1例H7N9禽流感病毒感染引起重症肺炎的病例报告

A case report of severe pneumonia caused by H7N9 avian influenza virus infection

目的通过对已确诊为H7N9禽流感病毒感染患者的临床病例资料进行梳理总结,探讨H7N9的诊断、治疗及预防控制策略。方法以医院2017年4月确诊的H7N9禽流感病例为研究对象,用描述性流行病学方法分析该患者的病例资料,同时结合疾病进展时期的实验室检测结果和影像学资料进行分析总结。结果该患者H7N9核酸检测阳性;胸部CT显示两肺纹理增多,多发斑片状模糊影,右肺下叶见片状高密度影,境界不清,胸腔可见薄层积液;外周血WBC正常而淋巴细胞和血小板降低,继发耐碳青霉烯鲍氏不动杆菌(CRAB)和白假丝酵母感染;病情进展迅速,伴发急性呼吸窘迫综合征(ARDS)、多器官功能衰竭(MODS)、弥漫性血管内凝血(DIC),符合重症感染特征。结论 H7N9病毒核酸检测是诊断H7N9禽流感病毒感染的金标准,医务工作者应熟悉该疾病的流行病学史、掌握其临床症状体征,并结合实验室结果和影像学资料,做到早发现、早报告、早诊断、早隔离、早治疗。

OBJECTIVE To summarize the clinical data of a case of diagnosed avian influenza virus infection so as to explore the diagnosis and treatment of H7 N9 and put forward the prevention and control strategies. METHODS The patient who was diagnosed with H7 N9 avian influenza in Apr 2017 was recruited as the study objects, the descriptive epidemiological analysis was carried out for the clinical data of the patient, and the laboratory test results and imaging data during the progression stage were observed. RESULTS The patient showed positive for the H7 N9 nucleic acid test and increased texture of both lungs, multiple plaque-like blurred shadows, high-density shadows in the right lower lobe, unclear boundaries and thin effusion in the thoracic cavity on chest CT.The peripheral blood WBC level was in the normal range while the levels of lymphocytes and platelets were decreased, and the patient was prone to secondary infections of carbapenem-resistant Acinetobacter baumannii(CRAB) and Candida albicans.The patient had the rapid progression of illness condition, complication with acute respiratory distress syndrome(ARDS), multiple organ failure and disseminated intravascular coagulation(DIC), which met the diagnostic criteria for severe infection. CONCLUSION Nucleic acid test of H7 N9 virus is the gold standard for the diagnosis of H7 N9 avian influenza virus infection.It is necessary for health care workers to know about the epidemiological history of the disease, understand the clinical symptoms and signs and analyze the results of laboratory tests and imaging data so as to achieve the early detection, report, diagnosis, isolation and treatment.