日: モラクセラ・カタラーリス
ラ: Moraxella catarrhalis, Branhamella catarrhalis
関: モラクセラ属

特徴

シュードモナス目モラクセラ科モラクセラ属ブランハメラ亜属
グラム陰性球菌
双球菌
偏性好気性
通常、病原性はない。日和見感染の原因となる
60-70%がペニシリナーゼ産生(SMB.217)

病原体

感染症

モラクセラ・カタラーリス感染症

モラクセラ肺炎

疫学

潜伏期間

感染経路

症状

合併症

経過

治療

検査

予防

WordNet

of or relating to a catarrh; "catarrhal fever is any of several respiratory or oral diseases of livestock such as bluetongue in horses and sheep"

PrepTutorEJDIC

カタル性の

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/06/24 17:47:30」(JST)

wiki en

[Wiki en表示]

Moraxella catarrhalis is a fastidious, nonmotile, Gram-negative, aerobic, oxidase-positive diplococcus that can cause infections of the respiratory system, middle ear, eye, central nervous system, and joints of humans. It causes the infection of the host cell by sticking to the host cell using a Trimeric Autotransporter Adhesins (TAA).

Epidemiology

M. catarrhalis is a human pathogen with an affinity for the human upper respiratory tract. Other primates, such as macaques, might become infected by this bacteria.^[1]

History

M. catarrhalis was previously placed in a separate genus named Branhamella. The rationale for this was that other members of the genus Moraxella are rod-shaped and rarely caused infections in humans. However results from DNA hybridization studies and 16S rRNA sequence comparisons were used to justify inclusion of the species catarrhalis in the genus Moraxella. As a consequence, the name Moraxella catarrhalis is currently preferred for these bacteria. Nevertheless, some in the medical field continue to call these bacteria Branhamella catarrhalis.

Moraxella is named after Victor Morax, a Swiss ophthalmologist who first described this genus of bacteria. Catarrhalis is derived from catarrh, from the Greek meaning to flow down (cata- implies 'down'; -rrh implies 'flow'), describing the profuse discharge from eyes and nose typically associated with severe inflammation in colds.

Clinical significance

These bacteria are known to cause otitis media,^[2]^[3] bronchitis, sinusitis, and laryngitis. Elderly patients and long-term heavy smokers with chronic pulmonary disease should be aware that M. catarrhalis is associated with bronchopneumonia, as well as exacerbations of existing chronic obstructive pulmonary disease (COPD).

The peak rate of colonisation by M. catarrhalis appears to occur at approximately 2 years of age, with a striking difference in colonization rates between children and adults (very high to very low).

M. catarrhalis has recently been gaining attention as an emerging human pathogen. It has been identified as an important cause in bronchopulmonary infection, causing infection through pulmonary aspiration in the upper pulmonary tract.^[4] Additionally, it causes bacterial pneumonia, especially in adults with a compromised immune system.^[5] It has also been known to cause infective exacerbations in adults with chronic lung disease, and it is an important cause in acute sinusitis, maxillary sinusitis, bacteremia, meningitis, conjunctivitis, acute purulent irritation of chronic bronchitis, urethritis, septicemia (although this is rare), septic arthritis (which is also a rare occurrence), as well as acute laryngitis in adults and acute otitis media in children.^[6]^[7] M. catarrhalis is an opportunistic pulmonary invader, and causes harm especially in patients who have compromised immune systems or any underlying chronic disease.^[4]^[6]

Link with Bacteremia

M. catarrhalis has also been linked with septic arthritis in conjunction with bacteremia, as shown in a case recorded by Philipp Melendez and Royce Johnson in 1991 in the Kern Medical Center in the University of California, Los Angeles.^[6] Although there have been cases of bacteremia cased by M. catarrhalis reported before, this was the first instance in which bacteremia caused by M. catarrhalis was also associated with septic arthritis. A microbiological evaluation of the patient (a 41 year old male) revealed that M. catarrhalis was the cause of the disease rather than Neisseria as was previously believed. This was also the second case of M. catarrhalis causing septic arthritis (although in the first case there was no mention of bacteremia). ^[6]

Along with its relation to septic arthritis, bacteremia is also caused by M. catarrhalis infection. However, bacteremia caused by M. catarrhalis infection can range in severity from a slight fever to lethal sepsis and an associated respiratory tract infection) is usually also identified.^[8] In a 1995 case study by John Ioannidasa and his colleagues of bacteremia infections caused by M. catarrhalis, there was a 21% mortality rate among patients. However, this may have been due to a lack of knowledge about the bacterium because of its recent recognition as a pathogen.^[8]

In this same study, an infection of high-grade bacteremia was linked with the development of endocarditis.^[8] However, the patients without endocarditis in the case study has been related to the background of each patient, especially the existence of other illnesses and any possible immune impairments they may or may not have. Also, although bacteremia caused by M. catarrhalis has been infrequently reported, this may be due to a misdiagnosis or oversight because M. catarrhalis was only recently (1990s) identified as an important pathogen.^[8] Many chronic disease in patients with M. catarrhalis bacteremia can be linked to the patients with immune defects or respiratory debility. Likewise, respiratory debility in patients with bacteremic pneumonia caused by M. catarrhalis infection can be linked with increased rates of pharyngeal colonization, enhancement of bacterial adherence to abnormal epithelium, and increased susceptibility of pulmonary parenchyma to infection.^[8]

Antibiotic resistance

Antibiotic sensitivity test. This strain shows resistance to ampicillin because it produces the enzyme β-lactamase. This is confirmed by the disc labelled β turning red.

