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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2020/04/10 12:45:19」(JST)

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The Palm TX

Apple Newton MessagePad (1993) – Computer History Museum

A personal digital assistant (PDA), also known as a handheld PC,^[1]^[2] is a variety mobile device which functions as a personal information manager. PDAs have been mostly displaced by the widespread adoption of highly capable smartphones, in particular those based on iOS and Android.^[3]

Nearly all modern PDAs have the ability to connect to the Internet. A PDA has an electronic visual display, letting it include a web browser. Most models also have audio capabilities, allowing usage as a portable media player, and also enabling most of them to be used as telephones. Most PDAs can access the Internet, intranets or extranets via Wi-Fi or Wireless Wide Area Networks. Sometimes, instead of buttons, PDAs employ touchscreen technology. The technology industry has recently recycled the term personal digital assistance. The term is more commonly used for software that identifies a user's voice to reply to the queries.

The first PDA, the Organiser, was released in 1984 by Psion, followed by Psion's Series 3, in 1991. The latter began to resemble the more familiar PDA style, including a full keyboard.^[4]^[5] The term PDA was first used on January 7, 1992 by Apple Computer CEO John Sculley at the Consumer Electronics Show in Las Vegas, Nevada, referring to the Apple Newton.^[6] In 1994, IBM introduced the first PDA with full telephone functionality, the IBM Simon, which can also be considered the first smartphone. Then in 1996, Nokia introduced a PDA with telephone functionality, the 9000 Communicator, which became the world's best-selling PDA. Another early entrant in this market was Palm, with a line of PDA products which began in March 1996.

Typical features

A typical PDA has a touchscreen for navigation, a memory card slot for data storage, and IrDA, Bluetooth and/or Wi-Fi. However, some PDAs may not have a touchscreen, using softkeys, a directional pad, and a numeric keypad or a thumb keyboard for input. To have the functions expected of a PDA, a device's software typically includes an appointment calendar, a to-do list, an address book for contacts, a calculator, and some sort of memo (or "note") program. PDAs with wireless data connections also typically include an email client and a Web browser, and may or may not include telephony functionality.

Touchscreen

PalmPilot organiser on display at the Musée Bolo, EPFL, Lausanne

Many of the original PDAs, such as the Apple Newton and Palm Pilot, featured a touchscreen for user interaction, having only a few buttons—usually reserved for shortcuts to often-used programs. Some touchscreen PDAs, including Windows Mobile devices, had a detachable stylus to facilitate making selections. The user interacts with the device by tapping the screen to select buttons or issue commands, or by dragging a finger (or the stylus) on the screen to make selections or scroll.

Typical methods of entering text on touchscreen PDAs include:

A virtual keyboard, where a keyboard is shown on the touchscreen. Text is entered by tapping the on-screen keyboard with a finger or stylus.
An external keyboard connected via USB, Infrared port, or Bluetooth. Some users may choose a chorded keyboard for one-handed use.
Handwriting recognition, where letters or words are written on the touchscreen, often with a stylus, and the PDA converts the input to text. Recognition and computation of handwritten horizontal and vertical formulas, such as "1 + 2 =", may also be a feature.
Stroke recognition allows the user to make a predefined set of strokes on the touchscreen, sometimes in a special input area, representing the various characters to be input. The strokes are often simplified character shapes, making them easier for the device to recognize. One widely known stroke recognition system is Palm's Graffiti.

Despite research and development projects, end-users experience mixed results with handwriting recognition systems. Some find it frustrating and inaccurate, while others are satisfied with the quality of the recognition.^[7]

Touchscreen PDAs intended for business use, such as the BlackBerry and Palm Treo, usually also offer full keyboards and scroll wheels or thumbwheels to facilitate data entry and navigation. Many touchscreen PDAs support some form of external keyboard as well. Specialized folding keyboards, which offer a full-sized keyboard but collapse into a compact size for transport, are available for many models. External keyboards may attach to the PDA directly, using a cable, or may use wireless technology such as infrared or Bluetooth to connect to the PDA. Newer PDAs, such as the HTC HD2, Apple iPhone, Apple iPod Touch, and Palm Pre, Palm Pre Plus, Palm Pixi, Palm Pixi Plus, Google Android (operating system) include more advanced forms of touchscreen that can register multiple touches simultaneously. These "multi-touch" displays allow for more sophisticated interfaces using various gestures entered with one or more fingers.

