Corynebacterium durum が起炎菌として疑われた肺炎の1症例
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(2) ῌ+z"W, 2007. 1. ῌ῎. ῑ῍. Corynebacterium durum
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(6) Corynebacterium durum 1 GHI J K2A 65 L> 3J () 5 *MNO4G5PBCDE/6FQ7 G,RS J () 14 * 11 = 12 +8456"T9G,:> BCDE/
(7) Q7;<F > U=> V4=WXG>?T9FHYZ[S J () 15 * 10 = 17 +> \@A BF]S P9^ C4DEFG^ J C4
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(14) U=[\WnoG p^WSlWXab Nocardia LFMk&GS]Q-F&^> q
(15) r sulfamethoxazole-trimethoprim 7ST %s< FMkQ7tu^ J DEab 3 +;F1vw xy z)f_` !Ga{ l|> }~_` !fA Nocardia asteroides _`^ > 5
(16) PF 16S rRNA ) bG o> 99.98
(17) cf C. durum _`^. J Key words: Corynebacterium durum> BCDE/> #+ _`*O3P> Nocardia> Kinyoun H ῏. ῒ. Corynebacterium durum A> d<F Nocardia L. A> UTGw vW¡> xy F¢^ v
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(20) ¤. i Actinomyces Le
(21) fQgFgk_`*O. fk6)J z{fA?@. 3PfkJ Corynebacterium LA diphtheria. }vWkJ. ¥¦ |§fAz. toxin G"k C. diphtheriae, C. ulcerans TA +& > hBiij> klWX. I. ῐ. ^Wmab#n^ kJ > *o. 1.. K29 65 L> 3. 2
(22) ph3i> qOWX^W+&. 2.. ]~9 \@> O4G¨C4©. r;Gs> ^bFU=Ftu3. 3.. ª«9 +\ 7¬<> > h®3¬T. 4.. ³9 M´µwlW. 5.. 89 () 5 *FO4G5P6G,:J g. GpwSklv^ Sk15)J a> ?@#n C. durum [2&^9 (·076῍8765) ¸¹ 13 1 º !" TEL: 0167῍23῍2181 7UQ 227< FAX: 0167῍39῍1077 E-mail: [email protected]. ΐ. > ¯°±²)3. hR
(23) BCDE/:^ > Q7G,R S J q
(24) r() 14 * 11 = 12 +F ¡ P8456"T9G,:> +() 14 * 11 = 13 +MNBCDE/
(25) Q7G¶ k PW J () 15 * 10 = 17 +> \@ABF]S P09^ J +z"W,»¼. Vol. 17. No. 1. 2007.. 1.
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(28) 15 . &F &4< . 10 17 130/88 mmHg, . 15 10 17 . .
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(30) ¡. !"#. $%&' ()*+ 15 10 17 ,. 7.. -./0()123$%&' $4$ 5 67
(31) 89:;<=$ 10 17 >?@A1B<C 9:;<DE4F GHIJK
(32) ' L MNOP 14 11 13 QR$MN X S TU 1V MN CT TU 2V EWX$% 15 10 17 QR$ MN X S TU 3V :YGZ[\]9^G MN CT TU 4V :YG_`abcd efgh1i ZIjk ' lm] 14 11 13 nMN. 8.. X S%YG_`abP1i o B p carbocisteine q r
(33) ' 12 11 st+F & clarithromycin (CAM) 1 1 u 200 mg 28 vw x1yz$' CAM wx1yz{|E } n~$st1i . U 2.. MN CT ¢ 6 14 11 13 nMN CT' Y G_`abP1i |'. U 3.. MN X S£¤ 15 10 17 $%MN X S' YGZ[\]9^G$%|'. :w & & <%nF ' 4F 1 v n;|o. U 1.. 2. MN X S¢ 6 14 11 13 n M N X S' YGZ[_`abP1i |'. ¥l¦/g0. § Vol. 17. No. 1. 2007..
(34) Corynebacterium durum Rs§o 1 ³. * 6. * 4.. &' CT .% : ; 15 < 10 = 17 8 . / 0 & ' CT#
(35) ¡_¢£ J¤rW#. 3. &' CT ¥¦% :; 16 < 1 = 14 8 ST 5623%&' CT#
(36) ¡_¢£ J¬#.
(37) Nocardia !"# $% &' X ( )* 3+ &' CT )* 4+ ,- ./01 CAM 2 34 sulfamethoxazole-trimethoprim )ST 56+ 1 7 2 g 1 8 2 7 28 8923 # ST 5623%:; 16 < 1 = 14 8>? @ ABCDEFG HIJKL M NJOD PQRSATUVWXY"J&' X ( )* 5+ &' CT )* 6+ Z [\ # 9. i). ]^_`aRSb cdefRRSb ghTUPQRS1A carbocisteine 23ijklRm1O" no pqrW ARsVWXY" # Y:; 15 < 10 = 17 8EFRS1 A tF )Miller & Jones
(38) u1 P2 vw+ JxsVWyz{|} G ~ F {. * 5.. &' X (¥¦% :; 16 < 1 = 14 8 ST 5623%&' X (# §¨©ª«J[\ #. )8 + . TU# . 1A * 7 No-. cardia
(39) # Vr Nocardia . 1 1 1. )Kinyoun. 8®¯°]^_`±². + TU . Vol. 17. No. 1. 2007.. 3.
