豕链球菌所致感染性心内膜炎一例

A Case of Infective Endocarditis Caused by Streptococcus suis

摘要: 目的：探讨豕链球菌(Streptococcus suis)所致感染性心内膜炎的临床特点、诊断过程及治疗策略，提高对该罕见病原引起心内膜炎的识别与处理能力。方法：对我院收治的1例经血培养确诊为豕链球菌感染性心内膜炎患者的临床资料进行回顾性分析，重点总结其临床表现、辅助检查、治疗过程及预后。结果：患者男性，56岁，职业为厨师，因突发呼吸困难2小时入院。入院后检查提示左侧枕叶脑梗死、双肺渗出、二尖瓣赘生物形成及重度返流。两次血培养均检出豕链球菌，对青霉素中介但对万古霉素敏感。初始青霉素及万古霉素治疗效果欠佳，后改用哌拉西林他唑巴坦联合万古霉素后病情好转。因赘生物脱落风险高，进一步行二尖瓣机械瓣置换及三尖瓣成形术，术后恢复良好。随访一年，患者心功能稳定，生活自理。结论：豕链球菌感染性心内膜炎起病急、进展快，易并发多器官损害。早期识别病原、合理选择抗菌药物及把握外科干预时机对改善预后至关重要。

Abstract: Objective: To investigate the clinical characteristics, diagnostic process, and treatment strategies for infective endocarditis (IE) caused by Streptococcus suis, aiming to enhance the recognition and management of this rare pathogen causing endocarditis. Methods: A retrospective analysis was conducted on the clinical data of one patient with Streptococcus suis IE confirmed by blood culture in our hospital. The focus was on summarizing the clinical manifestations, auxiliary examinations, treatment process, and prognosis. Results: The patient was a 56-year-old male, working as a chef, who was admitted due to acute dyspnea for 2 hours. Examinations upon admission indicated left occipital lobe cerebral infarction, bilateral pulmonary infiltrates, and mitral valve vegetation with severe regurgitation. Streptococcus suis was isolated in two separate blood cultures, showing intermediate susceptibility to penicillin but susceptibility to vancomycin. Initial treatment with penicillin and vancomycin was suboptimal. The patient’s condition improved after switching to piperacillin-tazobactam combined with vancomycin. Due to the high risk of vegetation embolization, the patient subsequently underwent mechanical mitral valve replacement and tricuspid valve annuloplasty. Postoperative recovery was favorable. At one-year follow-up, the patient’s cardiac function remained stable, and he was capable of self-care. Conclusion: Streptococcus suis infective endocarditis presents with an acute onset and rapid progression, often complicated by multi-organ damage. Early pathogen identification, appropriate antimicrobial selection, and timely surgical intervention are crucial for improving prognosis.