Triple Viral Respiratory Co-Infection With Respiratory Syncytial Virus (RSV), Human Metapneumovirus (HMPV), and Influenza A (H1N1) Leading to Acute Respiratory Distress Syndrome (ARDS) in an Infant: A Case Report.
病毒性呼吸道感染是儿科致病和致死的主要原因。我们报告一例既往健康的九月龄婴儿发生呼吸道合胞病毒（RSV）、人偏肺病毒（HMPV）和甲型流感（H1N1）三重感染的罕见病例，并并发急性呼吸窘迫综合征（ARDS）。患者表现为严重呼吸窘迫、炎症标志物升高及双肺肺泡浸润，需无创通气支持。使用BioFire®呼吸道检测面板2.1 plus（RP2.1plus；bioMérieux，Marcy-l'Étoile，法国）进行床旁多重PCR检测，检出全部三种病毒。采用Xpert® Xpress Flu/RSV四重PCR（Cepheid，Sunnyvale，CA）进行确认检测，显示RSV和H1N1的循环阈值（Ct）较低。尽管给予抗病毒治疗，患者病情仍恶化，需要有创机械通气60天。本病例凸显了三重呼吸道病毒混合感染的罕见性及诊断复杂性，并强调了多重PCR在快速病原体检测中的作用。Ct值的解读可提供额外的诊断信息，但应结合临床背景加以考虑。
Viral respiratory infections are a major cause of morbidity in pediatrics. We report a rare case of triple infection with respiratory syncytial virus (RSV), human metapneumovirus (HMPV), and influenza A (H1N1) in a previously healthy nine-month-old infant, complicated by acute respiratory distress syndrome (ARDS). The patient presented with severe respiratory distress, elevated inflammatory markers, and bilateral alveolar infiltrates, requiring non-invasive ventilation. A point-of-care multiplex PCR using the BioFire® Respiratory Panel 2.1 plus (RP2.1plus; bioMérieux, Marcy-l'Étoile, France) detected all three viruses. Confirmatory testing with the Xpert® Xpress Flu/RSV quadriplex PCR (Cepheid, Sunnyvale, CA) showed low cycle threshold (Ct) values for RSV and H1N1. Despite antiviral treatment, the patient's condition worsened, requiring invasive mechanical ventilation for 60 days. This case highlights the rarity and diagnostic complexity of triple respiratory viral co-infection and underscores the role of multiplex PCR in rapid pathogen detection. The interpretation of Ct values may provide additional diagnostic information but should be considered within the clinical context.
Mohammed Hatimi, Nora Touyar, Ghizlane El Amin, Amal Zouaki, Soukayna Jebbar, Saad Elharrak, et al. Triple Viral Respiratory Co-Infection With Respiratory Syncytial Virus (RSV), Human Metapneumovirus (HMPV), and Influenza A (H1N1) Leading to Acute Respiratory Distress Syndrome (ARDS) in an Infant: A Case Report.. Cureus. 2026; doi:10.7759/cureus.108099.
Mohammed Hatimi, Nora Touyar, Ghizlane El Amin, Amal Zouaki, Soukayna Jebbar, Saad Elharrak, et al (2026). Triple Viral Respiratory Co-Infection With Respiratory Syncytial Virus (RSV), Human Metapneumovirus (HMPV), and Influenza A (H1N1) Leading to Acute Respiratory Distress Syndrome (ARDS) in an Infant: A Case Report.. Cureus. https://doi.org/10.7759/cureus.108099
Mohammed Hatimi, Nora Touyar, Ghizlane El Amin, Amal Zouaki, Soukayna Jebbar, Saad Elharrak, et al. Triple Viral Respiratory Co-Infection With Respiratory Syncytial Virus (RSV), Human Metapneumovirus (HMPV), and Influenza A (H1N1) Leading to Acute Respiratory Distress Syndrome (ARDS) in an Infant: A Case Report.[J]. Cureus, 2026 doi:10.7759/cureus.108099.
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