tag:blogger.com,1999:blog-79713055014799349722024-02-07T21:03:55.800+09:00AA: 上宇部こどもクリニック〒755−0097 山口県 宇部市 常盤台1丁目20−2,
診察時間9:00〜18:30
☎0836−29−1155, Fax:0836-29-1156萩原啓二 Keiji Hagiwara http://www.blogger.com/profile/16535134028283517468noreply@blogger.comBlogger267125tag:blogger.com,1999:blog-7971305501479934972.post-13930218739837140002017-07-19T16:37:00.000+09:002017-07-19T16:37:58.739+09:00赤ちゃんのオムツかぶれ?<div style="text-align: center;">
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<span class="Apple-style-span" style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">赤ちゃんのオムツかぶれは,紙オムツの出現と共に激減しました。</span></div>
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<span class="Apple-style-span" style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">これは治りにくい ”オムツかぶれ”-----------赤い粒様に少し盛り上がった丘疹</span></div>
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<span class="Apple-style-span" style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">------------ これはカビの1種のカンジダが寄生した為で,オムツかぶれの軟膏</span></div>
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<span class="Apple-style-span" style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">ではよくなりません。抗真菌剤の軟膏で治療します。</span></div>
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位相差顕微鏡写真)カンジダ・アルビカンス</div>
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<span class="Apple-style-span" style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">人の皮膚,口,腸に常在するカビです。</span></div>
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<span class="Apple-style-span" style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">時に乳幼児では口や皮膚で異常増殖します。</span></div>
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<span class="Apple-style-span" style="color: #333333; line-height: 20px;"><span class="Apple-style-span" style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><span class="Apple-style-span" style="font-size: small;">ご質問,問い合わせは------------</span></span> </span></div>
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<span class="Apple-style-span" style="color: #333333; line-height: 20px;"><span class="Apple-style-span" style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><span class="Apple-style-span" style="font-size: small;">〒755-0097<br />
山口県 宇部市 常盤台1丁目20−2<br />
上宇部こどもクリニック</span></span></span></div>
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<span class="Apple-style-span" style="color: #333333; line-height: 20px;"><span class="Apple-style-span" style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><span class="Apple-style-span" style="font-size: small;">萩原啓二 </span></span></span></div>
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<span class="Apple-style-span" style="color: #333333; line-height: 20px;"><span class="Apple-style-span" style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><span class="Apple-style-span" style="font-size: small;">電話:0836−29−1155<br />
<span class="Apple-style-span" style="color: blue;"> keijihagiwara@gmail.com</span></span></span></span></div>
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萩原啓二 Keiji Hagiwara http://www.blogger.com/profile/16535134028283517468noreply@blogger.comtag:blogger.com,1999:blog-7971305501479934972.post-49897172220789089602017-07-19T16:30:00.000+09:002017-07-19T16:30:30.296+09:00あせも水<div class="separator" style="clear: both; text-align: center;">
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<span class="Apple-style-span" style="font-family: "times" , "times new roman" , serif;">あせも水</span></div>
<span class="Apple-style-span" style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><span class="Apple-style-span" style="font-size: large;"><u>あせも水</u></span></span></div>
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<span class="Apple-style-span" style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"> 昔から病院で処方されてきた水薬です。アセモ</span><span class="Apple-style-span" style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">(汗疹)</span><span class="Apple-style-span" style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">の子供の数</span></div>
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<span class="Apple-style-span" style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"> </span><span class="Apple-style-span" style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">の減少と</span><span class="Apple-style-span" style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">ともに,病院でも処方される機会が少なくなってきました。</span></div>
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<span class="Apple-style-span" style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"> 効能:あせも(汗疹),皮膚のかぶれ,痒み</span></div>
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<span class="Apple-style-span" style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"> 成分:その主成分は</span><span class="Apple-style-span" style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">酸化亜鉛,フェノール,レスタミンです。抗生物質</span><br />
<span class="Apple-style-span" style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"> や澱粉,サルチル酸を</span><span class="Apple-style-span" style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">加えているのもあります。当院では下記の</span><br />
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<span class="Apple-style-span" style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"> 1)酸化亜鉛 30g</span></div>
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<span class="Apple-style-span" style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"> 2)液状フェノール 10ml</span></div>
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<span class="Apple-style-span" style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"> 3)ハッカ油 2</span><span class="Apple-style-span" style="font-family: 'helvetica neue', arial, helvetica, sans-serif;">0ml</span></div>
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<span class="Apple-style-span" style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"> 4)エタノール 50ml</span></div>
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<span class="Apple-style-span" style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"> 5)グリセリン 100ml ーーーー滅菌水で1,000mLへ</span></div>
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<span class="Apple-style-span" style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><br />
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<span class="Apple-style-span" style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><span class="Apple-style-span" style="font-family: "times" , "times new roman" , serif;"> </span> 価格:60ml,300円 </span><br />
<span class="Apple-style-span" style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><span class="Apple-style-span" style="font-family: "times" , "times new roman" , serif;"><br />
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<span class="Apple-style-span" style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"></span><br />
<span class="Apple-style-span" style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">ご質問は: <br />
〒755ー0097<br />
山口県 宇部市 常盤台1丁目20−2<br />
上宇部こどもクリニック 萩原啓二 <br />
電話: 0836-29-1155<br />
Fax: 0836-29-1156<br />
E-mail: <a href="mailto:keijihagiwara@gmail.com">keijihagiwara@gmail.com</a><br />
</span></div>
萩原啓二 Keiji Hagiwara http://www.blogger.com/profile/16535134028283517468noreply@blogger.comtag:blogger.com,1999:blog-7971305501479934972.post-21096287911467810882017-01-29T10:35:00.000+09:002017-01-29T21:01:14.071+09:00タロ,ジロが生き残った理由<div class="separator" style="clear: both; text-align: center;">
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タロは昭和36年5月南極から帰国(6才)。その後北海道</div>
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大学付属植物園で余生を送り昭和45年8月死亡(15才)。</div>
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ジロは昭和35年7月 南極基地で死亡(5才)</div>
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<span class="Apple-style-span" style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">第一次及び第三次南極越冬隊員として犬係り, オーロラ観測任務で参加された<br />
北村泰一 先生【1931(昭和6)年生まれ,九州大学名誉教授,京大理学部地<br />
球物理学科卒】によるとタロ,ジロが生き残った理由として--------<br />
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1)犬の年齢:第一越冬に参加した時点でのカラフト犬15匹の年齢は<br />
<span class="Apple-style-span" style="color: #f3f3f3;">ーー</span>1才から5才で,中心メンバーは3~4才犬。タロ,ジロ兄弟は<br />
<span class="Apple-style-span" style="color: white;">ーー</span>1才で一番若く予備軍の犬だった。タロ,ジロは同時に生まれた<br />
<span class="Apple-style-span" style="color: white;">ーー</span>兄弟(稚内で3匹同時に生まれたが,一番下のサブローは北海道<br />
<span class="Apple-style-span" style="color: white;">ーー</span>で訓練中に病死)でいつも行動を共にしていた。昭和基地で越冬<br />
<span class="Apple-style-span" style="color: white;">ーー</span>を開始した時は1才で,そこを我が家と思っていた節がある。<br />
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2)約1年ぶりにタロ,ジロと再会した時,最初はどの犬かわからな<br />
<span class="Apple-style-span" style="color: white;">ーー</span>かった。ましてタロ,ジロは大きく成長し,飢餓状態というより<br />
<span class="Apple-style-span" style="color: white;">ーー</span>栄養が満ち足りた体だった。</span><br />
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<span class="Apple-style-span" style="color: white;">ーー</span>犬の中には飢餓時に共食いするのがいるが,鎖につながれたまま<br />
<span class="Apple-style-span" style="color: white;">ーー</span>発見された7匹の遺体はそのまま。 不思議な事に昭和基地に残<br />
<span class="Apple-style-span" style="color: white;">ーー</span>してあった人間用及び犬用の保存食にはいっさい手をつけてなか<br />
<span class="Apple-style-span" style="color: white;">ーー</span>った。飢餓状態なら,これらを食べていたに違いない。<br />
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<span class="Apple-style-span" style="color: white;">ーー</span>第一次越冬中,アザラシの糞(不消化物が多い)を食べたり,<br />
<span class="Apple-style-span" style="color: white;">ーー</span>ペンギンを襲って殺していた。あと海鳥,氷に閉じ込められた魚<br />
<span class="Apple-style-span" style="color: white;">ーー</span>を食べていたんでしょう。<br />
<br />
<span class="Apple-style-span" style="color: white;">ーー</span>アメリカ版の南極物語(Eight Below) では,sea leopard 海豹に<br />
<span class="Apple-style-span" style="color: white;">ーー</span>犬が襲われるシーンがあるが,昭和基地の周囲海域にはいない。<br />
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<span class="Apple-style-span" style="color: white;">ーー</span>首輪を外していた他の6匹は行方不明だが,氷海に消えたか,<br />
<span class="Apple-style-span" style="color: white;">ーー</span>ブリザードで死んだか?どうか本当のことは分からない。<br />
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3)-------- あれから50年たったが,今でも悔やまれることがある。<br />
<span class="Apple-style-span" style="color: white;">ーー</span>基地に戻ってくる予定で15頭の犬たちの首輪を1つ締めたこと<br />
<span class="Apple-style-span" style="color: white;">ーー</span>である。しめなければ7頭は首輪を外して生き延びたかもしれない。</span><br />
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引用図書)<br />
i) 北村 泰一 :南極越冬隊 タロジロの真実,小学館文庫,2007年3月発行<br />
ii) 北村 泰一:タロジロ,私と映画 " 南極物語 " の真実,p21~40,<br />
<span class="Apple-style-span" style="color: white;">ーーーーーー</span>小野延雄,柴田鉄治 編:日本南極観測隊,丸善:平成18年11月発行<br />
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ご質問<br />
〒755ー0097<br />
山口県 宇部市 常盤台1丁目20−2<br />
上宇部こどもクリニック 萩原啓二 <br />
電話: 0836-29-1155<br />
Fax: 0836-29-1156<br />
E-mail: keijihagiwara@gmail.com</span></div>
萩原啓二 Keiji Hagiwara http://www.blogger.com/profile/16535134028283517468noreply@blogger.comtag:blogger.com,1999:blog-7971305501479934972.post-45141280108613866852017-01-29T10:20:00.000+09:002017-01-29T21:00:05.530+09:00南極で生き延びたカラフト犬:タロ,ジロ南極で生き延びたカラフト犬(Sakhalin Husky)タロ,ジロのお話です。<br />
明治に白瀬中尉が南極探検を行なって以来日本の南極観測は中止されて<br />
いましたが,戦後10有余年をえて南極観測隊を送りました。<br />
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1956(昭和31)年11月8日 第一次南極観測隊 東京晴海埠頭を出発。<br />
1957(昭和32)年1月29日 オングル島に到着<br />
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<span class="Apple-style-span" style="color: white;">ーーーーーーー ー</span>2月11日 オングル島に( 69°00′ S 39°35′ E)昭和基地が完成。<br />
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1957年2月,第一次越冬隊員11名。カラフト犬19匹,猫1匹,カナリア2羽も越冬。</div>
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------ 樺太犬(Sakhalin Husky dog)は北海道はじめ全国から集められた。</div>
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1957年10月27日 犬ぞりを使用してボツンヌーテン山に初登頂。<br />
<span class="Apple-style-span" style="color: white;">ーーーーーーーー</span>雪上車4台はエンジントラブルで使用不能。</div>
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1958(昭和33)年2月 越冬隊の交代。</div>
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<span class="Apple-style-span" style="color: white;">ーーー</span>天候が悪化して宗谷は氷に閉じ込められ昭和基地に接近することできず</div>
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<span class="Apple-style-span" style="color: white;">ーーー</span>アメリカの砕氷船に助けられる。24日第一次越冬隊員はヘリコプターで</div>
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<span class="Apple-style-span" style="color: white;">ーーー</span>緊急撤退し第二次越冬は中止。樺太犬15匹は鎖につながれたまま(気候</div>
