广西1例儿童危重型甲型H5N6禽流感脑炎救治成功报告

目的 总结南宁市第四人民医院确诊且救治成功1例儿童危重型甲型H5N6禽流感相关性脑炎病例临床特征以及诊疗经验。方法 回顾性分析2021年11月24日南宁市第四人民医院收治的1例儿童危重型甲型H5N6禽流感脑炎病例的临床资料及治疗经过。结果 本案例患儿，男性，3岁11月，因“发热9 d，意识障碍2 d”入院，病初以发热、咳嗽为表现，病后第2天出现呕吐，第3天出现乏力、嗜睡，第5天出现抽搐、意识障碍。经脑脊液、痰液、咽式子病原学检测出甲型流感病毒H5N6，确诊为儿童危重型甲型H5N6禽流感脑炎，积极快速有效抗病毒、抗感染、脱水治疗、镇静、抗癫痫等治疗，治疗后第9天，患儿神志转清，27 d后病情好转，转外院继续行康复治疗，分别于出院后2周、1月随访，患儿恢复良好。结论 临床工作中，如早期与普通呼吸道疾病症状类似，同时合并神经系统受累症状，病情进展迅速，需警惕排查流感。禽流感发病前不一定有明确禽类接触史，禽流感病毒可能存在其他宿主，有待相关研究证实。人感染H5N6禽流感重症率高，死亡率高，病情进展迅速，发病人群主要为成人，儿童病例极少，多数病例以重症肺炎为主，以神经系统受累表现少见；早发现、早...

A case report of critical H5N6 avian influenza encephalitis in a child successfully treated in Guangxi

Objective To summarize the clinical characteristics, diagnosis and treatment experience of a case of critical encephalopathy associated with avian influenza A (H5N6) in children diagnosed and successfully treated in our hospital. Methods The clinical data and treatment of a child critically infected with avian influenza A (H5N6) encephalitis admitted to the Fourth People's Hospital of Nanning city on November 24, 2021 were analyzed, and the clinical characteristics and treatment plan of the child infected with avian influenza A (H5N6) were analyzed. Results In this case, the child, a little 3 years and 11 months old boy, was admitted to hospital because of fever for 9 days and consciousness disturbance for 2 days. The disease was manifested by fever and cough at the beginning, vomiting on the second day, fatigue and lethargy on the third day, and convulsion and consciousness disturbance through cerebrospinal fluid and sputum on the fifth day. Avian influenza A virus H5N6 was detected by pharyngeal etiology, and the patient was diagnosed as a critical avian influenza A H5N6 encephalopathy in children. The patient was treated with active, rapid and effective antiviral, anti-infection, dehydration, sedation, anti-epilepsy and other treatments. On the 9th day after treatment he became conscious and improved 27 days later, and was transferred to another hospital for further rehabilitation treatment. At 2 weeks and 1 month follow-up, the patient recovered well. Conclusions In clinical work, when the symptoms of early respiratory diseases are similar to those of ordinary respiratory diseases, combined with symptoms of nervous system involvement, the disease progresses rapidly, so it is necessary to be vigilant to investigate influenza. Before the onset of avian influenza, there may not be a clear history of avian exposure. Avian influenza virus may have other hosts, which needs to be confirmed by relevant studies. Human infection with H5N6 avian influenza has high severe rate, high mortality and rapid progress. The incidence population is mainly adults, and there are few cases in children. Most cases are mainly severe pneumonia, and the manifestations of nervous system involvement are rare; Early detection and diagnosis of avian influenza and the application of effective and feasible comprehensive treatment are expected to control the disease and improve the prognosis.