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1例热紫链霉菌肺炎诊治过程及文献复习
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| 篇名： | 1例热紫链霉菌肺炎诊治过程及文献复习 |
| TITLE： | Diagnosis and treatment process of a case of Streptomyces thermoviolaceus pneumonia and literature review |
| 摘要： | 目的 报道1例热紫链霉菌肺炎的诊治过程，结合链霉菌肺炎文献为该类感染的诊疗提供参考。方法对陆军军医大学第一附属医院收治的1例热紫链霉菌肺炎诊治经过进行个案报道，并对链霉菌肺炎相关报道进行文献汇总分析。结果该例热紫链霉菌肺炎患者左肺实变、团片影，通过基质辅助激光解吸电离飞行时间质谱鉴定无法确诊，最终经16SrRNA基因扩增测序确定致病原为热紫链霉菌；予阿莫西林胶囊（1g，口服，tid）治疗6个月后病灶基本吸收。链霉菌肺炎文献分析显示，纳入13例链霉菌肺炎患者（含本文患者），年龄18～77岁，男性较多（8例），多患有基础疾病。在临床症状方面，所有入组病例均有咳嗽表现，部分病例伴有不同程度的呼吸困难；在影像学方面，链霉菌肺炎病灶好发部位无特征性，CT影像多见肺实变、双肺多发结节；全部病例依据16SrRNA基因扩增确诊；治疗药物包括四环素类、β内酰胺类药物联合酶抑制剂、头孢曲松、氨基糖苷类、大环内酯类及碳青霉烯类药物等，治疗周期均较长（6个月）；随访提示预后良好，仅有1例患者死亡。结论链霉菌肺炎首选16SrRNA基因扩增测序分析进行确诊；治疗药物可选四环素类、β内酰胺类药物联合酶抑制剂、头孢曲松、氨基糖苷类、大环内酯类及碳青霉烯类药物等，需长期服用，预后良好。 |
| ABSTRACT： | OBJECTIVE To report the diagnosis and treatment process of 1 case of Streptomyces thermoviolaceus pneumonia， and provide reference for the diagnosis and treatment of this type of infection by combining literature on Streptomyces pneumonia. METHODS A case study was conducted on a patient with S. thermoviolaceus pneumonia treated at the First Affiliated Hospital of Army Medical University. Additionally， a systematic literature review of Streptomyces pneumonia cases was performed. RESULTS The patient with S. thermoviolaceus presented with left lung consolidation and mass-like opacity. Initial diagnosis via matrix-assisted laser desorption/ionization time-of-flight mass spectrometry failed， but 16S rRNA gene amplification and sequencing confirmed S. thermoviolaceus as the causative pathogen. Six-month therapy with Amoxicillin capsules （1 g orally， three times daily） resulted in near-complete lesion resolution. The literature analysis of Streptomyces pneumonia revealed that 13 patients with Streptomyces pneumonia were included （including the patient reported in the article）， age range of 18-77 years， more males （8 cases）， and mostly suffering from underlying diseases. In terms of clinical symptoms， all enrolled cases exhibited cough， and some cases were accompanied by variable dyspnea. Imaging findings included that there was no characteristic predilection site for Streptomyces pneumonia lesions， and CT images commonly showed lung consolidation and bilateral nodules. Definitive diagnosis relied on 16S rRNA sequencing. Treatment regimens included tetracyclines， β -lactam drugs combined with enzyme inhibitors， ceftriaxone， aminoglycosides， macrolides， or carbapenems， administered for prolonged duration （6 months）. Follow-up indicated a good prognosis， and only one mortality occurred. CONCLUSIONS 16S rRNA gene sequencing should be prioritized for diagnosing S. pneumonia. Effective antimicrobial options include tetracyclines，β-lactam drugs combined with enzyme inhibitors， ceftriaxone， aminoglycosides， macrolides， and carbapenems. Prolonged therapy correlates with favorable prognosis. |
| 期刊： | 2025年第36卷第08期 |
| 作者： | 刘攀；戴晓天；刘婷婷；江灏；梁岚 |
| AUTHORS： | LIU Pan，DAI Xiaotian，LIU Tingting，JIANG Hao，LIANG Lan |
| 关键字： | 链霉菌肺炎；热紫链霉菌；16S rRNA；肺部感染 |
| KEYWORDS： | Streptomyces pneumonia； Streptomyces |
| 阅读数： | 3 次 |
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