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<span class="Apple-style-span" style="color: white;">ーーー</span>回復すればすぐに基地に帰る予定だったので)昭和基地に残された。</div>
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氷に閉じ込められた宗谷<br />
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1958(昭和33)年4月24日 南極観測隊が帰国。なぜカラフト犬15匹を置き</div>
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<span class="Apple-style-span" style="color: white;"> </span>去りにしたのかと日本国中から非難殺到,連日,脅迫状と電話が届く。</div>
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1958(昭和33)年11月12日 第三次南極観測隊 東京出発。</div>
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1959(昭和34)年1月14日 11か月ぶりに第三次越冬隊が昭和基地に<br />
<span class="Apple-style-span" style="color: white;"> </span>到着した時,2匹の黒犬タロ,ジロを発見。7匹は鎖に繋がれ<br />
<span class="Apple-style-span" style="color: white;"> </span>たまま息絶えており,6匹は鎖をはずしていて行方不明。<br />
<span class="Apple-style-span" style="color: white;"></span><br />
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生きていたタロ(左)ジロ(右)</div>
<div style="text-align: center;">
と再会した北村 泰一隊員</div>
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<br /></div>
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1983(昭和58)年 映画<南極物語>を公開。</div>
<div style="text-align: left;">
<span class="Apple-style-span" style="color: white;"> </span>高倉健,渡瀬恒彦が主演,夏目雅子が出ています。</div>
<div style="text-align: left;">
<span class="Apple-style-span" style="color: white;"> </span>音楽はギリシャのVangelisが作曲。</div>
<div style="text-align: left;">
→ <a href="http://www.youtube.com/watch?v=5w0Xy_6WIY0&feature=related"><span class="Apple-style-span" style="color: blue;">http://www.youtube.com/watch?v=5w0Xy_6WIY0&feature=related</span></a></div>
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<br /></div>
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2006年ウオルトデズニーがリメイク版<a href="http://www.blogger.com/goog_621371782"><span class="Apple-style-span" style="color: blue;"><</span></a><a href="http://www.blogger.com/goog_621371782"><span class="Apple-style-span" style="color: blue;">Eight Below</span></a><a href="http://www.youtube.com/watch?v=Z3eBOcWmZw4&feature=related"><span class="Apple-style-span" style="color: blue;">></span></a>をアメリカで公開。</div>
<div style="text-align: left;">
→ <a href="http://www.youtube.com/watch?v=Z3eBOcWmZw4&feature=related"><span class="Apple-style-span" style="color: blue;">http://www.youtube.com/watch?v=Z3eBOcWmZw4&feature=related</span></a></div>
<div style="text-align: left;">
<span class="Apple-style-span" style="color: white;"> </span>このディズニー映画では犬種は,カラフト犬(=Sakhalin Husky)でなく</div>
<div style="text-align: left;">
<span class="Apple-style-span" style="color: white;"> </span>Alaskan Malamutesと Siberian Huskies を使っていますが,日本版に</div>
<div style="text-align: left;">
<span class="Apple-style-span" style="color: white;"> </span>比較して実によく犬を描いてます。犬がよく訓練されていて,集団で</div>
<div style="text-align: left;">
<span class="Apple-style-span" style="color: blue;"><span class="Apple-style-span" style="color: white;"> </span><a href="http://www.youtube.com/watch?v=qrPeYHdSd0E&feature=related"><span class="Apple-style-span" style="color: blue;">海鳥をとるシーン</span></a></span>は圧巻。</div>
<div style="text-align: left;">
→ <a href="http://www.youtube.com/watch?v=qrPeYHdSd0E&feature=related"><span class="Apple-style-span" style="color: blue;">http://www.youtube.com/watch?v=qrPeYHdSd0E&feature=related</span></a></div>
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参照)</div>
<div style="text-align: left;">
i) 北村 泰一 :南極越冬隊 タロジロの真実,小学館文庫,2007年3月発行</div>
<div style="text-align: left;">
ii) 北村 泰一:タロジロ,私と映画 " 南極物語 " の真実,p21~40,</div>
<div style="text-align: left;">
<span class="Apple-style-span" style="color: white;">ーーーーーー</span>小野延雄,柴田鉄治 編:日本南極観測隊,丸善:平成18年11月発行<br />
iii) 南極物語ドキュメント:<a href="http://www.youtube.com/watch?v=udhGje2sCIs&feature=related"><span class="Apple-style-span" style="color: blue;">http://www.youtube.com/watch?v=udhGje2sCIs&feature=related</span></a><br />
<br />
ご質問<br />
〒755ー0097<br />
山口県 宇部市 常盤台1丁目20−2<br />
上宇部こどもクリニック 萩原啓二 <br />
電話: 0836-29-1155<br />
Fax: 0836-29-1156<br />
E-mail: keijihagiwara@gmail.com</div>
</div>
萩原啓二 Keiji Hagiwara http://www.blogger.com/profile/16535134028283517468noreply@blogger.comtag:blogger.com,1999:blog-7971305501479934972.post-72438605851237711422014-01-27T17:17:00.000+09:002014-01-27T17:17:23.723+09:00ノロ・ウイルスによる急性胃腸炎(嘔吐下痢症)<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhi7CzdEqaQeG78LmcYrcuDAAV0RFoMTqEJ-giMkza-l91VfXbgZMhxMa1tyV9uDgA4hxaoQwJrrd554wxTMP-RU4z5iTwOUT1mfD7zxwhxrVqMnbX2a6vCygzPPnDxRcRbRhchJSJxWqVl/s1600/%25E3%2583%258E%25E3%2583%25AD%25E3%2582%25A6%25E3%2582%25A4%25E3%2583%25AB%25E3%2582%25B9%25E3%2581%25AE%25E9%259B%25BB%25E9%25A1%2595%25E5%2586%2599%25E7%259C%259F.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhi7CzdEqaQeG78LmcYrcuDAAV0RFoMTqEJ-giMkza-l91VfXbgZMhxMa1tyV9uDgA4hxaoQwJrrd554wxTMP-RU4z5iTwOUT1mfD7zxwhxrVqMnbX2a6vCygzPPnDxRcRbRhchJSJxWqVl/s320/%25E3%2583%258E%25E3%2583%25AD%25E3%2582%25A6%25E3%2582%25A4%25E3%2583%25AB%25E3%2582%25B9%25E3%2581%25AE%25E9%259B%25BB%25E9%25A1%2595%25E5%2586%2599%25E7%259C%259F.jpg" height="320" width="272" /></a></div>
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ノロ・ウイルスの電子顕微鏡写真<br />
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<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">~~~~~~~~~~~~~~~~~~~~~~~~</span></span></div>
<br />
<div style="text-align: left;">
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">ノロ・ウイルスによる急性胃腸炎</span></div>
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"></span></span><br />
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"></span></span><br />
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><div style="text-align: left;">
~~~~~~~~~~~~~~~~~~~~~~~~</div>
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<br /></div>
<div style="text-align: left;">
急性胃腸炎(嘔吐下痢症)をおこします。嘔吐,腹痛から始まり半日</div>
<div style="text-align: left;">
は嘔吐がおさまりません。その後に下痢がきます。ロタウイルスや</div>
<div style="text-align: left;">
アデノウイルスによるものと同じ症状で区別がつきません。</div>
<div style="text-align: left;">
<br /></div>
<div style="text-align: left;">
ロタウイルスによる嘔吐下痢症は子供がよく罹りますが中学生ぐらいに</div>
<div style="text-align: left;">
なると,感染してもほとんど発病しません。</div>
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<br /></div>
<div style="text-align: left;">
しかし,ノロ・ウイルスは家族のうち1人が罹ると,だいたい全員がつぎ</div>
<div style="text-align: left;">
つぎと発病します。感染してから発病するまで(潜伏期間)が12時間</div>
<div style="text-align: left;">
〜48時間と短いのが特徴で,食中毒の型をとります。ただし嘔吐,下痢</div>
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の症状には個人差あり,感染しても発病しない人もいます。</div>
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<br /></div>
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ノロ・ウイルスは,以前はNorwalk-like viruses,caliciviruses, あるいは</div>
<div style="text-align: left;">
Small round structured viruses と呼ばれていました。</div>
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<br /></div>
<div style="text-align: left;">
感染経路)経口感染(ノロ・ウイルスに汚染された食べ物を食べる</div>
<span class="Apple-style-span" style="color: white;"><div style="text-align: left;">
<span class="Apple-style-span" style="color: black;"><span class="Apple-style-span" style="color: white;">ーーーーー</span>100個のウイルスが口から入ると感染し発病(個人差があり)</span></div>
</span><span class="Apple-style-span" style="color: white;"><div style="text-align: left;">
<span class="Apple-style-span" style="color: black;"><span class="Apple-style-span" style="color: white;">ーーーーー</span>することがあります。汚染された生カキを食べて感染発病</span></div>
</span></span></span><br />
<div style="text-align: left;">
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーー</span>した事例もありました。</span></div>
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"></span><br />
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"></span><br />
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><div style="text-align: left;">
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span></div>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><div style="text-align: left;">
集団発生)病院や学校でノロ・ウイルスに感染した調理員が料理を作り</div>
<span class="Apple-style-span" style="color: white;"><div style="text-align: left;">
<span class="Apple-style-span" style="color: black;"><span class="Apple-style-span" style="color: white;">ーーーーー</span>その食べ物を食べた入院患者さん,学童が集団感染した</span></div>
</span><span class="Apple-style-span" style="color: white;"><div style="text-align: left;">
<span class="Apple-style-span" style="color: black;"><span class="Apple-style-span" style="color: white;">ーーーーー</span>事例があります。</span></div>
</span><div style="text-align: left;">
<br /></div>
<span class="Apple-style-span" style="color: red;"><div style="text-align: left;">
▼ 注意:1)このウイルスは凍結しても死にません。冷凍冷蔵庫の中でも</div>
<span class="Apple-style-span" style="color: white;"><div style="text-align: left;">
<span class="Apple-style-span" style="color: red;">生存します。また60度の温度では死にません。</span></div>
</span></span></span></span><br />
<br />
<div style="text-align: left;">
<span class="Apple-style-span" style="color: red; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">2)ノロ・ウイルスにはアルコール消毒は無効です。</span></div>
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"></span><br />
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"></span><br />
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><div style="text-align: left;">
<span class="Apple-style-span" style="color: red; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーーー</span>赤ちゃんの哺乳瓶の消毒に使用する次亜塩素酸ナトリウム</span></div>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><div style="text-align: left;">
<span class="Apple-style-span" style="color: red;"><span class="Apple-style-span" style="color: white;">ーー </span>(ミノトン,ミルクポンpigeon)が有効。</span></div>
</span></span></div>
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<span class="Apple-style-span" style="color: red; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span></div>
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<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">ノロウイルスの迅速診断)
</span></span><br />
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<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> 糞便で検査。15分で判定しますが,擬陽性や</span></span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">陰性もあります。</span></div>
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;"> </span>その感度,特異性はRT-PCR法と比較すると以下の如く。</span></div>
<br />
製造販売:<a href="http://www.denka-seiken.jp/"><span class="Apple-style-span" style="color: blue;">デンカ生研</span></a> <a href="http://www.denka-seiken.jp/"><span class="Apple-style-span" style="color: blue;">http://www.denka-seiken.jp/</span></a><br />
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"></span></span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-family: Times;"><span class="Apple-style-span" style="color: white;">ーーーーーーーー</span>RT-PCR法との比較試験:擬陽性より偽陰性が多い。</span></span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;"><br /></span></span>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;"><span class="Apple-style-span" style="font-family: Times;">------------------------</span> </span></span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">---------------------------------------------------</span><br />
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">---------------------------------------------</span>RT-PCR<br />
<span class="Apple-style-span" style="color: white;">-------------------------------------------</span>(+)<span class="Apple-style-span" style="color: white;">-------</span>( - )<span class="Apple-style-span" style="color: white;">----- </span>total</span></span><br />
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"></span></span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">-------------------- </span>----------------------------------------------------</span><br />
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;"> -------------------</span>rapid test<span class="Apple-style-span" style="color: white;">----</span>( +)<span class="Apple-style-span" style="color: white;">----</span>53<span class="Apple-style-span" style="color: white;">--------</span>1<span class="Apple-style-span" style="color: white;">---------</span>54</span></span><br />
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"></span></span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">------------------------------------</span>( - ) <span class="Apple-style-span" style="color: white;">---</span>19<span class="Apple-style-span" style="color: white;">-------</span>90<span class="Apple-style-span" style="color: white;">-------</span>109</span><br />
