巻号一覧
90 巻 (2016)
- 6 号 p. 787-
- 5 号 p. 633-
- 4 号 p. 467-
- 3 号 p. 291-
- 2 号 p. 99-
- 1 号 p. 1-
前身誌
90 巻, 2 号
選択された号の論文の8件中1～8を表示しています
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原著
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下田 貴博, 津久井 智, 高橋 篤2016 年 90 巻 2 号 p. 99-104
発行日: 2016/03/20
公開日: 2017/08/19
ジャーナル フリー【目的】社会福祉施設のインフルエンザアウトブレイク（IO）の特徴は不明で，その特徴を明らかにする．【対象と方法】対象は平成23～25 年度における群馬県内社会福祉施設の保育所・障害者施設・高齢者施設で発生したIO 258 事例で，各施設の利用者数や職員数・IO の発生頻度と発生時期・初発から発生届までの期間（初期）・発生届から終息までの期間（後期）・初発から終息までの期間（流行期間）・利用者と職員の初期，後期，流行期間の発病率・インフルエンザタイプを調べ，施設間の比較検討を行った．【結果】（1）保育所は他施設と比べ利用者と職員一人あたりの利用者が多く，職員が少なかった．（2）IO 発生頻度は保育所で高かった．（3）保育所と高齢者施設はシーズン前半の発生が多かった．（4）初期期間，後期期間，流行期間は保育所が長かった．（5）利用者発病率は各期間で障害者施設が高かった．（6）職員発病率は初期で高齢者施設，後期で障害者施設が高く，高齢者施設で初期から後期にかけて低下した．【結語】保育所と高齢者施設におけるIO の発生には施設外インフルエンザの流行状況が影響することが示唆される．保育所は利用者間接触による2 次感染が多くて継続し易く，IO が長期化し易い．高齢者施設では介護による利用者職員間感染のため，初期で職員感染が多いと考えられる．障害者施設は利用者間と利用者職員間の接触が相対的に多く，感染が拡大し易いと考えられる．施設内2 次感染を介するIO の長期化と拡大には利用者の行動の自由度，利用者間と利用者職員間の接触度などが関連すると考えられる．以上の特徴とIO の長期化と拡大要因を念頭に入れた流行初期からの感染予防が重要である．抄録全体を表示PDF形式でダウンロード (231K) -
小野寺 直人, 鈴木 啓二朗, 高橋 雅輝, 櫻井 滋, 諏訪部 章2016 年 90 巻 2 号 p. 105-112
発行日: 2016/03/20
公開日: 2017/08/19
ジャーナル フリー基質特異性拡張型β―ラクタマーゼ（ESBL）産生菌は医療施設における急激な増加や地域での蔓延が危惧されており，感染対策上の問題となっている．本研究では，地域の医療施設におけるESBL 産生菌の分離率と保菌率，またそれらの危険因子を明らかにするために，岩手県盛岡二次医療圏内の医療施設（4 病院A～D，4 介護保険施設a～d）における横断的疫学調査を行った．2013 年4 月から2014 年3 月の期間に各病院の入院患者からのESBL 産生菌の分離状況とほぼ同時期における介護保険施設の入所者の糞便検体のESBL 産生菌の保菌状況と遺伝子型を解析した．さらに，病院における第三世代セファロスポリン系抗菌薬の使用量と擦式アルコール手指消毒薬の使用量，介護保険施設の入居者の背景を調査した．ESBL 産生菌の病院における分離率は13.3%（3.6%～25.0%），介護保険施設の保菌率は9.3%（3.4%～21.0%）であった．ESBL 産生菌の分離率の高い病院B では第三世代セファロスポリン系抗菌薬の使用量が有意に多く，分離率が低かった病院A では擦式アルコール手指消毒薬の使用量が有意に多かった．介護保険施設でESBL 産生菌を保菌していた入居者は，有意に経腸栄養剤の使用率が高かった（オッズ比2.71，p＜0.05）．ESBL 産生菌の保菌者が最も多い施設c では，オムツ使用率，直近3 カ月の入院歴がある患者の割合，経腸栄養剤の使用率が有意に高く，入所者の介護度も高い傾向にあった．また，この施設で分離されたESBL 産生Escherichia coli（13 例）の遺伝子型はすべてCTX-M-3 であった．調査した病院と介護保険施設のESBL 産生菌の分離状況は施設間で大きく異なっていた．その要因として，抗菌薬の使用や感染対策，入所者の背景の違いが示唆された．ESBL 産生菌対策を一施設のみで行っても，ESBL 産生菌は抑制されない可能性がある．したがって，感染防止対策地域連携の枠組みなどを利用し，同じ医療圏にある医療施設間において感染対策の教育や情報を共有することで，ESBL 産生菌対策はより有効性が高まるものと思われる．抄録全体を表示PDF形式でダウンロード (288K)
症例
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小田井 剛, 日比野 壮功2016 年 90 巻 2 号 p. 113-119
発行日: 2016/03/20
公開日: 2017/08/19
ジャーナル フリーPhlegmonous gastritis (PG) is a nonspecific suppurative inflammation disease arising from the submucosal layer, and extending to the full thickness of the stomach. We herein report on a case of acute PG which was diagnosed with abdominal ultrasonography. A 64-year-old man presented at a hospital after having recently undergone pacemaker implantation for the treatment of complete atrioventricular block. He was admitted as an emergency due to a fever of 39°C. He showed anorexia, epigastralgia, vomiting of coffee-ground emesis on the second hospital day, and abdominal ultrasonography (AUS) performed on the third hospital day showed the disappearance of the normal laminated structure and hypoechoic thickening of the stomach walls. Upper gastrointestinal endoscopy revealed significant hyperplasia of the stomach walls, an erythrogenic mucosa, and poor extension. On the fourth hospital day, computed tomography revealed concentric thickening of the stomach walls. Streptococcus pyogenes was cultured from his blood sample. Based on those findings, the patient was diagnosed as having acute phlegmonous gastritis. His clinical symptoms improved and the abnormal ultrasonographic examination findings thereafter returned to normal following the administration of antibiotics. PG should therefore be included in the differential diagnosis when encountering patients with acute abdomen. We experienced a rare case of acute phlegmonous gastritis and AUS was useful for making an early diagnosis.抄録全体を表示PDF形式でダウンロード (1144K) -
