Department of Pediatric Intensive Care Unit (PICU), Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310052, China.
Sci Rep. 2024 Sep 6;14(1):20880. doi: 10.1038/s41598-024-71867-5.
In March 2023, our pediatric intensive care unit (PICU) retrospectively examined six cases of pediatric necrotizing tracheobronchitis (NTB), focusing on co-infections with influenza A virus (IAV) and Staphylococcus aureus (S. aureus). This study aimed to elucidate NTB's clinical characteristics, diagnostics, and therapeutic approaches. Diagnostics included symptom assessment, microbiological testing that confirmed all patients were positive for IAV H1N1 with a predominant S. aureus co-infection, and bronchoscopy. The patients predominantly exhibited fever, cough, and dyspnea. Laboratory analysis revealed decreased lymphocyte counts and elevated infection markers like C-reactive protein and procalcitonin. Chest computed tomography (CT) scans detected tracheobronchial obstructions in half of the cases, while bronchoscopy showed severe mucosal congestion, edema, necrosis, and purulent-hemorrhagic exudates. Treatments encompassed comprehensive strategies like oxygen therapy, intubation, bronchoscopic interventions, thoracentesis, oseltamivir, and a regimen of antibiotics. Our findings suggested potential correlations between clinical markers, notably lymphocyte count and procalcitonin, and clinical interventions such as the number of rescues and intensive care unit (ICU) duration. This research highlights the importance of early detection and the role of bronchoscopy and specific markers in assessing NTB, advocating for continued research in larger cohorts to better understand its clinical trajectory and refine treatment approaches for this challenging pediatric disease.
2023 年 3 月，我院儿科重症监护病房（PICU）回顾性分析了 6 例儿童坏死性气管支气管炎（NTB），重点分析了甲型流感病毒（IAV）和金黄色葡萄球菌（S. aureus）合并感染的情况。本研究旨在阐明 NTB 的临床特征、诊断和治疗方法。诊断包括症状评估、微生物检测，所有患者均证实为 IAV H1N1 阳性，且均伴有金黄色葡萄球菌合并感染，还进行了支气管镜检查。患者主要表现为发热、咳嗽和呼吸困难。实验室分析显示淋巴细胞计数减少，感染标志物如 C 反应蛋白和降钙素原升高。胸部 CT 扫描显示半数病例存在气管支气管阻塞，而支气管镜检查显示严重的黏膜充血、水肿、坏死和脓性出血渗出。治疗包括综合治疗策略，如氧疗、插管、支气管镜介入、胸腔穿刺、奥司他韦和抗生素治疗。我们的研究结果表明，临床标志物（尤其是淋巴细胞计数和降钙素原）与临床干预（如抢救次数和 ICU 持续时间）之间可能存在相关性。本研究强调了早期检测的重要性以及支气管镜和特定标志物在评估 NTB 中的作用，倡导在更大的队列中进行进一步研究，以更好地了解其临床病程，并完善这种具有挑战性的儿科疾病的治疗方法。
