Fulminating Pneumococcal Pneumonia with Acute Respiratory Distress Syndrome in a Healthy Young Patient Following Pandemic (H1N1) 2009 Influenza

在2009新型流感感染期間併發續發性的細菌性肺炎是一個導致新型流感死亡的重要原因。在此我們報告一位23歲的健康軍人，一開始診斷出A型流感的感染，經投予抗病毒藥物治療，三天之後仍併發持續惡化的大葉性肺炎伴隨瀕臨插管的呼吸衰竭，最後經由陽性的2009新型流感聚合連鎖反應分析(PCR)及尿液肺炎球菌抗原篩檢證實為2009新型流感的感染併發續發性的鏈球菌肺炎，之後成功地以氧氣面罩供應氧氣、加上抗病毒藥物合併適當的抗生素治療解決其問題。由此提醒我們，在一個免疫功能健全的病患身上，若證實有A型流感的感染並接受標準的抗病毒藥物治療之後，仍發現呼吸道症狀有持續惡化的情形時，要考慮是否有續發性的細菌感染，因為在感染2009新型流感之後續發快速惡化的社區性肺炎伴隨呼吸窘迫症狀是一個潛在致命的併發症。

關鍵字

2009新型流感；鏈球菌肺炎；呼吸衰竭

並列摘要

Secondary bacterial pneumonia developing after (H1N1) 2009 influenza infection was an important cause of influenza-associated death. We report the case of a 23-year-old previously healthy soldier who was initially diagnosed with influenza A infection. Three days later, the disease progressed, pneumonia developed in the left upper and lower lobes, and respiratory failure was imminent, despite oseltamivir therapy. The diagnosis of secondary pneumococcal pneumonia after 2009 H1N1 infection was made on the basis of positive results for 2009 H1N1 influenza in the real-time reverse-transcriptase polymerase chain reaction performed on a nasal swab, and in the urinary pneumococcal antigen test. The patient was successfully treated using oxygen mask supplementation and antiviral and antibiotic therapies. In immunocompetent patients with confirmed influenza A infection, secondary bacterial infection should be considered when respiratory symptoms progress, even after standard management. The rapid progression of community-acquired pneumonia accompanied with respiratory distress syndrome is a potentially fatal complication occurring secondary to (H1N1) 2009 influenza infection.

並列關鍵字

pandemic H1N1 2009 infection ； pneumococcal pneumonia ； respiratory failure

國際替代計量

Fulminating Pneumococcal Pneumonia with Acute Respiratory Distress Syndrome in a Healthy Young Patient Following Pandemic (H1N1) 2009 Influenza

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