6．消化管感染症の病理

Pathology of Infectious Diseases of the Alimentary Tract

要旨　多種多様な消化管感染症を病因別に分け，それぞれの臨床病理学的特徴について概説した．このうち，組織像で確診できるのはHelicobacter pylori感染症，結核，非定型抗酸菌症，梅毒，巨細胞性封入体症，ヘルペス性食道炎，カンジダ症，アスペルギルス症，ムコール症，放線菌症，ランブル鞭毛虫症，クリプトスポリジウム症，イソスポーラ症，アメーバ赤痢，アニサキス症，糞線虫症，日本住血吸虫症，ビルハルツ住血吸虫症である．疑診可能なものは腸チフス，腸管出血性大腸菌O 157: H7大腸炎，Clostridium difficile腸炎，エルシニア腸炎である．その他の多くの細菌性腸炎は非特異的急性炎の像を呈し，それらの確診には細菌学的検査が必要である．以上から，消化管感染症の中にも，病理所見のみから確診できるものが少なからず存在するが，多くの細菌性腸炎の確診には細菌学的検査が必要であることが理解される．

　Variable infectious diseases of the alimentary tract which were classified according to their etiology and the clinicopathological characteristics of each disorder were briefly described. Among them, those which can be diagnosed by histological findings are Helicobacter pylori infection, tuberculosis, atypical mycobacterial infection (non-tuberculous mycobacterial infection), syphilis, cytomegalic inclusion disease, herpetic esophagitis, candidiasis, aspergillosis, mucormycosis, actinomycosis, giardia lamblia infection, cryptosporidiosis, isosporiasis, amebic dysentery, anisakiasis, strongyloidiasis, schistosomiasis japonica and bilharziasis. Tentative diagnosis can be made concerning such diseases as typhoid fever, enterohemorrhagic Escherichia coli O 157: H7-associated colitis, Clostridium difficile enteritis and Yersinia enteritis. As many other manifestations of bacterial enterocolitis show nonspecific acute inflammation, bacteriological examination is required for a definite diagnosis. In conclusion, some of infectious diseases of the alimentary tract can be diagnosed only by pathological findings, but, many of them require bacteriological examination for a definite diagnosis.