Memory cards

Although many early PDAs did not have memory card slots, now most have either some form of Secure Digital (SD) slot, a CompactFlash slot or a combination of the two. Although designed for memory, Secure Digital Input/Output (SDIO) and CompactFlash cards are available that provide accessories like Wi-Fi or digital cameras, if the device can support them. Some PDAs also have a USB port, mainly for USB flash drives.^{[dubious – discuss]} Some PDAs use microSD cards, which are electronically compatible with SD cards, but have a much smaller physical size.

Wired connectivity

While early PDAs connected to a user's personal computer via serial ports or another proprietary connection,^[specify] many today connect via a USB cable. Older PDAs were unable to connect to each other via USB, as their implementations of USB didn't support acting as the "host". Some early PDAs were able to connect to the Internet indirectly by means of an external modem connected via the PDA's serial port or "sync" connector,^[8] or directly by using an expansion card that provided an Ethernet port.

Wireless connectivity

Most modern PDAs have Bluetooth, a popular wireless protocol for mobile devices. Bluetooth can be used to connect keyboards, headsets, GPS receivers, and other nearby accessories. It's also possible to transfer files between PDAs that have Bluetooth. Many modern PDAs have Wi-Fi wireless network connectivity and can connect to Wi-Fi hotspots.^[9] All smartphones, and some other modern PDAs, can connect to Wireless Wide Area Networks, such as those provided by cellular telecommunications companies. Older PDAs from the 1990s to 2006 typically had an IrDA (infrared) port allowing short-range, line-of-sight wireless communication. Few current models use this technology, as it has been supplanted by Bluetooth and Wi-Fi. IrDA allows communication between two PDAs, or between a PDA and any device with an IrDA port or adapter. Some printers have IrDA receivers,^[10] allowing IrDA-equipped PDAs to print to them, if the PDA's operating system supports it. Universal PDA keyboards designed for these older PDAs use infrared technology.^{[citation needed]} Infrared technology is low-cost and has the advantage of being allowed aboard.

Synchronization

Most PDAs can synchronize their data with applications on a user's computer. This allows the user to update contact, schedule, or other information on their computer, using software such as Microsoft Outlook or ACT!, and have that same data transferred to PDA—or transfer updated information from the PDA back to the computer. This eliminates the need for the user to update their data in two places. Synchronization also prevents the loss of information stored on the device if it is lost, stolen, or destroyed. When the PDA is repaired or replaced, it can be "re-synced" with the computer, restoring the user's data. Some users find that data input is quicker on their computer than on their PDA, since text input via a touchscreen or small-scale keyboard is slower than a full-size keyboard. Transferring data to a PDA via the computer is therefore a lot quicker than having to manually input all data on the handheld device.^{[citation needed]}

Most PDAs come with the ability to synchronize to a computer. This is done through synchronization software provided with the handheld, or sometime with the computer's operating system. Examples of synchronization software include:

HotSync Manager, for Palm OS PDAs
Microsoft ActiveSync, used by Windows XP and older Windows operating systems to synchronize with Windows Mobile, Pocket PC, and Windows CE PDAs, as well as PDAs running iOS, Palm OS, and Symbian
Microsoft Windows Mobile Device Center for Windows Vista, which supports Microsoft Windows Mobile and Pocket PC devices
Apple iTunes, used on Mac OS X and Microsoft Windows to sync iOS devices (such as the iPhone and iPod touch)
iSync, included with Mac OS X, can synchronize many SyncML-enabled PDAs
BlackBerry Desktop Software, used to sync BlackBerry devices.

These programs allow the PDA to be synchronized with a personal information manager, which may be part of the computer's operating system, provided with the PDA, or sold separately by a third party. For example, the RIM BlackBerry comes with RIM's Desktop Manager program, which can synchronize to both Microsoft Outlook and ACT!. Other PDAs come only with their own proprietary software. For example, some early Palm OS PDAs came only with Palm Desktop, while later Palm PDAs—such as the Treo 650—have the ability to sync to Palm Desktop or Microsoft Outlook. Microsoft's ActiveSync and Windows Mobile Device Center only synchronize with Microsoft Outlook or a Microsoft Exchange server.^{[citation needed]} Third-party synchronization software is also available for some PDAs from companies like CommonTime^[11] and CompanionLink.^[12] Third-party software can be used to synchronize PDAs to other personal information managers that are not supported by the PDA manufacturers (for example, GoldMine and IBM Lotus Notes).

