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乙型流感病毒感染后耐甲氧西林金黄色葡萄球菌所致复杂急性心包炎及外周静脉导管相关血流感染:1例报告

Complicated Acute Pericarditis and Peripheral Venous Catheter-Related Bloodstream Infection Caused by Methicillin-Resistant after Influenza B Virus Infection: A Case Report.

作者信息

Ochi Fumihiro, Tauchi Hisamichi, Miura Hiromitsu, Moritani Tomozo, Chisaka Toshiyuki, Higaki Takashi, Eguchi Mariko

机构信息

Department of Pediatrics, Ehime Prefectural Niihama Hospital, Niihama, Ehime, Japan.

Department of Pediatrics, Ehime University Graduate School of Medicine, Toon, Ehime, Japan.

出版信息

Case Rep Pediatr. 2023 May 2;2023:4374552. doi: 10.1155/2023/4374552. eCollection 2023.

Abstract

BACKGROUND

In this study, we report the case of a 14-month-old female patient transferred from another hospital to our hospital with a 9-day history of fever and worsening dyspnea. . The patient tested positive for influenza type B virus 7 days before being transferred to our hospital but was never treated. The physical examination performed at presentation revealed redness and swelling of the skin at the site of the peripheral venous catheter insertion performed at the previous hospital. Her electrocardiogram revealed ST segment elevations in leads II, III, aVF, and V2-V6. An emergent transthoracic echocardiogram revealed pericardial effusion. As ventricular dysfunction due to pericardial effusion was not present, pericardiocentesis was not performed. Furthermore, blood culture revealed methicillin-resistant (MRSA). Thus, a diagnosis of acute pericarditis complicated with sepsis and peripheral venous catheter-related bloodstream infection (PVC-BSI) due to MRSA was made. Frequent bedside ultrasound examinations were performed to evaluate the outcomes of the treatment. After administering vancomycin, aspirin, and colchicine, the patient's general condition stabilized.

CONCLUSIONS

In children, it is crucial to identify the causative organism and provide appropriate targeted therapy to prevent worsening of the condition and mortality due to acute pericarditis. Moreover, it is important to carefully monitor the clinical course for the progression of acute pericarditis to cardiac tamponade and evaluate the treatment outcomes.

摘要

背景

在本研究中,我们报告了一名14个月大的女性患者,她从另一家医院转至我院,有9天的发热病史且呼吸困难加重。该患者在转至我院前7天检测出B型流感病毒呈阳性,但从未接受过治疗。入院时的体格检查发现,在前一家医院进行外周静脉导管插入部位的皮肤发红肿胀。她的心电图显示II、III、aVF及V2 - V6导联ST段抬高。紧急经胸超声心动图显示有心包积液。由于不存在因心包积液导致的心室功能障碍,未进行心包穿刺术。此外,血培养显示耐甲氧西林金黄色葡萄球菌(MRSA)。因此,诊断为急性心包炎并发败血症及由MRSA引起的外周静脉导管相关血流感染(PVC - BSI)。频繁进行床边超声检查以评估治疗效果。在给予万古霉素、阿司匹林和秋水仙碱后,患者的一般情况稳定。

结论

在儿童中,识别致病微生物并提供适当的靶向治疗对于预防急性心包炎病情恶化和死亡至关重要。此外,仔细监测临床病程以观察急性心包炎进展为心脏压塞的情况并评估治疗效果也很重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b80a/10169241/4ed836c5dc85/CRIPE2023-4374552.001.jpg

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