腸管感染症の診断と治療

Diagnostic Procedures and Treatment of Infectious Colitis

要旨●感染性腸炎の診断を進める場合，最も重要なのは臨床所見である．詳細な病歴から感染性腸炎との診断のみならず，疾患の絞り込みも可能である．これに糞便や血液を用いた細菌学・生化学・遺伝子的検査所見を加えることで，ほとんどの感染性腸炎の確定診断が可能となる．USやCT，X線造影・内視鏡などによる画像所見は，病変の好発部位，形状，配列などを分析することで潰瘍性大腸炎やCrohn病などの狭義のIBDとの鑑別に有用である．治療としては補液による脱水の補正と食事療法，適切な抗菌薬の使用が重要であり，起因菌が不明の場合はニューキノロン系抗菌薬，またはホスホマイシンの投与が推奨される．

　For the differential diagnosis of infectious colitis as well as to obtain its precise diagnosis, the evaluation of clinical findings is of utmost importance. A detailed disease history can help narrow down the diagnostic possibilities and lead to the precise diagnosis of infectious colitis. Definite diagnosis can be obtained by supplementing tests such as bacterial examinations with stool or blood samples, biochemistry, and genetic tests. The combined application of the imaging studies of ultrasound, CT scan, radiography, or colonoscopy for the analyses of the location, shape, and alignment of the lesions is useful for differentially diagnosing infectious colitis from IBD. The correction of dehydration by drip infusion, dietary therapy, and administration of adequate antibiotic drugs are considered to be most important approaches for the treatment of infectious colitis. In case of incomplete information on the disease-causing bacteria, the administration of new quinolone or fosfomycin is recommended as an empiric therapy.