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">--------------------</span> ----------------------------------------------------</span></span><br />
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">----------------------------------</span>total<span class="Apple-style-span" style="color: white;">l----</span>72<span class="Apple-style-span" style="color: white;">-------</span>91<span class="Apple-style-span" style="color: white;">------</span>163</span></span><br />
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">--------------------</span> ----------------------------------------------------<br />
</span></span><br />
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"></span></span><br />
<br />
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">
<div>
<br /></div>
問い合わせ先:</span></span><br />
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">〒755ー0097</span><br />
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">山口県 宇部市 常盤台1丁目20−2</span><br />
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">上宇部こどもクリニック 萩原啓二 </span><br />
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">電話: 0836-29-1155</span><br />
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Fax: 0836-29-1156</span><br />
<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">E-mail: keijihagiwara@gmail.com</span>萩原啓二 Keiji Hagiwara http://www.blogger.com/profile/16535134028283517468noreply@blogger.comtag:blogger.com,1999:blog-7971305501479934972.post-20196725247802360032014-01-27T15:41:00.000+09:002014-01-27T15:41:10.572+09:00嘔吐下痢の時に与える飲み物は?<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjusnU_Ef7xUyQYEtIpMF-af5vHiFmK17RqKwjd-Algk-ns0Pp3X4K-goFh82VXZODAh0ZIvKj_fx3_S-ntF7AioyL6rJ-hk1fzdwrqAXDvwRZ1sgLjXUJ6KxoC_W7QoFvHJ4HoYKzf_KSQ/s1600-h/%E7%B5%8C%E5%8F%A3%E8%A3%9C%E6%B0%B4%E6%B6%B2(1).jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em; text-decoration: none;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjusnU_Ef7xUyQYEtIpMF-af5vHiFmK17RqKwjd-Algk-ns0Pp3X4K-goFh82VXZODAh0ZIvKj_fx3_S-ntF7AioyL6rJ-hk1fzdwrqAXDvwRZ1sgLjXUJ6KxoC_W7QoFvHJ4HoYKzf_KSQ/s320/%E7%B5%8C%E5%8F%A3%E8%A3%9C%E6%B0%B4%E6%B6%B2(1).jpg" /></a></div>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">写真: <span class="Apple-style-span" style="color: red;">経口補水液</span>(<a href="http://pr.kenko.com/p/pr_0165001.html"><span class="Apple-style-span" style="color: red;">OS-1</span></a>)<br /><span class="Apple-style-span" style="color: white;">
-------- -</span>--------大塚製薬→ <a href="http://pr.kenko.com/p/pr_0165001.html">http://pr.kenko.com/p/pr_0165001.html</a></span><br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgMD-XazDvdh2hKY1SdwjaTO9g5GljFeWapV1wT-TJ3_9gAKDoULcodE8P8-TNk7bLaA5AWOa1arobXgQZE9HCMp7V-N72ZTzCDp6jumbkeqJZupnFbun2Ls0yrof608wp00l2YTvTH0B_O/s1600-h/%E7%B5%8C%E5%8F%A3%E8%A3%9C%E6%B0%B4%E6%B6%B2(2).jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgMD-XazDvdh2hKY1SdwjaTO9g5GljFeWapV1wT-TJ3_9gAKDoULcodE8P8-TNk7bLaA5AWOa1arobXgQZE9HCMp7V-N72ZTzCDp6jumbkeqJZupnFbun2Ls0yrof608wp00l2YTvTH0B_O/s1600-h/%E7%B5%8C%E5%8F%A3%E8%A3%9C%E6%B0%B4%E6%B6%B2(2).jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><br />
</a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgMD-XazDvdh2hKY1SdwjaTO9g5GljFeWapV1wT-TJ3_9gAKDoULcodE8P8-TNk7bLaA5AWOa1arobXgQZE9HCMp7V-N72ZTzCDp6jumbkeqJZupnFbun2Ls0yrof608wp00l2YTvTH0B_O/s1600-h/%E7%B5%8C%E5%8F%A3%E8%A3%9C%E6%B0%B4%E6%B6%B2(2).jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><br />
</a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgMD-XazDvdh2hKY1SdwjaTO9g5GljFeWapV1wT-TJ3_9gAKDoULcodE8P8-TNk7bLaA5AWOa1arobXgQZE9HCMp7V-N72ZTzCDp6jumbkeqJZupnFbun2Ls0yrof608wp00l2YTvTH0B_O/s1600-h/%E7%B5%8C%E5%8F%A3%E8%A3%9C%E6%B0%B4%E6%B6%B2(2).jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><br />
</a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgMD-XazDvdh2hKY1SdwjaTO9g5GljFeWapV1wT-TJ3_9gAKDoULcodE8P8-TNk7bLaA5AWOa1arobXgQZE9HCMp7V-N72ZTzCDp6jumbkeqJZupnFbun2Ls0yrof608wp00l2YTvTH0B_O/s1600-h/%E7%B5%8C%E5%8F%A3%E8%A3%9C%E6%B0%B4%E6%B6%B2(2).jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><br />
</a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgMD-XazDvdh2hKY1SdwjaTO9g5GljFeWapV1wT-TJ3_9gAKDoULcodE8P8-TNk7bLaA5AWOa1arobXgQZE9HCMp7V-N72ZTzCDp6jumbkeqJZupnFbun2Ls0yrof608wp00l2YTvTH0B_O/s1600-h/%E7%B5%8C%E5%8F%A3%E8%A3%9C%E6%B0%B4%E6%B6%B2(2).jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><br />
</a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgMD-XazDvdh2hKY1SdwjaTO9g5GljFeWapV1wT-TJ3_9gAKDoULcodE8P8-TNk7bLaA5AWOa1arobXgQZE9HCMp7V-N72ZTzCDp6jumbkeqJZupnFbun2Ls0yrof608wp00l2YTvTH0B_O/s1600-h/%E7%B5%8C%E5%8F%A3%E8%A3%9C%E6%B0%B4%E6%B6%B2(2).jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><br />
</a> <img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgMD-XazDvdh2hKY1SdwjaTO9g5GljFeWapV1wT-TJ3_9gAKDoULcodE8P8-TNk7bLaA5AWOa1arobXgQZE9HCMp7V-N72ZTzCDp6jumbkeqJZupnFbun2Ls0yrof608wp00l2YTvTH0B_O/s320/%E7%B5%8C%E5%8F%A3%E8%A3%9C%E6%B0%B4%E6%B6%B2(2).jpg" /><br />
<div style="text-align: center;">
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: red;">OS-1</span>の成分濃度。</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span></div>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~<br />
世界保健機構 WHO は乳児の嘔吐下痢症の時には<span class="Apple-style-span" style="color: red;">経口補水液</span></span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: red;"> </span></span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><a href="http://en.wikipedia.org/wiki/Oral_rehydration_therapy"><span class="Apple-style-span" style="color: blue;">ORS ( Oral Rehydration Solusion )</span></a> </span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">を与えるように指導してきました。</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> <br />
最初はコレラによる下痢の脱水の予防用に開発されました。その後</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">発展途上国の子どもの下痢症用に改良されてきました。</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br />
日本,欧米ではコレラでなく,ロタウイルス,アデノウイルス<br />
ノロウイルス,その他のウイルスによる嘔吐下痢症が圧倒的に多い<br />
ですので,Na, Clの濃度は低めになっています。</span><br />
<div>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br />
<br />
<span class="Apple-style-span" style="color: white;">--------------------- </span>Na<span class="Apple-style-span" style="color: white;"> --- -</span> K <span class="Apple-style-span" style="color: white;">-------</span>Cl <span class="Apple-style-span" style="color: white;">----</span> Citric acid<span class="Apple-style-span" style="color: white;">------</span> glucose</span><br />
<div>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> --------------------------------------------------------------------------------------<br />
<a href="http://en.wikipedia.org/wiki/Oral_rehydration_therapy"><span class="Apple-style-span" style="color: blue;">WHO-ORS</span></a><span class="Apple-style-span" style="color: white;">--------</span> 75~90<span class="Apple-style-span" style="color: white;">---</span>20<span class="Apple-style-span" style="color: white;">----</span> 65~80 <span class="Apple-style-span" style="color: white;">---- </span>10 <span class="Apple-style-span" style="color: white;">----------</span> 75~111<br />
<br />
<a href="http://pr.kenko.com/p/pr_0165001.html"><span class="Apple-style-span" style="color: blue;">OS-1</span></a><span class="Apple-style-span" style="color: blue;"> </span><span class="Apple-style-span" style="color: white;">-------------- </span>50 <span class="Apple-style-span" style="color: white;">------</span> 20 <span class="Apple-style-span" style="color: white;">-----</span> 50 <span class="Apple-style-span" style="color: white;">---------------------- </span>100 (mmol/L)</span></div>
<div>
------------------------------<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-family: Times;">--------------------------------------------------------------------------</span><span class="Apple-style-span" style="font-family: Times;"><br />
</span><span class="Apple-style-span" style="font-family: Times;">➞ <span class="Apple-style-span" style="color: red;">ポカリスエット</span>はスポーツ用に開発されたものでNa, K, Clの濃度が</span> <span class="Apple-style-span" style="color: white;">ーー</span></span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">------</span>OS-1より低い。</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br />
➞ <span class="Apple-style-span" style="color: red;">経口補水液</span>の与え方:</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">---------- 嘔吐が始まって半日の間は,最初は10〜20mlずつ少量を与えます。 </span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">----------</span> しばらくしたら,補水液を嘔吐しますが間をおいて少量ずつ与えて</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">----------</span> ください。半日〜1日すると(ロタウイルス,アデノウイルス,</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">----------</span> ノロウイルスなどは)吐き気はおさまってきます。おさまらない</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">----------</span> 時は他の原因によることが多い。</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">----------</span> 子どもさんは,ジュース類,他のプリンなど食べ物を欲しがります</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">----------</span> が与えないで下さい。<br />
</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br />
問い合わせ先:</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">〒755ー0097<br />
山口県 宇部市 常盤台1丁目20−2<br />
上宇部こどもクリニック 萩原啓二 <br />
電話: 0836-29-1155<br />
Fax: 0836-29-1156<br />
E-mail: <a href="mailto:keijihagiwara@gmail.com"><span class="Apple-style-span" style="color: blue;">keijihagiwara@gmail.com</span></a></span></span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br />
</span></div>
</div>
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<a href="http://www.yamaguchi-blog.com/wj.php?cd=00me&b=1" target="_blank" utn=""><img src="http://www.yamaguchi-blog.com/area/banner003.gif" style="border: 0; height: 30px; width: 150px;" /></a>萩原啓二 Keiji Hagiwara http://www.blogger.com/profile/16535134028283517468noreply@blogger.comtag:blogger.com,1999:blog-7971305501479934972.post-80843870180209179402014-01-27T15:34:00.000+09:002014-01-27T15:34:39.898+09:00ノロウイルスの消毒<div class="separator" style="clear: both; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-family: Times;"><span class="Apple-style-span" style="font-family: Times;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"></span></span></span></span></div>
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</span></span></span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-family: Times;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: red;">注意:</span> ノロウイルス<span class="Apple-style-span" style="color: red;">には<span class="Apple-style-span" style="color: black;">ア</span></span>ルコール消毒<span class="Apple-style-span" style="color: red;">は無効です。<br /> 赤ちゃんの哺乳瓶の消毒に使用する</span>次亜塩素酸ナトリウム<br /> (ミノトン,ミルクポンpigeon)<span class="Apple-style-span" style="color: red;">が有効。</span><br />
<br />
<br />
ご質問は: <br />
〒755ー0097<br />
山口県 宇部市 常盤台1丁目20−2<br />
上宇部こどもクリニック 萩原啓二 <br />
電話: 0836-29-1155<br />
Fax: 0836-29-1156<br />
E-mail:<span class="Apple-style-span" style="color: blue;"> </span><a href="mailto:keijihagiwara@gmail.com"><span class="Apple-style-span" style="color: blue;">keijihagiwara@gmail.com</span></a></span></span></span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br />
</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-family: Times;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"></span></span></span><a href="http://localwest.blogmura.com/ube/"><img alt="にほんブログ村 地域生活(街) 中国地方ブログ 宇部情報へ" border="0" src="http://localwest.blogmura.com/ube/img/ube468_60.gif" height="60" width="468" /></a><br />
<a href="http://www.yamaguchi-blog.com/wj.php?cd=00me&b=1" target="_blank" utn=""><img src="http://www.yamaguchi-blog.com/area/banner003.gif" style="border: 0; height: 30px; width: 150px;" /></a>萩原啓二 Keiji Hagiwara http://www.blogger.com/profile/16535134028283517468noreply@blogger.comtag:blogger.com,1999:blog-7971305501479934972.post-45561619145825707912014-01-27T15:30:00.000+09:002014-01-27T15:30:12.839+09:00ノロ・ウイルスの家族内感染<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">ノロ・ウイルスによる急性胃腸炎(嘔吐下痢症)は家族のうち1人が罹ると,<br />
だいたい全員がつぎつぎと発病します。感染してから発病するまで(潜伏期間)<br />
が12時間〜48時間と短いのが特徴で,食中毒の型をとります。</span><br />
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br />
</span></div>
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">ロタウイルスやアデノウイルスによる子供の嘔吐・下痢症は成人は感染しても</span></div>
