小児感染免疫第29巻第2号

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1 小児感染免疫 Vol. 29 No 症例報告 C 細菌性髄膜炎は, 肺炎球菌, インフルエンザ菌 b 型ワクチン導入により減少傾向であるが, 現在でも予後不良な疾患である. 先天性内耳奇形では, 細菌性髄膜炎を発症することがあることが知られているが 1,2), 細菌性髄膜炎を発症したワクチン未接種の先天性内耳奇形の 1 例を経験したため報告する Key wordsmondini

2 WBC Neut Lymp Hb PLT PT-INR APTT Fib D-dimer FDP AT- 20,100 / L 82.5 % 12.5 % 13.8 g/dl / L sec 31.5sec 597 mg/dl 2.8 g/ml 6.9 g/ml >130 % TP Alb UN Cre T.Bil AST ALT LDH -GT Amy Na K Cl Ca CRP 7.6 g/dl 4.3 g/dl 12 mg/dl 0.5 mg/dl 1.3 mg/dl 16 U/L 10 U/L 214 U/L 11 U/L 45 U/L 137 meq/l 4.3 meq/l 101 meq/l 10.2 mg/dl 10 mg/dl ph pco 2 HCO 3 BE Lac AG Glu mmhg 22.8 mmol/l 0.4 mmol/l 2.4 mmol/l 12.6 mmol/l 97 mg/dl ,120 /3 L 4,310 /3 L 6,810 /3 L 3 mg/dl 151 mg/dl Streptococcus pneumoniae PSSP Streptococcus pneumoniae PSSP 15C CT IgG IgA IgM IgG2 IgG4 1,012 mg/dl 72 mg/dl 119 mg/dl 420 mg/dl 19 mg/dl C3 C4 CH mg/dl 33 mg/dl >60 U/mL 32.9 % 98.4 % Mondini 3 4 BCG 3 DPT MR 1 1 HibPCV7, 13 GCS E4V5M / 114/71mmHg 26 / ,100/ L 82.5% 12.5% CRP 12 mg/dl 11,120/ 3 L 151 mg/dl 3 mg/ dl 15C Stetens Serum Institute

3 小児感染免疫 Vol. 29 No 右左 1 CT 6 IgG IgM IgA IgG2 IgG4 CT CT Mondini 1 2 CTX 200 mg/kg/ VCM 60 mg/kg/ DEX) 0.6mg/kg/ 40mL/kg/ ACV 60 mg/kg/ Streptococcus pneumoniae Penicillin susceptible Streptococcus pneumoniae : PSSP 5 VCM 6 CT CT 8 ABPC 300mg/kg/ Ormerod Mondini CT 3 3 1

5 小児感染免疫 Vol. 29 No Mondini CT 4 Mondini 10 5,6 Mondini Mondini 7, PCV PCV PCV13 PCV PPSV23 invasive pneumococcal disease: IPD IPD 9 ACIP IPD 9,10 2 PPSV23 PCV13 2 PCV13 PPSV23 Red book PCV13 2 PPSV23 5 PPSV23 PCV13 PPSV23 5 PPSV23 PPSV23 10 IgG IgM IgA IgG2 IgG IPD 7 4 6B 9V 14 18C 19F 23F 76.6% A 7F 19A % 7 4% 7 19A 44.7% A 24F 15A 15C serotype replacement PCV13 19A IPD 15C

6 Mondini : Mondini dysplasia 1 38 : , Kline MW, et al : Review of recurrent bacterial meningitis. Pediatr Infect Dis J 8 : , Ormerod FC, et al : The pathology of congenital deafness. J Laryngol Otol 7 : , : 89(2) : , Park TS, et al : Spontaneous cerebrospinal fluid otorrhea in association with a congenital defect of the cochlear aqueduct and Mondini dysplasia. Neurosurgery 11 : , Ohlms LA, et al : Recurrent meningitis and Mondini dysplasia. Arch Otolaryngol Head Neck Surg 116 : , : 2. Otology Japan 22(2) : , : Mondini 1 61(3) : , Centers for Disease Control and Prevention (CDC). Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among children aged 6-18 years with immunocompromising conditions: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 62 : , Kimberlin, et al : Pneumococcal infections. Red Book 2015 (Report of the Committee on Infectious Diseases), 2015, : : IASR34: 55-56, : 1976

7 小児感染免疫 Vol. 29 No A case of congenital inner ear anomaly with bacterial meningitis Yukimi OYOSHI 1, TAE OMORI 1, Yuki KASUGA 1, Hisamitsu TAMAKI 1, Masahiro ITO 1, Masahiro MISAWA 1 1 Department of Pediatrics, Tokyo Metropolitan Bokutoh Hospital This study reports the case of an 11-years-old girl with profound deafness, due to congenital inner ear anomaly. She had been admitted to hospital twice before because of aseptic meningitis. One day, she felt an uncomfortable feeling in her left ear and went to hospital. She received a diagnosis of acute otitis media and left myringotomy was performed. The next day, she presented headache, vomiting and fever to this emergency department. A blood test showed high inflammation level. The cerebrospinal fluid test showed increased number of cells and protein level. Also, the glucose level of cerebrospinal fluid decreased. Her illness was diagnosed as bacterial meningitis and antimicrobial therapy started. A blood and cerebrospinal fluid culture detected Streptococcus pneumoniae and the serum type was 15C. After a 14-day total term of antimicrobial therapy, the patient was discharged 17 days post hospital admission. There have been many case reports of recurrent bacterial meningitis with congenital inner ear anomaly. It is said that cerebrospinal fluid otorrhea is the cause of recurrent bacterial meningitis. To prevent recurrent bacterial meningitis, surgical inner ear plombage is performed. The degree of deafness with congenital inner ear anomaly ranges from mild to severe. Therefore, inner ear anomaly should be searched for in bacterial meningitis patients even if they are not deaf. This patient had not received pneumococcal vaccination, although she had the high risk for meningitis caused by congenital inner ear anomaly. Therefore, it is important to receive a vaccine

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_02三浦.indd 36, 7-11, 2016 IPD PCV 5 3 80% 1 invasive pneumococcal disease ; IPD 2010 7 PCV7 2013 13 PCV13 IPD IPD 2,3 2015 1 2015 12 5 1 IPD 2015 1 12 IPD 5 IPD 1 4 2 5 http://pneumocatch.jp/ 5 Statens Serum Institut