Adult influenza A (H3N2) with reduced susceptibility to baloxavir or peramivir cured after switching anti-influenza agents

Masafumi Seki; Yuko Sakai-Tagawa; Atsuhiro Yasuhara; Yuji Watanabe

doi:10.1016/j.idcr.2019.e00650

Adult influenza A (H3N2) with reduced susceptibility to baloxavir or peramivir cured after switching anti-influenza agents

IDCases. 2019 Oct 1:18:e00650. doi: 10.1016/j.idcr.2019.e00650. eCollection 2019.

Authors

Masafumi Seki¹, Yuko Sakai-Tagawa², Atsuhiro Yasuhara², Yuji Watanabe³

Affiliations

¹ Division of Infectious Diseases and Infection Control, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Japan.
² Department of Virology, Institute of Medical Science, University of Tokyo, Tokyo, Japan.
³ Laboratory for Clinical Microbiology, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Japan.

Abstract

We describe two adults with A/H3N2 influenza with (patient 1), and without (patient 2) polymerase acidic (PA) subunit I38 T substitution during the same season. Patient 1 had a reduced clinical response to baloxavir, a cap-dependent endonuclease inhibitor (CEI), but was cured by peramivir, a neuraminidase inhibitor. Baloxavir was clinically effective for patient 2, for whom peramivir had been ineffective. Susceptibility to baloxavir can be decreased by a PA unit mutation, but response to treatment can be increased by switching and/or combination with a neuraminidase inhibitor, even though CEI are clinically effective against influenza in adults.

Keywords: Baloxavir; Peramivir; Polymerase; Polymerase acidic subunit; Viral infection.

Publication types

Case Reports