Wireless synchronization

Some PDAs can synchronize some or all of their data using their wireless networking capabilities, rather than having to be directly connected to a personal computer via a cable. Devices running Palm's webOS or Google's Android operating system primarily sync with the cloud. For example, if Gmail is used, information in contacts, email, and calendar can be synchronized between the PDA and Google's servers. RIM sells BlackBerry Enterprise Server to corporations so that corporate BlackBerry users can wirelessly synchronize their PDAs with the company's Microsoft Exchange Server, IBM Lotus Domino, or Novell GroupWise servers.^[13] Email, calendar entries, contacts, tasks, and memos kept on the company's server are automatically synchronized with the BlackBerry.^[14]

Operating systems of PDAs

The most common operating systems pre-installed on PDAs are:

Palm OS
Microsoft Windows Mobile (Pocket PC) with a Windows CE kernel

Other, rarely used operating systems:

EPOC, then Symbian OS (in mobile phone + PDA combos)
Linux (e.g. VR3, iPAQ,^[15] Sharp Zaurus PDA, Opie, GPE, Familiar Linux^[16] etc.)
Newton
QNX (also on iPAQ)

Automobile navigation

Some PDAs include Global Positioning System (GPS) receivers; this is particularly true of smartphones. Other PDAs are compatible with external GPS-receiver add-ons that use the PDA's processor and screen to display location information.^[17] PDAs with GPS functionality can be used for automotive navigation. PDAs are increasingly being fitted as standard on new cars. PDA-based GPS can also display traffic conditions, perform dynamic routing, and show known locations of roadside mobile radar guns. TomTom, Garmin, and iGO offer GPS navigation software for PDAs.

Ruggedized

Some businesses and government organizations rely upon rugged PDAs, sometimes known as enterprise digital assistants (EDAs) or mobile computers, for mobile data applications. These PDAs have features that make them more robust and able to handle inclement weather, jolts and moisture. EDAs often have extra features for data capture, such as barcode readers, radio-frequency identification (RFID) readers, magnetic stripe card readers, or smart card readers. These features are designed to facilitate the use of these devices to scan in product or item codes.

Typical applications include:

Access control and security
Capital asset maintenance
Facilities maintenance and management
Infection control audit and surveillance within healthcare environments
Medical treatment and recordkeeping in hospitals
Meter reading by utilities
Military (U.S. Army, Pakistan Army)
Package delivery
Park and wildlife rangers
Parking enforcement
Route accounting
Supply chain management in warehouses
Taxicab allocation and routing
Waiter and waitress applications in restaurants and hospitality venues
Wildlife biologists

Medical and scientific uses

Many companies have developed PDA products aimed at the medical professions, such as PDAs loaded with drug databases, treatment information, and medical information. Services such as AvantGo translate medical journals into PDA-readable formats. WardWatch organizes medical records, providing reminders of information such as the treatment regimens of patients to doctors making ward rounds. Pendragon and Syware provide tools for conducting research with, allowing the user to enter data into a centralized database using their PDA. Microsoft Visual Studio and Sun Java also provide programming tools for developing survey instruments on the handheld. These development tools allow for integration with SQL databases that are stored on the handheld and can be synchronized with a desktop- or server-based database. PDAs have been used by doctors to aid diagnosis and drug selection and some studies^[who?] have concluded that when patients can use PDAs to record their symptoms, they communicate more effectively with hospital staff during follow-up visits. The development of Sensor Web technology may lead to wearable bodily sensors to monitor ongoing conditions, like diabetes or epilepsy, which would alert patients and doctors when treatment is required using wireless communication and PDAs.

