heparin, pantoprazole, docusate, and senna) failed to reveal any likely cause of his altered mental status. Neuroimaging was not obtained because of his inability to lay still for the study, and a lumbar puncture was not performed because of thrombocytopenia.
full article
http://www.journals.uchicago.edu/do...%7Cany%3A+influenza+h1n1%5D&searchHistoryKey=