Prolonged excretion of amantadine-resistant influenza A virus quasi species after cessation of antiviral therapy in an Immunocompromised patient

Phenotypic and molecular studies were conducted to characterize multiple influenza A isolates recovered from an immunocompromised patient who died of viral and fungal pneumonitis. The recovery of amantadine-resistant isolates was correlated with the detection of 2 drug-resistant M2 variants (codons 27 and 31) in combination with a wild-type virus. The mutant viruses persisted within the viral population in variable proportions >1 month after cessation of antiviral therapy. These results confirm animal studies reported elsewhere regarding the genetic stability of influenza M2 mutants and their potential for transmission in humans.