Educational uses

PDAs and handheld devices are allowed in many classrooms for digital note-taking. Students can spell-check, modify, and amend their class notes on a PDA. Some educators^[who?] distribute course material through the Internet or infrared file-sharing functions of the PDA. Textbook publishers have begun to release e-books, which can be uploaded directly to a PDA, reducing the number of textbooks students must carry.^[18] Brighton and SUSSEX Medical School in the UK was the first medical school to provide wide scale use of PDAs to its undergraduate students. The learning opportunities provided by having PDAs complete with a suite of key medical texts was studied with results showing that learning occurred in context with timely access to key facts and through consolidation of knowledge via repetition. The PDA was an important addition to the learning ecology rather than a replacement.^[19] Software companies have developed PDA programs to meet the instructional needs of educational institutions, such as dictionaries, thesauri, word processing software, encyclopedias, webinar and digital lesson planners.

Recreational uses

PDAs may be used by music enthusiasts to play a variety of music file formats. Many PDAs include the functionality of an MP3 player. Road rally enthusiasts can use PDAs to calculate distance, speed, and time. This information may be used for navigation, or the PDA's GPS functions can be used for navigation. Underwater divers can use PDAs to plan breathing gas mixtures and decompression schedules using software such as "V-Planner".

Models

Consumer

Acer N Series
AlphaSmart
Amida Simputer
Android-based devices
Apple Newton
Apple iPhone/iPad
Atari Portfolio
Dell Axim
E-TEN
Fujitsu Siemens Computers Pocket LOOX
GMate Yopy
Handspring (company)
HP iPAQ
HTC (Dopod, Qtek)'s series of Windows Mobile PDAs/phones
Huawei series
I-mate
HP Jornada Pocket PC
LifeDrive
NEC MobilePro
Osaris running EPOC OS distributed by Oregon Scientific
Palm (PDA) (Tungsten E2, TX, Treo, Zire Handheld)
Palm, Inc. smartphones under Palm OS and under the successor WebOS (Pre, and Pixi).
Philips Nino
Casio Pocket Viewer
PocketMail (email PDA with built-in acoustic coupler)
Psion
Roland PMA-5 (Personal Music Assistant)^[20]
Royal (ezVue 7, etc.)
Sharp Wizard and Sharp Zaurus
Sony CLIÉ
Sony Magic Link with the Magic Cap operating system
Tapwave Zodiac
Toshiba e310
Abacus PDA Watch

Ruggedized

American Industrial Systems (Mil-Spec, IP67)
Bluebird ^[21]
Catchwell^[22]
Datalogic Mobile
ecom instruments
Getac
Honeywell (Hand Held Products)
Intermec
M3 Mobile^[23]
Motorola (Symbol Technologies)
Psion Teklogix
Skeye (Hoeft & Wessel AG)
Trimble Navigation
Two Technologies, Inc.^[24] (Ultra Rugged Handheld Computers)
Unitech^[25]
Chainway^[26]

