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1例热紫链霉菌肺炎诊治过程及文献复习 Δ

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刘 攀 ，戴晓天 ，刘婷婷 ，江 灏 ，梁 岚 （1. 陆军军医大学第一附属医院呼吸与危重症医学科，重庆
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400038；2.陆军军医大学第一附属医院药剂科，重庆 400038）
中图分类号 R563.1 文献标志码 A 文章编号 1001-0408（2025）08-0981-05
DOI 10.6039/j.issn.1001-0408.2025.08.16

摘 要 目的 报道1例热紫链霉菌肺炎的诊治过程，结合链霉菌肺炎文献为该类感染的诊疗提供参考。方法 对陆军军医大学
第一附属医院收治的1例热紫链霉菌肺炎诊治经过进行个案报道，并对链霉菌肺炎相关报道进行文献汇总分析。结果 该例热紫
链霉菌肺炎患者左肺实变、团片影，通过基质辅助激光解吸电离飞行时间质谱鉴定无法确诊，最终经16S rRNA基因扩增测序确定
致病原为热紫链霉菌；予阿莫西林胶囊（1 g，口服，tid）治疗6个月后病灶基本吸收。链霉菌肺炎文献分析显示，纳入13例链霉菌
肺炎患者（含本文患者），年龄18～77岁，男性较多（8例），多患有基础疾病。在临床症状方面，所有入组病例均有咳嗽表现，部分
病例伴有不同程度的呼吸困难；在影像学方面，链霉菌肺炎病灶好发部位无特征性，CT影像多见肺实变、双肺多发结节；全部病例
依据16S rRNA基因扩增确诊；治疗药物包括四环素类、β内酰胺类药物联合酶抑制剂、头孢曲松、氨基糖苷类、大环内酯类及碳青
霉烯类药物等，治疗周期均较长（6个月）；随访提示预后良好，仅有1例患者死亡。结论 链霉菌肺炎首选16S rRNA基因扩增测序分
析进行确诊；治疗药物可选四环素类、β内酰胺类药物联合酶抑制剂、头孢曲松、氨基糖苷类、大环内酯类及碳青霉烯类药物等，需长
期服用，预后良好。
关键词 链霉菌肺炎；热紫链霉菌；16S rRNA；肺部感染

Diagnosis and treatment process of a case of Streptomyces thermoviolaceus pneumonia and literature review
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LIU Pan ，DAI Xiaotian ，LIU Tingting ，JIANG Hao ，LIANG Lan（1. Dept. of Respiratory and Critical Care
Medicine， the First Affiliated Hospital of Army Medical University， Chongqing 400038， China；2. Dept. of
Pharmacy， the First Affiliated Hospital of Army Medical University， Chongqing 400038， China）
ABSTRACT OBJECTIVE To report the diagnosis and treatment process of 1 case of Streptomyces thermoviolaceus pneumonia，
and provide reference for the diagnosis and treatment of this type of infection by combining literature on Streptomyces pneumonia.
METHODS A case study was conducted on a patient with S. thermoviolaceus pneumonia treated at the First Affiliated Hospital of
Army Medical University. Additionally， a systematic literature review of Streptomyces pneumonia cases was performed. RESULTS
The patient with S. thermoviolaceus presented with left lung consolidation and mass-like opacity. Initial diagnosis via matrix-assisted
laser desorption/ionization time-of-flight mass spectrometry failed， but 16S rRNA gene amplification and sequencing confirmed S.
thermoviolaceus as the causative pathogen. Six-month therapy with Amoxicillin capsules （1 g orally， three times daily） resulted in
near-complete lesion resolution. The literature analysis of Streptomyces pneumonia revealed that 13 patients with Streptomyces
pneumonia were included （including the patient reported in the article）， age range of 18-77 years， more males （8 cases）， and
mostly suffering from underlying diseases. In terms of clinical symptoms， all enrolled cases exhibited cough， and some cases were
accompanied by variable dyspnea. Imaging findings included that there was no characteristic predilection site for Streptomyces
pneumonia lesions， and CT images commonly showed lung consolidation and bilateral nodules. Definitive diagnosis relied on 16S
rRNA sequencing. Treatment regimens included tetracyclines， β -lactam drugs combined with enzyme inhibitors， ceftriaxone，
aminoglycosides， macrolides， or carbapenems， administered for prolonged duration （6 months）. Follow-up indicated a good
prognosis， and only one mortality occurred. CONCLUSIONS 16S rRNA gene sequencing should be prioritized for diagnosing S.
pneumonia. Effective antimicrobial options include tetracyclines，
Δ 基金项目 重 庆 市 卫 生 健 康 委 医 学 科 研 项 目（No. 2023- β-lactam drugs combined with enzyme inhibitors， ceftriaxone，
WSJK055） aminoglycosides， macrolides， and carbapenems. Prolonged
＊第一作者 主治医师，硕士。研究方向：肺部感染、肺癌及呼吸介
therapy correlates with favorable prognosis.
入的诊治。E-mail：liupan@tmmu.edu.cn
# 通信作者 副主任医师，硕士。研究方向：肺部感染、肺癌及呼吸 KEYWORDS Streptomyces pneumonia； Streptomyces
介入的诊治。E-mail：15923195527@sina.cn thermoviolaceus； 16s rRNA； pulmonary infection

中国药房 2025年第36卷第8期 China Pharmacy 2025 Vol. 36 No. 8 · 981 ·