Department of Pediatric Infectious Diseases, Cleveland Clinic Children's Hospital, Cleveland, Ohio 44195, USA.
J Heart Lung Transplant. 2010 May;29(5):582-4. doi: 10.1016/j.healun.2009.11.600. Epub 2009 Dec 31.
The novel 2009 H1N1 influenza virus has been reported to have increased severity in patients with underlying cardiovascular and lung disease. Pediatric patients also appear to have an increased incidence of infection. The impact on cardiothoracic transplant recipients, especially in pediatric recipients, has not been established. We report the case of a 12-year-old boy with history of congenital heart disease who was transplanted in June 2001. In October 2009, it was found that he had developed severe acute respiratory distress syndrome (ARDS) secondary to novel 2009 H1N1 influenza virus. Extracorporeal membrane oxygenation (ECMO) was given as support. Importantly, the initial specimen evaluated by real-time reverse transcriptase-polymerase chain reaction was negative for novel 2009 H1N1 influenza virus. The patient was successfully weaned from ECMO after 24 days, extubated at 6 weeks, and continues to make steady rehabilitative progress. Early suspicion for infection and initiation of treatment, even with negative testing, is essential for cardiothoracic transplant recipients during the current pandemic of novel 2009 H1N1 influenza virus.
据报道，新型 2009 年 H1N1 流感病毒可使伴有基础心血管和肺部疾病的患者病情加重。儿科患者的感染发病率似乎也有所增加。新型 2009 年 H1N1 流感病毒对心胸器官移植受者的影响，特别是儿科受者的影响，尚未确定。我们报告了 1 例 12 岁男孩的病例，该男孩患有先天性心脏病，于 2001 年 6 月接受了移植。2009 年 10 月，发现他患有严重的急性呼吸窘迫综合征（ARDS），继发于新型 2009 年 H1N1 流感病毒。给予体外膜氧合（ECMO）作为支持。重要的是，通过实时逆转录-聚合酶链反应评估的初始标本对新型 2009 年 H1N1 流感病毒检测呈阴性。患者在 ECMO 支持下成功撤机 24 天后拔管，6 周后出院，继续稳步康复。在当前新型 2009 年 H1N1 流感大流行期间，心胸器官移植受者即使检测结果为阴性，也应早期怀疑感染并开始治疗。
