Chen Xu, Wu Ling, Wu Ruoxi, Dong Jiajia
Department of Pulmonology, Shanxi Provincial Hospital of Traditional Chinese Medicine, Taiyuan, Shanxi Province, China.
Department of Respiratory and Critical Care Medicine, The First People's Hospital of Shuangliu District, Chengdu, Sichuan Province, China.
Clin Respir J. 2025 Jul;19(7):e70099. doi: 10.1111/crj.70099.
Lung abscess is a common disease in respiratory medicine, which is a suppurative lesion caused by various pathogens, and microbiological examination is crucial for the treatment of lung abscess. Due to the widespread use of antibiotics, it is difficult to obtain reliable microbiological evidence through routine tests. There are various pathogens present in the oral cavity, and periodontitis is a risk factor for the formation of lung abscess. Enhancing understanding of lung abscesses caused by Porphyromonas gingivalis and the importance of accurately interpreting NGS reports. This article will present a case report of a lung abscess related to oral bacteria (Porphyromonas gingivalis). The patient was initially treated with empirical anti-infective therapy, which was ineffective, and despite multiple sputum cultures and bronchoalveolar lavage fluid analysis using metagenomic next-generation sequencing (mNGS), the pathogen could not be identified clearly. However, based on the significant presence of oral bacteria in the NGS of the bronchoalveolar lavage fluid, which guided the examination to discover periodontitis. Subsequently, a percutaneous lung tissue biopsy was performed for NGS testing, which further suggested Porphyromonas gingivalis as the pathogenic bacterium. This article summarizes the clinical manifestations, imaging findings, and characteristics of the pathogenic microorganisms in this case of lung abscess, reviews relevant literature to enhance the understanding of lung abscess caused by Porphyromonas gingivalis. It also confirms the importance of careful analysis of background bacteria in bronchoalveolar lavage fluid NGS based on objective risk factors, and highlights that combining patient clinical features with multisample NGS examination can promptly clarify the microbiology.
肺脓肿是呼吸医学中的常见疾病，是由多种病原体引起的化脓性病变，微生物学检查对肺脓肿的治疗至关重要。由于抗生素的广泛使用，通过常规检测难以获得可靠的微生物学证据。口腔中存在多种病原体，牙周炎是肺脓肿形成的危险因素。加强对牙龈卟啉单胞菌引起的肺脓肿的认识以及准确解读二代测序（NGS）报告的重要性。本文将呈现一例与口腔细菌（牙龈卟啉单胞菌）相关的肺脓肿病例报告。患者最初接受经验性抗感染治疗，效果不佳，尽管多次进行痰培养以及使用宏基因组二代测序（mNGS）对支气管肺泡灌洗液进行分析，仍无法明确鉴定出病原体。然而，基于支气管肺泡灌洗液NGS中口腔细菌的大量存在，引导检查发现了牙周炎。随后进行经皮肺组织活检以进行NGS检测，进一步提示牙龈卟啉单胞菌为病原菌。本文总结了该例肺脓肿的临床表现、影像学表现及致病微生物特征，回顾相关文献以增进对牙龈卟啉单胞菌所致肺脓肿的认识。同时证实了基于客观危险因素仔细分析支气管肺泡灌洗液NGS中背景细菌的重要性，并强调将患者临床特征与多样本NGS检查相结合可迅速明确微生物学情况。
