"发热+白肺"就是新冠肺炎吗?—重症呼吸道合胞病毒肺炎1例诊治并文献复习  

Is"fever+white lungs"corona virus disease 2019?-Diagnosis and treatment of 1 case of severe respiratory syncytial virus pneumonia and literature review

作　　者：程行锋 张芙蓉[1] 熊瑞华 陈洋[1] 陈锋[1] 王文咏 韩杰 Cheng Xingfeng;Zhang Furong;Xiong Ruihua;Chen Yang;Chen Feng;Wang Wenyong;Han Jie(Department of Intensive Care Unit,Wuhan Children's Hospital,Tongji Medical College,Huazhong University of Science&Technology,Wuhan 430016,Hubei,China)

机构地区：[1]华中科技大学同济医学院附属武汉儿童医院重症医学科,湖北武汉430016

出　　处：《中国中西医结合急救杂志》2020年第3期271-274,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

摘　　要：目的 报告1例胸部影像学呈"白肺"样改变呼吸道合胞病毒(RSV)感染患儿的诊治经过,分析新型冠状病毒肺炎(简称新冠肺炎)流行期间其他病原菌感染造成的不常见影像学表现.方法 武汉儿童医院重症医学科在新冠肺炎流行期间收治了1例胸部影像学呈"白肺"样改变的RSV感染患儿,对其免疫状况、肺部影像学等进行描述,复习相关文献并与危重型新冠肺炎进行鉴别.结果 患儿男性,5个月,因间断腹泻2周,咳嗽、呻吟2 d,面色发绀1 d于2020年1月11日入院.患儿无特殊个人病史,家属诉无新冠肺炎接触史,新型冠状病毒(2019-nCoV)核酸检测阴性;呼吸道病毒常见病原免疫球蛋白M(IgM)检测均呈阴性,H7N9呈阴性,EB病毒及巨细胞病毒检测均呈阴性;结核芯片及结核菌感染T细胞斑点试验(T-SPOT)阴性;反复多次气管内外痰培养阴性;连续血培养未检出细菌生长;大便常规、沙门氏菌、志贺氏菌及轮状病毒/腺病毒联合检测均为阴性.患儿2020年1月11日胸部X线和1月14日胸部CT均显示重症新冠肺炎类似改变(肺部呈"白肺"样);于1月13日行免疫荧光法检测RSV阳性,确诊为RSV感染肺炎.但患儿白细胞介素(IL-6、IL-10)和肿瘤坏死因子-α(TNF-α)、铁蛋白及器官功能正常,白细胞计数(WBC)、中性粒细胞比例均升高,淋巴细胞比例、免疫球蛋白、小儿危重病例评分降低,与重症新冠肺炎不一致.经抗病毒、丙种球蛋白、甲泼尼龙及间断俯卧位机械通气等治疗后,患儿氧合得以改善,小儿危重病例评分升高,病情及影像学表现好转,于2月1日出院.结论 RSV是毛细支气管炎最常见致病菌,发病多表现为喘息、气促等症状,预后良好,免疫功能低下儿童可发生严重的RSV感染肺炎及不常见的影像学与临床情况.新冠肺炎流行期间,应注意其他病原菌感染也可形成类似的影像学表现,应及时鉴别诊断,以免延误治疗.Objective To report the diagnosis and treatment of a child with respiratory syncytial virus(RSV)infection whose chest imaging changes were like"white lung",and analyze the unusual imaging manifestations caused by other pathogenic bacteria during corona virus disease 2019(COVID-19)epidemic.Methods Intensive Care Unit of Wuhan Children's Hospital admitted a child with RSV infection whose chest imaging changes were like"white lung"during COVID-19 epidemic.The immune status and pulmonary imaging were described,and the related literature was reviewed to identify COVID-19.Results The 5 months old male patient was hospitalized on January 11,2020 for 2 weeks of intermittent diarrhea,2 days of coughing and moaning,and 1 day of cyanosis.The patient had no special personal history,family members complained no COVID-19 contact history,with novel coronavirus(2019-nCoV)negative result for nucleic acid detection.The detection of immunoglobulin M(IgM),H7N9,EB virus,cytomegalovirus,tubercle chip and tuberculosis infection T cell spot test(T-SPOT test)were all negative.The sputum culture inside and outside the trachea was negative repeatedly;No bacterial growth was detected in continuous blood culture;routine stool test,Salmonella test,Shigella test and rotavirus/adenovirus test were all negative.On January 11 and 14,2020,chest X-ray and CT showed similar changes with severe COVID-19 such as"white lung"like changes in the lung;on January 13,RSV was detected by immunofluorescence,and the patient was confirmed with RSV infected pneumonia.But the patient's interleukin(IL-6 and IL-10),tumor necrosis factor-α(TNR-α),ferritin and other inflammatory indicators and body organ function were normal,the white blood cell count,neutrophil ratio and inflammatory factors were all increased,while lymphocyte ratio,immunoglobulin and pediatric critical illness score were decreased.After treatment with antiviral,gamma globulin,methylprednisolone and intermittent prone position mechanical ventilation,the patient's oxygenation was improved,pediatric

关 键 词："白肺" 呼吸道合胞病毒 儿童 肺炎 

分 类 号：R72[医药卫生—儿科]