References

^ Viken, Alexander (April 10, 2009). "The History of Personal Digital Assistants 1980 – 2000". Agile Mobility. Archived from the original on 30 October 2013. Retrieved 22 September 2017.
^ "History of the HP 95LX computer". HP Virtual Museum. Hewlett-Packard. Retrieved February 18, 2011.
^ Andrew Smith, Faithe Wempen (2011). CompTIA Strata Study Guide. John Wiley & Sons. p. 140. ISBN 978-0-470-97742-2. Retrieved July 5, 2012.
^ "The Protea Story". The Register.
^ "3-Lib History of Psion". Retrieved 9 June 2015.
^ Newton, Reconsidered - Time magazine, June 1, 2012
^
Kahney, Leander (August 29, 2002). "Apple's Newton Just Won't Drop". Wired. Condé Nast Publications. Archived from the original on September 2, 2010. Retrieved August 21, 2010.
- Mayer, Don (July 1, 1997). "Kibbles&Bytes #29: Don's Review of the Newton Message Pad 2000". Small Dog Electronics. Archived from the original on April 16, 2008. Retrieved February 18, 2011.
- Klingsporn, Geoffrey (May 1997). "The Postgraduate Newton: a month in academia with Apple's new handheld computer". The History and Macintosh Society. note-taking. Retrieved August 21, 2010.
- Wittmann, Michael C. "What's Right With The Newton: Part I: Handwriting recognition". Archived from the original on September 8, 2006. Retrieved August 21, 2010.
^ Patrick (December 14, 2006). "Palm PDA Cables". DeepWave. Patrick Khoo. Archived from the original on August 30, 2010. Retrieved August 21, 2010.
^ "MC55A0 Rugged Wi-Fi Enterprise Mobile Computer". Retrieved January 26, 2013.
^ For example: "HP LaserJet 5P and 5MP Printers — Product Specifications". HP Business Support Center. Hewlett-Packard. Retrieved August 21, 2010.
^ "CommonTime - Cross platform mobile app development tools". CommonTime. Retrieved 9 June 2015.
^ "Sync calendar, contacts, tasks and notes to Android, iPhone, iPad, BlackBerry - CompanionLink". Retrieved 9 June 2015.
^ "BlackBerry — Enterprise Server — BlackBerry BES Server". Research In Motion. Archived from the original on July 13, 2012. Retrieved August 21, 2010.
^ "BlackBerry — Business Software Features". Research In Motion. Retrieved August 21, 2010.
^ "Ernest Khoo: Alternative operating systems on your PDA". Archived from the original on 2012-08-10.
^ "Highlights: Knowing the differences in PDA operating systems". Retrieved 9 June 2015.
^ "Palm Support: Palm GPS Navigator 3207NA". Retrieved August 21, 2010.
^ "10 tips to save on college textbooks". Centre Daily Times. August 20, 2010. Archived from the original on August 23, 2010. Retrieved August 21, 2010.
^ Davies, Bethany S.; Rafique, Jethin; Vincent, Tim R.; Fairclough, Jil; Packer, Mark H.; Vincent, Richard; Haq, Inam (1 January 2012). "Mobile Medical Education (MoMEd) - how mobile information resources contribute to learning for undergraduate clinical students - a mixed methods study". BMC Medical Education. 12: 1. doi:10.1186/1472-6920-12-1. PMC 3317860. PMID 22240206.
^ "ROLAND PMA-5 PERSONAL MUSIC ASSISTANT". Retrieved 9 June 2015.
^ "Pidion". Retrieved 9 June 2015.
^ CATCHWELL. "CATCHWELL - Handheld Mobile Computers". Retrieved 9 June 2015.
^ "M3 Mobile".
^ Two Technologies, Inc. "Rugged Handheld Computers and Android Devices - Two Technologies". Retrieved 9 June 2015.
^ "unitech - Global Website. Worldwide leading ADC manufacturer".
^ "Chainway".

External links

Annotated bibliography of references to gesture and pen computing
epocalc's List of PDA manufacturers

UpToDate Contents

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1. 乳児、小児および成人における動脈管開存症の臨床症状および診断clinical manifestations and diagnosis of patent ductus arteriosus in term infants children and adults [show details]
…constriction and eventual obliteration. A patent ductus arteriosus (PDA) occurs when the DA fails to completely close postnatally. The clinical manifestations and diagnosis of PDA in full-term infants, older children …
2. 正産児、小児、成人の動脈管開存症のマネージメントmanagement of patent ductus arteriosus in term infants children and adults [show details]
…obliteration. A patent ductus arteriosus (PDA) occurs when the DA fails to close postnatally. The management of PDA in term infants, older children, and adults will be reviewed here. PDA in the premature …
3. 早産児の動脈管開存症：マネージメントpatent ductus arteriosus in preterm infants management [show details]
… Preterm infants with clinically significant patent ductus arteriosus (PDA) have a greater mortality rate than those without a PDA. Hemodynamically significant PDAs also are associated with an increased risk …
4. 早産児の動脈管開存症：病態生理、臨床症状、診断patent ductus arteriosus in preterm infants pathophysiology clinical manifestations and diagnosis [show details]
…undergoes active constriction and eventual obliteration. A patent ductus arteriosus (PDA) occurs when the ductus fails to completely close after delivery. PDA occurs commonly in preterm infants, especially in those …
5. Right heart failure: Causes and managementright heart failure causes and management [show details]
…intracardiac shunts (eg, ventricular septal defects, atrial septal defects) and aortic shunts (eg, patent ductus arteriosus) increase pulmonary blood flow, leading to progressive pulmonary vascular disease and group…

English Journal

CaO-Nanoparticle-Enriched Polydopamine-Coated Hyper-Crosslinked Polymers as Heterogeneous Catalysts for the Transesterification of Vegetable Oils.

