肺咽峡炎链球菌群感染患者的临床特征

Clinical analysis of chest infections caused by streptococcus anginosus group

目的:总结肺咽峡炎链球菌群致感染患者的临床特征。方法:回顾性分析2014年1月至2019年10月在济宁医学院附属医院26例确诊为咽峡炎链球菌群致肺部感染患者的临床资料,包括一般资料、临床症状、辅助检查、治疗及转归。微生物学标本基于胸穿刺活检、支气管镜、人工气道吸引、胸腔穿刺术或胸腔镜检查时收集的。结果:26例患者中男23例(88.5%),女3例(11.5%),年龄(63.0±12.5)岁,有21例(80.8%)存在潜在疾病。临床主要表现为发热21例(80.8%)、胸痛13例(50.0%)、咳嗽13例(50.0%)、咳痰13例(50.0%)。胸部CT主要表现为结节18例(69.2%)、胸腔积液18例(69.2%)、斑片影17例(65.4%)、实变影12例(46.2%)、空洞4例(15.4%)、气胸3例(11.5%)。微生物培养结果:星座链球菌13例(50.0%)、咽峡炎链球菌12例(46.2%)、中间链球菌1例(3.8%)。患者经过抗感染及有创操作(包括气管镜、胸腔镜、肺穿刺及胸腔穿刺置管引流)治疗,24例(92.3%)预后良好,死亡2例(7.7%)。结论:肺咽峡炎链球菌群感染患者主要见于患有基础疾病的男性患者,临床表现无特异性,CT显示常有以下征象:肺内结节、斑片、实变影及胸腔积液。

Objective To clarify the clinical characteristics of chest infections caused by streptococcus anginosus group(SAG).Methods A total of 26 patients diagnosed in Affiliated Hospital of Jining Medical University from January 2014 to October 2019 were enrolled.The analyzed clinical data included baseline data,clinical symptoms,imaging manifestations,therapies,and outcomes.The microbiological diagnosis was established based on the specimens collected by lung needle biopsy,bronchoscopy,artificial airway aspiration,thoracentesis or thoracoscopy.Results Among the 26 patients,there were 23(88.5%)males and 3(11.5%)females aged(63.0±12.5)years,and 21 cases(80.8%)had potential diseases.The distribution of clinical manifestations included 21 cases(80.8%)with fever,13 cases(50.0%)with pectoralgia,13 cases(50.0%)with cough,and 13 cases(50.0%)with expectoration.Chest CT displayed 18 cases(69.2%)with nodules,18 cases(69.2%)with pleural effusion,17 cases(65.4%)with patchy shadows,12 cases(46.2%)with consolidation,4 cases(15.4%)with cavity,3 cases(11.5%)with spontaneous pneumothorax.13 cases(50.0%)of Streptococcus constellatus,12 cases(46.2%)of Streptococcus anginosus and 1 case(3.8%)of Streptococcus intermadius were observed through the bacterial culture.After anti-infection treatment and invasive operation(including tracheoscopy,thoracoscopy,lung puncture,and thoracic puncture drainage),the prognosis of 24 cases(92.3%)became satisfactory,and 2(7.7%)died.Conclusion Pulmonary infection caused by SAG is mainly seen in male patients with underlying diseases.No specificity is displayed in clinical manifestations.CT manifestations usually show intrapulmonary nodules,patchy shadows,consolidation and pleural effusion.