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">免疫があるため発病しませんが,ノロ・ウイルスに対しては免疫がありません</span></div>
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">から感染すると発病します。<br />
<br />
~~~~~~~~~~~~~<br />
家族内感染の例<br />
~~~~~~~~~~~~~<br />
<span class="Apple-style-span" style="color: white;">-----------</span>4月23日 10才男子,学校で給食時に腹痛,嘔吐あり,</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーーーーー</span>そのあと下痢が始まった。</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> <span class="Apple-style-span" style="color: white;"> ---------------</span>25日 朝から父親(50才)と母親(45才)が共に腹痛,嘔吐,下痢。<br />
<span class="Apple-style-span" style="color: white;"> ーーーーーーーーー</span>その夜から兄(15才)が嘔吐,下痢。</span><br />
<br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">写真1)便の迅速診断キットによる判定:ノロウイルス(+)</span><br />
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写真2)ノロウイルスの電子顕微鏡写真</div>
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</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: red;">注意:</span><span class="Apple-style-span" style="color: red;">ノロウイルスにはアルコール消毒,塩酸ベンザルニコウム(通常は</span></span></div>
<div>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーー</span><span class="Apple-style-span" style="color: red;">病院,診療所で使用してます)は無効です。 <span class="Apple-style-span" style="color: black;">赤ちゃんの哺乳瓶の</span></span></span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: red;"><span class="Apple-style-span" style="color: white;">ーーー</span><span class="Apple-style-span" style="color: black;">消毒に使用する<span class="Apple-style-span" style="color: red;">次亜塩素酸ナトリウム</span>(ミノトン,ミルクポン<span class="Apple-style-span" style="font-family: Times;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">pigeon)</span></span></span></span></span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: red;"><span class="Apple-style-span" style="color: black;"><span class="Apple-style-span" style="font-family: Times;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーー</span>が有効です。</span></span></span></span></span></div>
<div>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-family: Times;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span></span></span>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-family: Times;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> <br />
ご質問は ----------------<br />
〒755ー0097<br />
山口県 宇部市 常盤台1丁目20−2<br />
上宇部こどもクリニック 萩原啓二 <br />
電話: 0836-29-1155<br />
Fax: 0836-29-1156<br />
E-mail:<a href="mailto:keijihagiwara@gmail.com"> <span class="Apple-style-span" style="color: blue;">keijihagiwara@gmail.com</span></a> </span></span></span></div>
萩原啓二 Keiji Hagiwara http://www.blogger.com/profile/16535134028283517468noreply@blogger.comtag:blogger.com,1999:blog-7971305501479934972.post-89124182752841235052012-11-13T10:55:00.001+09:002012-11-24T16:10:06.364+09:00恩師を囲む会<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">11月10日(土) 柴田二郎 先生を囲む会。</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"></span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> ーーーーーーーー</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">山口市亀山町</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> </span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">ラ,フランチェスカで</span><br />
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<br />萩原啓二 Keiji Hagiwara http://www.blogger.com/profile/16535134028283517468noreply@blogger.comtag:blogger.com,1999:blog-7971305501479934972.post-79458887607871905792012-10-10T18:09:00.001+09:002012-10-10T18:10:26.837+09:002012年ノーベル医学生理学賞<div class="separator" style="clear: both; text-align: center;">
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">2012年度ノーベル医学生理学賞に</span><span class="Apple-style-span" style="color: #222222; line-height: 16px;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">山中伸弥 教授(</span></span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">京都大学)とジョン・</span></div>
<div class="separator" style="clear: both; text-align: left;">
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">ガードン教授</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">(ケンブリッジ大学)</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">が選ばれました。</span></div>
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<br />萩原啓二 Keiji Hagiwara http://www.blogger.com/profile/16535134028283517468noreply@blogger.comtag:blogger.com,1999:blog-7971305501479934972.post-72445519790937258242012-09-25T11:13:00.001+09:002012-09-25T11:14:35.730+09:00ポリオ不活化ワクチン<div class="separator" style="clear: both; text-align: center;">
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<br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">この9月からポリオワクチンが生ワクチン(経口)から不活化ワクチン(皮下注射)</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">に変更されました。 DPTワクチンと混合した4種ワクチンは,この後しばらくしたら</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">認可される予定です。</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">対象: 生後3か月〜7才半</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">投与回数: 初回接種は3回(3〜8週あけて)</span><br />
<span class="Apple-style-span" style="color: white;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">ーーーーーー</span></span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">追加接種 1回(6か月あけて)</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span>
<span class="Apple-style-span" style="color: white;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> </span></span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">経口生ポリオワクチン1回受けた➞ 2回(3〜8週あけて)</span><br />
<span class="Apple-style-span" style="color: white;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">ーーーーーーーーーーーーーーーーーーーーーーー</span></span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">追加1回(6か月以上あける)</span><br />
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">ご質問は: </span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">〒755ー0097</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">山口県 宇部市 常盤台1丁目20−2</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">上宇部こどもクリニック 萩原啓二 </span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">電話: 0836-29-1155</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Fax: 0836-29-1156</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">E-mail: keijihagiwara@gmail.com</span>萩原啓二 Keiji Hagiwara http://www.blogger.com/profile/16535134028283517468noreply@blogger.comtag:blogger.com,1999:blog-7971305501479934972.post-28588215661649732922012-09-01T12:24:00.003+09:002012-10-25T11:32:11.596+09:00マイコプラズマ肺炎<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">NHKから電話があり,NHK総合放送の”朝いち”で,マイコプラズマ肺炎のX線写真</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">を使用したい旨連絡がありました(8月31日放送)。</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> </span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">今年は,マイコプラズマ・ニューモニエ (肺炎マイコプラズマ </span><i><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Mycoplasma </span></i><br />
<i><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">pneumoniae</span></i><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">) 感染症が流行しています。これについて少し詳しく説明します。</span><br />
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">出典は 萩原啓二.マイコプラズマ,小児科臨床ピクシス20,かぜ症候群</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> と合併症,p128〜130,2010年8月発行,中山書店。</span><br />
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜<br /><span class="Apple-style-span" style="font-size: large;"> マイコプラズマ感染症</span></span><br />
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">1)<b>病原体</b><br />
マイコプラズマ・ニューモニエ(肺炎マイコプラズマ<i>Mycoplasma pneumoniae</i>)<br />
</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">2)<b>疫学</b><br />
<span class="Apple-style-span" style="font-size: x-small;"> <span class="Apple-style-span" style="font-size: small;">◯ヒトが感染源。動物の宿主は知られていない。飛沫感染で濃厚接触が必要,</span></span></span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: x-small;"><span class="Apple-style-span" style="font-size: small;"> 家族内</span></span>発生が多いのはそのためである。<br />
◯季節は秋〜冬〜春に多い。<br />
◯罹患年齢:小学生(特に7〜9才にピーク)中学生に多発し1才以下は少ない。<br />
3才以下の小児では不顕性感染が多いと言われているが,各年齢層</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> での顕性感染率,不顕性感染率を詳しく調べたデータはない。</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> アメリカでは大学生,軍隊での発生が多い。<br />
◯日本ではオリンピックの開催年に流行をくりかえしていたが,1992年以降から</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> 4年周期性はなくな<br />
ってきた。<br />
◯潜伏期間が約2〜3週間なので,インフルエンザウイルスのように短期間に</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> 幼稚園,小学校で患者が集中発生することはない。地域での流行は</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> 数ヶ月かけておこる(smoldering epidemic くすぶり流行)。<br />
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3)<b>臨床症状と診察所見</b>:</span><br />
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a)<b>急性上気道炎</b>:初期は他の病原体のものと区別がつかない。咽頭発赤はない。 <br />
日常臨床ではこの病型をとるのが多いと思われるが,風邪としてマクロライド系<br />
抗生剤が処方されそのまま軽快する。小学生1名がこの菌による肺炎になった場<br />
合そのクラスには4〜5名の急性上気道炎の患者が発生している可能性がある。<br /><span class="Apple-style-span" style="font-size: x-small;"> </span></span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: x-small;"> </span>マイコプラズマ感染では咳はひどいが通常は喘鳴はない。気管支喘息をしばしば,</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> 誘発するので</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">注意したい。</span><br />
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">b)<b><span class="Apple-style-span" style="color: red;">マイコプラズマ肺炎</span></b>:発熱,空咳が日が経つにつれて次第に強くなる。聴診所見<br />
では乾性ラや呼吸音の減少を認めることが多いが,湿性ラ音もある。聴診所見が<br />
はっきりしないのに胸部X線で浸潤像(スリガラス状陰影,図1)を認めること<br />
がある。</span><br />
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胸部X線上の陰影の大きさの割に患児が元気であるのが特徴。皮膚に不定形発疹<br />
をみることがある。白血球数は正常,軽度の増加ないし減少で一定しない。CRP<br />
は軽度陽性。寒冷凝集反応は陽性となるが特異的ではない。AST 、ALT の上昇<br />
を一過性に認めることもある。胸膜炎,胸水貯留のある症例は高熱がつづく。</span><br />
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: x-small;"> </span>セフェム系抗生物質を3日以上内服しているのに解熱せず咳がひどくなり,</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> 白血球数の増減もそれ</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">ほど</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">強くなくCRPは弱陽性,胸部X線所見の割には患児は</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> 元気である症例はマイコプラズマ肺炎を疑う。 </span><br />
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<i>図1。左肺のすりガラス様陰影,11才,女, 第5病日</i></div>
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2月11日 夕方から39度の発熱。翌日近くの小児科を</div>
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受診し薬をもらうが,その後も高熱つずき,</div>
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咳がひどく(特に夜中)なってきた。</div>
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2月15日 当院を受診。胸部(左)で乾性ラ音(+)。</div>
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白血球数5,300。CRP1.43mg/dl,ESR 36mm/hr.</div>
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胸部X線写真で左肺に均一陰影(+)</div>
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ーーーー 大学病院へ紹介し入院。</div>
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2月22日 退院。</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6ly8-cw22GRx3lIxs8ttUyC2h8a44ytOKP-M_mUZYmCP1n7ttwhzR6L2_drpIkB69PUvihQ2wcE2zhyJ3n_atxWaylhalUoisAecRn7CuSAR9eSW-L9BjbyeeFTiPUE3izfZcWb1R2g_I/s1600/%E3%83%9E%E3%82%A4%E3%82%B3%E8%82%BA%E7%82%8E%EF%BC%96%E6%89%8D%E5%BC%9F%EF%BC%96%E7%97%85%E6%97%A5.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6ly8-cw22GRx3lIxs8ttUyC2h8a44ytOKP-M_mUZYmCP1n7ttwhzR6L2_drpIkB69PUvihQ2wcE2zhyJ3n_atxWaylhalUoisAecRn7CuSAR9eSW-L9BjbyeeFTiPUE3izfZcWb1R2g_I/s400/%E3%83%9E%E3%82%A4%E3%82%B3%E8%82%BA%E7%82%8E%EF%BC%96%E6%89%8D%E5%BC%9F%EF%BC%96%E7%97%85%E6%97%A5.jpg" width="400" /></a></div>
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<i><span class="Apple-style-span" style="font-size: x-small;"> </span>右上肺の陰影,6才,男,第6病日<span class="Apple-style-span" style="font-size: x-small;"> </span> </i></div>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> </span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> マイコプラズマ感染症のまれな合併症としては、急性脳炎,無菌性髄膜炎,中耳炎、</span></span><br />
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"></span> 肝炎、膵炎、溶血性貧血、心筋炎、関節炎、ギラン・バレー症候群、スティーブンス・ ジョンソン症候群などがある。<br />
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4)<b>検査</b>: <br />
a)<b>間接赤血球凝集反応(Indirect hemagglutination=IHA)</b>:<br />
マイコプラズマ抗原で感作したタンニン酸処理ヒツジ赤血球溶液に被検血清<br />
を加えた後の血球凝集の有無で判定。主としてIgM抗体とIgG抗体を反映している。</span></div>
<div>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> 現在は一部の研究室以外は使用されない。<br />
<br />
b) <span class="Apple-style-span" style="color: red;"><b>粒子凝集法(Particle agglutination=PA法)</b></span><br />
ヒツジ赤血球のかわりにゼラチン粒子(セロデア-MYCOII®)を使用した方法。<br />
原理はIHAと同じだが凝集が明瞭,溶血の影響をうけず感度がよい。<br />
第5病日以内での採血では抗体価が上昇しない。抗体価は第15〜21病日で最高<br />
となり,その後数ヶ月かけて低下する。患児の採血病日に注意したい。</span></div>
