Seki Masafumi, Shimada Daishi
Division of Infectious Diseases and Infection Control, Saitama Medical University International Medical Center, Hidaka City, Japan.
Division of Respirology, Tohoku Medical and Pharmaceutical University, Sendai City, Japan.
Int Med Case Rep J. 2025 May 26;18:621-627. doi: 10.2147/IMCRJ.S519471. eCollection 2025.
Three cases of severe influenza that required ventilator management in the 2024-2025 season, which was a major influenza season in Japan, are presented. Case 1: A 54-year-old man with obesity developed lobar pneumonia as a result of severe community-acquired pneumonia (CAP) secondary to methicillin-susceptible (MSSA), as confirmed on sputum culture. The nasal swab was positive for influenza A antigen. Intravenous peramivir and piperacillin/tazobactam were administered for 2 days followed by lascufloxacin and linezolid for 2 weeks. Veno-venous extracorporeal membrane oxygenation (VV-ECMO) was also performed. Case 2: A 63-year-old man with multiple myeloma and chronic kidney disease developed severe pneumonia as a result of CAP. Although influenza A antigen was detected, no bacteria were isolated from his specimens. He showed severe hypoxia and massive ground-glass opacities (GGOs) in both lung fields, but he recovered after administration of peramivir and levofloxacin with prednisolone for 2 days and 2 weeks, respectively, with non-invasive positive pressure support. Case 3: A 43-year-old man without any related medical history developed severe heart failure with mild bronchopneumonia and was admitted to our hospital. Acute heart failure caused by myocarditis and CAP due to influenza A were suspected and treated effectively with peramivir and a percutaneous ventricular assist device (IMPELLA), which involved an auxiliary circulating pump with veno-arterial ECMO (VA-ECMO) for 1 day and 2 weeks, respectively. In three middle-aged patients, influenza virus may have accelerated pneumonia/heart failure. All three patients had not received influenza vaccines and were not elderly. Although the emphasis on most vaccines has decreased after the COVID-19 pandemic appears to have subsided, we should stress the importance of influenza vaccines and improvement of critical care protocols, because severe influenza can be a concern for young and middle-aged adults during the influenza season after the post COVID-19 pandemic period.
本文介绍了2024 - 2025年日本流感大流行季节中3例需要呼吸机管理的重症流感病例。病例1：一名54岁肥胖男性，因痰培养确诊为甲氧西林敏感金黄色葡萄球菌（MSSA）引起的严重社区获得性肺炎（CAP），进而发展为大叶性肺炎。鼻拭子甲型流感抗原检测呈阳性。静脉注射帕拉米韦和哌拉西林/他唑巴坦2天，随后使用左氧氟沙星和利奈唑胺治疗2周。同时进行了静脉 - 静脉体外膜肺氧合（VV - ECMO）治疗。病例2：一名63岁患有多发性骨髓瘤和慢性肾脏病的男性，因CAP发展为重症肺炎。虽然检测到甲型流感抗原，但标本中未分离出细菌。他出现严重缺氧，双肺野有大量磨玻璃影（GGOs），但在分别给予帕拉米韦和左氧氟沙星联合泼尼松龙治疗2天和2周，并给予无创正压通气支持后康复。病例3：一名无相关病史的43岁男性，因轻度支气管肺炎并发严重心力衰竭入院。怀疑是由心肌炎引起的急性心力衰竭和甲型流感导致的CAP，并分别使用帕拉米韦和经皮心室辅助装置（IMPELLA）进行有效治疗，其中涉及使用静脉 - 动脉体外膜肺氧合（VA - ECMO）辅助循环泵1天和2周。在这3例中年患者中，流感病毒可能加速了肺炎/心力衰竭的发生。所有3例患者均未接种流感疫苗，且并非老年人。尽管在新冠疫情似乎平息后，大多数疫苗的关注度有所下降，但我们仍应强调流感疫苗的重要性以及改进重症护理方案，因为在新冠疫情后时期的流感季节，重症流感可能会成为中青年人群关注的问题。