M. catarrhalis can be treated with antibiotics, but it is commonly resistant to penicillin, ampicillin, and amoxicillin.^[8]

Current research priorities involve trying to find a suitable vaccine^[9] for this genotypically diverse organism, as well as determining factors involved with virulence, e.g. complement resistance. Lipooligosaccharide is considered one possible virulence factor.^[9]

Since the recent recognition of M. catarrhalis as an important pathogenic microbe, there have been developments for a possible antibiotic. According to a correspondence from T. G. Winstanley regarding M. catarrhalis and antibiotics, Winstanley reported that a fraction of M. catarrhalis strains seemed to be resistant to ampicillin, which makes ampicillin and amoxicillin inappropriate choices of antibiotic against M. catarrhalis.^[4] Although all strains of M. catarrhalis were susceptible to cotrimoxazole, erythromycin, sulfadimidine, and tetracycline, all strains of M. catarrhalis were also resistant to trimethoprim.^[4] One of the reasons for the resistance of M. catarrhalis to ampicillin and trimethoprim is because of the beta-lactamase production, which is resistant to ampicillin.^[4] Also, the resistance of M. catarrhalis to other antibiotics may be attributed to beta-lactamase as well because the use of these antibiotics has triggered an increase in development of beta-lactase, which resists antibiotics.^[4]

However, a 1994 study by Merja Helminen and her colleagues has identified a large protein on the surface of M. catarrhalis that may serve as a target for protective antibodies.^[5] This UspA (the designated antigen) protein is the first surface-exposed protein on M. catarrhalis that can be a target for biologically active antibodies, and therefore lead to a vaccination. This protein was also present in all of the strains that Helminen and her colleagues were able to test. The large size of the exposed protein macromolecule makes it similar to Neisseria gonorrhoeae outer membrane protein macromolecular complex, which implies that UspA may be a single polypeptide chain.^[5]

Another study by Isobel Maciver in 1993 determined that active immunization of M. catarrhalis in the respiratory tract allowed the control of the growth of M. catarrhalis and led to the development of serum antigens.^[7] Also, there was an enhanced ability in the test subjects (mice) to clear M. catarrhalis from their lungs. Likewise, passive immunization of M. catarrhalis from the mice respiratory tracts also enhanced the mice’s ability to clear the microbes from their lungs, which means that serum antibodies likely play a large role in the immunization and protection of the respiratory tract.^[7] Maciver also notes that, along with outer membrane proteins that are consistent among different strains of M. catarrhalis, there may also be a sort of subclass-specific IgG antibody response to certain outer membrane proteins. Therefore, the outer membrane antigens of M. catarrhalis also provide a possible vaccine source. Also, there has also been the development of a bactericidal serum antibody in response to the diseases caused by M. catarrhalis.^[7]

Treatment

Treatment options include antibiotic therapy or a so-called "watchful waiting" approach. The great majority of clinical isolates of this organism produce beta-lactamases and are resistant to penicillin. Resistance to trimethoprim, trimethoprim-sulfamethoxazole (TMP-SMX), clindamycin, and tetracycline have been reported. It is susceptible to fluoroquinolones, most second- and third-generation cephalosporins, erythromycin, and amoxicillin-clavulanate.

Vaccine development

Currently, there is no vaccine in the US against Moraxella catarrhalis infection. Moraxella catarrhalis is a significant cause of respiratory tract infection against which a vaccine is sought. Several outer membrane proteins are currently under investigation as potential vaccine antigens, including the porin M35.