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br />
<b>診断基準(PA法):</b></span>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> </span><br />
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: x-small;"><span class="Apple-style-span" style="color: white;">ーーーー</span><span class="Apple-style-span" style="font-size: small;">抗体価の表記法は×40倍以下,</span></span>×40, ×80,×160,×320,×640, ×1280,×2560, </span></div>
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーー</span>×5120, </span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">×10240 ------- である。</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーー</span></span><br />
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーー</span>i) ペアー血清(急性期,その2週間後の回復期)で4倍以上。 </span><br />
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーーーーーーーーー </span>例:急性期×40以下 → 回復期×160。<br />
ii)単1血清では×320〜640倍以上。ただし過去に同菌に罹患したあと6ヵ月<br />
後も×320倍以上の抗体価を示す患児もいるので,単一血清の高い値だけ<br />
では今回の病気の起炎菌であるとは判定できない。やはりペアー血清が<br />
望ましい。</span><br />
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c)<span class="Apple-style-span" style="color: red;"><b>迅速診断キット</b></span>:血清中のIgM抗体を酵素抗体法で測定するキット (イムノカードマイコプラズマ抗体®)が市販されている。定性反応で15分</div>
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で判定できる。ただしPA法を基準とした場合,感度95%,特異度43.5%,</div>
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
陽性反応的中度44.2%,陰性反応的中度94.9%,有用度60%で<span class="Apple-style-span" style="color: red;">信頼性に欠ける</span>。</div>
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<br /></div>
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d)咽頭スワッブを使用しての<b>分離培養</b>,あるいは<b>PCR法</b>で<i>Mycoplasma</i> <i>pneumoniae</i></div>
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
特異的DNA検査は一部の地方衛生研究所と研究機関で実施。</div>
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
ただしマイコプラズマ感染には不顕性感染がある。さらに抗生物質で治療をう<br />
け治癒した後も数ヶ月以上にわたり患者の咽頭から菌が分離されることがある<br />
ので留意。 <br />
<br /></div>
5)<b>治療</b><br />
我が国ではマクロライド耐性菌が2000年初頭より認められ,耐性率が増加して<br />
きている。ただし耐性菌感染でも,感受性菌に比較して2〜4日ほど発熱の遷延が<br />
みられるだけであり,日常臨床上でも重症化率が増加している傾向はない。<br />
現在の第一選択はマクロライド系抗生物質である。</span><br />
<div>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br />
経口薬:エリスロマイシン:DS/200mg錠 20〜40mg/kg/日,分4。<br />
リカマイシン:DS/100mg錠 20〜30mg/kg/日,分3。<br />
クラリスロマイシン:DS/50mg錠/200mg錠10〜15mg/kg/日,分2〜3。<br />
アジスロマイシン:細粒 10mg/kg/日,分1で3日間。 <br />
注射薬:クリンダマイシン: 8〜16mg/kg/日,分3〜4。<br />
ミノマイシン:2〜4mg/kg/日,分2。 <br />
耐性菌に有効なもの:<br />
ミノマイシン細粒(MINO): 2〜4mg/kg/日,分1〜2。8才以上に使用。<br />
スパロフロキサシリン,レボフロキサシン:小児への適応なし。</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span>
<br />
<div>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> マイコプラズマ肺炎で左記の抗生物質で治療するも発熱し咳がひどくなる場合は</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> 胸膜炎ないし</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">胸水貯留があるかどうかを確かめる。耐性菌の問題もさることながら</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> 発熱がつづく原因で,</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">ステロイド剤の内服を短期間おこなうことで軽快する。</span></div>
<div>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: x-small;"><br /></span>
6)<b>感染制御</b><br />
抗生物質の予防内服は家族内感染防御に有効との報告もあるが,ルーチンに推奨は<br />
されていない。ただし鎌状赤血球症,ダウン症,免疫不全症,慢性心臓呼吸器疾患<br />
をもつ患児の場合は予防内服が必要。<br />
</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-family: Times;"><br /></span></span>
<br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b>文献</b></span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> 1) 萩原啓二ほか.F小学校で集団発生したマイコプラズマ・ニュ−モニエによる急性呼吸</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> 器疾患の調査. 第99回日本小児科学会総会. 1996.4.21.熊本.</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> 2) 岡崎則夫ほか. <i>Mycoplasma pneumoniae</i>感染患者における<i>M.pneumoniae</i>分離と</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> IHA抗体価. 感染症学雑誌1989; 63:714−719.</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> 3) 加藤彰一. 半定量解析によるイムノカードマイコプラズマ抗体キットの有用性の評価.</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> 小児感染免疫 2007;19:27-35.</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> 4) 成田光生.薬剤耐性マイコプラズマの現状と今後の展望.モダンメデイア2007;53:</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> 297-306.</span><br />
<div>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜〜</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span></div>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">ご質問は: </span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">〒755ー0097</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">山口県 宇部市 常盤台1丁目20−2</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">上宇部こどもクリニック 萩原啓二 </span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">電話: 0836-29-1155</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Fax: 0836-29-1156</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">E-mail: keijihagiwara@gmail.com</span><br />
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萩原啓二 Keiji Hagiwara http://www.blogger.com/profile/16535134028283517468noreply@blogger.comtag:blogger.com,1999:blog-7971305501479934972.post-61690057841978612092012-08-30T12:03:00.000+09:002012-08-30T12:05:01.633+09:00朝顔<div class="separator" style="clear: both; text-align: center;">
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<br />萩原啓二 Keiji Hagiwara http://www.blogger.com/profile/16535134028283517468noreply@blogger.comtag:blogger.com,1999:blog-7971305501479934972.post-42286504685591878702012-08-28T18:46:00.002+09:002012-08-30T12:01:35.079+09:00アサガオ<div class="separator" style="clear: both; text-align: center;">
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<br />萩原啓二 Keiji Hagiwara http://www.blogger.com/profile/16535134028283517468noreply@blogger.comtag:blogger.com,1999:blog-7971305501479934972.post-50775532711902411792012-07-23T18:37:00.000+09:002012-07-23T18:37:16.034+09:00緑のカーテン<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">診療所の裏側のとこで,朝顔で緑のカーテンを作りました。</span><br />
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span>萩原啓二 Keiji Hagiwara http://www.blogger.com/profile/16535134028283517468noreply@blogger.comtag:blogger.com,1999:blog-7971305501479934972.post-60686072728487092502012-07-16T19:46:00.000+09:002012-07-16T19:46:25.158+09:00食中毒:ボツリヌス菌<div class="separator" style="clear: both; text-align: center;">
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<div style="text-align: center;">
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">ボツリヌス菌(A型)のコロニー(5倍に拡大):血液寒天培地で72時間培養</span></div>
<div style="text-align: center;">
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> -----------<span class="Apple-style-span" style="font-size: x-small;"><span class="Apple-style-span" style="color: blue;"><a href="http://phil.cdc.gov/phil/home.asp"> <span class="Apple-style-span" style="color: blue;">Public Health Image Library</span></a></span></span> </span></div>
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<div style="text-align: center;">
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">ボツリヌス菌:グラム陽性の桿菌(1x5 μm)</span></div>
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<div style="text-align: center;">
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> ------------ <span class="Apple-style-span" style="font-size: x-small;"><a href="http://phil.cdc.gov/phil/home.asp"><span class="Apple-style-span" style="color: blue;">Public Health Image Library</span></a></span> </span></div>
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">ボツリヌス菌の芽胞(Malachite green染色):広く土壌,ヘドロに</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">芽胞の形で生息。</span></div>
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> -----------------<span class="Apple-style-span" style="font-size: x-small;"> </span><span class="Apple-style-span" style="color: blue;"><a href="http://phil.cdc.gov/phil/home.asp"><span class="Apple-style-span" style="font-size: x-small;">Public Health Image Library</span></a></span> </span></div>
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br />
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b>ボツリヌス菌</b><i><b> Clostridium botulinum</b></i>:</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーーー</span>グラム陽性の桿菌(1x5 μm)。</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーーー</span>広く土壌,ヘドロ</span><span class="Apple-style-span" style="line-height: 22px;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">に</span></span><span class="Apple-style-span" style="line-height: 22px;"><a href="http://ja.wikipedia.org/wiki/%E8%8A%BD%E8%83%9E" style="background-attachment: initial; background-clip: initial; background-color: initial; background-image: none; background-origin: initial; text-decoration: none;" title="芽胞"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: black;">芽胞</span></span></a></span><span class="Apple-style-span" style="line-height: 22px;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">の形で</span></span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">生息。</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">空気のない嫌気状態</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーーー</span>では芽胞から増殖しボツニヌス毒素を産生。</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br />
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<span class="Apple-style-span" style="line-height: 22px;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="line-height: normal;"><span class="Apple-style-span" style="color: white;">ーーーーーーー</span></span>毒素の違いによりA~G型に分類され、</span></span><span class="Apple-style-span" style="line-height: 22px;"><a href="http://ja.wikipedia.org/wiki/%E3%83%92%E3%83%88" style="background-attachment: initial; background-clip: initial; background-color: initial; background-image: none; background-origin: initial; text-decoration: none;" title="ヒト"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: black;">ヒト</span></span></a></span><span class="Apple-style-span" style="line-height: 22px;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">に対する中毒は</span></span><br />
<span class="Apple-style-span" style="line-height: 22px;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーーー</span>A,B,E,F,G型で</span></span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 22px;">起こる。</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 22px;"><span class="Apple-style-span" style="color: white;">-----------------</span></span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 22px;"><span class="Apple-style-span" style="color: white;">--------</span>A型:アメリカ太平洋岸</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 22px;"><span class="Apple-style-span" style="color: white;">-------------------------</span>B型:ヨウロッパ,アメリカ中部</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 22px;"><span class="Apple-style-span" style="color: white;">-------------------------</span>C型:南アフリカ,オーストラリア,アメリカ</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="line-height: 22px;"><span class="Apple-style-span" style="color: white;">-------------------------</span>D型:南アフリカ</span></span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="line-height: 22px;"><span class="Apple-style-span" style="color: white;">-------------------------</span>E型:日本</span></span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーーー</span>ボツリヌス毒素自体は100℃で1~2分の加熱で失活されるが,</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーーー</span><span class="Apple-style-span" style="color: red;">菌を不活化</span></span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: red;">させる</span></span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: red;">には100℃で6時間、芽胞では120℃で4分間</span></span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーーー</span><span class="Apple-style-span" style="color: red;">の加熱が必要。</span></span><br />
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b>ボツリヌス症:</b>多くはボツリヌス毒素を含んだ食物を食べることで起こる。</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> 潜伏期間は数時間から数日。</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"></span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーーー</span>複視から</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">顔面麻痺,四肢の麻痺へと進行する。</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">乳児では便秘,</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> </span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">ほ乳力が低下,</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">脱力状態となる。</span><br />
