目的

探讨肺炎链球菌与EB病毒（EBV）共感染儿童坏死性肺炎（NP）病例的临床特征及治疗。

方法

回顾性分析2024年4月15日广州医科大学附属清远医院（清远市人民医院）收治的1例NP患儿的病历资料，并通过检索万方数据库、中国知网和PubMed进行相关文献复习。

结果

患儿，女，2岁，因“咳嗽10余天，反复发热6天，呼吸困难3天”收治入本院。患儿胸部CT显示右肺中叶实变伴多发空洞形成，右侧胸腔积液。对支气管肺泡灌洗液（BALF）进行病原学分析，传统病原学检测方法未检出致病微生物，而靶向高通量测序（tNGS）则检出高序列数的肺炎链球菌、人类γ疱疹病毒4型（为EBV）以及低序列数的流感嗜血杆菌和人类哺乳动物腺病毒C组。治疗措施包括给予患儿抗菌药物、祛痰药、抗凝血药、糖皮质激素和静注人免疫球蛋白等，以及双水平气道正压通气（BiPAP）、可弯曲支气管镜介入治疗等。治疗21天后患儿康复出院。3个月余随访中，患儿状态良好。相关文献显示，引起我国儿童NP的常见病原体包括肺炎支原体、肺炎链球菌、金黄色葡萄球菌、铜绿假单胞菌、流感嗜血杆菌、腺病毒和流感病毒等。国内外医学文献中EBV相关性NP的成人病例已见1例，但儿童病例迄今尚未见报告。

结论

EBV可能参与儿童NP发病，但目前依据尚不充分。基于病原微生物tNGS有助于NP患儿的病原学诊断和抗微生物治疗的精准性，但临床上对其报告应谨慎解读。

Objective

To investigate the clinical characteristics and treatment of a pediatric necrotizing pneumonia （NP） case with coinfection of Streptococcus pneumoniae and Epstein-Barr virus（EBV）.

Methods

A retrospective analysis was conducted on the medical records of a child with NP admitted to The Affiliated Qingyuan Hospital （Qingyuan People's Hospital）， Guangzhou Medical University in April 15th， 2024， and relevant literatures were reviewed by searching Wanfang data， China National Knowledge Infrastructure （CNKI） and PubMed.

Results

The patient was a 2-year-old female， who was admitted to our hospital due to coughing for longer than 10 days， recurrent fever for 6 days and dyspnea for 3 days.The chest CT showed consolidation and multiple cavity formation in the middle lobe of the right lung， accompanied by pleural effusion on the right side.Microbiological analysis was performed on the bronchoalveolar lavage fluid （BALF） sample.Traditional pathogen detection methods detected no pathogenic microorganisms；however， targeted next generation sequencing （tNGS） revealed Streptococcus pneumoniae and human gammaherpesvirus 4 （Epstein-Barr virus， EBV） with high read counts， as well as Haemophilusinfluenzae and Human mastadenovirus C with low read counts.The treatment measures included the use of antibiotics，expectorants， anticoagulants， glucocorticoids， intravenous immunoglobulin and other drugs， as well as bilevel positive airway pressure therapy （BiPAP）， flexible bronchoscopy intervention therapy， etc.After 21 days of treatment， the patient recovered clinically and discharged.During the follow-up of over 3 months，the child remained in good condition.Literatures showed that common pathogens causing NP in children in China include Mycoplasma pneumoniae， Streptococcus pneumoniae， Staphylococcus aureus， Pseudomonas aeruginosa， Haemophilus influenzae， adenovirus and influenza virus， etc.Currently， one adult case of EBVassociated NP has been documented in medical literature， whereas no pediatric case have been reported in either domestic or international studies.

Conclusions

EBV may be involved in the pathogenesis of NP in children， but the evidence is not yet sufficient.The tNGS based on pathogenic microorganisms can help the etiological diagnosis of NP in children and improve the precision of antimicrobial therapy， but need to be carefully interpreted in clinical practice.