Cellular morphology and biochemistry

During the first reported case of M. catarrhalis causing bacteremia that was associated with septic arthritis, the microbe was cultured, which revealed much about the morphology of colonies of M. catarrhalis as well as M. catarrhalis itself.^[6] M. catarrhalis is a large, kidney-shaped gram-negative diplococcus. It can be cultured on blood and chocolate agar plates after an aerobic incubation at 37 degrees Celsius for 24 hours. Cultures of the M. catarrhalis bacterium revealed gray-white hemispheric colonies about 1 millimeter in diameter. These colonies were fragile and easy to crumble and appeared to have a waxy surface.^[6]

The hockey puck test was applied to these M. catarrhalis colonies.^[6] This is a test in which a wooden stick is used to try and push the colonies across the agar plate. The M. catarrhalis colonies scored positively on this test, which means that the colonies could be slid across the plate. The colonies did not demonstrate hemolysis, and were not able to ferment glucose, sucrose, maltose, and lactose. They were able to produce DNase. Cultures of the M. catarrhalis tested positive for oxidase and nitrate reduction, which is characteristic of M. catarrhalis.^[6] Many laboratories also perform a butyrate esterase test and a beta-lactamase test. Both tests should be positive and can help to rapidly identify M. catarrhalis from a culture.^[10]

The recognition of M. catarrhalis as a pathogenic bacterium has led to studies for possible antibodies against it, which have led to a wider understanding of the composition of M. catarrhalis. A study by Merja Helminen and her colleagues revealed that the outer membrane protein (OMP) profiles of different strains of M. catarrhalis are extremely similar to each other.^[5] Analyses of these outer membrane protein profiles with monoclonal antibodies (MAbs) revealed that a few proteins with similar molecular masses in the different strains of M. catarrhalis have cross-reactive epitopes.^[5] Their experiments also identified a surface-exposed protein on M. catarrhalis that has an unusually high molecular mass. There has been a report that an 80kDa outer membrane protein on M. catarrhalis is immunogenic and common to all nonencapsulated strands of M. catarrhalis, which suggests that it may be used as an antigen for immunization.^[5]

References

^ Embers, Monica E.; Doyle LA, Whitehouse CA, Selby EB, Chappell M, Philipp MT (27 January 2011). "Characterization of a Moraxella species that causes epistaxis in macaques". Veterinary Microbiology 147 (3-4): 367–375. doi:10.1016/j.vetmic.2010.06.029. PMID 20667430. Retrieved 2 October 2013. Cite uses deprecated parameters (help)
^ Mawas F, Ho MM, Corbel MJ (January 2009). "Current progress with Moraxella catarrhalis antigens as vaccine candidates". Expert Rev Vaccines 8 (1): 77–90. doi:10.1586/14760584.8.1.77. PMID 19093775.
^ Yu S, Gu XX (June 2007). "Biological and Immunological Characteristics of Lipooligosaccharide-Based Conjugate Vaccines for Serotype C Moraxella catarrhalis". Infect. Immun. 75 (6): 2974–80. doi:10.1128/IAI.01915-06. PMC 1932890. PMID 17371852.
^ ^a ^b ^c ^d ^e ^f Winstanley, T.G. and R.C. Spencer. “Moraxea catarrkar: antibiotic susceptibility with special reference to trimethoprim.” Journal of Antimicrobial Chemotherapy 18, no. 3 (1986): 425-426.
^ ^a ^b ^c ^d ^e ^f Helminen, Merja E., Isobel Maciver, Jo L. Latimer, Julia Klesney-Tait, Leslie D. Cope, Maria Paris, George H. McCracken, Jr., and Eric J. Hansen. “A Large, Antigenically Conserved Protein on the Surface of Moraxella catarrhalis Is a Target for Protective Antibodies.” The Journal of Infectious Diseases 170, no. 4 (1994): 867-872.
^ ^a ^b ^c ^d ^e ^f ^g ^h Melendez, Philipp R. and Royce H. Johnson. “Bacteremia and Septic Arthritis Caused by Moraxella catarrhalis.” Reviews of Infectious Diseases 13, no. 3 (1991): 428-429.
^ ^a ^b ^c ^d Maciver, Isobel, Manaswat Unhanand, George H. McCracken Jr., and Eric J. Hansen. “Effect of Immunization on Pulmonary Clearance of Moraxella Catarrhalis in an Animal Model.” The Journal of Infectious Diseases 168, no. 2 (1993): 469-472.
^ ^a ^b ^c ^d ^e ^f Ioannidis, John P. A. Ioannidis, Michael Worthington, Jeffrey K. Griffiths, and David R. Snydman. “Spectrum and Significance of Bacteremia Due to Moraxella catarrhalis.” Clinical Infectious Diseases 21, no. 2 (1995): 390-397.
^ ^a ^b Peng D, Hong W, Choudhury BP, Carlson RW, Gu XX (November 2005). "Moraxella catarrhalis Bacterium without Endotoxin, a Potential Vaccine Candidate". Infect. Immun. 73 (11): 7569–77. doi:10.1128/IAI.73.11.7569-7577.2005. PMC 1273912. PMID 16239560.
^ Manual of Clinical Microbiology, 10th edition. James Versalovic, copyright 2012 ASM press.

