ICAAC online　小児感染症　症例検討会　（Session 113) #6 　最後

ICAAC online　小児感染症　症例検討会　（Session 113)

今日で終わりです。ICAACのReviewも殆ど、2014年分は終わり

演者:
Samir Shah, MD, MSCE
Charles Woods, MD, MS
Michael Levin, PhD
Hermione Lyall, MD


＃：概要
2 yo boy at ED with fever and poor oral intake
-5 -7 days fever, 39-420 C
-Dry cough/coryza
-Vomit x 1, diarrhoea x 3
-1-2 days reduced po intake
-Rx Erythromycin by GP but refused it

＃：救急受診
• T39, HR 190 -140,RR 30, Sat 97%
• Alert， irritable ++
• Mild TM hyperemia, inflammed tonsils ++, no pus.
• Cervical adenopathy
• Sepsis w/u :blood, throat, urine cx.
• Hb 11 .2g/d, WBC 18.9, ANC 14.19, Plts 284,
• CRP 309mg/L、CXR：WNL
• CSF 3 WBC, Glu & Protein normal
-Dx:Pharyngitis & Rx IV benzylpenicillin
-更にCTXに変更して少し解熱・・

＃：その後手がかりなく
-川崎病としての診療・治療を始める　→　改善　→　再び発熱
-やがてMicro Labから電話：嫌気性GNRが生えている＠27時間
-そして、このGNRはFusobacterium necrophorum
-しかし、咽頭はOK。CTでも咽頭OK。
-CTで乳突炎。穿刺液からFusobacterium necrophorum

＃：Fusobacterium necrophorum
-Oropharyngeal flora
-Non-spore forming, anaerobic thin GNB
Causes up to
ー10% acute sore throats
-20% of recurrent sore throats
-23% of peritonsillar abscesses
- <1% of all bacteremias

<font color="olive">-Lemierre's s yndrome
(1:400 cases)
uncommon but potentially latal
internal jugular vein thrombophlebitis_
associated with abscess
(Brain, Liver, Lung, Spleen etc.)
-Mortality:up to 5 %
-TX: Beta-lactamase resistant penicillin,metronidazole, clindamycin

＃：小児の乳突炎Mastoiditis/原因菌
・pneumo 36.1%, GAS 13.9%, CNS 13.9%, P.aeruginosa 8.3%, F.necrophorum 8.3%
・という事でF necrophorumは緑膿菌なみに多い原因