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[两例流感病毒感染后侵袭性肺曲霉病成功治疗的病例]

[Two cases of successfully treated invasive pulmonary aspergillosis following influenza virus infection].

作者信息

Ohnishi Tsukasa, Andou Kouichi, Kusumoto Soujiro, Sugiyama Hidetoshi, Hosaka Takamichi, Ishida Hiroo, Shirai Kunio, Nakashima Masanao, Yamaoka Toshimitsu, Okuda Kentarou, Hirose Takashi, Horichi Naoya, Adachi Mitsuru

机构信息

The First Department of Internal Medicine, Showa University Hospital.

出版信息

Nihon Kokyuki Gakkai Zasshi. 2007 Apr;45(4):349-55.

Abstract

While invasive pulmonary aspergillosis usually occurs in immunocompromised hosts, it has been described after influenza virus infection in healthy individuals. The first case was a 76-year-old previously healthy woman admitted because of chest pain, cough, sputum, fever, and a chest radiograph abnormality. A transbronchial biopsy specimen showed fungal hyphae. Amphotericin B (AMPH) and Itraconazole (ITCZ) were given, and she improved gradually. A viral test showed a titre of 1/128 to influenza A. Case 2 was a 72-year-old previously healthy man admitted because of cough, fever, chest pain and a consolidation and cavitation on the chest radiograph. Antibiotics were ineffective. Cavitation with a halo sign appeared on the contralateral lung. Because his daughter was infected with Influenza B, we suspected he had been infected with IPA following influenza infection. AMPH and ITCZ and Micafungin sodium were given. His respiratory failure worsened, and on the tenth hospital day he required artificial ventilation; his condition improved gradually, (extubation after 40 days.) A viral test showed a titre of 1/128 to influenza B. IPA must be considered for the differential diagnosis of complications of influenza virus infection.

摘要

侵袭性肺曲霉病通常发生在免疫功能低下的宿主中,但在健康个体感染流感病毒后也有相关报道。首例病例是一名76岁的既往健康女性,因胸痛、咳嗽、咳痰、发热及胸部X线片异常入院。经支气管活检标本显示有真菌菌丝。给予两性霉素B(AMPH)和伊曲康唑(ITCZ)治疗后,她逐渐好转。病毒检测显示甲型流感病毒滴度为1/128。病例2是一名72岁的既往健康男性,因咳嗽、发热、胸痛及胸部X线片显示实变和空洞入院。抗生素治疗无效。对侧肺出现有晕征的空洞。由于他的女儿感染了乙型流感,我们怀疑他在感染流感后发生了侵袭性肺曲霉病(IPA)。给予了AMPH、ITCZ和米卡芬净钠治疗。他的呼吸衰竭加重,在住院第10天需要人工通气;他的病情逐渐好转(40天后拔管)。病毒检测显示乙型流感病毒滴度为1/128。对于流感病毒感染并发症的鉴别诊断,必须考虑侵袭性肺曲霉病。

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