Mauch T J, Bratton S, Myers T, Krane E, Gentry S R, Kashtan C E
Department of Pediatrics, University of Minnesota Medical School, Minneapolis 55455.
Pediatrics. 1994 Aug;94(2 Pt 1):225-9.
Influenza B virus causes epidemic infection in normal children, but only one case of infection in an immunocompromised solid organ transplant (SOT) recipient has been reported. Characterization of the clinical course of influenza B virus infection in pediatric SOT recipients may increase the utilization of preventive and therapeutic interventions by pediatricians caring for these immunocompromised children.
Retrospective chart review of patients whose respiratory viral cultures yielded influenza B from January 1989 through March 1992.
Twelve pediatric SOT recipients with influenza B virus infection were identified. These included five renal, four hepatic, and three cardiac allograft recipients, ranging from 19 months to 17 years 9 months of age (median 6 years 2 months). The posttransplant interval ranged from 6 weeks to 4 years 6 months (average 26.7 months). No patient had been immunized against influenza. Exposure histories were documented for eight children; five of these occurred in the hospital.
Clinical symptoms included fever (12/12), respiratory (11/12), or gastrointestinal complaints (8/12). Five patients had neurologic involvement; one died of uncal herniation. Ten children were hospitalized (median duration, 3 days; range, 2 to 79 days). Two patients (post-transplant interval, 3 to 8 months) required mechanical ventilation, and one of these received aerosolized ribavirin. Three children had concurrent allograft rejection.
Influenza B infection is potentially life-threatening in pediatric SOT recipients. We recommend annual immunization of pediatric SOT recipients, their household contacts, and health care workers. Prospective studies are needed to evaluate the efficacy of influenza vaccination in pediatric SOT recipients.
乙型流感病毒可在正常儿童中引发流行性感染，但免疫功能低下的实体器官移植（SOT）受者中仅报告过1例感染病例。了解儿科SOT受者感染乙型流感病毒的临床病程特征，可能会提高照顾这些免疫功能低下儿童的儿科医生对预防和治疗干预措施的应用。
对1989年1月至1992年3月期间呼吸道病毒培养检出乙型流感病毒的患者进行回顾性病历审查。
确定了12例感染乙型流感病毒的儿科SOT受者。其中包括5例肾移植受者、4例肝移植受者和3例心脏移植受者，年龄从19个月至17岁9个月（中位数为6岁2个月）。移植后的时间间隔从6周至4年6个月（平均26.7个月）。没有患者接种过流感疫苗。记录了8名儿童的接触史；其中5例发生在医院。
临床症状包括发热（12/12）、呼吸道症状（11/12）或胃肠道不适（8/12）。5例患者有神经系统受累；1例死于小脑幕切迹疝。10名儿童住院（中位数持续时间为3天；范围为2至79天）。2例患者（移植后间隔时间为3至8个月）需要机械通气，其中1例接受了雾化利巴韦林治疗。3名儿童同时发生移植排斥反应。
乙型流感感染对儿科SOT受者有潜在生命威胁。我们建议对儿科SOT受者及其家庭接触者和医护人员每年进行免疫接种。需要进行前瞻性研究以评估流感疫苗接种对儿科SOT受者的疗效。
