Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
Student Research Committee, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
J Med Case Rep. 2023 Oct 21;17(1):437. doi: 10.1186/s13256-023-04187-3.
Respiratory syncytial virus (RSV)-induced disease is one of the important causes of flu-like illness in older adults and can cause serious disease in those who are at high-risk medical conditions. During coronavirus disease 2019 (COVID-19) pandemic, because of overlapping symptoms of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection with other respiratory infections, diagnosing diseases based on clinical and radiological findings was challenging and could cause misdiagnosis.
An 87-year-old Persian man was admitted to the hospital due to loss of consciousness, respiratory distress, tachypnea, and oliguria. He had previously hospitalized because of cough, fever, loss of appetite, and fatigue. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) test was performed which was negative; however, based on ground glass opacity on his chest computed tomography (CT) scan and being on the outbreak of COVID-19, he fulfilled case definition of COVID-19; therefore, he received protocol's treatment (remdesivir) for COVID-19 and relatively recovered and discharged. In our center, we requested brain and chest CT scans, blood tests, and multiplex PCR. Multiplex PCR revealed co-infection of influenza virus and RSV. Although we had started pneumonia and sepsis treatment, old age, weak immune system and the delay in initiation of right antibiotic and antivirus therapy altogether led him to die.
As a takeaway lesson of this case report, it is necessary to pay attention to viruses that show similar symptoms during future specific virus pandemics, especially in patients with old age and weak immune systems.
呼吸道合胞病毒（RSV）感染是导致老年人出现类似流感症状的重要原因之一，并且可能导致高危医疗条件人群罹患严重疾病。在 2019 年冠状病毒病（COVID-19）大流行期间，由于严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染与其他呼吸道感染的症状重叠，基于临床和影像学发现进行疾病诊断具有挑战性，并且可能导致误诊。
一名 87 岁的波斯男性因意识丧失、呼吸急促、呼吸急促和少尿而入院。他之前因咳嗽、发热、食欲不振和疲劳而住院。进行了严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）聚合酶链反应（PCR）检测，结果为阴性；然而，根据他胸部计算机断层扫描（CT）上的磨玻璃样混浊影以及 COVID-19 的爆发情况，他符合 COVID-19 的病例定义；因此，他接受了 COVID-19 的治疗方案（瑞德西韦），并相对康复出院。在我们中心，我们要求进行脑和胸部 CT 扫描、血液检查和多重 PCR。多重 PCR 显示流感病毒和 RSV 合并感染。尽管我们已经开始进行肺炎和败血症治疗，但由于年老、免疫系统较弱以及抗生素和抗病毒治疗的启动延迟，导致他最终死亡。
作为本病例报告的一个重要教训，在未来特定病毒大流行期间，需要注意表现出类似症状的病毒，尤其是在老年和免疫系统较弱的患者中。
