人细小病毒B19(B19)可引起急性肝炎,并归因于酒精性肝炎(AH)的高死亡率。B19感染在以前健康的人中通常是自我修复的,但是它可以在一些高危人群中引起致命的影响,并增加其毒力和传染性。播散性B19感染引起的AH患者多器官功能障碍综合征(MODS)尚未报道。这里,我们描述了一例AH伴溶血性贫血(HA)的成人患者的B19病毒血症,导致播散性感染和继发性MODS,以及照顾他的7名护士的自限性B19感染。同时,我们回顾了有关AH和B19感染的文献。
一名43岁的男性AH患者在医管局的陪同下被转往中山大学附属第三医院,广州,中国,2021年3月31日。支持治疗后,他的转氨酶和胆红素水平降低,但他的贫血加重了.他于4月9日接受了血红蛋白(Hb)低于6g/dl的红细胞(RBC)输注。4月13日,他突然发高烧。在经验性抗感染下,他的高烧下降并保持在低烧状态;然而,他的贫血加重了。四月二十五日,他因重症肺炎被转往医疗加护病房(MICU),急性呼吸窘迫综合征(ARDS),急性再生障碍性危机(AAC),和噬血细胞综合征(HPS),随后被证实与B19感染有关。甲基强的松龙之后,静脉注射免疫球蛋白(IVIG),经验性抗感染,和支持性治疗,肺部感染好转,但是造血和肝脏异常加重,并发生全身B19感染。最后,病人出现了难治性心律失常,心力衰竭,并感到震惊,并于2021年5月8日被家人转诊到当地医院。不幸的是,他第二天就死了.他被转移到重症监护病房14天后,在MICU的前两天,有7名护理他的护士出现了自限性感染性红斑(EI)。
B19感染在健康人中是自限性的,具有低毒力和传染性;然而,在患有HA的AH患者中,它可能导致致命的后果和高度传染性。
Human parvovirus B19 (B19) can cause acute hepatitis and is attributed to the high mortality of alcoholic hepatitis (AH). B19 infection is generally self-healing in previously healthy people, but it can cause fatal effects in some high-risk groups and increase its virulence and infectivity. Disseminated B19 infection-induced multiple organ dysfunction syndrome (MODS) in patients with AH has not been reported yet. Here, we described B19 viremia in an adult patient with AH accompanied by hemolytic anemia (HA), leading to disseminated infection and secondary MODS, as well as self-limiting B19 infections in seven nurses caring for him. Meanwhile, we reviewed the literature on AH and B19 infection.
A 43-year-old male patient with AH accompanied by HA was transferred to the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China, on March 31, 2021. After supportive treatment, his transaminase and bilirubin levels were reduced, but his anemia worsened. He received a red blood cell (RBC) infusion on April 9 for hemoglobin (Hb) lower than 6 g/dl. On April 13, he suddenly had a high fever. Under empirical anti-infection, his high fever dropped and maintained at a low fever level; however, his anemia worsened. On April 25, he was transferred to the medical intensive care unit (MICU) due to severe pneumonia, acute respiratory distress syndrome (ARDS), acute aplastic crisis (AAC), and hemophagocytic syndrome (HPS), which were subsequently confirmed to be related to B19 infection. After methylprednisolone, intravenous immunoglobulin (IVIG), empirical anti-infection, and supportive treatment, the lung infection improved, but hematopoietic and liver abnormalities aggravated, and systemic B19 infection occurred. Finally, the patient developed a refractory arrhythmia, heart failure, and shock and was referred to a local hospital by his family on May 8, 2021. Unfortunately, he died the next day. Fourteen days after he was transferred to MICU, seven nurses caring for him in his first two days in the MICU developed self-limiting erythema infectiosum (EI).
B19 infection is self-limiting in healthy people, with low virulence and infectivity; however, in AH patients with HA, it can lead to fatal consequences and high contagion.