小児感染免疫 Vol. 29 No. 2 153 症例報告 1 1 1 1 1 1 11 2 15C 14 17 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. 11 37.7 3 Key wordsmondini 1 130-8575 4-23-15
154 2017 1 1 WBC Neut Lymp Hb PLT PT-INR APTT Fib D-dimer FDP AT- 20,100 / L 82.5 % 12.5 % 13.8 g/dl 35.7 10 4 / L 1.27 39.6 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 7.470 31.7 mmhg 22.8 mmol/l 0.4 mmol/l 2.4 mmol/l 12.6 mmol/l 97 mg/dl 2 2 11,120 /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 CH50 131 mg/dl 33 mg/dl >60 U/mL 32.9 % 98.4 % Mondini 3 4 BCG 3 DPT 4 2 1 1 MR 1 1 HibPCV7, 13 GCS E4V5M6 38.6 118 / 114/71mmHg 26 / 98. 1 2 20,100/ L 82.5% 12.5% CRP 12 mg/dl 11,120/ 3 L 151 mg/dl 3 mg/ dl 15C Stetens Serum Institute
小児感染免疫 Vol. 29 No. 2 155 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 3+ 3 4 Penicillin susceptible Streptococcus pneumoniae : PSSP 5 VCM 6 CT CT 8 ABPC 300mg/kg/ 14 17 Ormerod Mondini CT 3 3 1
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小児感染免疫 Vol. 29 No. 2 157 2 Mondini CT 4 Mondini 10 5,6 Mondini 60 4 92 2 7 Mondini 7,8 2009 10 2010 2 7 PCV7 2013 4 PCV7 11 13 PCV13 PCV13 2014 6 2014 10 23 PPSV23 invasive pneumococcal disease: IPD IPD 9 ACIP IPD 9,10 2 PPSV23 PCV13 2 PCV13 PPSV23 Red book 2015 10 6 18 PCV13 2 PPSV23 5 PPSV23 PCV13 PPSV23 5 PPSV23 PPSV23 10 IgG IgM IgA IgG2 IgG4 5 11 IPD 7 4 6B 9V 14 18C 19F 23F 76.6% 6 1 3 5 6A 7F 19A 13 90.2% 7 4% 7 19A 44.7% 12 2013 19A 24F 15A 15C serotype replacement 13 2013 PCV13 19A IPD 15C
158 2017 13 23 2 Mondini 47 2015 10 1 : Mondini dysplasia 1 38 : 449-452, 2006 2 Kline MW, et al : Review of recurrent bacterial meningitis. Pediatr Infect Dis J 8 : 630-634, 1989 3 Ormerod FC, et al : The pathology of congenital deafness. J Laryngol Otol 7 : 919-650, 1960 4 : 89(2) : 165-171, 1996 5 Park TS, et al : Spontaneous cerebrospinal fluid otorrhea in association with a congenital defect of the cochlear aqueduct and Mondini dysplasia. Neurosurgery 11 : 356-362, 1982 6 Ohlms LA, et al : Recurrent meningitis and Mondini dysplasia. Arch Otolaryngol Head Neck Surg 116 : 608-612, 1990 7 : 2. Otology Japan 22(2) : 148-152, 2012 8 : Mondini 1 61(3) : 467-472, 2008 9 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 : 521-524, 2013 10 Kimberlin, et al : Pneumococcal infections. Red Book 2015 (Report of the Committee on Infectious Diseases), 2015, 626 11 7 19 7 22 1 12 : 25 1 25 12 13 : 2013 3. IASR34: 55-56, 2013 14 : 1976
小児感染免疫 Vol. 29 No. 2 159 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. 2016 9 20 2017 4 21