瀧口 純司, 置村 健二郎, 石井 真梨子, 岡村 佳代子, 坂本 浩一, 稲本 真也, 安藤 秀二2016 年 90 巻 2 号 p. 120-124
発行日: 2016/03/20
公開日: 2017/08/19
ジャーナル フリーWe report herein on a case of severe Japanese spotted fever complicated by acute respiratory failure in Kobe City. A 70-year-old female presenting with general malaise and systematic erythema was admitted to our hospital in June, 2013. From her history and physical examination, she was found to be suffering from scleroderma and mild interstitial pneumonia. From admission, the patient was noted to have a fever of 39℃ accompanied by relative bradycardia. Physical examination revealed a black eschar on her right leg, making us suspect rickettsial infection since Kobe City is not an area predisposed to Japanese spotted fever. Three days after admission, her condition worsened and treatment with minocycline and levofloxacin was initiated in accordance with the treatment protocol for Japanese spotted fever. The following day, the patient developed acute respiratory distress syndrome (ARDS) and was put on a respirator. She gradually recovered with the antibiotic treatment and was discharged from the hospital 23 days after admission. The diagnosis of Japanese spotted fever was confirmed by conducting a polymerase chain reaction test on the eschar. Japanese spotted fever is noted to occur in any place other than Kobe City. Late diagnoses may result in aggravated cases of Japanese spotted fever, with the possibility of developing ARDS as a complication.抄録全体を表示PDF形式でダウンロード (575K) -
的野 多加志, 忽那 賢志, 加藤 康幸, 竹下 望, 早川 佳代子, 金川 修造, 大曲 貴夫2016 年 90 巻 2 号 p. 125-128
発行日: 2016/03/20
公開日: 2017/08/19
ジャーナル フリーIn 2014, an outbreak of 162 domestic dengue fever infections occurred in Tokyo, Japan ; the first outbreak of its kind in 70 years. Nineteen of these cases were confirmed in our center. Advancements in diagnostic methods have enabled an earlier diagnosis of dengue fever ; however, unfamiliarity with the clinical course and characteristics of diagnostic tests for dengue fever can lead to misdiagnosis. We herein describe 2 cases of Japanese patients with false-positive dengue immunoglobulin M antibody test results, who were finally diagnosed as having dermatomyositis and acute hepatitis A infection, respectively.抄録全体を表示PDF形式でダウンロード (420K) -
平井 潤, 山岸 由佳, 坂梨 大輔, 小泉 祐介, 末松 寛之, 三鴨 廣繁2016 年 90 巻 2 号 p. 129-133
発行日: 2016/03/20
公開日: 2017/08/19
ジャーナル フリーWe report herein on a case of bacteremia caused by Ochrobactrum intermedium (O. intermedium) identified with biotyper matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). An 86-year-old man was admitted to our hospital with paralysis of the right side of the body and dysphagia. He was diagnosed as having a pontine infarction based on the brain MRI findings and was admitted to hospital to have anti-platelet therapy. Three days after admission, he had a fever. Although he had redness and swelling at the peripheral venous catheter insertion site, he was diagnosed as having aspiration pneumonia, since he had fine crackles on auscultation. Soon after taking two sets of blood cultures and removal of the peripheral venous catheter, sulbactam/ampicillin (SBT/ABPC) was