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Views: 0 Author: Diffei Medical Publish Time: 2023-08-21 Origin: 迪飞医学
Hemophagocytic syndrome, also known as hemophagocytic lymphohistiocytosis (HLH).This disease is mainly caused by ineffective immunity leading to the activation of a large number of immune cells and the secretion of large amounts of cytokines, thereby causing progressive immune damage to the body.Usually, patients will have serious problems such as persistent fever, decreased blood count, hepatosplenomegaly, abnormal coagulation, and abnormal function of multiple organs. It is considered a critical disease with sudden onset, severe illness, rapid progression, and extremely high mortality rate. symptoms.
recently,The team of Deputy Director Bao Yongjian of the Respiratory Medicine Department of Guangxi Jiangbin Hospital (Third People's Hospital of the Autonomous Region) cooperates with Difei Medical, mNGS testing of alveolar lavage fluid was performed on a critically ill patient with repeated high fever. The test results quickly identified Epstein-Barr virus infection and diagnosed hemophagocytic syndrome. After symptomatic treatment, the patient improved and was discharged from the hospital and returned to school 11 days later.The editor has compiled the cases as follows for clinical communication and learning.
Case sharing
1 ► General situation
The patient is a 19-year-old female, a college student, who usually has exercise habits and has always been in good physical condition.
2 ► May 31
In the absence of inducement, repeated high fever occurs, with the body temperature above 39°C.
3 ► From June 4th
He went to several hospitals successively, and chest CT examination showed multiple infection lesions in both lungs, accompanied by hepatosplenomegaly, liver function damage, agranulocytosis, and thrombocytopenia.
4 ► June 8
The condition progressed rapidly, and the damage to multiple organ functions further worsened. The patient developed septic shock and was admitted to the intensive care unit (ICU) of a local hospital.
5 ► June 10
When he was transferred to the Department of Respiratory Medicine of Guangxi Jiangbin Hospital, the patient still had fever, multiple lesions in both lungs, leukopenia, anemia, liver function damage, hepatomegaly, hyperlipidemia and other symptoms.
mNGS examination of alveolar lavage fluid showed: Corynebacterium striatus, Staphylococcus aureus, Enterococcus faecalis, Candida albicans, Epstein-Barr virus, etc.
Hemophagocytic syndrome secondary to Epstein-Barr virus infection was diagnosed.After receiving gamma globulin and methylprednisolone pulse therapy, supplemented by anti-infection, white blood cell raising, liver protection and other treatments, the patient's body temperature returned to normal, and his white blood cells and platelets were normal.The B-ultrasound examination showed no abnormality in the liver and spleen, and the lesions in both lungs on chest CT showed obvious improvement in absorption.
6 ► June 21
The patient was discharged from the hospital and returned to school.
Encyclopedia of Pathogenic Microorganisms
Epstein-Barr virus (EBV), also known as human herpes virus type 4, is a double-stranded DNA virus with latent and transforming characteristics.The symptoms of EB virus infection are similar to those of a cold, and laboratory tests are required for a clear diagnosis.
The source of infection of EB virus is virus carriers and patients. It is mainly transmitted through saliva (oral-oral), droplets, etc., and rarely through blood transfusion.EB virus is highly susceptible, and more than 95% of adults have virus antibodies in their bodies, and infection is most common in young children.Among them, the infection rate among children aged 3 to 5 years old is as high as 90%. Most of them can recover, but a few children will have serious consequences.
The incubation period of EB virus infection is 4 to 7 weeks. Prodromal symptoms include headache, fatigue, etc. 80% of patients may suffer from the clinical triad: pharyngitis, fever and lymphadenopathy.Infection can involve various organs of the body, usually including fever, loss of appetite, nausea, vomiting, diarrhea, generalized lymphadenopathy, hepatosplenomegaly, rash, etc.Some patients may also experience neurological symptoms.EBV infection is self-limiting and generally requires a recovery period of 2 to 4 weeks.
It is generally believed that EB virus is a virus that can induce cancer: infection of B cells can cause infectious mononucleosis and lymphoma; infection of epithelial cells can cause malignant tumors such as nasopharyngeal cancer and gastric cancer.
Once infected with EBV, it is difficult to clear.Vaccines are the most effective way to prevent EB virus infection, but the genetic recombinant vaccine developed in my country is under observation, and there is currently a lack of anti-EB virus infection drugs with confirmed efficacy.
Since EBV is mainly transmitted through saliva, we should develop good personal hygiene habits.To prevent infection in infants and young children, mothers and family members should avoid mouth-to-mouth feeding of their infants.
Conclusion
Identifying the pathogen is the top priority in the treatment of severe infections. mNGS technology has large throughput, wide coverage, and high sensitivity, especially for the detection of special bacterial groups. It can help ICU doctors reduce diagnostic delays and identify the pathogens of severe infections. plays an increasingly important role in medical diagnosis.As a pioneer in promoting mNGS technology for clinical use, Diffei Medical will continue to adhere to high standards and continue to carry out product optimization and product development in order to help more clinical infection patients.
