5）サルモネラ腸炎の臨床像―X線および内視鏡所見を中心に

Salmonella Enterocolitis : Clinical, Radiographic and Endoscopic Features

要旨　サルモネラ腸炎の臨床像について，X線・内視鏡像を中心に概説した．Salmonella属の菌種の表記方法は統一されておらず，混乱している．非チフス性サルモネラ菌は食中毒の主要な病原菌であり，近年Salmonella Enteritidisの鶏卵汚染による食中毒が増加している．サルモネラ腸炎の主病変はS状結腸から深部大腸に多くみられ，直腸病変は少ない．X線所見では潰瘍性大腸炎に類似した微細顆粒状粘膜・ハウストラの消失とびらんないし小潰瘍を呈するが，直腸が侵されにくい点が特徴的であり，内視鏡では粘膜の浮腫・発赤・びらん・粗糙・出血・潰瘍など多彩な像を呈する．治療にはニューキノロン系抗菌薬などが使用されるが，近年，Salmonella Typhimuriumの多剤耐性菌が増加している．

　The clinical, radiographic and endoscopic features of Salmonella enterocolitis were reviewed. The nomenclature for the bacterium is complex, and it has not yet been standardized. Nontyphoid Salmonella organisms are the major cause of bacterial gastroenteritis, and the incidence of egg-borne outbreaks of Salmonella enterica serotype Enteritidis infections has been increasing. In patients with Salmonella enterocolitis, each segment of the colons is equally involved, while the rectum is rarely affected. The radiographic findings are characterized by fine mucosal granularity, loss of haustration, and erosions or small ulcerations, which mimic ulcerative colitis, with rectal sparing. Endoscopically, various findings including edema, hyperemia, erosions, mucosal friability, bleeding or ulcerations are observed. Patients with salmonellosis are often treated by antimicrobiological agents such as fluoroquinolones. Recently, the outbreak of multidrug-resistant Salmonella enterica serotype Typhimurium has been confirmed.