感染性腸炎の病理

Histopathology of Infectious Colitis

要旨　感染性腸炎77例の自験生検材料と文献を参考にし，起因病原体別の組織像の特徴を分析した．このうち，組織像で確診ないし疑診できるものは，サイトメガロウイルス腸炎，アメーバ赤痢，Clostridium difficile腸炎，エルシニア腸炎，腸管出血性大腸菌腸炎，腸チフス，アニサキス症であった．ブドウ球菌性腸炎，細菌性赤痢，サルモネラ腸炎，キャンピロバクター腸炎，腸管出血性大腸菌を除くその他の病原性大腸菌性腸炎や腸炎ビブリオ腸炎は非特異的急性炎の組織像（多核白血球と慢性炎症細胞浸潤）を示した．後者の群の組織変化は，1～3病日には，好中球・好酸球が優位で，そこにリンパ球・形質細胞が加わり，4～7病日には，好中球が減少し，リンパ球・形質細胞優位となり，8病日以降は一般にすべての炎症細胞浸潤は減少した．最後に，感染性大腸炎とその他の炎症性腸疾患，特に，潰瘍性大腸炎の初発例との生検上での鑑別についても検討した．

　We analysed the histological features of various kinds of infectious colitis, using biopsy specimens from 77 cases of infectious colitis. We concluded that seven kinds of colitis induced by pathogenic organisms-Cytomegalovirus colitis, Amebic dysentery, Clostridium difficile colitis, Yersinia colitis, Escherichia coli O157: H7 associated colitis, Thphoid fever, and Anisakiasis-could be diagnosed or suspected only by their histological features.

　Among them, Staphylococcus associated colitis, Bacillary dysentery, Salmonella colitis, Campylobacter colitis, and Enteropathogenic E.coli except E.coli O157: H7 associated colitis, and Vibrio paraheamolyticus enterocolitis show non-specific acute inflammation; infiltration of neutrophils and chronic inflammatory cells. The histologic transition of these types of colitis is neutrophilic predominant infiltration on day 1 to day 3, lymphoid and plasma cell-predominant infiltration on day 4 to day 7, and decrease of inflammation cells after day 8.

　We also compared the histological features of infectious colitis with that of vergin ulcerative colitis.