UpToDate Contents

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1. モラクセラ・カタラーリス感染 moraxella catarrhalis infections
2. 細菌検査室におけるグラム染色および培養結果に対するアプローチ approach to gram stain and culture results in the microbiology laboratory
3. 慢性閉塞性肺疾患（COPD）の増悪における感染のマネージメント management of infection in exacerbations of chronic obstructive pulmonary disease
4. 小児における急性中耳炎：治療 acute otitis media in children treatment
5. 小児における急性細菌性副鼻腔炎：微生物および治療 acute bacterial rhinosinusitis in children microbiology and treatment

English Journal

Effect of nasal mometasone furoate on the nasal and nasopharyngeal flora.

Aksoy F, Demirhan H, Bayraktar Gİ, Yıldırım YS, Ozturan O, Gönüllü N, Sapmaz B.SourceBezmialem Vakıf University, Medical Faculty, Department of Otorhinolaryngology and Head and Neck Surgery, Istanbul, Turkey.
Auris, nasus, larynx.Auris Nasus Larynx.2012 Apr;39(2):180-5. Epub 2011 Sep 1.
OBJECTIVE: Mometasone furoate (MF) is one of the commonly used topical steroids, particularly for patients with allergic rhinitis. However, its effect on the colonization of bacteria that may cause superinfections by suppressing the local immunity is not known. Thus, we investigated the effect of MF
PMID 21889281

Passive smoking and nasopharyngeal colonization by Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in daycare children.

Bakhshaee M, Naderi HR, Ghazvini K, Sotoudeh K, Amali A, Ashtiani SJ.SourceDivision of Rhinology, Ear, Nose and Throat Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran, mehbakhsh@yahoo.com.
European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery.Eur Arch Otorhinolaryngol.2012 Apr;269(4):1127-32. Epub 2011 Oct 28.
Exposure to tobacco smoke may be associated with higher risk of nasopharyngeal colonization and infection by Streptococcus pneumoniae (SP), Haemophilus influenzae (HI), and Moraxella catarrhalis (MC). This study was done to determine the influence of passive smoking on S. pneumoniae, H. influenzae,
PMID 22033573

Activity of JNJ-Q2, a new fluoroquinolone, tested against contemporary pathogens isolated from patients with community-acquired bacterial pneumonia.

Biedenbach DJ, Farrell DJ, Flamm RK, Liverman LC, McIntyre G, Jones RN.SourceJMI Laboratories, 345 Beaver Kreek Centre, Suite A, North Liberty, IA 52317, USA.
International journal of antimicrobial agents.Int J Antimicrob Agents.2012 Apr;39(4):321-5. Epub 2012 Feb 4.
JNJ-Q2 is a broad-spectrum fluoroquinolone with bactericidal activity against Gram-positive and Gram-negative pathogens and is currently in clinical development for the treatment of community-acquired bacterial pneumonia (CABP) and acute bacterial skin and skin-structure infections. This study deter
PMID 22306239

Japanese Journal

A prospective study of intrafamilial transmission and antimicrobial susceptibility of Moraxella catarrhalis

Masaki Hironori,Qin Liang,Zhou Zhaoyan [他]
Microbiology and immunology 55(9), 599-604, 2011-09
NAID 40019010572

臨床報告淋菌結膜炎との鑑別を要した新生児モラクセラ結膜炎--いわゆる偽淋菌結膜炎

渡辺純子,稲田紀子,立花敦子 [他]
眼科 53(1), 137-142, 2011-01
NAID 40018697446

成人急性鼻副鼻腔炎のスコアリングシステムによる抗菌薬の有効性評価に関する検討 : ―急性鼻副鼻腔炎に対するガレノキサシン（GRNX）の有効性評価―

山中昇,保富宗城,戸川彰久,池田頼彦,田村真司
耳鼻咽喉科臨床 104(10), 741-754, 2011
… In a prospective study of rhinosinusitis treatment efficacy in 163 subjects at 30 medical facilities between 2008 and 2009, we studied isolation of three major pathogenic bacteria-Streptococcus pneumoniae, Haemophillus influenzae, and Moraxella catarrhalis. … catarrhalis 6.8% (3/44) in 106 acute rhinosinusitis subjects. … catarrhalis. …
NAID 130001148507

Related Pictures

★リンクテーブル★

国試過去問	「110D022」「112D003」
リンク元	「細菌」「慢性閉塞性肺疾患」「急性中耳炎」「モラクセラ属」「モラクセラ・カタラーリス感染症」
関連記事	「catarrhalis」「catarrhal」

「110D022」

Moraxella catarrhalis
Scientific classification
Kingdom:	Bacteria
Phylum:	Proteobacteria
Class:	Gammaproteobacteria
Order:	Pseudomonadales
Family:	Moraxellaceae
Genus:	Moraxella
Species:	M. catarrhalis
Binomial name
	Moraxella catarrhalis;

　　[★]

