Department of Respiratory and Critical Care Medicine,Bishan Hospital of Chongqing Medical University, Bishan Hospital of Chongqing, Chongqing, China.
BMC Infect Dis. 2024 Nov 4;24(1):1238. doi: 10.1186/s12879-024-10138-0.
Streptococcus salivarius is an opportunistic pathogen, and there have been no reported cases of Streptococcus salivarius pneumonia to date. Pneumomediastinum is usually secondary to tracheal or esophageal injury and is very rare as a complication of pneumonia. We report a case of Streptococcus salivarius pneumonia complicated by pneumomediastinum, aiming to enhance clinicians' awareness of rare pathogens and uncommon complications in pneumonia.
The patient, a 36-year-old male, presented with a persistent cough and sputum production for one week, accompanied by a sore throat that had developed just one day prior. Chest computed tomography (CT) disclosed pneumomediastinum alongside obstructive atelectasis in the left lower lobe. Streptococcus salivarius infection was conclusively identified through bronchoalveolar lavage metagenomic next-generation sequencing (mNGS), as well as smear and culture analyses. The patient was administered intravenous amoxicillin-clavulanate potassium for a duration of seven days as part of the anti-infection regimen. Given the stability of the patient's respiratory and circulatory systems, a tube drainage procedure was deemed unnecessary. Post-treatment, the patient's clinical symptoms notably improved. A subsequent chest CT scan revealed the re-expansion of the left lower lung and near-complete resolution of pneumomediastinum.
There are numerous pathogens that can cause pneumonia. While focusing on common pathogens, it is important not to overlook rare ones. When considering infections from rare pathogens, it is recommended to promptly perform a bronchoscopy and submit bronchoalveolar lavage fluid for mNGS to improve pathogen detection rates. During the diagnosis and treatment of pneumonia, it is crucial to be vigilant for rare complications. When a patient presents with symptoms such as dyspnea or subcutaneous emphysema, it is advisable to immediately perform a chest CT scan to rule out pneumomediastinum.
唾液链球菌是一种机会致病菌，目前尚无唾液链球菌肺炎的报道。纵隔气肿通常继发于气管或食管损伤，作为肺炎的并发症非常罕见。我们报告了一例唾液链球菌肺炎并发纵隔气肿的病例，旨在提高临床医生对肺炎中罕见病原体和罕见并发症的认识。
患者为 36 岁男性，因持续咳嗽、咳痰 1 周，伴咽痛 1 天就诊。胸部 CT 显示纵隔气肿伴左下肺阻塞性肺不张。通过支气管肺泡灌洗宏基因组下一代测序（mNGS）、涂片和培养分析，明确诊断为唾液链球菌感染。患者接受了为期 7 天的静脉用阿莫西林克拉维酸钾抗感染治疗。鉴于患者呼吸和循环系统稳定，无需进行引流管放置。治疗后，患者的临床症状明显改善。随后的胸部 CT 扫描显示左下肺复张，纵隔气肿几乎完全吸收。
有许多病原体可引起肺炎。在关注常见病原体的同时，也不应忽视罕见病原体。当考虑罕见病原体感染时，建议及时进行支气管镜检查，并提交支气管肺泡灌洗液进行 mNGS，以提高病原体检测率。在肺炎的诊断和治疗过程中，需警惕罕见并发症的发生。当患者出现呼吸困难或皮下气肿等症状时，应立即进行胸部 CT 扫描，以排除纵隔气肿。
