人感染H3N8型甲型流感重症肺炎死亡1例  

One case of severe pneumonia and death from H3N8 influenza in human

作　　者：冯雪琴[1] 李亮明[1] 王娟[1] 吴桂深[1] 李洋 Feng Xueqin;Li Liangming;Wang Juan;Wu Guishen;Li Yang(Laboratory Medicine Center,People′s Hospital of Zhongshan,Zhongshan 528403,China)

机构地区：[1]中山市人民医院检验医学中心,中山528403

出　　处：《中华检验医学杂志》2023年第9期950-954,共5页Chinese Journal of Laboratory Medicine

摘　　要：患者女,56岁,5 d前无明显诱因出现发热、咳嗽、气促,因社区获得性肺炎于2023年3月3日收入中山市人民医院,3月11日通过肺泡灌洗液进行宏转录组测序确认甲型流感病毒感染,通过流感分型确认为A-H3N8,于3月16日经抢救无效死亡。本病例为难治性多发性骨髓瘤自体干细胞移植、持续化疗免疫功能缺陷患者,有慢性上呼吸道感染史,影像学显示两肺广泛分布斑片、实变影等肺炎表现,并出现白细胞、血小板、嗜中性粒细胞和淋巴细胞计数严重减少,实验室炎症指标明显升高,临床考虑为慢性呼吸道感染急性加重,抗细菌治疗效果不佳后,考虑合并真菌感染,多次根据病情更改抗菌药物治疗,但疗效不佳,病情进展迅速;在肺泡灌洗液病原学确认为A-H3N8流感后,马上进行奥司他韦抗病毒治疗,但由于出现全身性复杂多样症状,包括炎症风暴、脓毒症、急性呼吸衰竭、心动过速、凝血功能障碍以及其他肺外脏器损伤等,在出现症状19 d后由于严重呼吸衰竭及多器官衰竭死亡。A female patient,years of age 56,having no distinct inducement before 5 d but developed fever,coughing,and shortness of breath,presented in People′s Hospital of Zhongshan with community-acquired pneumonia on March 3rd,2023.Influenza A virus infection was confirmed on March 11th after performing macro transcriptome sequencing with alveolar lavage fluid,and H3N8 was confirmed with influenza typing afterward,having declared dead on March 16th.This case is a patient with refractory multiple myeloma autologous stem cell transplantation and continuous chemotherapy with immune dysfunction.She has a history of chronic upper respiratory tract infection.Imaging showed a widespread distribution of plaques,solid lesions,and other pneumonia manifestations in both lungs,a severe decrease in the counts of white blood cells,platelets,neutrophils,and lymphocytes,and a significant increase in laboratory inflammation indicators.After the clinical consideration was an acute aggravation of chronic respiratory tract infection and poor effect of anti-bacterial treatment,fungal infection was considered,and antibiotic treatment was changed several times according to the condition.Still,the outcome was poor,and the disease progressed rapidly.Medical workers initiated Oseltamivir antiviral therapy immediately after the alveolar lavage fluid etiology confirmed A-H3N8 influenza.However,due to complex and varied systemic symptoms,including inflammatory storm,sepsis,acute respiratory failure,tachycardia,coagulopathy,and other extrapulmonary organ injuries,she died 19 days after signs due to severe respiratory failure and multiple organ failure.

关 键 词：流感病毒A型 H3N8亚型 肺炎 多发性骨髓瘤 

分 类 号：R511.7[医药卫生—内科学] R563.1[医药卫生—临床医学]