76歳の男性。発熱を主訴に来院した。10年前から慢性閉塞性肺疾患のため抗コリン薬とβ2刺激薬とを吸入している。喫煙は20本/日を46年間。3日前から発熱、咳嗽および膿性痰が出現したため受診した。意識は清明。体温 38.5℃。脈拍 108/分、整。血圧 102/62mmHg。呼吸数 24/分。両側の胸部に軽度のwheezesを聴取する。白血球 8,200(桿状核好中球4%、分葉核好中球 84%、単球2 %、リンパ球 10%)。CRP 7.3mg/dL。胸部エックス線写真(別冊No. 1Ａ)と喀痰のGram染色標本(別冊No. 1Ｂ)とを別に示す。原因菌はどれか。

a　腸球菌
b　肺炎球菌
c　化膿連鎖球菌
d　黄色ブドウ球菌
e　Moraxella catarrhalis

[正答]

※国試ナビ4※　［110D021］←［国試_110］→［110D023］

「112D003」

　　[★]

小児期からの増悪と寛解を繰り返す耳漏を主訴に受診した患者の左鼓膜写真(別冊No. 1)を別に示す。
この疾患で、耳漏の細菌検査で同定される可能性が最も高いのはどれか。

[正答]

※国試ナビ4※　［112D002］←［国試_112］→［112D004］

「細菌」

　　[★]

英: bacterium,(pl.) bacteria
同: バクテリア
関: 特殊な細菌、細菌の鑑別、細菌の同定？、細菌の分類？

細菌の命名

ラテン語であり、イタリックで表す。
「属名 + 種名」で表現される。

グラム染色性と形状による分類と疾患

形状

球菌

Staphylococcus aureus

多様

ナイセリア属

淋菌

Neisseria gonorrhoeae

淋病

ストレプトコッカス属

化膿性連鎖球菌

Streptococcus pyogenes

多様

莢膜

髄膜炎菌

Neisseria meningitidis

多様

肺炎球菌

Streptococcus pneumoniae

ベイヨネラ属

Veillonella

エンテロコッカス属

(総称)腸球菌

Enterococcus faecalis

モラクセラ属/
ブランハメラ亜属

Moraxella catarrhalis

肺炎

Enterococcus faecium

桿菌

Bacillus anthracis

好気性菌、有芽胞菌、莢膜

肺炎、尿路感染

Bacillus cereus

好気性菌、有芽胞菌

Escherichia coli

通性嫌気性

Clostridium tetani

嫌気性菌、有芽胞菌

下痢、肺炎、尿路感染

Clostridium botulinum

ボツリヌス中毒

プロテウス属

尿路感染

ウェルシュ菌

Clostridium perfringens

多様

サルモネラ属

パラチフス菌

Sallmonella serovar Paratyphi

腸チフス

通性嫌気性

ディフィシル菌

Clostridium difficile

多様

チフス菌

Sallmonella serovar Typhi

通性嫌気性

ガス壊疸菌群

セラチア属

Serratia

日和見感染

通性嫌気性

マイコバクテリウム科

マイコバクテリウム属

結核菌

Mycobacterium tuberculosis

無芽胞菌

Shigella

通性嫌気性

Mycobacterium leprae

Yersinia pestis

通性嫌気性

コリネバクテリウム科

コリネバクテリウム属

ジフテリア菌

Corynebacterium diphtheriae

ジフテリア

Yersinia enterocolitica

多様

通性嫌気性

Vibrio cholerae

通性嫌気性

アクチノマイセス科

アクチノマイセス属(放線菌属)

(総称)放線菌

Actinomyces

腸炎ビブリオ

Vibrio parahaemolyticus

腸炎ビブリオ感染症

通性嫌気性

リステリア属

Listeria monocytogenes

リステリア症

嫌気性菌、無芽胞菌、人獣共通感染症、通性細胞内寄生菌

パスツレラ科

ヘモフィルス属

インフルエンザ菌

Haemophilis influenzae

多様

パスツレラ属

パスツレラ属菌

Pasteurella multocida

人獣共通感染症

ストレプトバシラス属

ストレプトバシラス属菌

Streptobacillus moniliformis

鼠咬症

シュードモナス属

緑膿菌

Psudomonas aeruginosa

緑膿菌感染症

好気性、院内感染症

ボルデテラ属

百日咳菌

Bordetela pertussis

好気性、短桿菌

Brucella

好気性、細胞内増殖菌、短桿菌

Francisella tularensis

野兎病

好気性、球桿菌

レジオネラ属

Legionella pneumophila

ポンティアック熱/レジオネラ肺炎

好気性

バクテロイデス属

Bacteroides fragilis

嫌気性感染症

偏性嫌気性菌

らせん菌

スピロヘータ科

トレポネーマ属

梅毒トレポネーマ

Treponema pallidum subspecies pallidum

梅毒

ボレリア属

回帰熱ボレリア

Borrelia recurrentis

回帰熱

ライム病ボレリア

Borrelia burgdorferi

Leptospira interrogans serovar icterohaemorrhagiae

黄疸出血性レプトスピラ症(レプトスピラ症、ワイル病、黄疸性ワイル病)

？

？

カンピロバクター属菌

？

Helicobacter pylori

「慢性閉塞性肺疾患」

　　[★]

英: chronic obstructive pulmonary disease, COPD
同: chronic obstructive lung disease COLD
関: 慢性気道閉塞

日本語訳としての「慢性閉塞性肺疾患」より「COPD」を使用することが勧められている

概念

1.

