2）イソスポーラ症

Diagnosis of Isosporiasis

要旨　イソスポーラ症の消化管病変について，自験例を含め文献的に考察した．本症は大量の腸管内腸液貯留のためX線検査による描出は不良になる傾向にあるが，発症数年以内の症例では小腸粘膜の浮腫やKerckring皺襞の腫大を認め，長期化に伴いKerckring皺襞の消失や粘膜の凹凸不整，粗大顆粒像を呈していた．十二指腸内視鏡所見では発症早期には粘膜の浮腫が中心で次第に粘膜の粗糙化から顆粒状，結節状へと進展しKerckring皺襞の消失を伴っていた．診断に関しては上部小腸，特に十二指腸粘膜において上記所見を拾い上げ，鑑別の中に本症を入れ，十分な臨床的情報とともに検体を提出することが重要である．

　Isosporiasis, aperoral infection of Isospora belli, is divided into two forms; acute and transient diarrhea in normal subjects and prolonged diarrhea in immunocompromised ones. We reported a case of isosporiasis and discussed the diagnosis of this infection. A review of the Japanese literature revealed that radiographic features of the small intestine were characterized by swollen Kerckring's folds during the first few years, and by disappearance of the folds and coarse and granular mucosa in the later period. Such differences in duodenoscopic findings according to the duration of symptoms were also reported. Biopsy specimens, duodenal juice and stools should be carefully examined when clinical features and radiographic or endoscopic findings suggested isosporiasis.