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Respiratory Failure Caused by 2009 Novel Influenza A/H1N1 in a Hematopoietic Stem-Cell Transplant Recipient: Detection of Extrapulmonary H1N1 RNA and Use of Intravenous Peramivir

Angela P. Campbell, MD, MPH; Shevin T. Jacob, MD, MPH; Jane Kuypers, PhD; Anna Wald, MD, MPH; Janet A. Englund, MD; Lawrence Corey, MD; and Michael Boeckh, MD
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From University of Washington, Seattle, WA 98195.

Note: Drs. Campbell and Jacob contributed equally to this article.

Acknowledgment: The authors thank Christi Dahlgren and Deborah Reyes for assistance compiling clinical and laboratory data; Anne Cent, Nancy Wright, Patricia Nguyen for specimen processing, testing, and laboratory expertise; and Debra Mattson for critical review of the manuscript. Biocryst Pharmaceuticals provided peramivir under emergency investigational new drug status.

Grant Support: By the National Institutes of Health (grants CA18029, HL081595, K23HL091059, L40AI071572, K24AI071113, and K24HL093294).

Potential Conflicts of Interest: Dr. Campbell has received grant support from MedImmune. Dr. Jacob received grant support from Pfizer. Dr. Wald received grant support from Roche Pharmaceuticals and GlaxoSmithKline. Dr. Englund has received grant support from MedImmune, Adamas Pharmaceuticals, and Novartis. Dr. Boeckh received grant support from Adamas Pharmaceuticals and Roche Pharmaceuticals, is a consultant for Roche and Novartis, and has received speaking fees from Roche.

Ann Intern Med. 2010;152(9):619-620. doi:10.7326/0003-4819-152-9-201005040-00022
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Time course of novel influenza A/H1N1 infection in a hematopoietic stem-cell transplant recipient.

The limit of reverse-transcription polymerase chain reaction assay detection is 3 log10 viral copies/mL. Bronchioalveolar lavage on hospital day 7 and blood culture on hospital day 29 were also positive for Saccharomyces cerevisiae. The patient received a short course of intravenous micafungin initially. Positive blood culture was treated with line removal and intravenous micafungin followed by oral voriconazole. BAL = bronchoalveolar lavage.

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