「COPD とは有毒な粒子やガスの吸入によって生じた肺の炎症反応に基づく進行性の気流制限を呈する疾患である．この気流制限には様々な程度の可逆性を認め、発症と経過が緩徐であり、労作性呼吸困難を生じる」疾患
完全に可逆性ではない気流制限が特徴　←　気管支喘息ではβ2受容体作動薬により気流制限の改善をみる。

2. ICU.387

慢性気管支炎や肺気腫により常に気道閉塞(一秒率:一秒量 FEV1/努力肺活量 FVC<70%)に陥っている病態で、気管支拡張薬に対する反応は乏しく、症状(呼吸困難)が恒常的・慢性的である。

疫学

患者の9割が喫煙者

病因

参考1

臨床上のリスク因子

喫煙
気道の過敏性
環境からの暴露
アトピー体質
抗酸化物質の欠乏
気管支肺低形成
結核

遺伝形式

α1アンチトリプシン欠損症は常染色体優性遺伝 AD

症状

身体所見

視診

打診上、鼓音
聴診上、呼吸音減弱、呼気延長

検査

血液ガス検査

PaO2：低下
PaCO2：上昇
A-aDO2：上昇

呼吸機能検査

%VC：軽度の肺気腫においては時に正常より増えていることがあるが、進行した肺気腫においては低下する。(093E019)
%DLCO：肺胞領域の破壊により拡散能低下

胸部単純X線写真：

肺肝境界の下降、肺の過膨張、
気管短縮(輪状軟骨上縁から胸骨上炎までが4-5cm未満に短縮していることがある、らしい)(出典不明、機序不明)

胸部CT

診断

スパイロメータの結果による

呼吸器学会ガイドライン

1. 気管支拡張薬投与後のスパイロ検査で、FEV1/FVC<70%
2. 他の気流制限を来しうる疾患を除外する

気管支拡張薬投与方法

検査は原則として急性呼吸器感染症のない臨床安定期に行う
短時間作用型気管支拡張薬は少なくとも 6 時間、長時間作用型気管支拡張薬は 24 時間中止したうえで検査を行う
検査に用いる気管支拡張薬は、通常、短時間作用型吸入用 β2刺激薬を原則とするが、抗コリン薬あるいは両者の併用であってもよい
投与方法はスペーサーを用いた β2刺激薬定量噴霧式吸入薬(MDI)吸入、ネブライザー吸入のいずれであってもよい
気管支拡張薬吸入後の検査は吸入後 30～60 分後に行うべきものとする．
気管支拡張薬吸入効果の評価は、吸入前の FEV1．0 と吸入後 FEV1．0 を比較して、200ml 以上の増加かつ前値に対して 12%以上の増加があったときに有意と判定

鑑別診断

喘息、びまん性汎細気管支炎、先天性副鼻腔気管支症候群、閉塞性細気管支炎、気管支拡張症、肺結核、塵肺症、リンパ脈管筋腫症、うっ血性心不全、間質性肺疾患、肺癌

評価法

mMRC(the Modified British Medical Research Council):日常生活に対する呼吸困難（息切れ）の影響を測定
CAT(COPD assessment test)：COPDの症状やQOLに関する8項目を0〜40点で評価
IPAG(International Primary Care Airways Group)：COPD 関連症状と危険因子を測定

BODE指数：予後評価
ADO指数：予後評価

治療

病期分類

ガイドライン1

0期：リスク群：慢性症状(咳嗽・喀痰)：(a) 禁煙、インフルエンザワクチン接種(肺炎球菌ワクチンはガイドライン上では推奨されていないが(COPD増悪予防に対する効果が証明されなかった？)、接種した方がよいとする意見がある)
I期：軽症：80%≦%FEV1：(a)。(b) 必要に応じ短時間作用型の気管支拡張薬を使用。
II期：中等症：50%≦%FEV1＜80%：(a)。(b)。(c) 呼吸リハビリテーション、長時間作用型気管支拡張薬の定期的使用
III期：重症：30%≦%FEV1＜50%：(a)。(b)。(c)。(d) 吸入ステロイド薬の考慮(増悪を繰り返す)
IV期：最重症：%FEV1＜30%または%FEV1＜50%かつ慢性呼吸不全あるいは右心不全合併：(a)。(b)。(c)。(d)。(e) 長期酸素療法、外科的治療の考慮