(40) IJKLMNOPQMNRSTMUVWMXYZ[\M]^_`. 4. 7.. Gram 1000
(41) Nocardia !"#$%. 9.. 4. 8.. Kinyoun 1000
(42) &' ()*+,- () !"#$%. ./012 C. durum 345 3 6789:;% '<=89:;12>!?$%. 6@ABCDEFGH Vol. 17. No. 1. 2007..
(43) Corynebacterium durum . CT¼ 1 U. 5. 8
(44) . C. durum " mannitol zqr<. Nocardia . C. matruchotii " z Api Coryne 98KL" O . ii) . !" 5# $%& . M} rKL8rbO"9sI.
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(47) ' () 7. durum O>¢qrP "Pb. 3589:; <= 18 >?. OI29sr u vw#5/98. @ A 14 11 B 16 C 9. Nocardia O C. du-. "DEFG<HII. rum r g & ? b-. I A 15 10 B 17 9"J. galactosidase 9trbO@6) ^K. KLI Nocardia HM. L v w # 5 / M b-. 9 5# $%&
(48) *+,-./& . galactosidase " | £ o-Nitrophenyl-b-9-.
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(50) OP 2 . galactopyranoside r Rap ID CB Plus. Q 0.5 mm 3 Q 2 mm . 9 " 2-Naphthyl-b-galactopyranoside. . R!STU
(51) VWXYZ. r Api Coryne 9P OKL. [,\].H ^,\].. 8 AB C. durum b-galactosidase. 5# $%&
(52) 9_ ' 9) `Sa. " Or9 e ONPG ¤¥.
(53) Ob "cd"`. 4x ' () b-galactosidase . Sa" e. KL O 9P Nocar-. iii) #. ! J $KLI. !%f . Nocardia #O Nocardia g&. dia 2 iv). ¦Z§. ! CD¨ Nocardia . hijk&
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(57) 'OP. romycin (EM), imipenem / cilastatin (IPM /. BBL) '()op *qr. CS), E 3 © F cephem O ª t . O N. asteroides O*9s I b. 9 D«97Mr¦Z§ ¬. #+"tu9vwg&9tr 16S. 3 PMIC 31 J, NMIC 5 J '® DADE BE-. rRNA PCR +9,- l.xyk4z.. HRING) ª t ¦ ¯ M. ={|/0} l.xyk4z.. MIC G°± ^KL" EM 4 mg/. KL 99.98# C. durum O~1 Nocardia. ml ²³ MIC H9t ^I¦9. 2 3 C. durum . !¦ ST ¦ eryth-. C O. ":Z§ ´JµKL . 4 @ l.xyk4z.KLI. ST ¦ MIC " 2/38 mg/ml ²¶O:. C. durum eqr hm. Z§ u ²MI7M. S . i Api Coryne (Bio Merieux) O. CAM MIC H" 4 mg/ml ²³ON 9 'O. Rap ID CB Plus 'a,) KL hmS.i5" Api Coryne Profile Code " 3040105 O Rap ID CB Plus Profile Code " 7504041 O P#679t vw#5 /8 " {5 pyrazinamidase, glucose, sucrose, " ) 6 94 MrPO #95 I maltose 5 z :"r; C. durum tr C. matruchotii P C. durum O # 9 5 q 9 mannitol K L O r b O O . O 1.. Corynebacterium durum ¦ Z§ KL ¦P. MIC ( mg/ml) ·8 8 ·2 ·1 ·1 ·1 ·2/38 ·0.5 ¸4 ¸4. Cefotaxime Ceftazidime Cefpirome Cefepime Cefozopran Flomoxef Sulfamethoxazole-trimethoprim Imipenem/Cilastatin Erythromycin Clarithromycin. AQ¹RSº». Vol. 17. No. 1. 2007.. 5.