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b>感染経路:</b> </span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">肉類の缶詰,キャビアの</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">缶詰,</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">腸</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">詰</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">ソーセージの処理過程</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーーー</span>(多くは自家製)で,</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">ボツリヌス菌</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">の</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">芽胞</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">が混入し</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">空気の</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーーー</span>ない状態で発芽して増殖。</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーーー</span></span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">乳児では輸入した<span class="Apple-style-span" style="color: red;">蜂蜜</span>を摂取して発病した事例がある。</span><br />
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーーー</span>1984年、熊本県で製造された真空パックの<span class="Apple-style-span" style="color: red;">辛子蓮根</span>を食べた</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーーー</span>36名がボツリヌス菌(A型)に感染し、内11名が死亡した。</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーーー</span>原料のレンコンを加工する際に滅菌処理を怠り、なおかつ真空</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーーー</span>パックし常温で保管流通させたために、土の中に繁殖する嫌気性</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーーー</span>のボツリヌス菌がパック内で繁殖した</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">。</span><br />
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"></span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">ご質問は: <br />
〒755ー0097<br />
山口県 宇部市 常盤台1丁目20−2<br />
上宇部こどもクリニック 萩原啓二 <br />
電話: 0836-29-1155<br />
Fax: 0836-29-1156<br />
E-mail: keijihagiwara@gmail.com</span>萩原啓二 Keiji Hagiwara http://www.blogger.com/profile/16535134028283517468noreply@blogger.comtag:blogger.com,1999:blog-7971305501479934972.post-75557429518363336882012-07-16T19:45:00.000+09:002012-07-16T19:45:47.475+09:00食中毒:細菌性赤痢<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdlRscE7jOXUw-kXuIsdzJppOdFrCfeVqeWv2jjDdoFYqUOWRrnRauFmrSYCKi_fN9olr9qTiggvGBzqDjkm8wy7EXJAxqFmhgHFaUhdUE1Rar9eoa5Jmamsl-nMnajXooOOrYMSLc3cj-/s1600/Shigella+boydii(blood+agar).jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdlRscE7jOXUw-kXuIsdzJppOdFrCfeVqeWv2jjDdoFYqUOWRrnRauFmrSYCKi_fN9olr9qTiggvGBzqDjkm8wy7EXJAxqFmhgHFaUhdUE1Rar9eoa5Jmamsl-nMnajXooOOrYMSLc3cj-/s320/Shigella+boydii(blood+agar).jpg" /></a></div>
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">赤痢菌:</span><i><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Shigella boydii,</span></i><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> 血液寒天培地</span><br />
<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;">--------<a href="http://phil.cdc.gov/phil/quicksearch.asp"> <span class="Apple-style-span" style="color: blue;">Public Health Image Librararty, CDC.</span></a></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_hkZ14xwSX2V1UAwDjoHJMLjEnVTUhCGu6sZw4yF3pHfH0-ZqI49Vo9ZPACd88oUz6x6ZcIXtSEkpqKINOJ82Wqy8Yln4vADDD0yQxYgBvAoXdri8sTjLmzc_T_8-cBgvUpWuubhhbDVP/s1600/Shigella+dysenteriae(SEM,x2,200).jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_hkZ14xwSX2V1UAwDjoHJMLjEnVTUhCGu6sZw4yF3pHfH0-ZqI49Vo9ZPACd88oUz6x6ZcIXtSEkpqKINOJ82Wqy8Yln4vADDD0yQxYgBvAoXdri8sTjLmzc_T_8-cBgvUpWuubhhbDVP/s320/Shigella+dysenteriae(SEM,x2,200).jpg" /></a></div>
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">赤痢菌:</span><i><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Shigella dysenteriae</span></i></div>
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">2,200倍,走査電顕写真</span></div>
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">病原体 :赤痢菌(Shigella)。</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーー</span>Shigella 属には4菌種あり</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i>Shigella dysenteriae, </i></span></div>
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーー</span><i>Shigella flexneri , Shigella boydii, </i></span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i>Shigella sonnei ある。</i></span></div>
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">感染経路: ほとんどが海外からの輸入例である。</span></div>
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーー</span>細菌性赤痢の主な感染源はヒトであり、患者や保菌者の糞便、</span></div>
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーー</span>汚染された手指、食品、水、ハエ、器物を介して感染する。</span></div>
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーー</span>水系感染は大規模な集団発生を起こす。感染源がヒトである</span></div>
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーー</span>ので、衛生水準の向上と共にその発生は減少する。</span></div>
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">潜伏期: 1 ~3日</span></div>
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">症状: 急激な発熱、水様性下痢,腹痛、膿粘血便</span></div>
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーー</span><i>S. dysenteriae</i> や<i>S. flexneri </i>は典型的な症状を起こす事が多いが、</span></div>
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーー</span><i>S. sonnei </i>の場合は軽度な下痢、あるいは無症状に経過することが多い。</span></div>
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br />
</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br />
</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"></span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">ご質問は: <br />
〒755ー0097<br />
山口県 宇部市 常盤台1丁目20−2<br />
上宇部こどもクリニック 萩原啓二 <br />
電話: 0836-29-1155<br />
Fax: 0836-29-1156<br />
E-mail: keijihagiwara@gmail.com<br />
</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><div>
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</span></div>萩原啓二 Keiji Hagiwara http://www.blogger.com/profile/16535134028283517468noreply@blogger.comtag:blogger.com,1999:blog-7971305501479934972.post-26313559755670561372012-07-16T19:44:00.000+09:002012-07-16T19:44:37.634+09:00食中毒:エルシニア菌<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEinTPF1Xum_iWbg7KmI3_npIH5JXhSD1hVB63nzk9hsPC7WcKU0DIGWW81CiX5s7D5t1U3FwmZX3BfA1BlsWAfs7z6wEYhMeMNY0cjel-2WhUsozXcNAY2Ie9_ESiKrEz7rotRAKwIova5k/s1600/yersinia+enterocolitica(Macro).jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="261" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEinTPF1Xum_iWbg7KmI3_npIH5JXhSD1hVB63nzk9hsPC7WcKU0DIGWW81CiX5s7D5t1U3FwmZX3BfA1BlsWAfs7z6wEYhMeMNY0cjel-2WhUsozXcNAY2Ie9_ESiKrEz7rotRAKwIova5k/s400/yersinia+enterocolitica(Macro).jpg" width="400" /></a></div>
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">エルシニア菌(エンテロコリチカ,XLD寒天培地)</span></div>
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<a href="http://phil.cdc.gov/phil/home.asp"><span class="Apple-style-span" style="color: blue;">Public Health Image Library, CDC</span></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhU1lmUjd6ESuuuXLfQKhsGvPYxi6Y3ut1NKZ6iL-cnpblcJOQZmnNysTJ_0XUmObhr4_bj_LaTCRQAkqTO3KtPF7ojTNg5HjBAmk4dC84xgnAdcoOA89AqbAcAAcHBmMgBa_JLsH65KdLc/s1600/yersinia+enterocolitica(Macro-2).jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="272" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhU1lmUjd6ESuuuXLfQKhsGvPYxi6Y3ut1NKZ6iL-cnpblcJOQZmnNysTJ_0XUmObhr4_bj_LaTCRQAkqTO3KtPF7ojTNg5HjBAmk4dC84xgnAdcoOA89AqbAcAAcHBmMgBa_JLsH65KdLc/s400/yersinia+enterocolitica(Macro-2).jpg" width="400" /></a></div>
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">エルシニア菌(エンテロコリチカ,鞭毛染色)</span></div>
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<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><a href="http://phil.cdc.gov/phil/home.asp"><span class="Apple-style-span" style="color: blue;">Public Health Image Library, CDC</span></a></span></div>
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b>エルシニア菌:</b>グラム陰性の桿菌で腸内細菌科に属しており、冷蔵庫内温度</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーーー</span>である4 ℃でも発育できる。</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">11種類に分類される。</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーー</span><b>感染経路:</b><i>Yersinia enterocolitica 、</i></span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i>Yersinia pseudotuberculosis</i></span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">では</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーーー</span>汚染された</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">飲み水</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">(井戸水),ミルク,ブタ肉,食物を介して</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">経口的に</span></div>
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーーー</span></span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">感染する。</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">保菌動物はブタ,</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">犬,猫,ネズミ(</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i> pseudotuberculosis)</i></span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーー ーーー</span></span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">白鳥(</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i>enterocolitica)。</i>ブタの小腸を扱った母親から赤ちゃんに</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーーー</span>感染した例もある。季節は夏より冬に発生しやすい。</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span class="Apple-style-span" style="color: white;">ーー</span></i><b>潜伏期間:</b>4〜6日(1〜14日)</span><br />
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b>i) </b><i><b> Yersinia enterocolitica</b></i>(エルシニア・エンテロコリチカ):下痢や腹痛をともなう</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> 急性腸炎が多いが,急性虫垂炎様,敗血症,髄膜炎,ポリオ様,腎炎,</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> 結節性紅斑や関節炎まで</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">多彩である。</span></div>
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b>ii) </b><i><b> Yersinia pseudotuberculosis </b></i>(エルシニア・シュードツベルクローシス):</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーー</span>乳幼児に多くみられ、発熱は殆ど</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">必発で</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">あり、比較的軽度の下痢と腹痛、嘔吐</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーー</span>がこれに次ぐ。</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">発疹、紅斑、咽頭炎もしばしば観察される。川崎病と同じ症状</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーー</span>を示す例など。</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b>iii) </b><i><b>Yersinia pestis</b></i>(エルシニア・ペスチス):ペスト菌含有ノミ(野ネズミ)の</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーー</span>咬傷による。</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">ーーー 次のブログで後述します。</span><br />
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b>日本での集団発生:</b></span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">1972年に下痢症患者から初めて</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i>Yersinia enterocolitica</i> </span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">菌が分離</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーー </span></span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">されて</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">から</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">現在までに、</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">14例の集団食中毒の発生が確認されている。</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: #f3f3f3;">ーーーーーーー</span>患者数が最も多かったの</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">は1980年に発生した沖縄県の事例で、</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーーー</span>1,051名の報告がなされた。</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">最近では1997 年に、</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">徳島県の病院や</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーーー</span>学校の寮で患者66 名発生。ペストは大正以来日本で発生はない。</span></div>
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"></span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">ご質問は: <br />
〒755ー0097<br />
山口県 宇部市 常盤台1丁目20−2<br />
上宇部こどもクリニック 萩原啓二 <br />
電話: 0836-29-1155<br />
Fax: 0836-29-1156<br />
E-mail: keijihagiwara@gmail.com</span></div>萩原啓二 Keiji Hagiwara http://www.blogger.com/profile/16535134028283517468noreply@blogger.comtag:blogger.com,1999:blog-7971305501479934972.post-25505926759784855352012-07-09T18:18:00.000+09:002012-07-09T18:18:58.614+09:00夏の食中毒:ウエルシュ菌<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"></span><br />
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ウエルシュ菌(顕微鏡,グラム染色)</div>
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<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;">-----------<a href="http://phil.cdc.gov/phil/quicksearch.asp"> <span class="Apple-style-span" style="color: blue;">Public Health Image Library, CDC</span></a></span></div>
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6iF1UEy51eDo5jAQ3DiIWElArETt0fjfLXI1ToBpFC6aM4Zm5UKd7jTmOttavZ6LstRLe-CIT_1r_VqpvYuyK0yrK-pIQ3KHIsjlx47RhJuL9_sD7ZopHg4LmON712zChdmDluPXV05OI/s1600/Clostridium+perfringens(SEMx1,600).jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6iF1UEy51eDo5jAQ3DiIWElArETt0fjfLXI1ToBpFC6aM4Zm5UKd7jTmOttavZ6LstRLe-CIT_1r_VqpvYuyK0yrK-pIQ3KHIsjlx47RhJuL9_sD7ZopHg4LmON712zChdmDluPXV05OI/s320/Clostridium+perfringens(SEMx1,600).jpg" /></a><br />
