重症胃腸炎の原因としてのAeromonas Hydrophila：1例報告

Aeromonas Hydrophila as the Etiologic Agent in Severe Gastroenteritis: Report of a Case:

　82歳の女性．6週間にもわたる下痢のために入院した，糞便は泡沫状を呈し，緑色から黄色の色調変化を示した．入院約1週間前から食欲不振と脱水感を覚えるようになった．患者は生来極めて健康で，特に心臓や神経系には異常はなかった．5年前に腹部大動脈瘤の切除術を受けた．

　理学的検査では脱水の徴候をみる以外には異常は認められなかった．中毒（様）状態が続き，下痢も止まらず，大量のガスを伴った緑色の，悪臭を持つ水様便であった．便培養ではA．hydrophilaが純培養状に発育した．この菌は大部分のアミノ配糖体，テトラサイクリン，クロラムフェニコール，セファロシンに感性であり，ペニシリン，アンピシリン，カーベニシリンに耐性であった．そのほかの臨床検査所見：総蛋白4g/dl（6〜8.5）；アルブミン1.9g/dl（3.5〜5）．第2病日にテトラサイクリン（2g/日）の投与が開始された．（しかし）下痢の劇的な変化（改善）はみられなかった．以後3日間は便通が1日3〜5回あった．テトラサイクリン投与開始4日目になって，下痢は止まり再び下痢をみることはなかった．そのときの便培養では正常常在菌叢であり，A. hydropyilaは検出されなかった．胃，小腸，大腸のX線検査，S字状結腸の内視鏡検査では異常はなかった．治療10日後に患者は退院した．

An 82-year-old female entered the hospital with a history of diarrhea of six weeks duration. The stools were foamy and varied in color from green to yellow. Anorexia and weaknessbegan about one week prior to admission. The patient had a history of excellent health, particularly in regard to her cardiac and neurologic status. An abdominal aortic aneurysm wasresected five years previously. Physical examination was unremarkable except for signs of dehydration. She continued to appear toxic and the diarrhea persisted with much greener, foul-smelling liquid stools^*1 with large amounts of gas. The stcol culture grew pure culture of A. hydrophda.^*2 The organism was susceptible to most aminoglyccsides, tetracycline, chloramphenicol, and cephalothin but resistant to penicillin, ampicillin, and carbenicillin. Other laboratory results of note were : total protein 4g/dl (6-8.5); albumin 1.9 g/dl (3.5-5). Tetracycline(2g per day) was started on the second hospital day. There was no dramatic change in thediarrhea ; she continued having three to five stools per day for the next three days. The fourthday following the institution of tetracycline,^*3 the diarrhea stopped and did not recur. At thattime stcol culture revealed normal flora and no A. hydrophda. X-ray examination of the stomach, small and large bowel, and sigmoidoscopy revealed no abnormalities. The patient wasdischarged after 10 days of treatment.