Varyambath A, Song WL, Kim I.
Journal of nanoscience and nanotechnology. 2019 Oct;19(10)6341-6346.
Biodiesel is an alternative fuel produced by the transesterification of vegetable oils in the presence of homogeneous or heterogeneous catalysts. Herein, we report the transesterification of vegetable oils using CaO nanoparticles supported on a polydopamine-coated hyper-crosslinked polymer, CaO@PDA-
PMID 31026958

Effects of Microwave Annealing on High- Dielectric HfO₂ Thin Films.

Kang MS, Cho WJ.
Journal of nanoscience and nanotechnology. 2019 Oct;19(10)6232-6238.
In this study, the effect of microwave annealing (MWA), which has been attracting considerable attention as a low-thermal-budget method, on the high- materials required for next-generation ultrahigh-integration semiconductor devices is investigated. Metal-oxide-semiconductor (MOS) capacitor-structur
PMID 31026942

Improving Charge Trapping/Detrapping Characteristics of Amorphous In-Ga-ZnO Thin-Film-Transistors Using Microwave Irradiation.

Lee HW, Choi HS, Cho WJ.
Journal of nanoscience and nanotechnology. 2019 Oct;19(10)6164-6169.
We investigated the effect of post-deposition annealing (PDA) on the gate-bias-stress-induced charge trapping/detrapping phenomenon in amorphous indium-gallium-zinc oxide (a-IGZO) thin-film transistors (TFTs). To evaluate device reliability, we used the microwave irradiation (MWI), rapid thermal ann
PMID 31026929

Japanese Journal

動脈管開存 (特集研修医必携!心電図判読のコツ) -- (先天性心疾患,肺高血圧,心筋症)

小川潔
小児科診療 83(5), 617-620, 2020-05
NAID 40022230339

アルメニアの天然染料染色布の試薬呈色試験と高速液体クロマトグラフィー分析(HPLC-PDA) : アカネ、アルメニアコチニール、キバナマツムシソウ

石井美恵,柴山伸子
佐賀大学芸術地域デザイン学部研究論文集 / 佐賀大学芸術地域デザイン学部 (3), 9-22, 2020-03
NAID 120006842766

循環管理未熟児動脈管開存症(PDA)の治療の変遷 (特集 NEO Speciality 比べてわかる根拠と極意新生児のCare&Cure : むかし・いま・みらい)

与田仁志
With neo = ウィズ・ネオ : 赤ちゃんを守る医療者の専門誌 33(1), 101-105, 2020-02
NAID 40022153226

Related Pictures

Pda-O2 Xda Atom Exec Ms PDA Home / AT&T 8525 PDA / Product Reviews FUJAIRAH IN FOCUS Commander Pro' Reports on your PDA PDA any type of pda terminal running pocket pc General Components of a PDA

★リンクテーブル★

リンク元	「感染性心内膜炎」「完全大血管転位症」「心雑音」「動脈管開存症」「冠状動脈」
拡張検索	「PDAスコア」「PDAY研究」
関連記事	「PD」「P」

「感染性心内膜炎」

　　[★]

英: infective endocarditis, IE
関: 心内膜炎、細菌性心内膜炎

概念

感染性心内膜炎は弁膜や心内膜、大血管内膜に細菌集蔟を含む疣腫(vegetation)(注1)を形成し、菌血症、血管塞栓、心障害など多彩な臨床症状を呈する全身性敗血症性疾患である。感染性心内膜炎はそれほど頻度の多い疾患ではないがいったん発症すれば、的確な診断の下、適切な治療が奏功しないと多くの合併症を引き起こし、ついには死に至る。(ガイドライン.1)

疫学

緑色連鎖球菌が感染性心内膜炎の原因として最多である。(YN.C-129)
院内発症：Streptococcus viridans ＞ブドウ球菌＞腸球菌
院外発症：ブドウ球菌(Staphylococcus aureus > CNS ) ＞ Streptococcus viridans

