1例人感染高致病性禽流感(H5N1)死亡的调查  

Investigation of a Human Case Died From H5N1 in Suining County of Hunan Province

作　　者：彭进平[1] 胡世雄[1] 刘富强[1] 张红[1] 李俊华[1] 高立冬[1] 刘孙杰 肖善良 陈媛[2] 曾泉 

机构地区：[1]湖南省疾病预防控制中心,湖南长沙410005 [2]邵阳市疾病预防控制中心 [3]绥宁县疾病预防控制中心

出　　处：《实用预防医学》2006年第5期1181-1183,共3页Practical Preventive Medicine

摘　　要：目的探讨2006年2月4日湖南省邵阳市中心医院报告的1例不明原因肺炎死亡病因。方法访谈病例发病前后相关知情人,了解病例活动情况以及所在地家禽死亡情况,查阅临床病志,对密切接触者进行医学观察,采集病例的鼻咽分泌物、气管吸取物、肺穿刺物、唾液,应用逆转录-聚合酶链反应(RT-PCR)和实时荧光定量PCR法(Real-timePCR)检测A/H5N1亚型特异的核酸片段。结果病例发病前6d有宰杀鸡鸭史,对103例密切接触者经7d的医学观察,没有发热和异常情况,病例主要表现为双肺渗出性病变伴白细胞计数显著下降迅速进展为呼吸循环哀竭,病例气管分泌物、肺穿刺液H5N1禽流感病毒核酸均为阳性,咽拭子、唾液检测阴性。结论该病例是一起“禽-人”感染禽流感病毒致死的病例,正常家禽有可能携带H5N1禽流感病毒,应引起高度重视。Objective To explore the cause of death for an unknown pneumonia case reported by Central Hospital of Shaoyang City in Hunan Province on Feb. 4th, 2006. Method Interview people who know about the situation of the patient before and after her onset of illness and understand about the activities of the patient as well as the death of poultry in local area. Review the clinical case history records and make medical observation to close contacts. Collect samples as nasopharynx secretion, drawings from trachea, puncture things from lung, and saliver as well from the patient. Apply RT- PCR and Real- time PCR to detect the specific viral nucleic acid segment of A/HSN1. Results The patient had ever had practices on killing chickens and ducks with in the six days before the onset of illness. No feverish or other abnormal situation was found in 103 close contacts during the seven - day medical observation. The major manifestation of the patient was exudative lesion in two lungs accompanying with significant reduction of leukocyte count, which developed rapidly to respiratory failure. HSN1 viral nucleic acid was detected as positive both for trachea secretion and lung puncture, and negative for throat swab and saliver. Conclusion This is a fatal case due to infection with HPAI through ＂bird- human＂ route, during which normal poultry may have possibly infected and carried with HSN1 avian influenza virus, which deserves an intensive attention.

关 键 词：禽流感 H5N1 RT—PCR Real—time—PCR 

分 类 号：R511[医药卫生—内科学]