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 5 1 IPD 2 3 0 1 2 2015 10 12 5 4 1 1 4 penicillin susceptible streptococcus pneumoniae 1 penicillin intermediate streptococcus pneumoniae PISP 5 1 4 1 4 1 PCV13 1
8 1. 2015 IPD 1 2 3 4 5 y, m 0y1m 1y4m 1y3m 1y4m 2y10m S. pneumoniae PISP MIC PCG, μg/ml 0.063 4 0.063 2 0.063 7F* 15A 15B/C 35B 24F PCV13 4 PCV13 4 PCV13 4 PCV7 3 PCV13 1 * PCV13 2. 1 WBC 25,200 /μl ph 7.422 RBC 341 10 /μl pco2 30.7 mmhg Hb 10.0 g/dl HCO3 20.2 mmol/l Ht 30.3 % BE 4.5 mmol/l Plt 57.2 10 /μl Lac 1.6 mmol/l Na 133 meq/l K 4.7 meq/l Cl 102 meq/l 5 /μl Ca 10.1 mg/dl : 1:04 IP 5.5 mg/dl 61 mg/dl AST 26 U/l 49 mg/dl ALT 28 U/l LDH 212 U/l S. pneumoniae γ - GTP 145 U/l S. pneumoniae CRP 2.08 mg/dl PT - INR 1.06 APTT 52.9 sec Fbg 441 mg/dl D - dimer 0.80 μg/dl 1 :1 27 : : : 41 0 3,252 g : PCV13 sick contact : : 4 38.4 C 40.1 C 2 : 38.9 C 184 / 80 / SpO 100% 2 : 5/μl
9 病日 1 2 3 6 10 15 16 ABPC+CTX 270mg/kg/day MEPM 120mg/kg/day CTX 310mg/kg/day ABPC 344mg/kg/day 発熱 易刺激性 WBC(/μl) 25,200 23,900 14,500 11,900 13,400 13,000 CRP(mg/dl) 2.08 8.28 4.56 0.34 0.12 <0.05 CC (/μl) 5 4,467 2 頭部 CT 異常所見なし 1. ABPC : ampicillin, CTX : cefotaxime, MEPM : meropenem CC : 頭部 MRI 硬膜下血腫 + 聴性脳幹反応異常なし 1 : 5 ABPCCTX 270 mg/kg/ 15 WBC 23,900/μl CRP 8.28 mg/dl 2 4,467/μl 13% : 87% 2014 6 MEPM 120 mg/kg/ CTX 310 mg/kg/ 3 S. pneumoniae 6 ABPC 344 mg/kg/ de - escalation 8 CT 3 2/μl 2: 0 15 16 MRI 2 2. MRI 10 a : T1 b : T2 c: d : FLAIR FLAIR MR FLAIR 17
10 PCV13 7F 2010 70% 7 3 PCV7 2 85% B 40% 8 2014 6 1 empirical 4 B ABPC+ 1 / PAPM/BP MEPM CTX CTRX 1 1 2 9,10 S. pneumoniae 90 IPD 2010 11 4 6B 9V 14 18C 19F 23F PCV7 2013 4 PCV7 2013 11 PCV7 6 1, 3, 5, 6A, 7F, 19A PCV13 大腸菌 4% B 群連鎖球菌 6% 肺炎球菌 16% 2003 2010 N=49 リステリア 4% 緑膿菌 2% インフルエンザ菌 68% 2011 2015 N=10 B 群連鎖球菌 50% インフルエンザ菌 20% 肺炎球菌 30% 3. 2010 80% 2011 50% B 50%
11 2014 5 IPD PCV7 IPD 2.1% PCV13 36.5% 63.5% PCV13 11 IPD 1 4 4 PCV13 IPD 12 PCV13 2 Pneumocatch Pneumocatch 1 1 : SADO - study IASR 34 : 57-58, 2013 3 2 Ubukata K et al : Serotype change and drug resistance in invasive pneumococcal diseases in adults after vaccinations in children. Emerg Infect Dis 21 : 1956-1965, 2015 3 Nakano S et al : Serotype, antimicrobial susceptibility, and molecular epidemiology of invasive and non - invasive Streptococcus pneumoniae isolates in paediatric patients after the introduction of 13 - valent conjugate vaccine in a nationwide surveillance study conducted in Japan in 2012-2014. Vaccine 34 : 67-76, 2016 4 Ozawa D et al : Impact of seven - valent pneumococcal conjugate vaccine on acute otitis media in Japanese children : Emergence of serotype 15A multidrug - resistant Streptococcus pneumoniae in middle ear fluid isolates. Pediatr Infect Dis J 34 : e217 - e221, 2015 5 Pneumocatch : http://www. pneumocatch.jp/ 28 3 6 : 7. 2014 pp 98-102, 2015 7 : 1. 2014 pp 2-3, 2015 8 : 18 109 : 499-504, 2005 9 : 2 22 : 151-155, 2010 10 : HIV 49 : 100-103, 2009 11 : HibHPV 26 7-13, 27 2015 3 http://mhlw - grants. niph.go.jp/niph/search/nidd00.do?resrchnum=201420 046A 12 Feikin DR et al : Serotype - specific changes in invasive pneumococcal disease after pneumococcal conjugate vaccine introduction : A pooled analysis of multiple surveillance sites. PLOS Med 10 : e1001517, 2013