Oguri Noriaki, Sakuraba Akihito, Morikubo Hiromu, Kikuchi Oki, Sato Taro, Tokunaga Soutaro, Minowa Shintaro, Ikezaki Osamu, Mitsui Tatsuya, Miura Miki, Saito Daisuke, Hayashida Mari, Mori Hideaki, Osaki Takako, Kamiya Shigeru, Senoh Mitsutoshi, Kato Haru, Hisamatsu Tadakazu
Third Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.
Department of Infectious Diseases, Kyorin University School of Medicine, Tokyo, Japan.
Clin J Gastroenterol. 2019 Aug;12(4):325-329. doi: 10.1007/s12328-019-00949-z. Epub 2019 Feb 14.
We report a case of community-acquired fulminant colitis caused by Clostridium difficile in Japan. A 46-year-old woman was diagnosed with severe infectious enterocolitis and was admitted at another hospital. The stool culture was positive for toxigenic C. difficile. Since the patient presented with fulminant C. difficile infection (CDI) with toxic megacolon, respiratory insufficiency, and circulatory failure, she was transferred to Kyorin University Hospital for intensive care. Intubation and antibiotic therapy were performed. The general condition improved with conservative treatment, and she was discharged without sequelae. While the recovered isolate was toxin A and B-positive and binary toxin-positive, it was identified as polymerase chain reaction (PCR) ribotype ts0592 and slpA sequence type ts0592. The isolate was different from PCR ribotype 027 epidemic in Europe and North America. In Japan, binary toxin-producing strains are rare and have not caused an epidemic to date. Furthermore, there are few data on community-acquired CDI in Japan. In this case, a non-elderly woman with no major risk factors such as antibiotic use, administration of proton pump inhibitor and history of gastrointestinal surgery developed community-acquired fulminant CDI caused by the binary toxin-positive strain, and ICU treatment was required. Further studies focusing on the role of binary toxin-positive C. difficile in the severity of community-acquired CDI are necessary.
我们报告了一例在日本由艰难梭菌引起的社区获得性暴发性结肠炎病例。一名46岁女性被诊断为严重感染性小肠结肠炎，在另一家医院住院。粪便培养显示产毒素艰难梭菌阳性。由于该患者出现伴有中毒性巨结肠、呼吸功能不全和循环衰竭的暴发性艰难梭菌感染（CDI），她被转至杏林大学医院进行重症监护。进行了插管和抗生素治疗。经保守治疗，患者的一般状况有所改善，出院时无后遗症。虽然分离出的菌株毒素A和B阳性且二元毒素阳性，但被鉴定为聚合酶链反应（PCR）核糖型ts0592和slpA序列型ts0592。该分离株与在欧洲和北美的PCR核糖型027流行株不同。在日本，产二元毒素的菌株很少见，迄今为止尚未引起流行。此外，日本关于社区获得性CDI的数据很少。在本病例中，一名无抗生素使用、质子泵抑制剂给药及胃肠道手术史等主要危险因素的非老年女性发生了由二元毒素阳性菌株引起的社区获得性暴发性CDI，且需要重症监护病房治疗。有必要进一步开展研究，聚焦二元毒素阳性艰难梭菌在社区获得性CDI严重程度中的作用。
