Multiple cases of life-threatening adenovirus pneumonia in a mental health care center
Multiple cases of life-threatening adenovirus pneumonia in a mental health care center
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DOI：
10.1164/ajrccm.157.2.9608057
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发表时间：
1998-02-01
影响因子：
24.7
通讯作者：
Matyas, B
中科院分区：
文献类型：
--
作者：
Klinger, JR;Sanchez, MP;Matyas, B
18例肺炎发生在一个慢性精神病护理机构的腺病毒感染爆发期间。受影响最严重的六名患者被送入我们机构的重症监护室（ICU）。其中4名患者发生了感染性休克。我们报告这些患者的临床表现、疾病进展和治疗反应。临床表现为高热、干咳、肺下叶致密浸润。实验室检查异常包括白色血细胞和血小板计数一过性下降，以及转氨酶、乳酸脱氢酶（LDH）和肌酐磷酸激酶（CPK）升高。5名患者因低氧血症接受插管治疗，4名患者出现急性呼吸窘迫综合征（ARDS）和感染性休克（平均心输出量，14.1 +/- 1.3 L/min;心脏指数，6.4 +/- 0.4 L/min/min（2）;全身血管阻力，326 +/- 107 dyne cm/s（2））。除1例慢性肾衰竭患者在入院后2个月死亡外，所有患者均痊愈并出院返回慢性护理机构。从5名患者的呼吸道分泌物中分离出腺病毒（血清型35），另一名患者的抗体滴度增加了6倍。这些患者构成了由腺病毒肺炎引起的ARDS和败血性休克患者的最大系列，并且是免疫功能正常的平民成人中首次爆发的单一来源的多例腺病毒肺炎。
Eighteen cases of pneumonia developed during an outbreak of adenovirus infection in a chronic psychiatric care facility. The six patients most severely affected were admitted to the intensive care unit (ICU) at our institution. Four of these patients developed septic shock. We report the presentation, disease progression, and response to treatment of these patients. Clinical features consisted of high fever, nonproductive cough, and dense lower lobe infiltrates. Laboratory abnormalities included transient fall in white blood cell and platelet counts, and elevations of transaminases, lactate dehydrogenase (LDH), and creatinine phosphokinase (CPK). Five patients were intubated for hypoxemia and four developed the acute respiratory distress syndrome (ARDS) and septic shock (mean cardiac output, 14.1 +/- 1.3 L/min; cardiac index, 6.4 +/- 0.4 L/min/min(2); systemic vascular resistance, 326 +/- 107 dyne cm/s(2)). All patients recovered and were discharged back to the chronic care facility except for one patient with chronic renal failure who died 2 mo after admission. Adenovirus (serotype 35) was isolated from the respiratory secretions of five patients and antibody titers increased 6-fold in the other. These patients constitute the largest series of patients with ARDS and septic shock caused by adenovirus pneumonia and the first outbreak of multiple cases of adenovirus pneumonia in immunocompetent civilian adults occurring from a single source.