投稿分類 微生物

主委發表種類: 壁報

投稿標題(中): 一位膀胱癌病人呼吸道持續感染A型流感(H3N2)後發生難治療的侵襲性肺部麴病

投稿標題(英): Refractory Invasive Pulmonary Aspergillosis Following Influenza A (H3N2) Viral Respiratory Tract Infection Persisted in a Patient with Bladder Cancer

投稿摘要: A 71 y/o man of bladder cancer was admitted to the ICU on Mar. 30, 2015 due to dyspnea and fever for 2 days. CXR showed slight infiltrations. White cell count was 8,800/uL. Influenza A antigen and PCR of nasopharyngeal swab showed positive (H3N2). The sputum culture yielded Pseudomonas aeruginosa. Oseltamivir and piperacillin were used. Then ceftazidime plus colistin was used due to carbapenem- resistant Acinetobacter baumanii in sputum culture later. CXR pattern progressed to bilateral consolidations. PCR-FluA remained positive on Apr. 9. A 2nd course of oseltamivir was given. But, cavitary lung lesions occurred. Two sputum cultures on Apr. 13 and 14 and one bronchoalveolar lavage culture on Apr. 16 all yielded Aspergillus species. The blood Aspergillus antigen index was 0.66 (positive). Voriconazole was given for 4 weeks. Cavitary lung lesions deteriorated. PCR-FluA was still positive on May 4. A 3rd course of oseltamivir was given. Pyopneumothorax in left hemithorax developed and chest tube was inserted on May 6. The pleural fluid culture showed no growth. As septic shock persisted, he passed away on May 12. Conclusion: we report a refractory curse of pulmonary aspergillosis after a Flu A infection. Early diagnosis and therapy for aspergillosis are warranted.

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