小児感染免疫第27巻第4号
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1 2015 小児感染免疫 Vol. 27 No , cat scratch diseasecsd CSD CSD cat scratch diseasecsd Bartonella henselae CSD CSD B. henselae CSD CSD CDTR PI Key words
2 WBC 5,230l Neut 58.4 Lymp 29.4 Mono 9.9 RBC l HGB 11.7 gdl HCT 33.1 MCV 79.8 fl MCH 28.2 pg PLT l ESR1 86 mm AST ALT LDH TBil BUN CRNN Na K Cl BS CRP IgG IgA IgM 13 Ul 8 Ul 233 Ul 0.47 mgdl 12.4 mgdl 0.59 mgdl 138 meql 4.0 meql 102 meql 93 mgdl 5.37 mgdl 970 mgdl 189 mgdl 205 mgdl C3 C4 CH mgdl 30.6 mgdl 41.8 CH 50 Uml 11l 45.5 mgdl 55 mgdl RBC! 1HPF WBC! 14HPF 29.5 kg0.5 SD mmhg 1 5,230l 58.4 CRP 5.37 mgdl 11l CT MRI OCT CMV EB EBV EIA CMVIgM 0.48CMVIgG0.2EBV IgM 0.1EBVIgG 0.7 EBNA10 IgM 0.1 IgG3 PR3ANCAMPO ANCA CSD azithromycin AZM 5 macular star CSD AZM 1 B. henselae IFA 3 B. henselae IgM IgG CSD 2 CSD
3 2015 小児感染免疫 a b 図 Vol. 27 No c 入院後経過 左眼底所見の推移 a 入院日 b 入院 5 日目 c 退院時 入院 20 日目 上段は眼底写真 下段は眼底三次元解析画像 表 2 血清 B. henselae IgM IgG 抗体価 IFA 法 IgM 抗体価 女児 母 父 IgG 抗体価 初回 2 回目 初回 2 回目 9 月 30 日 10 月 6 日 9 月 30 日 10 月 6 日 40 倍 40 倍 512 倍 10 月 21 日 11 月 7 日 10 月 21 日 11 月 7 日 20 倍 20 倍 256 倍 10 月 22 日 11 月 26 日 10 月 22 日 11 月 26 日 40 倍 40 倍 以下の項目 1 3 のいずれかを一つ以上認めた場合 陽性と判定 1 IgG 抗体価が 256 倍以上 2 ペア血清 2 3 週間の間隔 で 2 管以上の抗体価の上昇 3 IgM 抗体が 20 倍以上 のうち その 2/3 を CSD が占めるとの報告があ の家族内発症を経験した CSD の定型例ではネコの掻傷や咬傷により感 る6 また 小児の不明熱に関する疫学研究では 染を起こし 受傷部位の所属リンパ節と発熱を主 全体の 23 を感染性疾患が占め そのなかでは 症状 とするが 局所リンパ節腫脹を伴わない全 CSD が最多であった7 したがって 不明熱の小 身性の非典型例が約 20 存在し その臨床像は多 児例では 局所のリンパ節腫脹を認めなくても眼 彩である 科的検索を行い 視力低下や視神経網膜炎の所見 1 発端となった女児のように 視神経 4,5 網膜炎を合併する頻度は 2 4 と高くはない 4,5 が 眼科領域からは視神経網膜炎を呈した感染症 を認めた場合は CSD を疑い 積極的に鑑別して いく必要があると思われた
4 CSD CSD 5 8 CSD B. henselae CSD 3 CSD AZM ST AZM AZM AZM 5 CSD B. henselae Ctenocephalides felis 1 1American Academy of PediatricsCatScratch DiseaseBartonella henselae. Red Book 2009 Report of the Committee on Infectious Diseases, 28th. 2009, Bartonella henselae IgG Regnery RL, et alserological response to Rochalimaea henselaeantigen in suspected catscratch disease. Lancet , Tsuneoka H, et alanalysis of data in 30 patients with cat scratch disease without lymphadenopathy. J Infect Chemother , Brunetti E, et alcatscratch disease in Northern Italyatypical clinical manifestations in humans and prevalence of bartonella infection in cats. Eur J Clin Microbiol Infect Dis , Purvin V, et alneuroretinitisreview of the literature and new observations. J NeuroOphthalmol , Kasai K, et alnational survey of childhood febrile illness cases with fever of unknown origin in Japan. Pediatr Int , Reed JB, et albartonella henselae neuroretinitis in cat scratch disease. Ophthalmology , Raihan AR, et alneuroretinitis in ocular bartonellosisa case series. Clin Ophthalmol , 2014
5 2015 小児感染免疫 Vol. 27 No Familial cases of cat scratch disease starting from a 10yearold girl with only fever and neuroretinitis Megumi MIYAGI 1, Takafumi OKADA 1,2, Keiko NISHIMURA 3, Masashi YANAGIHARA 4, Hidehiro TSUNEOKA 4 1 Department of Pediatrics, National Hospital Organization Shikoku Medical Center for Children and Adults 2 Department of Pediatric infectious diseases, National Hospital Organization Shikoku Medical Center for Children and Adults 3 Department of Clinical Laboratory, National Hospital Organization Shikoku Medical Center for Children and Adults 4 Department of Laboratory Sciences, Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine This study reported a familial case of cat scratch diseasecsd, starting from a 10 yearold girl of prolonged fever and neuroretinitis without lymphadenitis. She was admitted to hospital as an index case to examine the cause of the prolonged fever. On admission, she also complained of recent left visual loss, and a prompt examination of her ocular fundus found neuroretinitis of the left eye. At the same time, her parents had cervical or inguinal lymphadenopathy. Their record of keeping a number of cats and dogs raised suspicion of CSD. The girl was treated with antibiotics and systemic corticosteroids for neuroreninitis, and her parents were given antibiotics. In retrospect, CSD was diagnosed serologically in all cases. If a case has prolonged fever without focus or with neuroretinitis, CSD should be considered in differential diagnosis. Additionally, familial occurrence of CSD should be noted
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