administrated. Fifty three hours after incubation, gram-negative bacilli was detected from an aerobic bottle and identified as O. intermedium with MALDI-TOF MS (Bruker MS). Antimicrobial chemotherapy was changed to meropenem (MEPM). He was treated for a total of seven days, and recovered without relapse. Infection caused by O. intermedium has been very uncommon, however, O. intermedium has been recognized as an emerging pathogen in immunodeficient and immunocompetent patients. Since identification of Ochrobactrum species by biochemical methods could be difficult, MALDI-TOF MS might be helpful to clarify Ochrobactrum species just as in the present case.抄録全体を表示PDF形式でダウンロード (297K) -
坪井 基行, 宇野 俊介, 馳 亮太, 矢野 勇大, 山藤 栄一郎, 大塚 喜人, 細川 直登2016 年 90 巻 2 号 p. 134-137
発行日: 2016/03/20
公開日: 2017/08/19
ジャーナル フリーAlthough candiduria is becoming increasingly common among hospitalized patients, Candida lusitaniae is a rare pathogen that account for less than 1% of Candida species isolated from urine. Ascending pyelonephritis and candidemia due to Candida species are uncommon complications. We report herein on a case of acute pyelonephritis and candidemia due to C. lusitaniae. A 66-year-old man presented with a high fever during hospitalization at our hospital following septic shock due to ischial osteomyelitis treated with tazobactam/piperacillin for 29 days. We suspected acute pyelonephritis, and urinary Gram staining showed only yeasts and leucocytes. The next day, blood culture and urine culture tested positive and showed yeast-like fungi. We diagnosed acute pyelonephritis and candidemia due to Candida species and started treatment with fluconazole. C. lusitaniae was identified on the hospital day 34 and treated with fluconazole for 14 days. Candida albicans was the most prevalent species isolated from the urinary tract, however non-albicans Candida species have emerged and are now dominant because of the advent and increasing use of fluconazole. C. lusitaniae is a rare but important pathogen, that is generally susceptible to fluconazole and resistant to amphotericin B. It is necessary to choose an appropriately effective antifungal drug based on identification of the fungal species.抄録全体を表示PDF形式でダウンロード (311K) -
池田 浩, 永峰 恵介2016 年 90 巻 2 号 p. 138-141
発行日: 2016/03/20
公開日: 2017/08/19
ジャーナル フリーWe herein report on a 62-year-old man who presented with symptoms of intermittent fever that persisted after returning from a trip to France. During his trip, he had eaten natural cheese. Although no bacteria could be isolated from blood culture, the serum agglutination test showed a positive antibody titer of 1 : 160 for Brucella canis. The patient responded well to combination antibiotic therapy consisting of gentamicin, rifampicin, and doxycycline, and his symptoms improved. He became antibody-negative after antibiotic therapy. Although the present case may have been a case of B. canis infection, considering the epidemiology of brucellosis in France, serological cross-reactivity with Brucella melitensis infection is also a possibility. Concerns regarding the reemergence of brucellosis have recently been reported in France, and most cases are caused by B. melitensis. Clinicians should be aware of the fact that blood cultures must be incubated for ≥21 days for isolation of Brucella and that in Japan, antibody measurement of B. melitensis cannot be performed on a commercial basis.抄録全体を表示PDF形式でダウンロード (277K)
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