発症のメカニズム

非細菌性血栓性心内膜炎(nonbacterial thrombogenic endocarditis, NBTE)は次の2つの影響で生じるとされる；(1)弁膜疾患や先天性心疾患に伴う異常血流、(2)人工弁置換術語例など異物の影響。非細菌性血栓性心内膜炎の存在下で一過性の菌血症(医原性など)すると、NBTEに病原体が付着・増殖し疣腫が形成される。疣腫は僧帽弁の心房側、半月弁の心室など逆流血流がアル部位や、シャント血流や狭窄血流の異常ジェット血流が心内膜面にある所に認められる。(ガイドライン.1改変)
ジェット血流の存在が発症に関わっているので、軽症の弁膜症の方がジェット血流を来しやすい。従って、心内膜炎も来しやすい。(QB.C-454)

リスクファクター

心室中隔欠損(VSD)、動脈管開存症(PDA)(QB CBT vol2 p.221)
僧帽弁閉鎖不全症(MR)、大動脈弁閉鎖不全症(AR)で起こりやすい (QB CBT vol2 p.221)
心房中隔欠損(ASD)、僧帽弁狭窄症(MS)で起こりにくい(QB CBT vol2 p.221)

資料(1)より

人工弁置換患者：(感染性心内膜炎による？)手術例の3分の2を占める！
心内膜炎の既往を有する患者：再発しやすい
先天性心疾患：心房中隔欠損症(ASD)(二次口型)を除いてほとんどの先天性心疾患がハイリスク群となる。

動脈管開存症、心室中隔欠損症、大動脈縮窄症
心房中隔欠損症(一次口型)：僧帽弁閉鎖不全症の合併などを有する場合が多いため

大動脈二尖弁：0.5-1.0％に存在するとされ、また感染性心内膜炎患者の約20%程度が大動脈二尖弁
大動脈弁閉鎖不全症(AR)、僧帽弁閉鎖不全症(MR)、僧帽弁逸脱症(MVP)はリスクとなる

ASはARよりリスクは小さいとされ、MSについてはハイリスクかは議論が分かれている。

閉塞型肥大型心筋症：ハイリスク群とのコンセンサスがある
中心静脈カテーテル留置患者

分類

経過

急性感染性心内膜炎：ブドウ球菌
亜急性感染性心内膜炎：緑色連鎖球菌、腸球菌、心筋

病原体を細菌に限定

急性細菌性心内膜炎：強毒菌(Staphylococcus aureus)。健常人にでも起こる：ブドウ球菌
亜急性細菌性心内膜炎：弱毒菌(Staphylococcus viridans)。弁に障害がある人によく起こる：緑色連鎖球菌、腸球菌

宿主の要因

native valve endocarditis：心内膜炎患者の60-80%を占める
prosthetic valve endocarditis：Staphylococcus epidermidisが病原体であることが普通
endocarditis in the setting of intravenous drug abuse：右心系の弁に起こりやすい

検査

心エコー：疣贅
血液培養：診断のために必要

臨床経過

菌血症が起こってから，症状の発現までの期間は短く、80％以上の例では2週間以内(ガイドライン.1)。

身体所見

感染性心内膜炎の身体所見JaRO　→ ジェーンウェー病変(Janeway斑)、ロス斑(Roth斑)、オスラー結節(Osler結節)

症状

亜急性感染性心内膜炎

非特異的な症状(発熱・全身倦怠感、食欲不振、体重減少、関節痛)が徐々に進展。

急性感染性心内膜炎

高熱を呈し、心不全症状の急激な進行

心臓外の合併症

ガイドライン.1

塞栓症

頻度：27-45%
好発時期：発症後2週間
検査：CTなど
好発部位：中枢神経系(60-70%)、脾臓、腎臓、肺、末梢動脈、冠動脈、肝臓、腸間膜動脈

脾臓：脾梗塞、脾膿瘍、脾破裂
肺梗塞：IE全体の9-11%の頻度で見られる。右心系の疣腫(三尖弁、肺動脈弁、右室流出路)
腎障害

脳合併症

原因：疣贅による脳動脈の塞栓
頻度20-40%
感染性心内膜炎初発症状としての脳合併症：47%
種類：脳梗塞、一過性脳虚血発作、脳出血、脳動脈流、髄膜炎、脳膿瘍、てんかん発作

