Cuddihy Joshua, Patel Shreena, Mughal Nabeela, Lockie Christopher, Trimlett Richard, Ledot Stephane, Cheshire Nicholas, Desai Ajay, Singh Suveer
Magill Department for Anaesthesia, Critical Care and Pain Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London SW10 9NH, United Kingdom.
Chelsea and Westminster Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London SW10 9NH, United Kingdom.
World J Crit Care Med. 2021 Sep 9;10(5):301-309. doi: 10.5492/wjccm.v10.i5.301.
Panton-Valentine leukocidin (PVL) is an exotoxin secreted by (), responsible for skin and soft tissue infections. As a cause of severe necrotising pneumonia, it is associated with a high mortality rate. A rare entity, the epidemiology of PVL (PVL) pneumonia as a complication of influenza coinfection, particularly in young adults, is incompletely understood.
An adolescent girl presented with haemoptysis and respiratory distress, deteriorated rapidly, with acute respiratory distress syndrome (ARDS) and profound shock requiring extensive, prolonged resuscitation, emergency critical care and venovenous extracorporeal membrane oxygenation (ECMO). Cardiac arrest and a rare complication of ECMO cannulation necessitated intra-procedure extracorporeal cardiopulmonary resuscitation, venoarterial ECMO. Coordinated infectious disease, microbiology and Public Health England engagement identified causative agents as PVL and influenza A/H3N2 from bronchial aspirates within hours. Despite further complications of critical illness, the patient made an excellent recovery with normal cognitive function. The coordinated approach of numerous multidisciplinary specialists, nursing staff, infection control, specialist cardiorespiratory support, hospital services, both adult and paediatric and Public Health are testimony to what can be achieved to save life against expectation, against the odds. The case serves as a reminder of the deadly nature of PVL when associated with influenza and describes a rare complication of ECMO cannulation.
PVL- can cause severe ARDS and profound shock, with influenza infection. A timely coordinated multispecialty approach can be lifesaving.
潘顿-瓦伦丁杀白细胞素（PVL）是由（）分泌的一种外毒素，可导致皮肤和软组织感染。作为严重坏死性肺炎的病因，它与高死亡率相关。作为流感合并感染的并发症，尤其是在年轻人中，PVL肺炎这一罕见疾病的流行病学情况尚不完全清楚。
一名青春期女孩出现咯血和呼吸窘迫，病情迅速恶化，出现急性呼吸窘迫综合征（ARDS）和严重休克，需要进行广泛、长时间的复苏、紧急重症监护和静脉-静脉体外膜肺氧合（ECMO）。心脏骤停以及ECMO插管的罕见并发症使得在操作过程中需要进行体外心肺复苏，即静脉-动脉ECMO。传染病、微生物学和英国公共卫生部门协同合作，数小时内就从支气管吸出物中确定病原体为PVL和甲型H3N2流感病毒。尽管出现了更多的危重症并发症，但患者恢复良好，认知功能正常。众多多学科专家、护理人员、感染控制人员、专业心肺支持人员、医院服务部门（包括成人和儿科）以及公共卫生部门的协同方法证明，在看似不可能的情况下，通过努力可以挽救生命。该病例提醒人们，PVL与流感相关时具有致命性，并描述了ECMO插管的一种罕见并发症。
PVL与流感感染相关时可导致严重的ARDS和严重休克。及时采取协同的多专业方法可挽救生命。
