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目的通过分析北京市首例人禽流感(H5N1)病例的发病确诊过程,探讨人禽流感病例早发现、早报告、早诊断的关键点。方法对该病例的流行病学、临床和实验室资料进行分析。结果患者2008年12月24日发病,先后就诊过3家医院,期间出现重症肺炎且病情逐渐加重。2009年1月4日专家会诊时发现患者发病前有禽类接触史。当晚诊断为“不明原因肺炎”上报。1月5日7:20患者死亡。患者的下呼吸道吸取物H5N1病毒核酸检测阳性,咽拭子检测为阴性。1月6日患者确诊为人禽流感(H5N1)病例。对患者多种标本进行病毒分离,仅从肺穿刺标本中分离出H5N1病毒。结论不明原因肺炎病例监测发现人禽流感病例的灵敏度受到医院诊断报告意识的影响;禽类接触史的及时掌握有助于早期发现人禽流感病例;禽流感病毒检测应尽量采集患者的下呼吸道标本。
Objective To explore the key points of early detection, early report and early diagnosis of human bird flu cases by analyzing the diagnosis of the first case of human bird flu (H5N1) in Beijing. Methods The epidemiological, clinical and laboratory data of this case were analyzed. Results The patient developed on December 24, 2008 and visited three hospitals successively. Severe pneumonia was present and his condition gradually aggravated. January 4, 2009 Expert consultation found that patients before the onset of poultry exposure history. The night was diagnosed as “unexplained pneumonia” reported. Patient died at 7:20 on January 5th. The patient’s H5N1 virus nucleic acid, the lower respiratory tract aspirate, was positive and the throat swab was negative. On January 6, the patient was diagnosed as human bird flu (H5N1). Virus isolation was performed on a wide variety of patients and only H5N1 virus was isolated from lung biopsy specimens. Conclusions The sensitivity of the surveillance of pneumonia cases was found to be influenced by the awareness of the hospital diagnosis report for unknown causes of pneumonia. The timely detection of bird contact history is helpful for the early detection of human bird flu cases. The detection of avian influenza virus should be performed on the lower respiratory tract specimens of patients.