冬季に検出し得た Vibrio vulnificus 感染症の 1 例

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Key words: Vibrio vulnificus, V. vulnificus infection in winter season, import of fresh fish
and shellfishes
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Vol. 16
No. 1
2006.
1
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2
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Table 1.
Laboratory findings on admission.
(Atrina pectinata japonica) (Fig. 1) !"#$%%&'(
)("#$% 3 11 * 17 16 +,- ."/01234
5"/0% 6
+7- Japan Coma Scale 1 890%0
:9- ;<1=7$>?0@- AB
71/45 mmHg- - !C#?- "DE/
#- $%F 8&G'@ "#$% 4( A )H
*+- IJ,/-HKLMN."# B )H
/ + B ) H * 0 +- : - 1 O
33.2P- 23 68/- AB 87/30- 4- 5
A6- 7- 8Q9:;&- %- ARST<
=7- B )H-HKLMN.+U?> CK ?@- IVABW;&/0% ABCD@B
X E F- C G H D sulbactam / cefoperazone
(SBT/CPZ) 1 g IJKL%HYMZ!
(- N 20 +,- OT[PQR%&SH\T6
6]^_`aUb0H1$%
0H+ST5 (Table 1)c 0H+dARS
T<=7- IVAVVAC- CKῌCRP ?@WAeXdUfAYZXC- ghVACi
;&%
[\KLc 0H+ Japan Coma Scale 1, Glasgow
Coma Scale 13 8jkc lRjkm- no]pc
5^_%%q`- r]pc ab]p1/
r@- 1O 33.6P- st 20/- 23 76/- AB
74/u mmHg 1OC%&- Ocd[OeU
Results
Blood chemistry
AST (GOT)
725 U/l
ALT (GPT)
215 U/l
LD
584 U/l
ALP
232 U/l
T.B
2.44 mg/100 ml
D.B
1.41 mg/100 ml
TP
4.4 g/100 ml
ALB
2.06 g/100 ml
UN
45.4 mg/100 ml
Crea
1.68 mg/100 ml
UA
8.91 mg/100 ml
Ca
7.17 mg/100 ml
CK
19910 U/l
CKMB
381 U/l
Amylase
54 U/l
Serological tests
CRP
6.23 mg/100 ml
HBsAg
below sensitivity
CBC
WBC
17 ±102 /ml
RBC
374 ±104 /ml
Hb
13.3 g/100 ml
Ht
37.3 ²
Plt
2.8 ±104 /ml
Coagulation
PT
40 ²
FDP
6.4 mg/ml
Fib
212 g/100 ml
AT-ῌ
11 ²
PLG
19 ²
Reference limits
13°33
8°42
119°229
115°359
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°0.6
6.7°8.3
4.0°5.0
8°22
0.6°1.1
3.6°8.0
8.7°10.3
62°287
6°28
50°159
°0.4
40°90
430°570
14°18
40°52
13°36
60°130
°2.5
200°400
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96°117
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S[\Ÿ˜º»¼ Vol. 16
No. 1
2006.
C¸7¹ Vibrio vulnificus Ž,¹D
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Vol. 16
No. 1
2006.
3
4
Fig. 1.
Fig. 2.
Fig. 3.
4
Atrina pectinata japonica
Fig. 4.
Pathological analysis of the right-leg
muscles obtained from the autopsied
patient. Infiltration by inflammatory
cells mainly neutrophils, was observed
at perivascular and intermuscular areas.
Muscle tissues were partially necrotized.
(HE stain200)
Fig. 5.
Microbiological analysis of the right-leg
muscles obtained from the autopsied
patient Gram negative cocci, and rods
were mainly observed. (Gram stain
1000)
Red-purple colored change of the lower
extremities, and enlarged right lower
extremity.
Growth of V. vulnificus on Trypticase
Soy Agar with 5 Sheep Blood (left)
and TCBS Agar (right).
Vol. 16
No. 1
2006.
¶·‰] Vibrio vulnificus i]
Table 2.
5
Drug susceptibility test of Vibrio vulnificus and Staphylococcus epidermidis.