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(59) . ^_L 2 rsb]#Q, II. ῏. FGJ: C. durum 'tA#,. ῐ. Corynebacterium C. diphtheriae
(60) . ' Philippe fy6) NWt2%. !". Y#L # ^_ Nocardia ] ,. # $%&
(61) ' #()*+. 1 C. durum u % #
(62) : b-. #,. !- -".. galactosidase ' X b ]. -/01%2'
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(64) :;<=# C. durum. galactosidase vdv NW. ' 6789 > !"#>. w #
(65) : L Api Coryne Profile. ?"#>'
(66) :$+%&@ABCD 6'(. Code C. durum ,fy,g. !")*E"#> ?"#>,. #8) #,x Profile Code . +,=F#-*.. . !- G/H. 01 I" #J ,6''234K L5. b]#=# )#MN@\. M -N:66789'7O% . d4
(67) UVC: #J ,iTjk. J , 6789+,F/H-. ' G_QR=JIcJ\K . *'?"#>PQ,RS1' C.. MN@\d#yz\KL,\QR\. durum T89,'8) UVC. def b]\d# ,\ ]&#. :;W5 X % X)<=>) W5. ^)z{n,: [;'a2 ¡. CT 9678#?@ABCY1. |b]" b]' 2" . Z#0[RS&'\7 1. #}¢,\d,1'.#
(68) l. "#J-]'
(69) DE. . 7). ^_ F`GDJ: 1 HZ",#. III. ῌ. ῎. J-]'a ' b$#IcJ\K. \~ Nocardia bJ^):;. L,MN@\def,1 O. n iq:#g£nYb]#xc. .'PgRS G_QR\. # b]% =# ¤). d=hSTiTUV#J:WjX'CY. }jTno##2l ' L ST. ,=F g
(70) : QR\def%#k. 2-4'q
(71) YWjXCY. l=F RS. 1' . UVC:#J , mUVCYZC Y=[ Nocardia \]1#Q, Nocardia #^)m;n,o: p CY Kinyoun :#o,gEiqn. ῑ. ¥ ¦ 1995. §+ #oK Corynebacterium striatum )<[ 1 ¦ MN@¨© 5: 22ῌ26.. 2). ¥ ª5«¬ r¬ ¦ 2000. Corynebacterium amycolatum #J IVH - 1 ¦ MN@¨© 10: 51ῌ55.. 3). v ®5 ¯ ¥ ¦ 1998. Corynebacterium pseudotuberculosis #J° 1 ¦ MN@¨© 8: 240ῌ245.. 4). ¥ ±¬ §²³¬ ¦ 1997. Corynebacterium striatum )&)´ µ¦ ~\d 46: 995ῌ999.. 5). ¥ ¦ 1994. Corynebacterium jeikeium #J° 1 ¦ - ¨© 68: 1527ῌ1532.. , Nocardia _E\d`Y Pa `\drstu ll'v b ]\dfv 1w, QRgxc
(72) :UVC: defy%z' d{ UVC: Kinyoun :gQ:h. 6 789# Nocardia 'iO%'
(73) 9) 1 " |}~# Nocardia iTjk#Q ,l1w mPnoT,MpK , ST 2UV' )# ST 2 '<[}j#LT
(74) 1 T-4\d 'q
(75) 1 'O 6. MN@¨©. Vol. 17. No. 1. 2007.. ῍. 1).
(76) Corynebacterium durum JKL0=)M 1 > 6). Riegel, P., R. Heller, G. Prevost, et al. Oct. 1997. Corynebacterium durum sp. nov., from Human Clinical Specimens. p. 1107ῌ1111, In: International Journal of Systematic Bacteriology.. 7). 2000.
(77) 3999: 1ῌ8.. 8). Funke, G., K. A. Bernard. 2003. Coryneform Gram-Positive Rods. p. 472ῌ488, In: Manual of. 7. Clinical Microbiology, 8th ed. (P. R. Murray, E. J. Baron, J. H. Jorgensen, et al. ed.), American Society for Microbiology,Washington, D.C. 9). !"# $%&"' ( 2002. )* +,
(78) -./0123456789 :;<0=) Nocardia asteroides 1 > ? @ABC 76: 212ῌ215.. A Case of Corynebacterium durum Pneumonia Suspicion Takahiro Kinebuchi1) Yoshihito Otsuka2) Kiyofumi Ohkusu3) Kyoko Nakanishi4) Kazuo Usami1) Takayuki Ezaki3) 1). 2). 3). 4). Department of Clinical Laboratory, Social Welfare Corporation Hokkaido Social Work Society Furano Hospital Department of Clinical Laboratory, Infection Control Team, Social Insurance Central General Hospital Department of Microbiology, Regeneration and Advanced Medical Science, Gifu University School of Medicine Department of Pulmonology, Social Welfare Corporation Hokkaido Social Work Society Furano Hospital. We report, Corynebacterium durum experienced a doubted example as the cause bacteria of the pneumonia which was caused according to the bronchiectasis. The patient is a 65 year-old man. The sputum is sometimes of mixed-blood from 1993 and it was undergoing the medical care of the bronchiectasis at the other hospital. On November 12 2002, we took medical advice because of the medical care of the bronchiectasis in the pulmonology at my hospital. Then, we did antibacterial medicine and an expectorant and so on in the formula and we decided to observe an elapse. On October 17 2003, we observed ramifying Gram positive bacillus which is peculiar to the Nocardia genus with the inflammatory image from Gram dyeing by the sputum. Because I doubted an infection by the Nocardia genus, I told the doctor of the taking charge these meaning. Then, we prescribed sulfamethoxazole-trimethoprim and we began a medical care. When inspecting in the identification using the colony which grew 3 days after cultivation, in the simple identification inspection, we identified as Nocardia asteroides, but we did 16S rRNA sequence analysis to confirm and we identified it as C. durum (D consistence, 99.98).. EFGHIABC. Vol. 17. No. 1. 2007.. 7.
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