Nishimura Hidekazu, Sato Ko, Kadji Francois Marie Ngako, Ohmiya Suguru, Ito Hiroko, Kubo Toru, Hashimoto Sho
Virus Research Center, Clinical Research Division, Sendai Medical Center, National Hospital Organization, Sendai, Miyagi, Japan.
Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.
J Thorac Dis. 2018 May;10(5):E322-E327. doi: 10.21037/jtd.2018.04.74.
Reports on respiratory syncytial virus (RSV) infections are abundant in pediatric and geriatric populations but not many in healthy adults, and particularly, those which demonstrated the illness throughout its time course are rare. We report two otherwise-healthy adult cases, showing a number of evidence essential for confirmation of exclusive infections with RSV, and document their clinical features from the onset of the disease to recovery, including secondary sinusitis with magnetic resonance (MR) and computed tomography (CT) images. The infection was proven by isolating RSV belonging to subgroup B and by observing elevated anti-RSV antibody titer in the paired sera. Possible contribution of other pathogens including almost all respiratory viruses and representative bacteria, was excluded by negative results in multiplex PCR examination. In the first case, illness initiated with pharyngeal pain, followed by symptoms of sneezing, severe rhinorrhea and coughing, which peaked at approximately 5-7 days and persisted for 12 days. The patient experienced a slight chill, but the body temperature did not exceed 37 °C during illness. The patient showed no significant finding but only a slight increase in serum C-reactive protein level in the routine clinical laboratory examinations. On the 9th day of illness, a dull headache started persisting for at least a week after which it gradually waned. Sinusitis was found by chance on MR images of maxillary sinus 8 days after the headache started, and the finding disappeared on CT images taken after 6 months. In the second case, the symptoms included severe rhinorrhea and dull facial pain around the upper nose; the pain also occurred on the 9th day of illness and the symptom was clinically diagnosed to be acute sinusitis during a visit to a physician.
关于呼吸道合胞病毒（RSV）感染的报告在儿科和老年人群中很多，但在健康成年人中并不多见，尤其是那些在整个病程中都表现出该病的报告更是罕见。我们报告了两例原本健康的成年病例，展示了确诊RSV单独感染所需的一些证据，并记录了从疾病发作到康复的临床特征，包括通过磁共振（MR）和计算机断层扫描（CT）图像显示的继发性鼻窦炎。通过分离出属于B亚组的RSV以及观察配对血清中抗RSV抗体滴度升高来证实感染。多重PCR检查结果为阴性，排除了包括几乎所有呼吸道病毒和代表性细菌在内的其他病原体的可能作用。在第一例中，疾病始于咽痛，随后出现打喷嚏、严重流涕和咳嗽症状，在大约5 - 7天达到高峰并持续了12天。患者感到轻微寒战，但患病期间体温未超过37°C。在常规临床实验室检查中，患者除血清C反应蛋白水平略有升高外，无明显异常发现。在患病第9天，开始出现隐痛性头痛，持续至少一周后逐渐减轻。在头痛开始8天后，上颌窦的MR图像偶然发现鼻窦炎，6个月后拍摄的CT图像上该发现消失。在第二例中，症状包括严重流涕和鼻上部周围隐痛性面部疼痛；疼痛也在患病第9天出现，在就诊时临床诊断为急性鼻窦炎。