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">ウエルシュ菌:長さ3~9μm、幅0.9~1.3μm</span></div>
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走査電顕,<span class="Apple-style-span" style="color: blue;"> </span>x1,600倍。青色に人工着色してあります。<br />
----------- <span class="Apple-style-span" style="color: blue;">D</span><a href="http://www.denniskunkel.com/index.php"><span class="Apple-style-span" style="color: blue;">ennis Kunkel Microscopy, Inc.</span></a></div>
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</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">ウエルシュ菌(Clostridium perfringens ):ヒトや動物の大腸内常在菌であり、下水、<br />
<span class="Apple-style-span" style="color: white;">ーーーーーー</span>河川、海、耕地などの土壌に広く分布する。ヒトの感染症としては<br />
<span class="Apple-style-span" style="color: white;">ーーーーーー</span>食中毒の他に、ガス壊疽、化膿性感染症、敗血症等が知られている。</span><br />
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">汚染食品:食肉、あるいは魚介類等を使った調理品。<br />
潜伏期間:6~18時間<br />
症状 :腹痛,水様便。嘔吐や発熱などの症状はきわめて少なく一般的に軽くて</span></div>
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーー ー</span>1~2日で回復する。</span></div>
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</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br />
</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"></span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">ご質問は: <br />
〒755ー0097<br />
山口県 宇部市 常盤台1丁目20−2<br />
上宇部こどもクリニック 萩原啓二 <br />
電話: 0836-29-1155<br />
Fax: 0836-29-1156<br />
E-mail: keijihagiwara@gmail.com<br />
</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><div>
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</span></div>萩原啓二 Keiji Hagiwara http://www.blogger.com/profile/16535134028283517468noreply@blogger.comtag:blogger.com,1999:blog-7971305501479934972.post-37131012897932682592012-07-09T18:17:00.000+09:002012-07-09T18:17:02.190+09:00食中毒:セレウス菌<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"></span><br />
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セレウス菌(ヒツジ赤血球を含む寒天培地に増殖したもの)</div>
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<span class="Apple-style-span" style="color: blue; font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="color: black;"> </span><a href="http://phil.cdc.gov/phil/home.asp"><span class="Apple-style-span" style="color: blue;">Public Health Image Library, Centers for Control and Prevention.</span></a></span></div>
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkGxEVn6KWJdiGCVRSNPB11x-9rjwwvGPOyergbpOK6l_OdotM1zJBL-hOOLIMy3IdX4kWSIE87-aaq-ggdOPyikvst87Z_-WNEsTdSJ43INJIwyD1NQ4uYqXd4dFRhdvRWLF63_i_SXPJ/s1600/Bacillus+cereus(Gram+stain).jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="263" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkGxEVn6KWJdiGCVRSNPB11x-9rjwwvGPOyergbpOK6l_OdotM1zJBL-hOOLIMy3IdX4kWSIE87-aaq-ggdOPyikvst87Z_-WNEsTdSJ43INJIwyD1NQ4uYqXd4dFRhdvRWLF63_i_SXPJ/s400/Bacillus+cereus(Gram+stain).jpg" width="400" /></a><br />
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セレウス菌(グラム染色)</div>
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<div class="separator" style="clear: both; text-align: center;">
<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><a href="http://phil.cdc.gov/phil/home.asp"><span class="Apple-style-span" style="color: blue;">Public Health Image Library, Centers for Control and Prevention.</span></a></span></div>
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</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">セレウス菌(Bacillus cereus):炭疽の病原菌はこの仲間。<br />
<span class="Apple-style-span" style="color: white;">ーーーーー</span>100 ℃30 分の加熱にも耐える芽胞の形で土壌などを中心に自然環境に<br />
<span class="Apple-style-span" style="color: white;">ーーーーー</span>広く分布し、野菜や穀物などの農産物を汚染している。毒素を産生。<br />
<span class="Apple-style-span" style="color: white;">ーーーーー</span>嘔吐をおこす毒は消化酵素や熱、酸・アルカリにも安定であるため、<br />
<span class="Apple-style-span" style="color: white;">ーーーーー</span>食品中で産生された毒素で中毒が発現する。<br />
<br />
潜伏期間:30分~5 時間<br />
症状 :腹痛,嘔吐,下痢。<br />
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発生年月 患者数 原因食品 場所<br />
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1990年1月 350 仕出し弁当 会社<br />
1990年8月 291 牛乳 保育所,家庭<br />
1991年8月 359 給食弁当 社員食堂<br />
1991年9月 1,877 学校給食 学校<br />
1992年4月 541 弁当 学校<br />
1995年10月 296 仕出し弁当 自宅<br />
1996年5月 254 スパゲッテイ 学校給食<br />
1998年10月 516 米飯 飲食店<br />
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><div>
ご質問は: </div>
<div>
〒755ー0097</div>
<div>
山口県 宇部市 常盤台1丁目20−2</div>
<div>
上宇部こどもクリニック 萩原啓二 </div>
<div>
電話: 0836-29-1155</div>
<div>
Fax: 0836-29-1156</div>
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E-mail: keijihagiwara@gmail.com</div>
</span></div>萩原啓二 Keiji Hagiwara http://www.blogger.com/profile/16535134028283517468noreply@blogger.comtag:blogger.com,1999:blog-7971305501479934972.post-55163969972929553732012-07-09T18:15:00.000+09:002012-07-09T18:15:29.488+09:00夏の食中毒:腸炎ビブリオ菌<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"></span><br />
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<div style="text-align: center;">
腸炎ビブリオ菌(走査電顕,1,400倍)</div>
<div style="text-align: center;">
<a href="http://www.denniskunkel.com/index.php"><span class="Apple-style-span" style="color: blue;">Dennis Kunkel Microscopy, Inc.</span></a></div>
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<br /></div>
</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">腸炎ビブリオ菌:</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">学名は</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i>Vibrio parahaemolyticus。</i></span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーーーー</span>日本では特に6月から9月の、海水温が20℃を超える時期に多く</span><br />
<div>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーーーー</span>発生する。本菌は海水に広く存在するため、イカや貝類が比較的多い</span></div>
<div>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーーーー</span>が、その他の一般の魚など、<span class="Apple-style-span" style="color: red;">ほとんどの海産魚介類の生食</span>が原因に</span></div>
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーーーー</span>なりうる。<br />
潜伏期間:6〜12時間。<br />
症状 :発熱,嘔吐,腹痛,下痢であるが,2〜3日で回復。<br />
<span class="Apple-style-span" style="color: white;">ーーーーー</span>毒素による心臓毒性によって死亡することもある。<br />
<br />
1950年、泉州地方を中心とした大阪府下で、激しい腹痛を伴う原因不明の下痢の患者<br />
が集団発生。患者数は272名(死者はうち20名)。発症者がいずれも、大阪府下で行商<br />
販売されていた<span class="Apple-style-span" style="color: red;">白子干し(シラス干し)</span>を食べていたことから、これが原因食品である<br />
ことは早期に特定されたが,当初考えられた既知の食中毒菌は分離されなかったこと<br />
から毒物混入事件として疑われ、刑事事件として立件された。その後,大阪大学医学部<br />
の藤野恒三郎によって,これまで知られていないビブリオ属に属する好塩性のグラム陰<br />
性桿菌の一種が分離された。</span></div>
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</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br />
</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"></span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">ご質問は: <br />
〒755ー0097<br />
山口県 宇部市 常盤台1丁目20−2<br />
上宇部こどもクリニック 萩原啓二 <br />
電話: 0836-29-1155<br />
Fax: 0836-29-1156<br />
E-mail: keijihagiwara@gmail.com<br />
</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><div>
<br /></div>
</span></div>萩原啓二 Keiji Hagiwara http://www.blogger.com/profile/16535134028283517468noreply@blogger.comtag:blogger.com,1999:blog-7971305501479934972.post-40704924134598424862012-07-09T18:14:00.000+09:002012-07-09T18:23:40.630+09:00夏の食中毒:腸管出血性大腸菌<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"></span><br />
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腸管出血性大腸菌( O157:H7):走査電顕,7,075倍。</div>
<div class="separator" style="clear: both; text-align: center;">
<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><a href="http://phil.cdc.gov/phil/home.asp"><span class="Apple-style-span" style="color: blue;">Public Health Image Library, Centers for Disease Control and Prevention</span>.</a></span></div>
<div style="text-align: center;">
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</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">腸管出血性大腸菌:ベロ毒素を産生することのあるO抗原としては、O1、O2、O18、</span><br />
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">------------------------</span> O26、O103、O111、O114、O115、O118、O119、O121、O128、</span></div>
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">------------------------</span> O143、O145、O157、O165などがある。</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">全体の約80%が</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">O157。</span></div>
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">潜伏期間:3~5 日。<br />
症状: 激しい腹痛をともなう頻回の水様便の後に、血便となる。<br />
原因食品:ベロ毒素(Verotoxin, またはShigatoxin )を産生する大腸菌で汚染<br />
<span class="Apple-style-span" style="color: white;">ーーーーー</span>された<span class="Apple-style-span" style="color: red;">牛肉,</span><span class="Apple-style-span" style="color: red;">ハンバーガー。</span><br />
合併症: 病気の回復期に小学生,特に幼児では溶血性尿毒症症候群(Hemolytic </span></div>
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーー</span>Uremic Syndrome),稀には脳症などの重症な合併症がおこる。</span></div>
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腸管出血性大腸菌(0:157)の集団感染事例:</div>
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1)1990 年埼玉県浦和市の幼稚園で<span class="Apple-style-span" style="color: red;">井戸水(2次汚染)</span>を原因とした集団発生で<br />
<span class="Apple-style-span" style="color: white;">ーー</span>120名の園児が急性腸炎に罹患,20名が溶血性尿毒症症候群(年令が2〜8才)<br />
<span class="Apple-style-span" style="color: white;">ーー</span>園児2 名が死亡。</div>
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2)1996 年5月,岡山県に始まった集団発生から、7月には大阪府堺市の小学生5,591名に</div>
<div>
<span class="Apple-style-span" style="color: white;">ーー</span>上る集団発生。入院総数約600人(?)溶血性尿毒症症候群,約300人(?),<br />
<span class="Apple-style-span" style="color: white;">ーー</span>3名が名死亡。原因は給食あるいは仕出し弁当であった。<span class="Apple-style-span" style="color: red;">カヨワレ大根</span><br />
<span class="Apple-style-span" style="color: white;">ーー</span>が疑われたが原因食品が確定できなかった。<br />
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3)1998年には北海道産の<span class="Apple-style-span" style="color: red;">イクラ</span>を原因食品として7 都府県で患者49 名が発生。</div>
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4)2001年には輸入牛肉を原材料とした「<span class="Apple-style-span" style="color: red;">牛タタキ</span>」を汚染源とし7都県で240名の患者</div>
</div>
<div>
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<span class="Apple-style-span" style="color: white;">ーー</span>が発生する事例も報告された。<br />
<br />
一方、本症では家族内発生と二次感染が多いことも特徴である。発生時期は、夏季に多い<br />
が冬季にもみられる。<span class="Apple-tab-span" style="white-space: pre;"> </span>1997年以降、集団事例の報告数は減ったものの、散発事例におけ<br />
る患者数はほぼ横ばい状態で年間千数百人の患者が発生している。</div>
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</div>
<div>
<br />
腸管出血性大腸菌(O:111)の集団感染:<br />
2011年4月:焼き肉チェーン店(主に富山県内)で患者数181名,溶血性尿毒症症候群<br />
32名(1〜70才),脳症9例,死亡5名。<span class="Apple-style-span" style="color: red;">ユッケ</span>が主たる原因食肉。<br />
<br />
<br />
ご質問は: <br />
〒755ー0097<br />
山口県 宇部市 常盤台1丁目20−2<br />
上宇部こどもクリニック 萩原啓二 <br />
電話: 0836-29-1155<br />
Fax: 0836-29-1156<br />
E-mail: keijihagiwara@gmail.com<br />
<div>
<br /></div>
</div>
</span></div>萩原啓二 Keiji Hagiwara http://www.blogger.com/profile/16535134028283517468noreply@blogger.comtag:blogger.com,1999:blog-7971305501479934972.post-81440045609344703042012-07-03T18:06:00.000+09:002012-07-03T18:06:33.678+09:00夏の食中毒:サルモネラ菌<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"></span><br />
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サルモネラ菌(血清型 enteriditis, SS寒天培地)</div>
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<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;">---------- 山口大学医学部臨床検査 水野</span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiryZm9qtyOJZzklgcChEViPJWOeQlQ4eueyeaeN33PCzJwJXB4ORrFFj1ADtCUjwT5F95moXImnOLn_i_o2709X2HeeC_B8l460B_e4RovJgHWKvuUprmGhwZSu979DxFW0emf43LPkGWf/s1600/Salmonella+typhimurium.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="295" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiryZm9qtyOJZzklgcChEViPJWOeQlQ4eueyeaeN33PCzJwJXB4ORrFFj1ADtCUjwT5F95moXImnOLn_i_o2709X2HeeC_B8l460B_e4RovJgHWKvuUprmGhwZSu979DxFW0emf43LPkGWf/s400/Salmonella+typhimurium.jpg" width="400" /></a></div>
<div style="text-align: center;">
サルモネラ菌(血清型 <i>Typhimurium, </i>走査電顕 2,500倍)</div>
<div style="text-align: center;">
<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><a href="http://phil.cdc.gov/phil/home.asp"><span class="Apple-style-span" style="color: blue;">Public Heath Image Library, Centers for Disease Control and Prevention.</span></a></span></div>
