Methods: A 63 year old lung transplant recipient was diagnosed with PIV-1 and was admitted to the hospital with worsening respiratory status —requiring transfer to the ICU with progressive hypoxic respiratory failure. She was intubated and placed on mechanical ventilation and multiple bilateral patchy opacities were observed following chest X-ray. In addition to PIV, she was demonstrated to be positive for H1N1 influenza by bronchoalveolar lavage. In light of continued severe disease in spite of initiation of oseltamivir therapy, DAS181 therapy was commenced on a compassionate use basis and viral load and clinical response to treatment were monitored.
Results: Over a five-day course of therapy, O2 requirement was reduced and the patient's respiratory status improved. Extubation occurred on day 5. Viral RNA was serially quantified by reverse-transcriptase PCR. Between day 2 and day 4 of dosing, there was a 60-fold reduction in influenza viral load in the patient's tracheal aspirates. During this same time frame, there was a 7-fold reduction in PIV RNA viral load. NP swabs were negative for both viruses following extubation. The patient tolerated DAS181 well with no signs of significant systemic toxicity.
Conclusion: DAS181 was an effective antiviral in the setting of dual infection with two viruses, PIV and influenza A (H1N1), in a lung transplant recipient with life-threatening lower respiratory tract disease. Viral loads were reduced substantially within 48 hours of treatment, and infection cleared at the end of a treatment course. Respiratory virus co-infections in transplant patients may be well-suited to DAS181 treatment, which merits further study in this high-risk population.
M. R. Schleiss,
R. Moss, Ansun: Employee , Salary
R. Routh, Ansun: Employee , Salary