Gemzella haemolysansによる心内膜炎を合併した心室中隔欠損症兼重症大動脈弁閉鎖不全の1例

A Case of Ventricular Septal Defect and Severe Aortic Regurgitation complicated with Subacute Endocarditis caused by Gemella Haemolysans

　心室中隔欠損症兼重症大動脈弁閉鎖不全の症例でGenzella haemolysansによる心内膜炎を合併した症例を経験した．同菌は，グラム陽性の双球菌で，呼吸器系の弱毒の常在菌であるが，極めてまれに心内膜炎の起炎菌として報告がみられる．経験した症例は文献にみられる同菌の心内膜炎の特徴を備えており，持続感染から発症したと考えられた．重症化する前に抗菌剤が計画的に使用されていれば，より効果的に治療し得たと思われた．Gemellahaemollysansは，培養・同定に困難があり，またその病原性があまり知られないため，臨床検体から分離されても雑菌として取り扱われる可能性もあり，見逃されている感染症例が少なからず存在すると思われる．報告例が極めてまれな感染症であるが，同菌の薬剤耐性の報告もあり，今後，日常の臨床で注意して対応を要する感染症のひとつと考え報告した．

This is a case of a 48-year-old Japanese female suffering from subacute bacterial endocarditis caused by Gemella haemolysans associated with ventricular septal defect and severe aortic regurgitation. While this organism is considered weakly virulent and commensal with humans in the respiratory system. it is occasionally implicated as a cause of infective endocarditis. Although the patient in the present case unfortunately died of an accidental complication after successful surgical procedures, it was characterized by features similar to those in previously reported cases of infective endocarditis caused by this organism and we probably could have managed this case more effectively, if a proper antibiotic had been chosen and its cautious application had been carried out.

Since there have been difficulties in cultivation and identification of Gomella haemolysans its pathogenicity has remained indefinite. A considerable number of cases of this type of endocarditis might have been overlooked in the past. Although only a limited mumber of cases of endocarditis caused by Gemella haemolvsans has been reported, there has been clinical evidence of drug resis-tant cases of this organism and, therefore. cautious strategies managing this problem have to be planned in daily clinical practice.