安定期の治療

治療のmodality：薬物療法、包括的呼吸リハビリテーション、患者教育、栄養管理、酸素療法、換気補助療法、肺容量減量手術、肺移植、在宅管理

急性増悪

COPDの急性増悪や重症度の分類には定説はない (ガイドライン1)
COPDの急性増悪とは「病態が日内変動を超えて悪化し、日常施行していた治療内容を変更せざるを得ない状態」(呼吸器疾患最新の治療2004-2006 p.267)
原因：気道感染と大気汚染が最多。1/3は原因不明。

COPDの急性増悪

定義

COPDの自然の進行の中で起きる現象で、呼吸困難、咳嗽、喀痰といった症状が日常の変動を超えて増悪したもの

入院適応

突然の安静時呼吸器困難の出現など、症状の顕著な増悪
基盤にあるCOPDが重症(III度,IV度)
新たな身体所見の発言
増悪に対する初期治療に反応しない
重大な合併症の存在
頻回の増悪
新たに発生した不整脈
診断が不確実な例
高齢者
不十分な住宅サポート

modality (ガイドライン1)

気管支拡張薬吸入の容量/回数の増加(例えば、短期間作用型β2刺激薬が用いられる)
ステロイドの全身投与(経口/静脈注射)：増悪からの回復、肺機能の回復までの時間を短縮する
(喀痰から感染症が疑われる場合)抗菌薬の投与

外来　：経口ペニシリン系薬、ニューキノロン系薬
入院例：注射用β-ラクタム系薬/β-ラクタマーゼ阻害薬、第3,4世代セフェム系薬、カルバペネム系薬、ニューキノロン系薬

病原体

三大病原体の一つがMoraxella catarrhalis

予後

参考

1. [charged] Chronic obstructive pulmonary disease: Risk factors and risk reduction - uptodate [1]

ガイドライン

1. COPD診断と治療のためのガイドライン第2版

http://www.jrs.or.jp/quicklink/glsm/guideline/nopass_pdf/copd_summary.pdf

国試

104I036、102A051

「急性中耳炎」

　　[★]

英: acute otitis media, AOM
ラ: otitis media acuta
同: 急性化膿性中耳炎 acute suppurative tympanitis
関: 中耳炎

小児が高頻度に小児が罹患する代表的な上気道炎 (参考1)
疫学：生後1歳までに62%、生後3歳までに83%が少なくとも1回は罹患 (参考1)
リスク因子：2歳以下では難治性である。集団保育下では耐性菌の出現率が高い。
病原体は肺炎球菌、インフルエンザ菌、モラクセラ・カタラーリス Moraxella catarrhalisが多い。　←　年齢毎に異なる。
小児軽症例では、3日間経過を観察してから、5日間の抗菌薬投与とする。
小児軽症例における抗菌薬はアモキシシリンを第一選択とする

診断

1. 急性の発症
2. 中耳貯留液の存在(鼓膜の膨隆, 鼓膜の可動制限, 水疱形成, 耳漏)
3. 中耳炎症所見と症状(鼓膜の明らかな発赤または耳痛)

1-3をすべて満足する場合確定例、その他不確定例とする

重症度

米国小児科学会ガイドライン「急性中耳炎の診断と治療」

非重症：軽い耳痛かつ 24 時間以内の発熱が＜39℃
重症：中等度～重度の耳痛あるいは≧39℃の発熱

治療

米国のガイドラインによる抗生剤の適応

米国小児科学会ガイドライン「急性中耳炎の診断と治療」

	不確定例		確定例
	非重症	重症	非重症	重症
6ヵ月未満	antibiotics	antibiotics	antibiotics	antibiotics
6～24ヵ月	no	antibiotics	antibiotics	antibiotics
2歳以上	no	no	no	antibiotics

薬剤と治療期間

米国小児科学会ガイドライン「急性中耳炎の診断と治療」

重症度	初期治療	初期治療無効時	投与期間
非重症	AMPC　80～90 mg/kg/日	AMPC/CVA 14:1 90mg/kg/日
重症	AMPC/CVA 14:1 90 mg/kg/日	CTRX 50mg/kg/日 3 日間	2歳以上非重症：5～7 日間

参考

1. 小児急性中耳炎診療ガイドライン長崎大学大学院医歯薬学総合研究科耳鼻咽喉・頭頸部外科学領域高橋晴雄

http://www.k3.dion.ne.jp/~i-sibasi/2010.4.2aom.pdf

2.

http://www20.big.or.jp/~ent/topics/chuujien/chuujienjijou.html

国試

104D014

「モラクセラ属」

　　[★]

英: Moraxella
関: 細菌

グラム陰性球菌/グラム陰性桿菌
好気性

モラクセラ属

ブランハメラ亜属

球菌

Moraxella catarrhalis

モラクセラ亜属

桿菌

「モラクセラ・カタラーリス感染症」

　　[★]

英: Moraxella catarrhalis infection, Branhamella catarrhalis infection
同: ブランハメラ・カタラーリス感染症
関: Moraxella catarrhalis、モラクセラ属

「catarrhalis」

　　[★]

.

