重症A型流感合併C. glabrata與E. faecium雙重菌血症

Severe Influenza A Complicated with Dual Blood Stream Infection of Candida glabrata and Enterococcus faecium

A型流感除了造成呼吸道損傷外，亦會因破壞黏膜屏障與免疫調節失衡，而增加細菌或真菌繼發性感染的風險，尤其在高齡與多重共病者更與高死亡率相關。本病例報告一名87歲女性，具高血壓、椎間盤突出術後及氣喘病史（未規則控制），且未接種流感疫苗。患者因嘔吐、腹痛及A型流感快篩陽性住院。雖接受peramivir治療，仍因病毒清除延遲，於住院第12天惡化為呼吸衰竭需並進行氣管內插管，隨後併敗血性休克與急性腎損傷，接受持續性低效率每日血液透析術（sustained low efficiency daily dialysis，SLEDD）。血液培養先後分離出Candida glabrata與Enterococcus faecium，推測為腸道屏障受損導致的菌群易位。雖依敏感性給予Meropenem、Anidulafungin及Teicoplanin治療，患者最終仍敗血性休克與多重器官衰竭死亡。本案例提醒臨床醫師，當高齡流感患者經抗病毒治療後病情仍持續惡化、發燒或休克時，應提高對侵襲性真菌感染及非典型病原體的警覺，同時亦再次凸顯高危險群接種流感疫苗接種的重要性。

Influenza A virus infection not only injures the respiratory tract but also increases the risk of secondary bacterial or fungal superinfections through mucosal barrier disruption and immune dysregulation, which is associated with high mortality, particularly among elderly patients and those with multiple comorbidities. We report the case of an 87-year-old unvaccinated woman with a history of hypertension, herniated intervertebral disc (status post operation), and uncontrolled asthma, who was admitted for vomiting, abdominal pain, and a positive rapid influenza A test. Despite antiviral treatment with peramivir, delayed viral clearance led to progressive acute respiratory failure requiring endotracheal intubation on hospital day 12. Her course was further complicated by septic shock and acute kidney injury, necessitating sustained low-efficiency daily dialysis (SLEDD). Sequential blood cultures grew Candida glabrata and Enterococcus faecium, suggestive of microbial translocation secondary to intestinal barrier impairment and extensive antibiotic selection pressure. Although meropenem, anidulafungin, and teicoplanin were administered based on drug susceptibility testing, the patient ultimately succumbed to refractory septic shock and multiple organ failure. This case reminds clinicians that when elderly influenza patients experience persistent fever or shock, they should heighten vigilance for invasive fungal infections and atypical pathogens, while underscoring the vital importance of vaccination in high-risk populations.