</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br />
サルモネラ菌:自然界のあらゆるところに生息し、鳥類、爬虫類、両生類が </span><br />
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーーー</span>保菌している。とくに家畜(ブタ、ニワトリ、ウシ)の腸管内</span></div>
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーーー</span>では</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">常在菌として保菌していることが知られている。</span></div>
<div>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">-----------</span>種類:2,000種類以上の血清型に細分。</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">日本の腸チフス(</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i>Salmonella typhi </i></span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">),</span></div>
<div>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーーー</span></span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">パラチフス(<i>Salmonella paratyphi </i>)の</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">感染例は海外からの帰国者である。</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"></span><span class="Apple-style-span" style="color: white; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">ーーーーーーー</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="background-color: white;">日本国内では<i> </i></span></span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i>Salmonella</i> </span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="background-color: white;"><i>enteriditis</i></span></span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">による食中毒が近年急激に増加。</span></div>
<div>
<div>
<div>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="background-color: white;"><span class="Apple-style-span" style="color: white;">ーーーーーーー</span></span></span></div>
<div>
<div>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">潜伏期間 :8~48 時間</span></div>
<div>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">症状<span class="Apple-style-span" style="color: white;">ーーーー</span>:悪心および嘔吐で始まり、数時間後に腹痛および下痢を起こす。</span></div>
<div>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーーー</span><i>Typhimurium </i>などは小児で</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">意識障害、痙攣および菌血症、高齢者では</span></div>
<div>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーーー</span>急性脱水症および菌血症を起こす</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">など重症化しやすく、回復も遅れる。</span></div>
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br />
</span></div>
<div>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">原因食品:1)<span class="Apple-style-span" style="color: red;">生卵</span>:洋菓子クリーム,シュークリーム,卵納豆,ヤマかけ,とろろ</span></div>
<div>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーー</span>2)<span class="Apple-style-span" style="color: red;">卵調理品</span>:オムレツ,卵焼き,だし巻き,錦糸卵,卵とじ。</span></div>
<div>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーーーーーーーー</span>魚の黄身焼き,サラダ,どんぶり,</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">ちらし寿司</span></div>
<div>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーー</span><span class="Apple-style-span" style="color: red;"><i>Salmonella Enteritidis</i>に卵が汚染される経路は,親鳥から卵に感染。</span></span></div>
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: red;"><span class="Apple-style-span" style="background-color: white;"><span class="Apple-style-span" style="color: white;">ーーーーーー</span></span>生みたての新鮮卵の中に既に菌があるからで,卵殻表面の消毒だけ</span></span></div>
<div>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーーー</span><span class="Apple-style-span" style="color: red;">では防げない。</span></span></div>
<div>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーー</span>3)<span class="Apple-style-span" style="color: red;">乾燥イカ菓子</span>(1999年3月,<i>Salmonella Oranienburg </i>)</span></div>
</div>
</div>
</div>
<div>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: white;">ーーーーー</span>4)<span class="Apple-style-span" style="color: red;">鶏肉,生ハム</span></span></div>
<div>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br />
</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"></span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">ご質問は: <br />
〒755ー0097<br />
山口県 宇部市 常盤台1丁目20−2<br />
上宇部こどもクリニック 萩原啓二 <br />
電話: 0836-29-1155<br />
Fax: 0836-29-1156<br />
E-mail: keijihagiwara@gmail.com<br />
</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><div>
<br /></div>
</span></div>萩原啓二 Keiji Hagiwara http://www.blogger.com/profile/16535134028283517468noreply@blogger.comtag:blogger.com,1999:blog-7971305501479934972.post-88573562614970410972012-07-02T18:22:00.000+09:002012-07-02T18:22:52.197+09:00夏の食中毒:カンピロバクター菌<div class="separator" style="clear: both; text-align: center;">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi2ppRUqO36rwtRry0k4-PMEm1VqXKX3opZMYw-yj6ToiMsGixIl72mnDxYtqTeYf70oAm0LHktbnDlbjvH5tnlYTRSIgMv9JChYZxOGr7_x0s2LwCXleY3ZKfHaPS4rJMLtphVXpknkU-J/s1600/Campylobacter+jejuni.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="296" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi2ppRUqO36rwtRry0k4-PMEm1VqXKX3opZMYw-yj6ToiMsGixIl72mnDxYtqTeYf70oAm0LHktbnDlbjvH5tnlYTRSIgMv9JChYZxOGr7_x0s2LwCXleY3ZKfHaPS4rJMLtphVXpknkU-J/s400/Campylobacter+jejuni.jpg" width="400" /></a><br />
<div class="separator" style="clear: both; text-align: center;">
カンピロバクター・ジェジュニ菌(スキロー培地)</div>
<div class="separator" style="clear: both; text-align: center;">
----------- 山口大学医学部臨床検査部 水野</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlVSlxEFrY0M2w7IK275ctQdtNVA_7FBwA09MclZRUiKSek3Imsm1qqOPVJEG4q55f3jzpYdBInUw6Xd4eBFa_clrIIiemwgmwnYWvLrrY7hwB7B-DLQUC4WCt7rLXQ5xEy5w8j7BvY7Q_/s1600/Campyrobacter+jejuni%EF%BC%9A%E9%A1%95%E5%BE%AE%E9%8F%A1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="270" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlVSlxEFrY0M2w7IK275ctQdtNVA_7FBwA09MclZRUiKSek3Imsm1qqOPVJEG4q55f3jzpYdBInUw6Xd4eBFa_clrIIiemwgmwnYWvLrrY7hwB7B-DLQUC4WCt7rLXQ5xEy5w8j7BvY7Q_/s400/Campyrobacter+jejuni%EF%BC%9A%E9%A1%95%E5%BE%AE%E9%8F%A1.jpg" width="400" /></a></div>
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">カンピロバクター・ジェジュニ菌(</span>48時間培養したもの,顕微鏡写真)</div>
<div class="separator" style="clear: both; text-align: center;">
---------<a href="http://phil.cdc.gov/phil/home.asp"><span class="Apple-style-span" style="color: blue;"> Public Health Library, Centers for Disease Control and Prevention</span></a><span class="Apple-style-span" style="color: blue;">.</span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmnPpHTQRiSkHEJFFZYKGFk1VO7ElXxsnwPCoWjcBZ-0EGIJursNP7egBoQxDtULSqCcMoTe08lDnFqk_mq8cm39AXGhGoy0h0IdgrSSAqCcW0oAZotRvMulFogRD5g9Xm_w_Q-fjWG52A/s1600/Campyrobacter+jejuni-SEM.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmnPpHTQRiSkHEJFFZYKGFk1VO7ElXxsnwPCoWjcBZ-0EGIJursNP7egBoQxDtULSqCcMoTe08lDnFqk_mq8cm39AXGhGoy0h0IdgrSSAqCcW0oAZotRvMulFogRD5g9Xm_w_Q-fjWG52A/s320/Campyrobacter+jejuni-SEM.jpg" /></a></div>
<div style="text-align: center;">
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">カンピロバクター・ジェジュニ菌</span>(走査電子顕微鏡,倍率11,734)</div>
<div style="text-align: center;">
--------- <a href="http://phil.cdc.gov/phil/home.asp"><span class="Apple-style-span" style="color: blue;">Public Health Library, Centers for Disease Control and Prevention.</span></a></div>
<div style="text-align: center;">
<br /></div>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">カンピロバクター菌:<span class="Apple-style-span" style="color: red;">鶏肉</span>の調理時の十分な加熱、調理器具や手指などを介した</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">生食野菜・サラダへの二次汚染。<span class="Apple-style-span" style="color: red;">トリ刺し、レバ刺し</span>は避けて下さい。</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br />
</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">潜伏期間が2~5日と少し発病するまで時間あります。嘔吐,下痢,粘液血便の</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">程度が個人差があり,同じものを食べても発病しないヒトもいます。</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br />
</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">殆どが <i>Campylobacter jejuni </i>菌。</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br />
</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br />
</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"></span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">ご質問は: <br />
〒755ー0097<br />
山口県 宇部市 常盤台1丁目20−2<br />
上宇部こどもクリニック 萩原啓二 <br />
電話: 0836-29-1155<br />
Fax: 0836-29-1156<br />
E-mail: keijihagiwara@gmail.com</span>萩原啓二 Keiji Hagiwara http://www.blogger.com/profile/16535134028283517468noreply@blogger.comtag:blogger.com,1999:blog-7971305501479934972.post-91045161682641011162012-06-12T16:00:00.000+09:002012-06-12T16:00:28.436+09:00ブドウ球菌による食中毒<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"></span><br />
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"></span><br />
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<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjiO-fPzXYztplJ24EYS7sAXMqE5-RzakmuMwPG1ySjmev1-9_xKXffExAproqvfu92QBzFD8VA1egEEOKIY8P6D5nh7IzYakhHgVsBSeA_z3wL1XyQPZ3qDCM-UI4qcLQsiKBnlY144YPv/s1600/%E9%BB%84%E8%89%B2%E3%83%96%E3%83%89%E3%82%A6%E7%90%83%E8%8F%8C%EF%BC%9A%E3%82%B7%E3%83%A3%E3%83%BC%E3%83%AC.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="317" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjiO-fPzXYztplJ24EYS7sAXMqE5-RzakmuMwPG1ySjmev1-9_xKXffExAproqvfu92QBzFD8VA1egEEOKIY8P6D5nh7IzYakhHgVsBSeA_z3wL1XyQPZ3qDCM-UI4qcLQsiKBnlY144YPv/s320/%E9%BB%84%E8%89%B2%E3%83%96%E3%83%89%E3%82%A6%E7%90%83%E8%8F%8C%EF%BC%9A%E3%82%B7%E3%83%A3%E3%83%BC%E3%83%AC.jpg" width="320" /></a></div>
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黄色ブドウ球菌(<span class="Apple-style-span" style="font-size: small;">Luria Agar 培地で一昼夜培養したもの)</span></div>
<div class="separator" style="clear: both; text-align: center;">
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<div>
<div style="text-align: center;">
<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">Department of Biology, Furman University</span></span></div>
</div>
<span class="Apple-style-span" style="-webkit-text-decorations-in-effect: underline;"></span><br />
<span class="Apple-style-span" style="-webkit-text-decorations-in-effect: underline;"></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjdW-CgP1s7I3v2MfN99ticUvSttImew8FgSXilbxKE_gebunlVRzloxWOK8fD5sUo8AZnrb5i88C3Etuofs0T1cNTbwrJZc8os9m_lc_2R4wIDaTs2-U0DJfyxe5yFjxhVCAwGEg9mfwt6/s1600/%E9%BB%84%E8%89%B2%E3%83%96%E3%83%89%E3%82%A6%E7%90%83%E8%8F%8C%EF%BC%9A%E8%B5%B0%E6%9F%BB%E9%9B%BB%E9%A1%95.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="245" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjdW-CgP1s7I3v2MfN99ticUvSttImew8FgSXilbxKE_gebunlVRzloxWOK8fD5sUo8AZnrb5i88C3Etuofs0T1cNTbwrJZc8os9m_lc_2R4wIDaTs2-U0DJfyxe5yFjxhVCAwGEg9mfwt6/s320/%E9%BB%84%E8%89%B2%E3%83%96%E3%83%89%E3%82%A6%E7%90%83%E8%8F%8C%EF%BC%9A%E8%B5%B0%E6%9F%BB%E9%9B%BB%E9%A1%95.jpg" width="320" /></a></div>
</span></div>
<div style="text-align: center;">
黄色ブドウ球菌(走査電子顕微鏡写真,2万倍)</div>
<div style="text-align: center;">
<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;"><a href="http://phil.cdc.gov/phil/quicksearch.asp"><span class="Apple-style-span" style="color: blue;">Public Health Image Library, Centers for Disease Control and Prevention.</span></a></span></span></div>
<div style="text-align: center;">
<br /></div>
</span><span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> 黄色ブドウ球菌による食中毒は,一見,農薬や毒物中毒と似て,摂取後すぐに<br />
症状がでるのが特徴。</span><br />
<div>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br />
</span></div>
<div>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">食品中で黄色ブドウ球菌(毒素を産生する株)が増殖する時に産生するエンテ</span></div>
<div>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">ロトキシンを、食品と共に摂取することでおこります。数時間後に激しい嘔気・</span></div>
<div>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">嘔吐、腹痛、下痢を伴う急激な急性胃腸炎症状がでます。<br />
<br />
2000年(平成12年)6月から7月にかけて、近畿地方を中心に発生した、雪印乳業<br />
の乳製品(主に低脂肪乳)による集団食中毒事件では,製造工程でエンテロトキシン</span></div>
<div>
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Aが混入した。認定者数14,780人。</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br />
</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br />
</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"></span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">ご質問は: <br />
〒755ー0097<br />
山口県 宇部市 常盤台1丁目20−2<br />
上宇部こどもクリニック 萩原啓二 <br />
電話: 0836-29-1155<br />
Fax: 0836-29-1156<br />
E-mail: keijihagiwara@gmail.com<br />
</span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"></span><br />
<span class="Apple-style-span" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><div>
<br /></div>
</span></div>萩原啓二 Keiji Hagiwara http://www.blogger.com/profile/16535134028283517468noreply@blogger.com