Chang Hsu-Liang, Hsu Jui-Feng, Tsai Ying-Ming, Lin Shang-Yi, Kuo Hsuan-Fu, Yang Chih-Jen
Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Division of Pulmonary and Critical Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, #100, Tzyou 1st Road, Kaohsiung 807, Taiwan.
BMC Pulm Med. 2016 Jan 4;16:1. doi: 10.1186/s12890-015-0163-3.
Influenza B virus infection is generally considered to be mild and is rarely associated pulmonary cardiovascular involvement in adults. However fatal complications may occur.
A 43-year-old previously healthy Taiwanese male came to our emergency department due to high fever, chills, general malaise and myalgia for about 4 days. An influenza rapid test from a throat swab was negative. Chest radiography showed mild left lung infiltration and levofloxacin was prescribed. However, progressive shortness of breath and respiratory failure developed 48 h later after hospitalization. Emergent intubation was performed and he was transferred to the intensive care unit where oseltamivir (Tamiflu, Roche) 75 mg orally twice daily was given immediately. In the intensive care unit, cardiac catheterization revealed normal coronary arteries. However, a markedly elevated cardiac enzyme level (Troponin I level was up to 71.01 ng/ml), a positive cardiac magnetic resonance imaging findings and no coronary artery stenosis led to the diagnosis of acute myocarditis. Subsequent real-time polymerase chain reaction of endotracheal aspirates was positive for influenza B. His condition gradually improved and he was successfully weaned from the ventilator on day 22. He was discharged without prominent complications on day 35.
Influenza B infection is not always a mild disease. Early detection, early administration of antiviral agents, appropriate antibiotics and best supportive care, is still the gold standard for patients such as the one reported.
乙型流感病毒感染通常被认为症状较轻，在成人中很少伴有肺部和心血管系统受累。然而，可能会出现致命并发症。
一名43岁、既往健康的台湾男性因高热、寒战、全身乏力和肌痛约4天前来我院急诊科就诊。咽喉拭子流感快速检测呈阴性。胸部X线检查显示左肺轻度浸润，遂给予左氧氟沙星治疗。然而，住院48小时后出现进行性呼吸急促和呼吸衰竭。紧急进行了气管插管，并将其转入重症监护病房，立即给予口服奥司他韦（达菲，罗氏公司生产），每日两次，每次75毫克。在重症监护病房，心脏导管检查显示冠状动脉正常。然而，心肌酶水平显著升高（肌钙蛋白I水平高达71.01纳克/毫升），心脏磁共振成像结果呈阳性，且无冠状动脉狭窄，最终诊断为急性心肌炎。随后，气管内吸出物的实时聚合酶链反应检测显示乙型流感呈阳性。他的病情逐渐好转，在第22天成功脱机。第35天出院，无明显并发症。
乙型流感感染并不总是轻症疾病。对于本文所报道的这类患者，早期检测、早期给予抗病毒药物、适当的抗生素以及最佳的支持治疗，仍然是治疗的金标准。
