提高对口腔厌氧菌致肺脓肿的临床认识，分析齿垢密螺旋体(Treponema denticola, T．denticola)致肺脓肿的发病机制、诊断策略及治疗方法，强调口腔-肺轴感染在呼吸道感染性疾病中的重要性。

收治1例58岁女性，患有2型糖尿病及口腔卫生不良，确诊为齿垢密螺旋体肺脓肿，结合文献复习分析其临床特点。患者以慢性干咳为主要表现，影像学表现为双肺多发实变影。通过支气管镜活检、传统微生物培养及宏基因组二代测序(metagenomic next-generation sequencing, mNGS)进行病原学诊断，治疗上采用哌拉西林他唑巴坦，序贯青霉素G抗感染治疗，辅以口腔局部干预(聚维酮碘含漱)和血糖控制。文献检索涵盖自1986年至2024年相关发病机制、诊断难点及治疗策略，检索数据库包括PubMed和中国知网。

血沉(erythrocyte sedimentation rate, ESR)64.00 mm/1 h、血糖(glucose, GLU)11.10 mmol/L、C反应蛋白(C-reactive protein, CRP)8.3 mg/L，最后经mNGS检测确诊(齿垢密螺旋体序列数9165)，传统培养未检出病原体。予以哌拉西林他唑巴坦治疗10 d后症状改善，随后序贯青霉素G治疗6周，复查CT显示病灶显著吸收。口腔菌群误吸是核心致病机制，糖尿病及免疫低下为高危因素；mNGS可克服传统培养限制，精准识别厌氧菌；β-内酰胺类抗生素联合口腔清洁是有效治疗方案，疗程需4~6周。

齿垢密螺旋体肺脓肿罕见易误诊，多见于口腔卫生不良合并基础疾病者。mNGS技术可显著提升病原体检出率，利于临床有效抗感染治疗。青霉素类药物治疗结合口腔干预及基础疾病管理，是实现治愈的关键，多学科协作模式有助于优化诊疗流程。

This study seks to improve the clinical understanding of lung absceses that originate from the oral cavity. It emphasizes the pathogenesis, diagnostic aproaches, and treatment methods of Treponema denticola (T. denticola)-induced lung absceses. Moreover, the significance of oral-lung axis infection in respiratory infectious diseases is highlighted.

We present a case of T. denticola lung absces in a 58-year-old female patient with type 2 diabetes and por oral hygiene, and analyze its clinical characteristics while reviewing literature. The patient had chronic dry cough as the primary symptom, and imaging showed multiple consolidations in both lungs. We conducted a comprehensive etiological diagnosis by employing bronchoscopic biopsy, traditional microbial culture, and metagenomic next-generation sequencing (mNGS). The treatment regimen involved a sequential aproach with the use of piperacilin-tazobactam, penicilin G, and local oral care using povidone-iodine gargle, along with blod glucose management. A literature search included pathogenesis, diagnostic chalenges, and treatment strategies.

Erythrocyte sedimentation rate(ESR)64.00 mm/1 h, glucose(GLU)11.10 mmol/L, C-reactive protein(CRP)8.3 mg/L, The patient was definitively diagnosed by mNGS (T. denticola sequence count: 9, 165), while traditional culture failed to detect the pathogen. Symptoms improved after 10 days of initial piperacillin sodium-tazobactam sodium treatment, and follow-up CT after 6 weeks of sequential penicillin G therapy showed significant lesion resolution. Literature indicates that aspiration of oral flora is the core pathogenic mechanism, with diabetes and immunodeficiency as high-risk factors. Moreover, mNGS can overcome the limitations of traditional culture and accurately identify anaerobic bacteria. Effective treatments include β-lactam antibiotics combined with oral hygiene, typically requiring a 4-6 week course.

T. denticola lung abscess is rare but prone to misdiagnosis, particularly in individuals with poor oral hygiene and underlying diseases. mNGS technology significantly improves pathogen detection rates, guiding clinicians in precise anti-infective therapy. Penicillin-based treatment combined with oral intervention and management of underlying conditions is key to cure, and a multidisciplinary collaborative model is crucial for optimizing diagnosis and treatment.