感染性動脈瘤

好発部位：脳(→脳動脈瘤)

感染性脳動脈瘤

頻度：1.2-5.6%
症状：頭痛、知覚障害、脳神経症状
好発部位：中大脳動脈領域(二次分岐部)

診断

1. (QB CBT vol2 p.222)

病歴：先天性心疾患、弁膜症の既往、抜歯・手術後の発熱の遷延
血液培養：起炎菌の検出
心エコー：疣贅

2. Duke criteria(HIM.792)

Dukeの診断基準

ガイドライン.1より抜粋

IE 確診例

Ⅰ．臨床的基準

大基準2 つ，または大基準1 つと小基準3 つ，または小基準5 つ

（大基準）

1．IE に対する血液培養陽性

A．2回の血液培養で以下のいずれかが認められた場合

(i) Streptococcus viridans（注1），Streptococcus bovis，HACEKグループ，Staphylococcus aureus
(ii) Enterococcus が検出され（市中感染），他に感染巣がない場合（注2）

B．つぎのように定義される持続性のIE に合致する血液培養陽性

(i) 12 時間以上間隔をあけて採取した血液検体の培養が2 回以上陽性
(ii)3 回の血液培養すべてあるいは4 回以上の血液培養の大半が陽性（最初と最後の採血間隔が1 時間以上）

C．1 回の血液培養でもCoxiella burnetii が検出された場合，あるいは抗phase1 IgG 抗体価800 倍以上（注3）

2．心内膜が侵されている所見でAまたはB の場合（注4）

A．IEの心エコー図所見で以下のいずれかの場合

(i) 弁あるいはその支持組織の上，または逆流ジェット通路，または人工物の上にみられる解剖学的に説明のできない振動性の心臓内腫瘤
(ii)膿瘍
(iII) 人工弁の新たな部分的裂開

B．新規の弁閉鎖不全（既存の雑音の悪化または変化のみでは十分でない）

（小基準）（注5）

1．素因：素因となる心疾患または静注薬物常用
2．発熱：38.0℃以上
3．血管現象：主要血管塞栓，敗血症性梗塞，感染性動脈瘤，頭蓋内出血，眼球結膜出血，Janeway病変
4．免疫学的現象：糸球体腎炎，Osler結節，Roth斑，リウマチ因子
5．微生物学的所見：血液培養陽性であるが上記の大基準を満たさない場合，またはIE として矛盾のない活動性炎症の血清学的証拠

Ⅱ．病理学的基準

菌：培養または組織検査により疣腫，塞栓化した疣腫，心内膿瘍において証明，あるいは病変部位における検索：組織

学的に活動性を呈する疣贅や心筋膿瘍を認める

IE 可能性

大基準1 つと小基準1 つ，または小基準3 つ（注6）

否定的

心内膜炎症状に対する別の確実な診断，または

心内膜炎症状が4 日以内の抗菌薬により消退，または

4 日以内の抗菌薬投与後の手術時または剖検時にIE の病理学所見なし

注1）本ガイドラインでは菌種の名称についてはすべて英語表記とし通例に従って Streptococcus viridans 以外はイタリック体で表示した．

注2） Staphylococcus aureus は，改訂版では，i)に含まれるようになった．

注3）本項は改訂版で追加された．

注4）改訂版では，人工弁置換例，臨床的基準でIE可能性となる場合，弁輪部膿瘍などの合併症を伴うIE，については，経食道心エコー図の施行が推奨されている．

注5）改訂版では，“心エコー図所見：IEに一致するが，上記の大基準を満たさない場合”，は小基準から削除されている

注6）改訂版では，“IE可能性”は，このように変更されている

治療

QB.C-454

緑色連鎖球菌：ペニシリンG(大量投与)
腸球菌：ペニシリン＋アミノグリコシド系抗菌薬
黄色ブドウ球菌：第1-2世代セフェム系抗菌薬＋アミノグリコシド系抗菌薬

外科的治療

ガイドライン.1

以下の病態が観察されるか予想されるときに手術適応を考慮。

1. うっ血性心不全
2. 抵抗性感染
3. 感染性塞栓症

うっ血性心不全

抵抗性感染

感染性塞栓症