背景:脓毒症是由儿童严重感染引起的全身性炎症反应综合征,但是新生儿中很少报道与人副流感病毒(HPIV)相关的败血症病例。
方法:我们报告了一例因血尿在北京儿童医院新生儿重症监护病房住院的HPIV-3阳性足月新生儿,阴郁的精神,6小时不活动和食欲不振。他到达急症室时出现感染性休克,需要立即插管和机械通气。开始静脉注射抗生素。他对包括液体复苏和血管加压药支持在内的所有抗休克治疗都有完全负面的反应,14小时后死亡。鼻咽抽吸物和血液标本的病毒核酸检测和宏基因组下一代测序(mNGS)分析证实了HPIV-3感染,细菌培养结果为阴性。在该患者中检测到的HPIV-3菌株被亚型为HPIVC3a,在HN蛋白区域发现了两个未报告的氨基酸突变。
结论:患者患有与HPIV-3相关的严重感染,HPIV-3是脓毒症和脓毒性休克的原因。本研究显示了mNGS在病因诊断中的诊断价值。尤其是严重的新生儿病例。
Sepsis is a systemic inflammatory response syndrome caused by severe infection in children, but cases of sepsis associated with human parainfluenza virus (HPIV) have been rarely reported in newborns.
We report a
case of HPIV-3 positive full-term newborn admitted to the Neonatal Intensive Care Unit of Beijing Children\'s Hospital due to hematuria, gloomy spirit, inactivity and loss of appetite for 6 h. He had septic shock when he arrived the Accident & Emergency Department requiring immediate intubation and mechanical ventilation. Intravenous antibiotics were started. He had completely negative response to all anti-shock treatments including fluid resuscitation and vasopressor supports, and died 14 h later. Viral nucleic acid detection and metagenomic next-generation sequencing (mNGS) analyses of nasopharyngeal aspirate and blood specimens verified an HPIV-3 infection, with negative bacterial culture results. The HPIV-3 strain detected in this patient was subtyped as HPIV C3a, and two unreported amino acid mutations were found in the HN protein region.
The patient had a severe infection associated with HPIV-3, which was the cause of sepsis and septic shock. This study showed the diagnostic value of mNGS in etiological diagnosis, especially in severe neonatal
case.