Clostridium difficile の分子疫学と病原性
「1. Clostridium difficileとタイピング」Clostridium difficileは偽膜性大腸炎(pseudomembranous colitis, PMC)の原因菌としてよく知られており, 抗菌薬関連下痢症/腸炎(antibiotic-associated diarrhea/colitis, AAC/AAD)の主要な原因菌である. 本菌は偏性嫌気性菌であるが, 芽胞のかたちで環境に生存し続け, 院内感染をひきおこすことが知られている. 欧米では, 本菌に対する関心が非常に高く, 病院や老人ホームにおける集団発生が多数報告されている. タイピング法は感染症の集団発生の際...
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| Published in | 日本細菌学雑誌 Vol. 53; no. 4; pp. 611 - 619 |
|---|---|
| Main Authors | , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本細菌学会
1998
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| Online Access | Get full text |
| ISSN | 0021-4930 1882-4110 |
| DOI | 10.3412/jsb.53.611 |
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| Abstract | 「1. Clostridium difficileとタイピング」Clostridium difficileは偽膜性大腸炎(pseudomembranous colitis, PMC)の原因菌としてよく知られており, 抗菌薬関連下痢症/腸炎(antibiotic-associated diarrhea/colitis, AAC/AAD)の主要な原因菌である. 本菌は偏性嫌気性菌であるが, 芽胞のかたちで環境に生存し続け, 院内感染をひきおこすことが知られている. 欧米では, 本菌に対する関心が非常に高く, 病院や老人ホームにおける集団発生が多数報告されている. タイピング法は感染症の集団発生の際に, 感染源や感染経路の調査に利用されており, C. difficileにおいても, 集団発生の解析に種々なタイピング法が利用されている. タイピングによる解析は, 疫学的調査に利用されるだけではなく, 微生物の生態や病原性の研究に有用である. C. difficileにおいては, 院内感染の疫学調査, 消化管への定着の仕組み, 病原性の違い, といった問題を解決する鍵の一つとしてタイピング法が役立てられている. |
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| AbstractList | 「1. Clostridium difficileとタイピング」Clostridium difficileは偽膜性大腸炎(pseudomembranous colitis, PMC)の原因菌としてよく知られており, 抗菌薬関連下痢症/腸炎(antibiotic-associated diarrhea/colitis, AAC/AAD)の主要な原因菌である. 本菌は偏性嫌気性菌であるが, 芽胞のかたちで環境に生存し続け, 院内感染をひきおこすことが知られている. 欧米では, 本菌に対する関心が非常に高く, 病院や老人ホームにおける集団発生が多数報告されている. タイピング法は感染症の集団発生の際に, 感染源や感染経路の調査に利用されており, C. difficileにおいても, 集団発生の解析に種々なタイピング法が利用されている. タイピングによる解析は, 疫学的調査に利用されるだけではなく, 微生物の生態や病原性の研究に有用である. C. difficileにおいては, 院内感染の疫学調査, 消化管への定着の仕組み, 病原性の違い, といった問題を解決する鍵の一つとしてタイピング法が役立てられている. |
| Author | 中村, 信一 加藤, 直樹 加藤, はる |
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| References | 2) Cartmill, T.D., Panigrahi, H., Worsley, M.A., McCann, D.C., Nice, C.N., Keith, E. (1994): Management and control of a large outbreak of diarrhoea due to Clostridium difficile. J. Hosp. Infect. 27, 1-15. 17) Rupnik, M., Avesani, V., Janc, M., von Eichel-Streiber, C., Delmee, M. (1998): A Novel toxinotyping scheme and correlation of toxinotypes with serogroups of Clostridium difficile isolates. J. Clin. Microbiol. 36, 2240-2247. 14) McFarland, L.V., Elmer, G.W., Stamm, W.E., Mulligan, M.E. (1991): Correlation of immunoblot type, enterotoxin production, and cytotoxin production with clinical manifestations of Clostridium difficile infection in a cohort of hospitalized patients. Infect. Immun. 59, 2456-2462. 11) Kato, H., Cavallaro, J.J., Kato, N., Bartley, S.L., Killgore, G.E., Watanabe, K., Ueno, K. (1993): Typing of Clostridium difficile by western immunoblotting with 10 different antisera. J. Clin. Microbiol. 31, 413-415. 15) Nakamura, S., Serikawa, T., Mikawa, M., Nakashio, S., Yamakawa, K., Nishida, S. (1981): Agglutination, toxigenicity and sorbitol fermentation of Clostridium difficile. Microbiol. Immunol. 25, 863-870. 19) Shim, J.K., Johnson, S., Samore, M.H., Bliss, D.Z., Gerding, D.N. (1998): Primary symptomless colonisation by Clostridium difficile and decreased risk of subsequent diarrhoea. Lancet. 351, 633-636. 10) Johnson, S., Homann, S.R., Bettin, K.M., Quick, J.N., Clabots, C.R., Peterson, L.R., Gerding, D.N. (1992): Treatment of asymptomatic Clostridium difficile carriers (fecal excretors) with vancomycin or metronidazole. A randomized, placebocontrolled trial. Ann. Intern. Med. 117, 297-302. 6) Depitre, C., Delmee, M., Avesani, V., L'Haridon, R., Roels, A., Popoff, M., Corthier, G. (1993): Serogroup F strains of Clostridium difficile produce toxin B but not toxin A. J. Med. Microbiol. 38, 434-441. 18) Samore, M., Killgore, G., Johnson, S., Goodman, R., Shim, J., Venkataraman, L., Sambol, S., DeGirolami, P., Tenover, F., Arbeit, R., Gerding, D. (1997): Multicenter typing comparison of sporadic and outbreak Clostridium difficile isolates from geographically diverse hospitals. J. Infect. Dis. 176, 1233-1238. 