肺炎链球菌临床感染疾病谱

The clinical spectrum of Streptococcus pneumoniae infections

肺炎链球菌是威胁人类健康的重要病原菌。全年龄段人群都可能感染该菌,尤其是5岁以下儿童和65岁以上老年人,以及存在基础疾病者。临床感染类型包括中耳炎等非侵袭性感染和菌血症等侵袭性肺炎链球菌感染(IPD)。除了常见的菌血症性肺炎、脓胸和化脓性脑膜炎以外,肺炎链球菌还可以引起很多其他类型IPD感染,曾有学者总结肺炎链球菌引起的少见侵袭性感染的病例报告,结果发现2 064个病例,分别属于95种临床类型。近年来文献又报道了一些新的表现类型或以前未曾报告的基础疾病。肺炎链球菌可侵犯全身各个系统的组织器官,临床感染类型多样,且不同的感染类型可能同时或先后发生。文献报道的多数少见IPD类型都未查及国内病例报告,提示国内临床实践中对病原学检测重视不足,或对肺炎链球菌临床感染类型可能囿于已经明确的诊断,忽视了同时存在的其他感染,也可能对肺炎链球菌能否引起相应感染还缺乏认识。本文就文献报道的肺炎链球菌临床感染类型进行了全面总结,尤其是IPD病例报告,重点介绍了近年来国外报告较多的眼内炎、泪囊脓肿、心包炎、溶血尿毒综合征、急性坏死性筋膜炎、奥地利综合征与噬血细胞综合征等疾病。以期临床能够重视肺炎链球菌感染,尤其是IPD的诊断和治疗,开展相关研究,将来为我国肺炎链球菌感染的防治提供系统全面的证据。

Streptococcus pneumoniae is an important pathogen that threats human health. People of all ages could be infec- ted by the bacterium, especially the children under 5 years old and the olds over 65 years old, as well as those with the underlying disease. It causes non-invasive infection such as otitis media. Furthermore, it causes invasive pneumococcal diseases （IPD） , such as bacteremia. Streptococcus pneumoniae, a common etiologic agent of pneumonia with bacteremia, pyothorax and meningitis, is also responsible for a remarkable array of unusual and uncommon clinical manifestations. The researchers had reviewed 95 different types of unusual pneumococcal infections representing 2 064 cases. In recent years, some new forms of performance or underlying diseases are reported in the literature. Streptococcus pneumoniae can invade all the tissues and organs, and there are various types of clinical infection. The different types of infection may oc- cur at the same time or in sequence. Most of the rare IPD types reported in the literature were not examined and reported in domestic cases. These suggested that there has been insufficient attention given to etiology detection in domestic clini- cal practice, or the clinical type of streptococcus pneumoniae infection may be confined to the definite diagnosis, ignoring other types that exist at the same time. Maybe, there is also lack of knowledge about whether streptococcus pneumoniae could cause the corresponding infection or not. In this paper, we summarized the clinical infection types of streptococcus pneumoniae in the literature, especially the IPD case report including endophthalmitis, lacrimal abscess, pericarditis, he- molytic-uremic syndrome, acute necrotizing fasciitis. Austrian syndrome and hemophagocytic syndrome. It is hoped that clinicians pay close attention to streptococcus pneumoniae infection, especially the diagnosis and treatment of IPD, and the relevant research will be carried out. This could provide systematic and comprehensive evidence for the prevention and treatment of streptococcus pneumoniae infection in our country in the future.