2例坏死性肺炎的病原学分析  

Etiological analysis of two necrotizing pneumonia cases

作　　者：王红燕 白冰 李萌 余治健 邓启文[1] Wang Hongyan;Bai Bing;Li Meng;Yu Zhijian;Deng Qiwen(Department of Infectious Diseases,Union Shenzhen Hospital of Huazhong University of Science and Technology,Shenzhen 518052,China)

机构地区：[1]华中科技大学协和深圳医院感染科,518052

出　　处：《国际病毒学杂志》2019年第5期327-330,共4页International Journal of Virology

基　　金：深圳市科技创新委课题(CYJ20170412143551332,JCYJ20170307153714512,JCYJ2017030715391973,JCYJ20170307153425389);深圳市卫计委课题(201601058)。

摘　　要：目的分析2例坏死性肺炎的临床特点及病原学特点.方法总结2例患者的临床特点、诊治经过,对临床血培养分离的金黄色葡萄球菌进行药敏检测.采用RT-PCR及高通量测序方法检测下呼吸道分泌物,明确2例患者呼吸道感染的病原微生物.结果2例患者起病急,进展迅速,肺部病变严重,积极治疗仍在短期内死亡,其中1例血培养、痰培养及药敏试验结果为甲氧西林敏感金黄色葡萄球菌(methicillin-staphylococcus aureus,MSSA),2例患者下呼吸道分泌物流感病毒核酸检测结果为乙型流感病毒,高通量测序均提示MSSA阳性,毒力基因检测结果为携带杀白细胞素基因(panton valentine leukocidin,PVL).结论2例坏死性肺炎患者均为PVL阳性MSSA合并乙型流感病毒感染,流感流行期需警惕PVL阳性MSSA坏死性肺炎的发生.Objective To analyze the clinical features and etiology characteristics of two cases of necrotizing pneumonia.Methods The clinical features,diagnosis and treatment process of the two patients were summarized.Drug sensitivity test of the Staphyloccocus aureus separated from the blood culture was performed.RT-PCR and next-generation sequencing were used to analyze lower respiratory tract secretion samples to identify the pathogens causing respiratory infections in the two patients.Results The two patients showed acute onset,rapid deterioration and severe lung damage.Both patients died within a short time despite active treatment.Methicillin sensitive S.aureus(MSSA)was identified from one patient by blood culture,sputum culture and drug sensitivity test.For both patients,the influenza B virus nucleic acids in lower respiratory tract secretion samples were positive and the results of next-generation sequencing indicated MSSA positive.Virulence gene test showed that the strains were carrying the gene of Panton-Valentine leukocidin(PVL).Conclusions Both patients with necrotizing pneumonia were co-infected with PVL-positive MSSA and influenza B virus.Necrotizing pneumonia caused by PVL-positive MSSA should be cautioned during influenza season.

关 键 词：乙型流感 金黄色葡萄球菌 坏死性肺炎 杀白细胞素 

分 类 号：R44[医药卫生—诊断学]