Life-threatening pneumonia caused by human cytomegalovirus and Mycoplasma pneumoniae coinfection in a young, immunocompetent patient
Life-threatening pneumonia caused by human cytomegalovirus and Mycoplasma pneumoniae coinfection in a young, immunocompetent patient
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DOI：
10.1099/jmm.0.017988-0
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发表时间：
2010-08-01
影响因子：
3
通讯作者：
Hamprecht, K.
中科院分区：
文献类型：
--
作者：
Jacobi, C. A.;Riessen, R.;Hamprecht, K.
一名年轻、先前健康且具有免疫能力的患者被转至本院，从其胆汁中取出一条疑似蛔虫。虽然无法确诊为蛔虫感染，但患者患有胆囊炎。令我们惊讶的是，在抗生素治疗下，患者的呼吸状况在24小时内恶化，不得不转到重症监护病房进行机械呼吸。直接从支气管肺泡灌洗(BAL)标本中分离人巨细胞病毒(HCMV)，并在同一BAL标本的增菌培养中用聚合酶链式反应(PCR)检测肺炎支原体DNA。HCMV和肺炎支原体的血清学明显支持这两种病原体的原发/继发感染(IgM检测，IgG滴度增加，对于HCMV，亲和力指数较低，仅为22%)。因此，我们推测罕见的巨细胞病毒和肺炎支原体的混合感染是暴发性肺炎的病原学。在广泛的抗生素和抗病毒治疗下，患者的情况改善非常缓慢。
A young, previously healthy and immunocompetent patient was transferred to our hospital to recover a suspected Ascaris worm from his gall bladder. Although the diagnosis of Ascaris infection could not be confirmed, the patient suffered from cholecystitis. To our surprise, the respiratory situation of the patient deteriorated within 24 h under antibiotic therapy and he had to be transferred to the intensive care unit for mechanical respiration. Human cytomegalovirus (HCMV) was isolated directly from a bronchoalveolar lavage (BAL) sample, and Mycoplasma pneumoniae DNA was detected by PCR in an enrichment culture of the same BAL sample. Serology for HCMV and M. pneumoniae clearly supported a primary/post-primary infection for both agents (IgM detection, increase of IgG titres and, in the case of HCMV, a low avidity index of only 22%). Therefore, we assumed that a rare HCMV and M. pneumoniae coinfection was the aetiology of the fulminant pneumonia. Under broad antibiotic and antiviral treatment, the situation of the patient improved only very slowly.