STUDIES ON INFLUENZA IN THE PANDEMIC OF 1957-1958 .2. PULMONARY COMPLICATIONS OF INFLUENZA
STUDIES ON INFLUENZA IN THE PANDEMIC OF 1957-1958 .2. PULMONARY COMPLICATIONS OF INFLUENZA
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DOI：
10.1172/jci103789
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发表时间：
1959-01-01
影响因子：
15.9
通讯作者：
ROGERS, DE
中科院分区：
文献类型：
--
作者：
LOURIA, DB;BLUMENFELD, HL;ROGERS, DE
本文报告了1957-1958年流感大流行期间因肺部并发症入院的33例病人的详尽研究。发现了四种不同的临床和实验室综合征（1）患者出现短暂的肺部体征，没有肺炎的X线证据。这些患者没有细菌感染，仅通过对症治疗即可迅速恢复。(2)在流感后期出现继发性细菌性肺炎的患者。这些肺炎主要由肺炎球菌引起;感染过程和对治疗的反应与无流感的单纯细菌性肺炎没有实质性差异。(3)有实验室和临床证据表明流感病毒和细菌合并感染的患者。在这些患者中，感染严重。尽管进行了充分的抗菌治疗，但仍有3例患者在急性期死亡，其中1例为肺炎球菌感染，2例为葡萄球菌感染。从所有3人的肺部分离出与细菌相关的流感病毒。(4)研究中有6名患者发生暴发性、弥漫性、出血性肺炎，其中5人死亡。除流感病毒外，没有其他病原体与这种无菌综合征有关。病程以极度呼吸困难、发绀、缺氧及对抗菌药物无效为特征。从肺中分离到高滴度的流感病毒。强调了慢性基础疾病在流感严重肺部并发症中的重要性。30例经X线确诊的肺炎患者中有21例有既往疾病或妊娠史。这21人中有14人有潜在的心脏病，其中10人是风湿性心脏病。这篇文章以及对最近和早期文献的回顾支持以下观点：（a）在没有其他微生物病原体的情况下，流感病毒感染本身可能诱发肺炎;（B）基础疾病，尤其是风湿性心脏病，可能在流感病毒肺炎的发生中起重要作用。
Exhaustive studies on 33 patients admitted with the pulmonary complications of influenza during the pandemic of 1957-1958 are reported. Four distinct clinical and laboratory syndromes were recognized (1) Patients with transient pulmonary signs without roentgenographic evidence of pneumonia. These patients did not have bacterial infection and recovery was prompt on symptomatic treatment alone. (2) Patients with secondary bacterial pneumonia arising late in the course of influenza. These pneumonias were predominantly produced by pneumococci; the course of the infection and response to therapy did not differ materially from that of uncomplicated bacterial pneumonia in the absence of influenza. (3) Patients with laboratory and clinical evidence of combined influenza virus and bacterial infection. In these patients the infection was severe. Despite adequate antibacterial therapy, 3 patients died during their acute illness, one with pneumococcal and 2 with staphylococcal infections. Influenza virus was isolated from the lungs of all 3 in association with bacteria. (4) Six patients studied developed a fulminating, diffuse, hemorrhagic pneumonia which led to death in 5. No pathogen other than the influenza virus could be related to this abacterial syndrome. The course was characterized by extreme dyspnea, cyanosis, hypoxia, and failure to respond to antibacterial drugs. Influenza virus was isolated in high titer from lungs. The importance of chronic underlying disease in the serious pulmonary complications of influenza was stressed. Twenty-one of 30 patients with roentgenographically confirmed pneumonia had pre-existing illness or pregnancy. Fourteen of these 21 had underlying cardiac disease which was of rheumatic origin in 10. This article and a review of recent and earlier literature supports the belief that: (a) influenza virus infection per se may induce pneumonia in the absence of other microbial pathogens; (b) underlying disease, and most particularly rheumatic heart disease, may be important in the genesis of influenza virus pneumonia.