PDF(Pubmed)
Abstract：
OBJECTIVE: Necrotizing tracheobronchitis is a rare clinical entity presented as a necrotic inflammation involving the mainstem trachea and distal bronchi. We reported a case of severe necrotizing tracheobronchitis caused by influenza B and methicillin-resistant Staphylococcus aureus (MRSA) co-infection in an immunocompetent patient.
METHODS: We described a 36-year-old man with initial symptoms of cough, rigors, muscle soreness and fever. His status rapidly deteriorated two days later and he was intubated. Bronchoscopy demonstrated severe necrotizing tracheobronchitis, and CT imaging demonstrated multiple patchy and cavitation formation in both lungs. Next-generation sequencing (NGS) and bronchoalveolar lavage fluid (BALF) culture supported the co-infection of influenza B and MRSA. We also found T lymphocyte and NK lymphocyte functions were extremely suppressed during illness exacerbation. The patient was treated with antivirals and antibiotics including vancomycin. Subsequent bronchoscopy and CT scans revealed significant improvement of the airway and pulmonary lesions, and the lymphocyte functions were restored. Finally, this patient was discharged successfully.
CONCLUSIONS: Necrotizing tracheobronchitis should be suspected in patients with rapid deterioration after influenza B infection. The timely diagnosis of co-infection and accurate antibiotics are important to effective treatment.
METHODS: We described a 36-year-old man with initial symptoms of cough, rigors, muscle soreness and fever. His status rapidly deteriorated two days later and he was intubated. Bronchoscopy demonstrated severe necrotizing tracheobronchitis, and CT imaging demonstrated multiple patchy and cavitation formation in both lungs. Next-generation sequencing (NGS) and bronchoalveolar lavage fluid (BALF) culture supported the co-infection of influenza B and MRSA. We also found T lymphocyte and NK lymphocyte functions were extremely suppressed during illness exacerbation. The patient was treated with antivirals and antibiotics including vancomycin. Subsequent bronchoscopy and CT scans revealed significant improvement of the airway and pulmonary lesions, and the lymphocyte functions were restored. Finally, this patient was discharged successfully.
CONCLUSIONS: Necrotizing tracheobronchitis should be suspected in patients with rapid deterioration after influenza B infection. The timely diagnosis of co-infection and accurate antibiotics are important to effective treatment.
摘要：
目的：坏死性气管支气管炎是一种罕见的临床实体，表现为累及主干气管和远端支气管的坏死性炎症。我们报道了一例由乙型流感和耐甲氧西林金黄色葡萄球菌（MRSA）共同感染引起的严重坏死性气管支气管炎。
方法：我们描述了一名36岁的男性，最初出现咳嗽症状，严格的,肌肉酸痛和发烧。两天后，他的病情迅速恶化，他被插管。支气管镜检查显示严重坏死性气管支气管炎，CT成像显示双肺多发斑片状和空化形成。下一代测序（NGS）和支气管肺泡灌洗液（BALF）培养支持乙型流感和MRSA的共感染。我们还发现，在病情加重期间，T淋巴细胞和NK淋巴细胞功能受到极大抑制。患者接受抗病毒药物和抗生素治疗，包括万古霉素。随后的支气管镜检查和CT扫描显示气道和肺部病变明显改善，淋巴细胞功能恢复。最后,这名患者成功出院。
结论：乙型流感感染后迅速恶化的患者应怀疑坏死性气管支气管炎。合并感染的及时诊断和准确的抗生素对有效治疗至关重要。
方法：我们描述了一名36岁的男性，最初出现咳嗽症状，严格的,肌肉酸痛和发烧。两天后，他的病情迅速恶化，他被插管。支气管镜检查显示严重坏死性气管支气管炎，CT成像显示双肺多发斑片状和空化形成。下一代测序（NGS）和支气管肺泡灌洗液（BALF）培养支持乙型流感和MRSA的共感染。我们还发现，在病情加重期间，T淋巴细胞和NK淋巴细胞功能受到极大抑制。患者接受抗病毒药物和抗生素治疗，包括万古霉素。随后的支气管镜检查和CT扫描显示气道和肺部病变明显改善，淋巴细胞功能恢复。最后,这名患者成功出院。
结论：乙型流感感染后迅速恶化的患者应怀疑坏死性气管支气管炎。合并感染的及时诊断和准确的抗生素对有效治疗至关重要。