MIC ( mg/ml³
Vibrio vulnificus
Ampicillin
Piperacillin
Amoxicillin/clavulanic acid
Cefoprazon/sulbactam
Cefazolin
Cefaclor
Cefotiam
Cefoperazone
Cefotaxime
Cefpodoxime
Ceftazidime
Cefozopram
Cefepime
Cefpirome
Cefsulodin
Cefmetazole
Latamoxef
Flomoxef
Aztreonam
Imipenem
Meropenem
Levofloxacin
Ciprofloxacin
Gentamicin
Tobramycin
Amikacin
Minocyclin
Sulfomethoxazole/trimethoprim
Fosfomycin
´8
´16
´8
´16
´8
´8
16
´16
´8
´2
´8
16
´8
´8
µ16
´16
´8
´8
µ16
´4
´4
´2
´1
´4
8
32
´4
´0.5
´4
Staphylococcus epidermidis
µ8
µ2
8
64
´8
´4
´16
´8
´8
µ4
µ2
´8
16
´8
´8
´4
8
´2
´4
µ8
´4
´4
µ2
µ4
µ4
´2
´8
´2
´4
Penicillin G
Oxacillin
Ampicillin
Piperacillin
Ampicillin/sulbactam
Amoxicillin/clavulanic acid
Cefoprazon/sulbactam
Cefazolin
Cefotiam
Cefotaxime
Cefpodoxime
Cefdinir
Cefozopram
Cefepime
Cefpirome
Flomoxef
Imipenem
Meropenem
Norfloxacin
Gentamicin
Arbekacin
Minocyclin
Clindamycin
Erythromycin
Clarithromycin
Vancomycin
Teicoplanin
Sulfomethoxazole/trimethoprim
Fosfomycin
tamination 1qrl1PQ,-!"
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Vol. 16
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2006.
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Vol. 16
No. 1
2006.
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‰Š‹Œž 2001ž Vibrio vulnificus ž 
50: 526῍531ž
Ž= Ÿ ‘ž 1999ž Vibrio vulnificus ž ’G.™ 54: 586῍593ž
€ “0ž 1998ž ¡¢…£š¢<¤¥;†
ž INFECTION CONTROL 7: 282῍288ž
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Vibrio vulnificus ῌ— ˜ & ™ ¤ ¨ ©
ª‘©«š|ῌž o¬› 109: 875῍884ž
=œ­ žŸ ®} –ž 2004ž :;
X¯ L¡ Xk [\?)]% Vibrio vulnificus V @ A / B C ^ž ¢ 7: 580῍
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£ ¤ ° “¥ :ž¤¦Œ –ž 2002ž
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Š=¨ ©ª¦« ¬ –ž 2003ž Vibrio
vulnificus ± 1 x e ž ™ § ›
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­ ­ ®¯°Œ ±²5 –ž 2004ž
Vibrio ²2³Ey´šh)³´
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¶0¸ž 2001ž ·¸D¡¢…£²
&GQ1)d(ž Modern Media 47: 272῍
282ž
Klontz, K. C., S. Lieb, M. Chreiber, et alž 1998ž
Syndrome of Vibrio vulnificus infectionsž Clini-
ABC< Vibrio vulnificus ;#<D
11)
cal and epidemiological features in Florida
cases 1981ῌ1987 Ann Intern Med 109:
318ῌ323
Jackson, J. J., H. Kropp. 1992 b-Lactam antibiotic-induced release of free endotoxin: in
vitro comparison of penicillin-binding protein
(PBP)2-specific imipenem and PBP3-specific
12)
13)
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ceftazidime J Infect Dis 165: 1033ῌ1041
2003
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A Case of Vibrio vulnificus Infection Occurring in the Winter Season
Rie Horita1), Kouji Hashimoto1), Kazunori Nakata1), Kanta Kikuma2), Kimitaka Sagawa, MD1)
1)
2)
Department of Laboratory Medicine, Kurume University Hospital
Emergency and Critical Care Medical Center, Kurume University Hospital
We report a rare case of Vibrio vulnificus infection that occurred in the winter season. A 79 year-old
single male with liver cirrhosis ate raw Atrina pectinata shellfish in his house on November 14, 2004. On
November 17 a neighbor discovered him lying in bed, unable to walk due to severe leg pain that had started
soon after he had eaten the raw shellfish meat. He was admitted to the Emergency and Critical Care Medical
Center of Kurume University Hospital. Physical examination of the patient revealed Japan Coma Scale 1,
respiratory rate 20/min, body temperature 33.6?, pulse rate 76/min, blood pressure 74/@ mmHg,
red-purple colored change of the lower extremities, and enlarged right lower extremity. The right lower
extremity was sectioned in order to relieve the higher pressure. The sectioned leg exhibit a bad smell,
necrotized muscles, and exudates. Although intensive therapies were applied, the patient was expired on
November 18. Pathological analysis of the right-leg muscles obtained from the autopsied patient showed
typical features of V. vulnificus infection.
EFGH()IJK
Vol. 16
No. 1
2006.
7