"A 16-year-old girl was hospitalized with a fever for a week, and when the nail flu was positive, chest CT showed multiple large high-density shadows in both lungs, bronchoscopy showed that the surface of the bronchial mucosa was covered with a large gray-white membrane, and sputum cultures repeatedly suggested the growth of Aspergillus and Mucormyces. This patient was found to have diabetes for 3 years, his blood sugar was not controlled, and he had shock, respiratory failure, heart failure when he came to the hospital, and after ECMO**, as well as active antifungal antiviral, anti-infective, anti-shock, etc., the patient did not show any improvement, and unfortunately passed away 3 days after being admitted to the hospital", Wen Shenglan, director of the Department of Respiratory and Critical Care Medicine of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, mentioned that he regretted the recent cases he had encountered. At the same time, Director Wen also analyzed the "two misunderstandings" that led to this tragedy.
Director Wen pointed out that the biggest mistake this girl made was that she did not seek medical attention in time, and she was hospitalized for a week with a fever, missing the best time for treatment. Influenza antiviral drugs are most effective when taken within 48 hours of the onset of symptoms, and Director Wen reminded patients with underlying diseases that if they have symptoms such as high fever, headache, muscle aches, etc., and have a history of contact with influenza patients, they should go to a medical institution in time to test for influenza antigens, and if influenza is diagnosed, they should immediately fight against influenza virus**.
If the patient does not have the antigen checked in time, has persistent high fever for 3 days without relief, and has respiratory symptoms such as shortness of breath, cough, chest tightness, chest pain, etc., especially accompanied by dyspnea and fatigue at rest, it is considered that the patient has developed severe influenza and needs to seek medical attention immediately**.
Director Wen told us that after the influenza virus infects the human body, it destroys the natural immune barrier of the respiratory mucosa, weakens the physical clearance of cilia to fungi, and makes cellular immune dysfunction, resulting in a decrease in lymphocyte levels. Immunocompromised people are more likely to have mixed fungal infections, leading to multiple organ dysfunction and various complications.
The girl had already developed diabetic ketoacidosis when she was admitted to the hospital, indicating that the girl's diabetes was not effectively controlled and her blood sugar may have been at a high level. The immune system function of uncontrolled diabetic patients is impaired, high sugar increases plasma permeability, and has a significant inhibitory effect on the function of immune cells, while the high sugar environment provides a lot of energy for the growth of fungi, when diabetes occurs ketoacidosis, the body will contain a large amount of iron ions, and the growth of mucormyces needs iron ions, so diabetic patients are more susceptible to mucormyces.
Therefore, diabetic patients are more likely to have severe influenza disease after being infected with influenza A, causing systemic inflammatory reactions, and hyperglycemia will also increase the chance of influenza virus replication in the body, causing serious complications.
We also noticed that sputum cultures in girls repeatedly suggested the growth of Aspergillus and Mucormycetes, and that fungal infections made the patient's condition more out of controlDirector Wen told us that due to the impaired immune system of the body or the destruction of the local mucosal barrier of the respiratory tract, Aspergillus and Mucormyces are easy to invade the respiratory tract and cause serious infections, and they need to be treated with antifungal treatment in time.
Director Wen reminded everyone that Aspergillus and Mucormyces infections secondary to influenza rarely occur in the general population, but for the elderly, people with underlying diseases (such as diabetes, tumors, chronic obstructive pulmonary disease, long-term use of glucocorticoids or immunosuppressants, etc.) and other patients with impaired immune system function, influenza combined with Aspergillus and Mucormyces infection may be life-threatening.