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目的探讨2006年2月4日湖南省邵阳市中心医院报告的1例不明原因肺炎死亡病因。方法访谈病例发病前后相关知情人,了解病例活动情况以及所在地家禽死亡情况,查阅临床病志,对密切接触者进行医学观察,采集病例的鼻咽分泌物、气管吸取物、肺穿刺物、唾液,应用逆转录-聚合酶链反应(RT-PCR)和实时荧光定量PCR法(Real-timePCR)检测A/H5N1亚型特异的核酸片段。结果病例发病前6d有宰杀鸡鸭史,对103例密切接触者经7d的医学观察,没有发热和异常情况,病例主要表现为双肺渗出性病变伴白细胞计数显著下降迅速进展为呼吸循环哀竭,病例气管分泌物、肺穿刺液H5N1禽流感病毒核酸均为阳性,咽拭子、唾液检测阴性。结论该病例是一起“禽-人”感染禽流感病毒致死的病例,正常家禽有可能携带H5N1禽流感病毒,应引起高度重视。
Objective To investigate the cause of death of pneumonia of unknown cause reported by Shaoyang Central Hospital on February 4, 2006. Methods Interview the relevant insiders before and after the onset of the disease to understand the case activity and the death of the poultry in the area. The clinical pathology was reviewed and the close contacts were observed. The nasopharyngeal secretions, tracheal aspirates, lung puncture, saliva, A / H5N1 subtype-specific nucleic acid fragments were detected by reverse transcription-polymerase chain reaction (RT-PCR) and real-time PCR. Results The cases of slaughtered chickens and ducks were observed 6 days before the onset of disease. There were no fever and abnormalities in 103 close contacts after 7 days of medical observation. The cases mainly manifested the rapid decline of leukocytopenia and leukocyte count in patients with respiratory complications Exhaustion, cases of tracheal secretions, lung puncture fluid H5N1 bird flu virus nucleic acid are positive, throat swab, saliva test negative. Conclusions This case is a lethal case of bird-human infection with the avian influenza virus. The normal poultry may carry the H5N1 bird flu virus, which deserves great attention.