小児感染免疫第25巻第2号
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1 Vol. 25No CT mmhg 1 ceftriaxonectrx120 mgkgvancomycin VCM40 mgkg metronidazole MNZ35 mgkg 3 Streptococcus mitis CTRX 120 mgkg Key words
2 WBCl RBC10 4 l Hbgdl Ht PLT10 4 l CRPmgdl BUNmgdl Cremgdl ASTUl ALTUl LDHUl 12, , , , , S. mitis S. mitis S. mitis Streptococcus Streptococcus Penicillin G Ampicillin Cefotaxime Meropenem Erythromycin Vancomycin clinical and laboratory standard institute gmls. mitisstreptococcus mitis 45 Streptococcus bpm 9646 mmhg ampicillinsulbactamabpcsbt150 mg kg acycloviracv15 mgkg S. mitis ABPCSBT 150 mgkg bpm mmhgspo 2 80room air PiperacillintazobactamPIPCTAZ450 mgkg 2 panipenembetamipronpapmbp100 mgkg S. mitis ampicillinabpc150 mgkg 2
3 小児感染免疫 a b c d 図 1 e g f h Vol. 25 No 症例 1 の入院時頭部 CT MRI a 単純 CT 隔壁を有する腫瘤と周囲の著明な脳浮腫を認める b 造影 CT 遅延相 隔壁はリング状造影効果を認める c MRI 拡散強調画像 内容液は高信号を示す d MRI ADC map 画像 内容液は低信号を示す e MRI T1 強調画像 隔壁は等 高信号 内容液は低信号を示す f MRI T2 強調画像 隔壁は低信号 内容液は高信号を示す g MRI FLAIR 画像 隔壁は低信号 内容液は高信号を示す h 造影 MRI 隔壁は造影効果を認め 内容液は造影効果を認めない 脳膿瘍の staging としては被膜形成早期である 4 症例 4 感染性心内膜炎 mg kg 日による治療を開始した 入院 12 日目の 5 歳 4 カ月女児 心室中隔欠損症 VSD で経 心臓超音波で三尖弁腱索付近に疣贅を認めた 図 過観察中 現病歴 入院 8 日前から発熱し 入院 5 日前に 当科を受診した 血液検査で WBC 6,800 μl CRP 2 PCG 30 万単位 kg 日による治療を 4 週間 GM 7.5 mg kg 日 2 週間併用 実施し退院となっ た その後 VSD 閉鎖術を実施した 1.57 mg dl のためウイルス性疾患を疑われ血液培 5 症例 5 グラフト感染疑い 養未採取 抗菌薬未処方で経過観察となった そ 1 歳 3 カ月男児 完全大血管転移症 TGA 心 の後も発熱が続き 発熱 9 日目に入院となった 入院時現症 体温 37.5 心拍数 125 bpm 呼 吸音清 心音は汎収縮期雑音を聴取 腹部平坦軟 皮疹などなし その他特記事項なし 経 過 入 院 直 後 に 実 施 し た 心 臓 超 音 波 で は VSD 以外の所見を認めず 疣贅も認めなかった 入院時に採取した血液培養からα Streptococcus 房中隔欠損症 ASD で他院管理中 入院 5 カ月 前に Blalock Taussig shunt BT shunt 術を実施 現病歴 入院 8 6 日前まで発熱があり 経口 抗菌薬を 4 日間服用した 抗菌薬終了後も発熱を 繰り返すため当科を受診し 炎症反応の上昇を認 めたため入院となった 入院時現症 体温 37.6 心拍数 153 bpm 血 が検出され 感染性心内膜炎を疑い penicillin G 圧 mmhg 呼吸音清 心雑音あり 咽頭発 PCG 30 万単位 kg 日と gentamicin GM 7.5 赤あり 腹部平坦軟 その他特記事項を認めない
4 ab CTRX 120 mgkg Streptococcus VCM 45 mgkggm 3 mgkg VCM teicoplanin TEIC10 mgkg 20 mgkg CTRX 120 mgkggm 3 mgkg 26 16S rrna mutans group salivaruis group sanguinis group mitis groupanginosus group 2 sanguinis group mitis groupstreptococcus mutans anginosus group Streptococcus intermedius mitis group Streptococcus salivarius toxic shock syndrome BT shunt TGA 1 3
5 Vol. 25No MRI 3 MRI S. mitis A 810 lactam VCM PCG PCG MIC gml MIC GM VCM 10 1 VCM CTRX PCG PCG ABPC 2 PCGABPC ABPCSBT 3 PIPCTAZ PAPMBP ABPC 4 PCGGM PCG ABPC CTX PCG 4 GM Streptococcus PCG MIC gml 10 VCMGM VCM CTRXGM PCGcefotaximeCTX GM 11
6 142 GM 3 mgkgday 4 GM GM 500g ml CTRX GM GM 500gml PCG ABPC CTRX CTRX 1Sinner SW, et alviridans Streptococci, Group C and G streptococci, and Gemella species. Principles and Practice of Infectious Diseases, 7th ed Mandell GL, et al eds. Churchill Livingstone, Philadelphia, 2010, Facklam RWhat happened to the streptococci overview of taxonomic and nomenclature changes. Clin Microbiol Rev , Lockhart PB, et albacteremia associated with toothbrushing and dental extraction. Circulation , Moss RL, et alnecrotizing fasciitis in children prompt recognition and aggressive therapy improve survival. J Pediatr Surg , Streptococcus mitis Lockhart PB, et alpoor oral hygiene as a risk factor for infective endocarditisrelated bacteremia. J Am Dent Assoc , Tunkel ARBrain abcess. Principles and practice of infectious diseases, 7th edmandell GL, et al eds. Churchill Livingstone, Philadelphia, 2010, Baddour LM, et alinfective endocarditisdiagnosis, antimicrobial therapy, and management of complicationsa statement for healthcare professionals from the committee on rheumatic fever, endocarditis, and Kawasaki disease, council on cardiovascular disease in the young, and the councils on clinical cardiology, stroke, and cardiovascular surgery and anesthesia, American Heart Associationendorsed by the Infectious Diseases Society of America. Circulation , Le T, et alcombination antibiotic therapy for infective endocarditis. Clin Infect Dis , 2003
7 Vol. 25No Invasive infectious diseases caused by viridans streptococci Hisamitsu TAMAKI, Masahiro OTSUKA, Masahiro ITO Department of Pediatrics, Tokyo Metropolitan Bokuto Hospital Viridans streptococci are a part of normal microbial flora in the human oral cavity. They are considered as bacteria of low virulencehowever, they also can invade natural barriers, infect a sterile site, and result in lifethreatening diseases such as bacteremia, infective endocarditis, and brain abscess. In our hospital, 5 pediatric patients were treated from 2001 to 2012 for invasive infectious diseases caused by viridans streptococci. Streptococcus mitis and Streptococcus were isolated in 3 and 2 of the 5 patients respectively. In the final diagnosis of the 5 patients, brain abscess, bacteremia caused by S. mitis, infective endocarditis and graftrelated infection caused by Streptococcus was found in 1 case, 2 cases, 1 case, and 1 case, respectively. Three of the 5 patients had underlying diseases such as ventricular septal defects in the patient with infective endocarditiscomplete transposition of the great arteries repaired by a BlalockTaussig shunt operation in the patient with graftrelated infection and spastic paralysis due to perinatal period disorder in one of the patients with bacteremia. Of the 2 healthy patients 1 case had a brain abscess following selfextraction of a milk tooth, and the other contracted bacteremia following chicken pox
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