カタル性の

関: catarrhal; Moraxella catarrhalis、Branhamella catarrhalis

「catarrhal」

　　[★]

adj.

カタル性の

関: catarrhalis

[1] Embers, Monica E.; Doyle LA, Whitehouse CA, Selby EB, Chappell M, Philipp MT (27 January 2011). "Characterization of a Moraxella species that causes epistaxis in macaques". Veterinary Microbiology 147 (3-4): 367–375. doi:10.1016/j.vetmic.2010.06.029. PMID 20667430. Retrieved 2 October 2013. Cite uses deprecated parameters (help)

[pmid19093775-2] Mawas F, Ho MM, Corbel MJ (January 2009). "Current progress with Moraxella catarrhalis antigens as vaccine candidates". Expert Rev Vaccines 8 (1): 77–90. doi:10.1586/14760584.8.1.77. PMID 19093775.

[pmid17371852-3] Yu S, Gu XX (June 2007). "Biological and Immunological Characteristics of Lipooligosaccharide-Based Conjugate Vaccines for Serotype C Moraxella catarrhalis". Infect. Immun. 75 (6): 2974–80. doi:10.1128/IAI.01915-06. PMC 1932890. PMID 17371852.

[Winstanley-4] ^ ^a ^b ^c ^d ^e ^f Winstanley, T.G. and R.C. Spencer. “Moraxea catarrkar: antibiotic susceptibility with special reference to trimethoprim.” Journal of Antimicrobial Chemotherapy 18, no. 3 (1986): 425-426.

[Helminen-5] ^ ^a ^b ^c ^d ^e ^f Helminen, Merja E., Isobel Maciver, Jo L. Latimer, Julia Klesney-Tait, Leslie D. Cope, Maria Paris, George H. McCracken, Jr., and Eric J. Hansen. “A Large, Antigenically Conserved Protein on the Surface of Moraxella catarrhalis Is a Target for Protective Antibodies.” The Journal of Infectious Diseases 170, no. 4 (1994): 867-872.

[Melendez-6] ^ ^a ^b ^c ^d ^e ^f ^g ^h Melendez, Philipp R. and Royce H. Johnson. “Bacteremia and Septic Arthritis Caused by Moraxella catarrhalis.” Reviews of Infectious Diseases 13, no. 3 (1991): 428-429.

[Maciver-7] Maciver, Isobel, Manaswat Unhanand, George H. McCracken Jr., and Eric J. Hansen. “Effect of Immunization on Pulmonary Clearance of Moraxella Catarrhalis in an Animal Model.” The Journal of Infectious Diseases 168, no. 2 (1993): 469-472.

[Ioannidis-8] ^ ^a ^b ^c ^d ^e ^f Ioannidis, John P. A. Ioannidis, Michael Worthington, Jeffrey K. Griffiths, and David R. Snydman. “Spectrum and Significance of Bacteremia Due to Moraxella catarrhalis.” Clinical Infectious Diseases 21, no. 2 (1995): 390-397.

[pmid16239560-9] Peng D, Hong W, Choudhury BP, Carlson RW, Gu XX (November 2005). "Moraxella catarrhalis Bacterium without Endotoxin, a Potential Vaccine Candidate". Infect. Immun. 73 (11): 7569–77. doi:10.1128/IAI.73.11.7569-7577.2005. PMC 1273912. PMID 16239560.

[10] Manual of Clinical Microbiology, 10th edition. James Versalovic, copyright 2012 ASM press.

匿名

検索

案内

Moraxella catarrhalis

特徴

病原体

感染症

疫学

潜伏期間

感染経路

症状

合併症

経過

治療

検査

予防

WordNet

PrepTutorEJDIC

Wikipedia preview

wiki en

Contents

Epidemiology

History

Clinical significance

Link with Bacteremia

Antibiotic resistance

Treatment

Vaccine development

Cellular morphology and biochemistry

References

UpToDate Contents

English Journal

Japanese Journal

Related Links

Related Pictures

★リンクテーブル★

「110D022」

「112D003」

「細菌」

細菌の命名

グラム染色性と形状による分類と疾患

「慢性閉塞性肺疾患」

概念

疫学

病因

臨床上のリスク因子

遺伝形式

症状

身体所見

検査

診断

鑑別診断

評価法

治療

病期分類

安定期の治療

急性増悪

COPDの急性増悪

定義

入院適応

病原体

予後

参考

ガイドライン

国試

「急性中耳炎」

診断

重症度

治療

米国のガイドラインによる抗生剤の適応

薬剤と治療期間

参考

国試

「モラクセラ属」

モラクセラ属

ブランハメラ亜属

モラクセラ亜属

「モラクセラ・カタラーリス感染症」

「catarrhalis」

「catarrhal」