Gonakoti Sriram, Bahirwani Janak, Maddala Raja Naga Mahesh, Vidyasagar Sudha
Department of Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India.
BMJ Case Rep. 2018 Apr 18;2018:bcr-2018-224334. doi: 10.1136/bcr-2018-224334.
H3N2 was first detected in July 2011 in the USA. It is responsible for sporadic cases of influenza and localised outbreaks and has not yet taken over on an epidemic or pandemic scale. An 84-year-old man presented with a dry cough, fever and myalgia for 3 days. On examination, he had a pulse of 98 bpm and blood pressure of 124/88 mm Hg. The patient was tachypnoeic, SpO was 90%. Auscultation revealed bilateral diffuse wheeze and crackles. He had generalised muscle tenderness on examination. On admission, creatinine was 1.9 mg/dL and CK(creatine kinase) was 44 000 U/L. Chest X-ray was suggestive of ARDS (acute respiratory distress syndrome). Throat swab was positive for H3N2. The patient was given intravenous fluids, oral sodium bicarbonate, oxygen and oseltamivir tablet. In view of ARDS, he was given intravenous methylprednisolone and bronchodilators for bronchospasm. The patient improved symptomatically; vitals and lab reports were normal at the time of discharge.
H3N2于2011年7月在美国首次被检测到。它导致了散发性流感病例和局部疫情爆发,尚未在流行或大流行规模上占据主导。一名84岁男性出现干咳、发热和肌痛3天。检查时,他的脉搏为98次/分钟,血压为124/88毫米汞柱。患者呼吸急促,血氧饱和度为90%。听诊显示双侧弥漫性哮鸣音和湿啰音。检查发现他全身肌肉压痛。入院时,肌酐为1.9毫克/分升,肌酸激酶(CK)为44000单位/升。胸部X光片提示急性呼吸窘迫综合征(ARDS)。咽喉拭子检测H3N2呈阳性。该患者接受了静脉输液、口服碳酸氢钠、吸氧和口服奥司他韦片治疗。鉴于ARDS,给予他静脉注射甲泼尼龙和支气管扩张剂以缓解支气管痉挛。患者症状有所改善;出院时生命体征和实验室报告均正常。