8) Haslam, S.C., Ketley, J.M., Mitchell, T.J., Stephen, J., Burdon, D.W., Candy, D.C. (1986): Growth of Clostridium difficile and production of toxins A and B in complex and defined media. J. Med. Microbiol. 21, 293-297. 4) Clabots, C.R., Johnson, S., Olson, M.M., Peterson, L.R., Gerding, D.N. (1992): Acquisition of Clostridium difficile by hospitalized patients: evidence for colonized new admissions as a source of infection. J. Infect. Dis. 166, 561-567. 7) Dijck, P.v., Avesani, V., Delmee, M. (1996): Genotyping of outbreak-related and sporadic isolates of Clostridium difficile belonging to serogroup C. J. Clin. Microbiol. 34, 3049-3055. 9) Ho, M., Yang, D., Wyle, F.A., Mulligan, M.E. (1996): Increased incidence of Clostridium difficile-associated diarrhea following decreased restriction of antibiotic use. Clin. Infect. Dis. 23, Suppl 1, S102-106. 12) Kato, H., Kato, N., Watanabe, K., Iwai, N., Nakamura, H., Yamamoto, T., Suzuki, K., Kim, S.M., Chong, Y., Wasito, E.B. (1998): Identification of toxin A-negative, toxin B-positive Clostridium difficile by PCR. J. Clin. Microbiol. 36, 2178-2182. 3) Cheng, S.H., Lu, J.J., Young, T.G., Perng, C.L., Chi, W.M. (1997): Clostridium difficile-associated diseases: comparison of symptomatic infection versus carriage on the basis of risk factors, toxin production, and genotyping results. Clin. Infect. Dis. 25, 157-158. 16) Pothoulakis, C. (1996): Pathogenesis of Clostridium difficile-associated diarrhoea. Eur. J. Gastroenterol. Hepatol. 8, 1041-1047. 21) von Eichel-Streiber, C., Meyer zu Heringdorf, D., Habermann, E., Sartingen, S. (1995): Closing in on the toxic domain through analysis of a variant Clostridium difficile cytotoxin B. Mol. Microbiol. 17, 313-321. 1) Brazier, J.S., Mulligan, M.E., Delmee, M., Tabaqchali, S. International Clostridium Difficile Study Group. (1997): Preliminary findings of the international typing study on Clostridium difficile. Clin. Infect. Dis. 25, S199-201. 13) Kato, H., Kato, N., Watanabe, K., Ueno, K., Ushijima, H., Hashira, S., Abe, T. (1994): Application of typing by pulsed-field gel electrophoresis to the study of Clostridium difficile in a neonatal intensive care unit. J. Clin. Microbiol. 32, 2067-2070. 20) Soehn, F., Wagenknecht-Wiesner, A., Leukel, P., Kohl, M., Weidmann, M., von Eichel-Streiber, C., Braun, V. (1998): Genetic rearrangements in the pathogenicity locus of Clostridium difficile strain 8864-implications for transcription, expression and enzymatic activity of toxins A and B. Mol. Gen. Genet. 258, 222-232. 5) Delmee, M., Laroche, Y., Avesani, V., Cornelis, G. (1986): Comparison of serogrouping and polyacrylamide gel electrophoresis for typing Clostridium difficile. J. Clin. Microbiol. 24, 991-994. |
| References_xml | – reference: 2) Cartmill, T.D., Panigrahi, H., Worsley, M.A., McCann, D.C., Nice, C.N., Keith, E. (1994): Management and control of a large outbreak of diarrhoea due to Clostridium difficile. J. Hosp. Infect. 27, 1-15. – reference: 20) Soehn, F., Wagenknecht-Wiesner, A., Leukel, P., Kohl, M., Weidmann, M., von Eichel-Streiber, C., Braun, V. (1998): Genetic rearrangements in the pathogenicity locus of Clostridium difficile strain 8864-implications for transcription, expression and enzymatic activity of toxins A and B. Mol. Gen. Genet. 258, 222-232. – reference: 21) von Eichel-Streiber, C., Meyer zu Heringdorf, D., Habermann, E., Sartingen, S. (1995): Closing in on the toxic domain through analysis of a variant Clostridium difficile cytotoxin B. Mol. Microbiol. 17, 313-321. – reference: 16) Pothoulakis, C. (1996): Pathogenesis of Clostridium difficile-associated diarrhoea. Eur. J. Gastroenterol. Hepatol. 8, 1041-1047. – reference: 6) Depitre, C., Delmee, M., Avesani, V., L'Haridon, R., Roels, A., Popoff, M., Corthier, G. (1993): Serogroup F strains of Clostridium difficile produce toxin B but not toxin A. J. Med. Microbiol. 