职业接触禽类致人感染高致病性H5N1型禽流感一例

Occupational exposure induced human transmissible highly pathogenic H5N1 avian influenza in one patient

目的描述人感染高致病性H5N1型禽流感的临床表现及肺部影像学特征。方法回顾分析1例确诊为人感染高致病性H5N1型禽流感的临床表现和影像学特点。结果患者有明确的职业接触史，以发热、咳嗽为首发症状，病程中流感样症状突出，伴消化道症状，实验室以白细胞总数和淋巴细胞均明显降低，肝功能和心肌酶损害为主，肺部病变发展快，累及多脏器（肺、心、肝、肾等），抗真菌、抗病毒、抗炎，机械通气以及对症支持疗法均无效；X线胸片特征病灶漫延快，变化多，吸收与发展并存；应用逆转录一聚合酶链反应（RT-PCR）、实时聚合酶链反应（realtime PCR）技术检测患者鼻咽拭子和含漱液标本显示禽流感病毒H，N-亚型特异性HA和NA基因均为阳性，同时在鼻咽拭子标本中分离获得1株禽流感病毒A／jiangxi／1／2005（H5N1）。尸检显示双肺弥漫性肺泡损伤，弥漫性血管内凝血及多脏器损伤。结论人感染高致病性H5N。型禽流感是致命性疾病，肺部病变发展快，吸收与发展并存，无有效治疗措施，对有职业接触的人群应加强传染病的防护。

Objective To describe the clinical manifestations and lung imaging characteristics of the human transmissible highly pathogenic H5N1 avian influenza. Methods The clinical manifestations and lung imaging characteristics of human transmissible highly pathogenic H5N1 avian influenza in one patient were reviewed and analyzed. Results The patient had the clear history of occupational exposure. The fever and symptoms of influenza were prominent at onset and associated with the symptoms of the digestive tract. The laboratory findings comprised the significant decrease of the white blood cell count and the lymphocyte number and the impairment of the liver function and the myocardial enzymes. The disease progressed rapidly and multiple organs including lung, heart, liver and kidneys were involved. It was ineffective to administer antifungal, anti-virus and anti-inflammation medicines. It was in vain to use mechanical ventilation and pneumothorax intubation and closed drainage as well as the support therapy. In the X-ray film, the lesions progressed quickly and changed diversely with absorption and development at the same time. The nasal and throat swabs and the gargle specimen were detected with RT-PCR and real time PCR by Chinese Center for Disease Control and Prevention. The results showed that both the specific HA and NA genes of the avian influenza virus HsN~ subtype were positive and in the same time a strain of avian influenza virus A/jiangxi/1/ 2005（H5N1） was separated and obtained from the nasal and throat swabs. The autopsy showed that diffuse injury of alveolus in lungs, D1C and multiple organ injury. Conclusion The human transmissible highly pathogenic H5N1 avian influenza is a lethal disease. The disease progresses rapidly with the absorption and development at the same time in the lungs and unfortunately there are no effective therapeutic measures. The prevention of the contagious disease for the occupationally exposed population should be emphasized.