抗菌薬関連消化管病変─Clostridium difficile感染症の診断と治療

Antibiotics Associated Gastrointestinal Disease: Diagnosis and Treatment of Clostridium difficile infection

要旨●最近の13年間に便毒素検査や便培養により，Clostridium difficile感染症（CDI）と診断され，大腸内視鏡検査を施行した39例について後方視的に内視鏡像，臨床像，診断方法，治療などについて検討した．CDIは内視鏡像から偽膜型，アフタ型，非特異型，正常型に分類することが可能であり，それぞれの割合は，36％，28％，15％，20％であった．臨床像と炎症反応の検討により，偽膜型はCDIの重症型であり，他の3型は軽症型であると考えられた．内視鏡像の検討より，アフタは偽膜の初期像の可能性が高いと推察された．また，非偽膜型の内視鏡像からもCDIを疑うことはある程度可能であると考えられた．CDIの診断はまずCD抗原とCD毒素の検査を行うことで迅速に判定を行う．それにCD培養，内視鏡検査などを組み合わせることで効率的で確実な診断が可能となる．偽膜型では薬物投与が必須であるが，それ以外では抗菌薬の中止のみで軽快する症例がみられる．

　For the past 13 years, CDI（Clostridium difficile infection）has been diagnosed by stool toxin testing and stool culture. We evaluated endoscopic images, clinical features, and diagnostic and treatment measures of CDI in 39 patients who underwent colonoscopy. Using endoscopic images, we could classify CDI into the following types：pseudomembranous（36%）, aphthoid（28%）, non-specific（15%）, and normal（20%）. Based on the clinical features and detection of inflammation on blood tests, the pseudomembranous type was observed to be a severe type of CDI, whereas the other three were observed to be milder types of CDI. It was speculated that the aphthoid type was likely to be an initial manifestation of the pseudomembranous type. Additionally, using endoscopic images, we could diagnose CDI from non-pseudomembranous type. Initially, diagnosis of CDI was determined quickly using CD antigen and toxin. Furthermore, CD stool culture in combination with colonoscopy were useful for the diagnosis of CDI. Drug administration is required for the pseudomembranous type ; however, other types can be relieved by stopping antibiotic administration.