腸アメーバ症

Intestinal Amebiasis

　近年，大腸ファイバースコープが普及し，潰瘍性大腸炎をはじめとする慢性炎症性大腸疾患，あるいは他の感染性腸炎や薬剤性腸炎などの急性出血性腸炎が多数発見されるようになってきたが，これらの疾患の鑑別診断の1つに腸アメーバ症を考えなければならなくなってきた．

　以上のような見地から古くは感染症学者の手にゆだねられていた本症の研究も，現在ではX線・内視鏡学的立場からのアプローチが要求されるようになってきたのである．

　腸アメーバ症は本邦では極めて少ない疾患であるが，自験例ならびに本邦報告例の集計から本症の臨床像を明らかにし，主としてその診断面について検討を加え，欧米の文献を参考にしつつ考察を試みた．

　In order to know clinical characteristics of intestinal amebiasis, a total of 32 cases were analyzed. Three of those were our experienced cases and the others were reported cases in Japan during a period of ten years from April 1972 to March 1982.

　Only 11 cases (46%) had a history of travel to foreign countries. One of the radiographic and endoscopic characteristics was multiple tiny ulcers with central yellowish coat surrounded by slight elevation and halo. Detectability of Entamoeba histolytica was 53% (9 out of 17 cases) in feces, 82% (18 out of 22 cases) in biopsy specimens and 100% (3 cases) in colonic mucus. As for the site of lesion, 34 per cent were in the rectum and sigmoid colon, 28% in the entire colon and 16% in the cecum or in the ileocecal region. In one of our experienced cases a lesion was suspected on radiography to exist in the appendix. Several surgical or autopsy cases had severe diseases such as extensive necrosis, huge ulceration and subsequent perforation and peritonitis.

　Metronidazole had therapeutic effects on most of the cases with intestinal amebiasis. Steroid was administered on five of the reported cases, and three of them had fatal prognosis. It seems most important to take intestinal amebiasis into consideration in the differential diagnosis of ulcero-hemorrhagic diseases of the colon. Steroid should not be used until the disease is ruled out.