Тяжелая вирусная-бактериальная пневмония, осложненная молниеносным легочным кровотечением с летальным исходом

Чижова О.Ю., Руслякова И.А., Бакулин И.Г. и др. Тяжелая вирусная-бактериальная пневмония, осложненная молниеносным легочным кровотечением с летальным исходом. Терапевтический архив. 2020; 92 (11): 57–61.
DOI: 10.26442/00403660.2020.11.000373

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Chizhova O.Y., Ruslyakova I.A., Baculin I.G., et al. Viruso-bacterial pneumonia, complicated by lightness pulmonary bleeding with death. Therapeutic Archive. 2020; 92 (11): 57–61. DOI: 10.26442/00403660.2020.11.000373

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Аннотация

Несмотря на значительные достижения и успехи медицинской науки, заболеваемость гриппом, его осложнения и социально-экономический ущерб не снижаются, оставаясь на высоком уровне. В клинике ФГБОУ ВО «СЗГМУ им. И.И. Мечникова» за период с декабря 2018 по февраль 2019 г. из 89 госпитализированных пациентов с клинико-рентгенологической картиной пневмонии/острого бронхита у 29 (32%) подтверждена вирусная этиология. При этом у 27 (97%) пациентов выявлен грипп А (H1N1), в остальных двух случаях зарегистрирован вирус гриппа А (H3N2). Из 29 пациентов 9 (31%) по тяжести состояния госпитализированы в отделение реанимации и интенсивной терапии. Представлен случай тяжелого течения вирусной пневмонии при гриппе А (H3N2), осложненной молниеносным легочным кровотечением с летальным исходом.

Ключевые слова: вирус гриппа, легочное кровотечение, острый респираторный дистресс-синдром, септический шок, вирусно-бактериальная пневмония.

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Despite the significant achievements and successes of medical science, the incidence of influenza, its complications and socio-economic damage do not decrease, remaining at a high level. In the clinic of Mechnikov North-Western State Medical University from December 2018 to February 2019, from 89 hospitalized patients with pneumonia/acute bronchitis viral etiology was determined in 29 (32%). In 27 (97%) patients it was virus A (H1N1), in 2 cases – A (H3N2). 9 (31%) patients were sever and were hospitalized in intensive care unit. The case of severe viral pneumonia caused by A (H3N2) complicated by fulminant pulmonary hemorrhage with a lethal outcome is presented.

Keywords: influenza virus, pulmonary hemorrhage, acute respiratory distress syndrome, septic shock, viral and bacterial pneumonia.

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1. Almirall J, et al. Epidemiology of community-acquired pneumonia in adults: a population-based study. Eur Respir J. 2000;15(4):757-63. doi: 10.1034/j.1399-3003.2000.15d21.x
2. WHO. Influenza vaccines. WHO position paper. Weekly Epid Rec. 2018;93: 73–96. doi: 10.1016/j.vaccine.2017.02.034
3. Infectious diseases in the Russian Federation in 2018 (In Russ.)
https://www.rospotrebnadzor.ru/activities/statistical-materials/statictic_details.php?ELEMENT_ID=11277 xls
4. Yakovlev AA, et al. Three epidemic seasons of flu 2009–2013. Epidemiologiya i infektsionnye bolezni. 2014;2 (In Russ.)]
5. Polushin YS, Khrapov KN, Maiskaya MY, et al. Viral Pneumonia Influenza A (H1N1) Complicated by Acute Viral Respiratory Distress Syndrome. General Reanimatology. 2010;6(3):15 (In Russ.) doi: 10.15360/1813-9779-2010-3-15
6. Burrell A, Huckson S, Pilcher DV. ICU Admissions for Sepsis or Pneumonia in Australia and New Zealand in 2017. N Engl J Med. 2018;378(22):2138-9. doi: 10.1056/nejmc1717178
7. Shcherba YV, Goncharova IV. Сommunity-acquired pneumonia in respect to the global process of emerging and re-emerging infectious diseases: novel etiological, epidemiological and clinical features, acquisition of a systemic infectious disease category. Poliklinika. 2011;1:2152 (In Russ.) http://www.infectology.ru/publik/stat49.aspx
8. McCullers JA. Insights into the interaction between influenza virus and pneumococcus. Clin Microbiol Rev. 2006;19(3):571-82. doi: 10.1128/cmr.00058-05
9. Gilbert CR, Vipul K, Baram M. Novel H1N1 influenza A viral infection complicated by alveolar hemorrhage. Respir Care. 2010;55(5):623-5. doi: 10.1164/ajrccm-conference.2010.a018
10. Monto AS. Viral respiratory infections in the community: epidemiology, agents, and interventions. Am J Med. 1995;99(6):24S-7S. doi: 10.1016/s0002-9343(99)80307-6
11. Ramsey C, Kumar A. H1N1: viral pneumonia as a cause of acute respiratory distress syndrome. Curr Opin Crit Care. 2011;17(1):64-71. doi: 10.1097/mcc.0b013e3283427259
12. Vazquez-Grande G, Kumar A. Optimizing antimicrobial therapy of sepsis and septic shock: focus on antibiotic combination therapy. Semin Respir Crit Care Med. 2015;36(1):154-66. doi: 10.1055/s-0034-1398742
13. Yaroshetsky AI, et al. Intensive care of influenza A (H1N1) pdm 2009 with сomplicated course. Anesteziologiya i reanimatologiya. 2017;62(4):315-24 (In Russ.) doi: 10.18821/0201-7563-2017-62-4-315-324
14. To KKW, et al. Delayed clearance of viral load and marked cytokine activation in severe cases of pandemic H1N1 2009 influenza virus infection. Clin Infect Dis. 2010;50(6):850-9. doi: 10.1086/650581
15. Phuc PH, et al. Successful treatment of pneumonia-induced severe ARDS complicated with DIC in two infants using recombinant human thrombomodulin. Integr Mol Med. 2017;4:1-5. doi: 10.15761/imm.1000289
16. Samra T, Pawar M, Yadav A. Comparative evaluation of acute respiratory distress syndrome in patients with and without H1N1 infection at a tertiary care referral center. Indian J Anaesth. 2011;55(1):47. doi: 10.4103/0019-5049.76602
17. Buchner J, et al. Single-center experience with venovenous ECMO for influenza-related ARDS. J Cardiothorac Vasc Anesth. 2018;32(3):1154-9. doi: 10.1053/j.jvca.2017.09.031
18. Steimer DA, et al. Timing of ECMO Initiation Impacts Survival in Influenza-Associated ARDS. Thorac Cardiovasc Surg. 2018. doi: 10.1055/s-0038-1642066
19. Fan E, Brodie D, Slutsky AS. Acute respiratory distress syndrome: advances in diagnosis and treatment. JAMA. 2018;319(7):698-710. doi: 10.1001/jama.2017.21907
20. Murray JF, et al. An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis. 1988;138(3):720-3. doi: 10.1164/ajrccm/138.3.720
21. Charles PGP, et al. SMART-COP: a tool for predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia. Clin Infect Dis. 2008;47(3):375-84. doi: 10.1086/589754
22. Ferreira FL, et al. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA. 2001;286(14):1754-8. doi: 10.1001/jama.286.14.1754

Авторы

О.Ю. Чижова, И.А. Руслякова, И.Г. Бакулин, С.А. Винничук, В.И. Сахаров

ФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава России, Санкт-Петербург, Россия

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O.Y. Chizhova, I.A. Ruslyakova, I.G. Baculin, S.A. Vinnichuk, V.I. Sakharov

Mechnikov North-Western State Medical University, Saint Petersburg, Russia

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