- 期刊
A Fatal Case of Viral Pneumonia in a Child Infected with Adenovirus Type 3
第三型腺病毒肺炎：一死亡病例報告
摘要
腺病毒在小孩主要造成呼吸道和腸胃道的疾病，呼吸道方面的疾病通常是急性且會痊癒，但在嬰兒期卻會造成死亡或長期的肺病變，腺病毒在嬰兒或兒童的造成百分之4至10的病毒性肺炎，其中第3、7和21型腺病毒是主要的致病原，且偶爾有死亡病例。通常有免疫系統缺損，榮養不良或已受某些病毒感染的病人，以及某些特定的種族會比較容易受到腺病毒的感染。 本篇報告－2歲10月大女孩，死於第三型腺病毒肺炎，病前一切正常且健康，民國78年6月9日有一次嘔吐，6月14日開始發燒及咳嗽有痰，6月16日起住院接受肺炎療，胸部X光片呈左肺上下肺野浸潤增加且右上肺野有模糊狀浸潤，白血球10,800/cmm，Ampicillir用了兩天，病情示獲改善，改用cefuroxime和Amikin，兩天後自動出院，6月20日轉至他院，Penicillin，Amikin和cefamezine使用6天後，呼吸困難主得更嚴重，白血球減少至5,400/cmm，於是在6月26日轉入台大，胸部X光片已呈右上，中葉及左上葉後節模糊狀浸潤及左下葉糜漫性浸潤，抗生素改用Imipenan及Vancomycin，6月28日有一次停止呼吸之後轉至加護病房，從此病情惡化，使用呼吸器，但血中氧濃渡一直無法維持正常，6月30晶呼吸症狀更加惡化，心跳變慢，血氧降低，急救無效，宣佈死亡，病中所作的痰液病毒分離及死後肺組織的病毒培養都長出第三型腺病毒，病理結果顯示有壞死性發炎及化膿纖維滲出物，且有核內嗜酸性包涵體的變化，這些證據顯示患孩是受了第三型腺病毒的感染。
關鍵字
無資料並列摘要
This reporet describes the clinical, roentgenologic, pathologic, and virologic findings in a 2 years and ten months old girl sho died from a severe pneumonia. Initially, the patient presented with fever and cough for 2 days. Physically, the patient appeared lethargic, and breathing sounds revealed diffuse rales and wheezing. Hemogram showed mild leukocytosis and lymphocyte predominant. Chest X ray revealed diffuse interstitial infiltration of the right upper lung, left upper and left lower lung field. Bacteria infection was first impressed. Although treated with several antibiotics (ampicllin, cefuroxime, amikacin, penicillin, cephazolin, imipenem and vancomycin) in three different hospitals, the patient's condition went downhill and the patient died 2 weeks later. Finally, adenoviurs type 3 was isolated from sputum specimen taken before death and necropsy lung tissue. The lung pathology showed diffuse necrotizing inflammation with fibrinopurulent exudate, and eosinophilic intranuclear inclusion bodies were also noted in the alveolar cells. These data proved the diagnosis of adenovirus pneumonia. This case adds to the evidence that adenovirus type 3 infection during childhood may cause fatal disease.