三例人类肺型鼠疫患者临床特征分析

Clinical characteristics of three cases of human pneumonic plague

目的探讨人类肺型鼠疫的临床特点。方法分析内蒙古自治区2023年7~8月发生的一起家庭聚集性肺型鼠疫病例的临床、影像学和实验室资料。结果3例人类肺型鼠疫患者系一家人,于7月31日、8月4日就诊多家医疗机构,其中男性1例,女性2例;年龄分别为46岁、41岁和21岁;死亡1例、重症1例、轻症1例。病例1为首发病例,以腺鼠疫发病,未能得到及时诊断和特效抗菌药物治疗,继发败血型鼠疫和肺型鼠疫,起病3 d后发生脓毒症休克、弥散性血管内凝血(DIC)以及多器官功能衰竭而死亡。病例2于暴露后4 d发病,表现为原发性肺型鼠疫,肺部炎症进展迅速,出现呼吸衰竭和休克,但因及时诊断,给予累计53 g链霉素联合莫西沙星等治疗,积极的呼吸支持和循环支持,经33 d治疗痊愈出院。病例3病情较轻,肺部病灶局限,早期应用链霉素累计18 g联合莫西沙星治疗,病情迅速改善。结论肺型鼠疫患者救治成功关键在于敏锐把握流行病学接触史,掌握鼠疫临床特征和演变规律,做到早期诊断、早期应用特效抗菌药物、积极进行脓毒症治疗等。

Objective To investigate the clinical characteristics of human pneumonic plague.Methods The clinical,imaging and laboratory data of a family cluster of pneumonic plague cases in Inner Mongolia from July to August 2023 were analyzed.Results The 3 cases with human pneumonic plague were from a same family,and they were treated in several medical institutions on July 31st and August 4th,including 1 male and 2 female,who were 46 years old,41 years old and 21 years old.There were 1 death,1 severe case and 1 mild case.Case 1 was the first case with bubonic plague onset and failed to receive timely diagnosis and specific antibiotic treatment,who developed secondary septicemic plague and pulmonary plague,and died 3 days after onset of the disease due to septic shock,disseminated intravascular coagulation(DIC)and multiple organ failure.Case 2 developed and presented as primary pneumonic plague 4 days after exposure,with rapid progression of pulmonary inflammation,respiratory failure and shock.However,due to timely diagnosis,the patient was given 53 g streptomycin combined with moxifloxacin and other treatments,as well as active respiratory and circulatory support,and was cured and discharged after 33 days of treatment.For case 3,the disease was mild and the lung lesions were limited.The early cumulative treatment of 18 g streptomycin combined with moxifloxacin showed rapid improvement.Conclusions The key to the successful treatment of pneumonic plague patients is to grasp the epidemiological contact history,the clinical characteristics and evolution of plague,to achieve early diagnosis,early application of specific antibiotics,and carry out sepsis treatment.