38, 434-441. – reference: 4) Clabots, C.R., Johnson, S., Olson, M.M., Peterson, L.R., Gerding, D.N. (1992): Acquisition of Clostridium difficile by hospitalized patients: evidence for colonized new admissions as a source of infection. J. Infect. Dis. 166, 561-567. – reference: 14) McFarland, L.V., Elmer, G.W., Stamm, W.E., Mulligan, M.E. (1991): Correlation of immunoblot type, enterotoxin production, and cytotoxin production with clinical manifestations of Clostridium difficile infection in a cohort of hospitalized patients. Infect. Immun. 59, 2456-2462. – reference: 9) Ho, M., Yang, D., Wyle, F.A., Mulligan, M.E. (1996): Increased incidence of Clostridium difficile-associated diarrhea following decreased restriction of antibiotic use. Clin. Infect. Dis. 23, Suppl 1, S102-106. – reference: 10) Johnson, S., Homann, S.R., Bettin, K.M., Quick, J.N., Clabots, C.R., Peterson, L.R., Gerding, D.N. (1992): Treatment of asymptomatic Clostridium difficile carriers (fecal excretors) with vancomycin or metronidazole. A randomized, placebocontrolled trial. Ann. Intern. Med. 117, 297-302. – reference: 11) Kato, H., Cavallaro, J.J., Kato, N., Bartley, S.L., Killgore, G.E., Watanabe, K., Ueno, K. (1993): Typing of Clostridium difficile by western immunoblotting with 10 different antisera. J. Clin. Microbiol. 31, 413-415. – reference: 17) Rupnik, M., Avesani, V., Janc, M., von Eichel-Streiber, C., Delmee, M. (1998): A Novel toxinotyping scheme and correlation of toxinotypes with serogroups of Clostridium difficile isolates. J. Clin. Microbiol. 36, 2240-2247. – reference: 19) Shim, J.K., Johnson, S., Samore, M.H., Bliss, D.Z., Gerding, D.N. (1998): Primary symptomless colonisation by Clostridium difficile and decreased risk of subsequent diarrhoea. Lancet. 351, 633-636. – reference: 1) Brazier, J.S., Mulligan, M.E., Delmee, M., Tabaqchali, S. International Clostridium Difficile Study Group. (1997): Preliminary findings of the international typing study on Clostridium difficile. Clin. Infect. Dis. 25, S199-201. – reference: 5) Delmee, M., Laroche, Y., Avesani, V., Cornelis, G. (1986): Comparison of serogrouping and polyacrylamide gel electrophoresis for typing Clostridium difficile. J. Clin. Microbiol. 24, 991-994. – reference: 8) Haslam, S.C., Ketley, J.M., Mitchell, T.J., Stephen, J., Burdon, D.W., Candy, D.C. (1986): Growth of Clostridium difficile and production of toxins A and B in complex and defined media. J. Med. Microbiol. 21, 293-297. – reference: 18) Samore, M., Killgore, G., Johnson, S., Goodman, R., Shim, J., Venkataraman, L., Sambol, S., DeGirolami, P., Tenover, F., Arbeit, R., Gerding, D. (1997): Multicenter typing comparison of sporadic and outbreak Clostridium difficile isolates from geographically diverse hospitals. J. Infect. Dis. 176, 1233-1238. – reference: 15) Nakamura, S., Serikawa, T., Mikawa, M., Nakashio, S., Yamakawa, K., Nishida, S. (1981): Agglutination, toxigenicity and sorbitol fermentation of Clostridium difficile. Microbiol. Immunol. 25, 863-870. – reference: 7) Dijck, P.v., Avesani, V., Delmee, M. (1996): Genotyping of outbreak-related and sporadic isolates of Clostridium difficile belonging to serogroup C. J. Clin. Microbiol. 34, 3049-3055. – reference: 12) Kato, H., Kato, N., Watanabe, K., Iwai, N., Nakamura, H., Yamamoto, T., Suzuki, K., Kim, S.M., Chong, Y., Wasito, E.B. (1998): Identification of toxin A-negative, toxin B-positive Clostridium difficile by PCR. J. Clin. Microbiol. 36, 2178-2182. – reference: 3) Cheng, S.H., Lu, J.J., Young, T.G., Perng, C.L., Chi, W.M. (1997): Clostridium difficile-associated diseases: comparison of symptomatic infection versus carriage on the basis of risk factors, toxin production, and genotyping results. Clin. Infect. Dis. 25, 157-158. – reference: 13) Kato, H., Kato, N., Watanabe, K., Ueno, K., Ushijima, H., Hashira, S., Abe, T. (1994): Application of typing by pulsed-field gel electrophoresis to the study of Clostridium difficile in a neonatal intensive care unit. J. Clin. Microbiol. 32, 2067-2070. |
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| Title | Clostridium difficile の分子疫学と病原性 |
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