Haemophilus parainfluenzae Key words: Infective endocarditis, H. parainfluenzae

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Transcription:

Haemophilus parainfluenzae Key words: Infective endocarditis, H. parainfluenzae

79 昭 和63年1月20日 呼 吸 音 に は 異 常 は み とめ ら れ な か っ た.肺 は 第6肋 間,肝 は 右 季 肋 下 に2横 肝境界 指 ふ れ,弾 性硬 Fig. 1 March Chest X-ray H. U. 45 years で あ っ た.脾 は ふ れ な か っ た.口 film taken on admission (25th on admission (26th 1986) old Male 唇単純 ヘル ペス が み ら れ た. 入院時検査所 見 Tableに し た.末 入 院 時 に施 行 した 諸 検 査 の 結 果 を表 示 梢 血 液 で は 白血 球 増 多 を 伴 う軽 度 の 貧 血 と,血 小 板 数 の 減 少 が み ら れ た.赤 沈 値 は35mm/ 時 とや や 亢 進 し,CRPは12.7mg/dlと た.尿 蛋 白 は 陽 性,沈 ら れ た.血 高 値 を示 し 渣 に多 数 の 赤血 球 が み とめ 液 化 学 検 査 で はLDH, よ び γ-グ ロ ブ リ ン値 の 上 昇,コ GOT, GPTお リンエ ス テ ラー ゼ お よ び 総 コ レ ス テ ロ ー ル 値 の 減 少 が み ら れ た.血 清 ク レ ア チ ニ ン 値,BUNは こ の 患 者 はHBs抗 さ れ た.胸 部X線 正 常 値 で あ っ た.な お 原 が 陽 性 で,HBe抗 像 をFig.1に 示 す が,心 ふ く め て 異 常 は み ら れ な か っ た.心 Fig.2に 示 す.大 動 脈 弁,右 エ コ ー が み と め ら れ,疣 Table Laboratory 体 が検 出 冠 尖 の 間 に結 節 状 の 贅 と 思 わ れ た.パ findings 陰影 を エ コ ー像 を ル ス ド on the admission Fig. 2 March Echocardiogram taken 1986) H. U. 45 years old Male Arrow the vegitation showes プ ラー で軽 度 の 大 動 脈 弁 逆 流 が み とめ られ た.僧 帽 弁 に は弁 尖 の 肥 厚 と,後 尖 の 開放 制 限 がみ とめ られ,パ ル ス ドプ ラ ーで 軽 度 の逆 流 が み られ た. 心 電 図 に は 異 常 は み られ な か っ た.肝 シ ンチ グ ラ

Fig. 3 Clinical course of the patient with H. parainfluenzae endocarditis tainer Supplemented Peptone Broth (B-DŽÐ),

2) Sawae, Y.: Current diagnosis of infective endocarditis. Jun. Circ. J., 49: 519-528, 1985. 4) Weinstein, L. & Rubin, R. H.: Infective endocarditis-1973. Progress in Cardiovascular Disease, 16: 239-273, 1973. 5) Ben-Chetrit, E., Nashif, M. & Levo, Y.: In-

fective endocarditis caused by uncommon bacterial Scand. J. Infect. Dis.,15: 179-183, 1983. 6) Cates, J. E. & Christie,R. V.: Subacute bacterial endocarditis. A review of 442 patients treated in 14 centres appointed by the penicillin trials committee of the medical research council. Qurt. J. Med.,20: 93-130, 1951. 7) Trollfors, B., Srorson, J.E., Claesson, B. & Sandberg,T.: Invasive infections caused by haemophhilus speces other than haemophilus influenzae. Infection,13: 12-14, 1985. 8)Oill, P. A., Chow, A. W. & Guze,L. B.: Adult bacteremic haemophilus parainfluenzae infections. Seven reports of cases and a review of the literature. Arch. Intern. Med.,139: 985 9) Hable, K. A., Logan, G. B. & Washington, J.A. II.: Three haemophilus species. Pathogenic activity. Amer. J. Dis. Child.,121: 35-37, 1971. 10) Chunn, C. J., Jones, S. R., McCutchan, J.A., Young, E. J. & Gilbert, D. N.: Haemophilius parainfluenzae infective endocarditis. Medicine,56: 99-113, 1977. 11) Jemsek, J. G., Greensberg, S. B., Gentry, L.O., Welton, D. E. & Mattox, K. L.: Haemophilus paranifluenzae endocarditis. Two cases and review of the literature in thepast decade. Amer. J. Med.,66: 51-57, 1979. 14) Lynn, D. J., Kane, J. G. & Parker,R. H.: Haemophilus parainfluenzae and influenzae endocarditis: A review of fourty cases. Medicine,56: 115-128, 1977. 15) Tuyau, J.E. & Sims,W.: Occurrence of haemophili in dental plaque and their associatiojn with neuramididase activity. J. Dint. Res.,54: 737-739, 1975. 16) Kilian, M., Parachyabrued, W. & Theilade,E.: Haemophili in developing dental plaque. Scand,. J. Dent. Res.,84: 16-19, 1976. A Case of Haemophilus Parainfluenzae Endocarditis Osamu KURIMURA, Yoshiharu ITO, Hiroshi ICHIMURA & Ikuo TAMURA Institute of Clinical Research, Kure National Hospital HideyukiDOI Clinical Laboratory, Kure National Hospital We reported a case of Haemophilus parainfluenzae endocarditis. A 45-year old male patient, who suffered from fever elevation and was administered some cephems orally or intravenously with no clinical efficacy, visited our hospital. He admitted on 25th March 1986, after a week from the onset of the disease. On admission his body temperature was 40.2 Ž and a grade of Levine II systolic murmur was audible at the mitral ostium, but no sign of the heart failure was recognized. H. parainfluenzae was isolated twicefromfour serial blood cultures.after the bacteriological examinations daily doses of 6.0 g of ampicillin (ABPC) with 600 mg of ofloxacin (OFLX), of 4.0 g of cefotaxime (CTX) and of 6.0 g of THR-221 were administered successively. However, the clinical effects were insufficient, so that the antimicrobial agents were changed on the 27th hospital day again up to daily doses of 9.0 g of ABPC and 600 mg of OFLX for 42 days, and then daily dosis of 2.0 g of amoxillin was prescribed in place of ABPC. The therapy was over on the 87th hospital day discharged on the 102 nd hospital day., resulting in good clinical course. Fainally, he MICs of CTX, THR-221, ABPC and OFLX against the isolated strain were 0.0125ƒÊg/ml, 0.0125

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