ノカルジア脳膿瘍とβ-ラクタムを中心とした抗生物質感受性—脳室穿破の1例を中心として

Nocardia Braim Abscess and Ventriculitls: Resistance to sulfonamides and susceptibility to beta-lactams of nocardia

I．はじめに

　近年，日和見感染としての，弱毒菌，真菌類などによる感染症の発生増加が認められているが，なかでも放線菌類に属するNocadiaは，Eppingerによってヒトでの脳膿瘍起因菌として初めて報告^4）されて以来，200例に及ぶ報告を見てきた^11）．

　治療としては，古くよりサルファ剤が奏効するといわれ，ほとんどの症例で第一選択薬剤として用いられ，著効を奏してきた．しかし，最近サルファ剤無効のノカルジア感染症が報告され，また近年多くの抗生物質が開発され市販されて，予防的および治療的に使用される機会が多いことから，これらの薬剤とノカルジア感受性についても，再検討する必要が生じてきた．

　A 31-year-old man had been healthy until the end of August, 1984 when he developed a sore throat, rhinorrhea, and high fever (39°C).

He was found to have hematuria and leukocytosis, though his complaints were not severe, and was not absent from his work.

　From the September 30, he experienced continuous pains on both temple regions and the neck. On October 6, he visited our hospital without any inflammatory signs.

　A screening CT scan demonstrated a ring-like enhancing mass with remarkable perifocal edema in the right temporal lobe. On emergency admission on October 9, a low grade fever (37.4ﾟC) and slight leukocytosis were noted, but no other primary lesions were present. He had normal immunological function of both humoral and cellular types.