诊断学理论与实践

诊断学理论与实践 ›› 2022, Vol. 21 ›› Issue (04): 520-523.doi: 10.16150/j.1671-2870.2022.04.017

• 病例报告 • 上一篇    下一篇

成人继发于化脓性扁桃体炎的血行播散性肺炎1例报道并文献复习

包志瑶1,2, 孟文凯1,3, 沈继敏1,2, 李庆云1,2()   

  1. 1.上海交通大学医学院附属瑞金医院呼吸与危重症医学科,上海 200025
    2.上海交通大学医学院 呼吸病研究所,上海 200025
    3.山西太原市人民医院呼吸与危重症医学科,山西 太原 030001
  • 收稿日期:2022-05-20 出版日期:2022-08-25 发布日期:2022-11-07
  • 通讯作者: 李庆云 E-mail:liqingyun68@hotmail.com

Hematogenous disseminated pneumonia secondary to suppurative tonsillitis in adults: a case report and literature review

BAO Zhiyao1,2, MENG Wenkai1,3, SHEN Jimin1,2, LI Qingyun1,2()   

  1. 1. Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
    2. Institute of Respiratory Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
    3. Department of Respiratory Medicine, Taiyuan People’s Hospital, Shanxi, Taiyuan 030001, China
  • Received:2022-05-20 Online:2022-08-25 Published:2022-11-07
  • Contact: LI Qingyun E-mail:liqingyun68@hotmail.com

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摘要：

化脓性链球菌即A组链球菌（group A Streptococcus,GAS）作为成人社区获得性肺炎的病原体并不常见,临床上易被忽视而漏诊。本文报道1例青年男性因急性化脓性扁桃体炎治疗不规范引发肺炎,病原菌为GAS,伴抗链球菌溶血素O（Antistreptolysin O,ASO）增高,予患者静脉注射万古霉素控制感染后,其ASO抗体滴度仍维持在高水平,遂序贯给予苄星青霉素肌肉注射每月1次,共5个月。之后随访6个月,患者未再有发热咽痛等症状,ASO水平正常,未出现风湿性多脏器损伤。近年,全球GAS感染仍有报道,且可引起一系列并发症,如风湿热、风湿性心脏病等,严重者可导致死亡。GAS感染的早诊、早治至关重要。

关键词: 化脓性链球菌, 社区获得性肺炎, 抗链球菌溶血素O

Abstract:

Streptococcus pyogenes is also called group A streptococcus (GAS), is an uncommon pathogen for community acquired pneumonia(CAP) in adults, which is easily ignored in clinical diagnosis. This paper reports a young man with pneumonia caused by nonstandard treatment of acute suppurative tonsillitis, who accompanied by an increase in antistreptolysin O(ASO) and pathogenic bacteria was identified as GAS. After vancomycin was injected intravenously to control the infection, the ASO antibody titer remained at a high level, so the patient was given intramuscular benzylpenicillin once a month for 5 months. After 6 months of follow-up, the patient had no fever, sore throat or other symptoms, the ASO level decreased to normal, and there was no rheumatic multiple organ injury. In recent years, there are still reports of global GAS infection, and it can cause a series of complications, such as rheumatic heat, rheumatic heart disease, and even death in severe cases. The early diagnosis and treatment of GAS infection is crucial.

Key words: Streptococcus pyogenes, Community acquired pneumonia, Antistreptolysin O

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