Proteus

プロテウス属

　 　

WordNet

1. type genus of the Proteidae (同)genus Proteus
2. (Greek mythology) a prophetic god who served Poseidon; was capable of changing his shape at will

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/10/19 00:17:34」(JST)

wiki en

[Wiki en表示]

This article is about Proteus in Greek mythology. For other meanings, see Proteus (disambiguation).

"Protean" redirects here. For other uses, see Protean (disambiguation).

Greek deities series
Primordial deities Titans and Olympians Chthonic deities Mycenaean deities Personified concepts Other deities
Aquatic deities
Amphitrite Ceto Glaucus Naiades Nereides Nereus Oceanides Oceanus Ophion Phorcys Pontus Poseidon Proteus Tethys Thetis Triton

In Greek mythology, Proteus (/ˈproʊtiəs, -tjuːs/; Greek: Πρωτεύς) is an early sea-god or god of rivers and oceanic bodies of water, one of several deities whom Homer calls the "Old Man of the Sea". Some who ascribe to him a specific domain call him the god of "elusive sea change", which suggests the constantly changing nature of the sea or the liquid quality of water in general. He can foretell the future, but, in a mytheme familiar to several cultures, will change his shape to avoid having to; he will answer only to someone who is capable of capturing him. From this feature of Proteus comes the adjective protean, with the general meaning of "versatile", "mutable", "capable of assuming many forms". "Protean" has positive connotations of flexibility, versatility and adaptability.

Etymology

Proteus' name suggests the "first" (from Greek "πρῶτος" - protos, "first"), as protogonos (πρωτόγονος) is the "primordial" or the "firstborn". It is not certain to what this refers, but in myths where he is the son of Poseidon, it possibly refers to his being Poseidon's eldest son, older than Poseidon's other son, the sea-god Triton. The first attestation of the name, although it is not certain whether it refers to the god or just a person, is in Mycenaean Greek; the attested form, in Linear B, is 𐀡𐀫𐀳𐀄, po-ro-te-u.

In Greek mythology

Proteus as envisioned by Andrea Alciato

According to Homer (Odyssey iv:412), the sandy island of Pharos situated off the coast of the Nile Delta was the home of Proteus, the oracular Old Man of the Sea and herdsman of the sea-beasts. In the Odyssey, Menelaus relates to Telemachus that he had been becalmed here on his journey home from the Trojan War. He learned from Proteus' daughter Eidothea ("the very image of the Goddess"), that if he could capture her father, he could force him to reveal which of the gods he had offended and how he could propitiate them and return home. Proteus emerged from the sea to sleep among his colony of seals, but Menelaus was successful in holding him, though Proteus took the forms of a lion, a serpent, a leopard, a pig, even of water or a tree. Proteus then answered truthfully, further informing Menelaus that his brother Agamemnon had been murdered on his return home, that Ajax the Lesser had been shipwrecked and killed, and that Odysseus was stranded on Calypso's Isle Ogygia.

According to Virgil in the fourth Georgic, at one time the bees of Aristaeus, son of Apollo, all died of a disease. Aristaeus went to his mother, Cyrene, for help; she told him that Proteus could tell him how to prevent another such disaster, but would do so only if compelled. Aristaeus had to seize Proteus and hold him, no matter what he would change into. Aristeus did so, and Proteus eventually gave up and told him that it was a punishment for causing the death of Eurydice. To make amends, he must sacrifice 12 animals to the gods, leave the corpses in the place of sacrifice, and return three days later. When Aristaeus returned after the three days, he found in one of the carcasses a swarm of bees which he took to his apiary. The bees were never again troubled by disease.

The children of Proteus, besides Eidothea, include Polygonus and Telegonus, who both challenged Heracles at the behest of Hera and were killed, one of Heracles' many successful encounters with representatives of the pre-Olympian world order.

Another Proteus occurs in Greek myth as one of the fifty sons of King Aegyptus. There are also legends concerning Apollonius of Tyana that say Proteus incarnated himself as the 1st century philosopher. These legends are mentioned in the 3rd century biographical work Life of Apollonius of Tyana.

Proteus of Egypt

Main article: Proteus of Egypt

In the Odyssey (iv.430ff) Menelaus wrestles with "Proteus of Egypt, the immortal old man of the sea who never lies, who sounds the deep in all its depths, Poseidon's servant" (Robert Fagles's translation). Proteus of Egypt is mentioned in an alternate version of the story of Helen of Troy in the tragedy Helen of Euripides (produced in 412 BC). The often unconventional playwright introduces a "real" Helen and a "phantom" Helen (who caused the Trojan War), and gives a backstory that makes the father of his character Theoclymenus, Proteus, a king in Egypt who had been wed to a Nereid Psamathe. In keeping with one of his themes in Helen, Euripides mentions in passing Eido ("image"), another unseen daughter of the king. The play's king (never seen) is only marginally related to the "Old Man of the Sea" and should not be confused with the sea god Proteus.

At Pharos—in Hellenistic times the site of the Lighthouse of Alexandria were indivisible, (in modern Greek the word still has the meaning "lighthouse")—a king of Egypt named Proteus welcomed Dionysus in the young god's wanderings.

In alchemy and psychology

The German mystical alchemist Heinrich Khunrath wrote of the shape-changing sea-god who, because of his relationship to the sea, is both a symbol of the unconscious as well as the perfection of the art. Alluding to the scintilla, the spark from ‘the light of nature’ and symbol of the anima mundi, Khunrath in Gnostic vein stated of the Protean element Mercury:

our Catholick Mercury, by virtue of his universal fiery spark of the light of nature, is beyond doubt Proteus, the sea god of the ancient pagan sages, who hath the key to the sea and …power over all things.

— Von Hyleanischen Chaos, Carl Jung, vol. 14:50

In modern times, the Swiss psychologist Carl Jung defined the mythological figure of Proteus as a personification of the unconscious, who, because of his gift of prophecy and shape-changing, has much in common with the central but elusive figure of alchemy, Mercurius.

In literature

The poet John Milton, aware of the association of Proteus with the Hermetic art of alchemy, wrote in Paradise Lost of alchemists who sought the philosopher's stone:

In vain, though by their powerful Art they bind
Volatile Hermes, and call up unbound
In various shapes old Proteus from the Sea,
Drain'd through a Limbec to his native form.

— John Milton, Paradise Lost, III.603–06

In his 1658 discourse The Garden of Cyrus, Sir Thomas Browne, pursuing the figure of the quincunx, queried:

Why Proteus in Homer the Symbole of the first matter, before he settled himself in the midst of his Sea-Monsters, doth place them out by fives?

Shakespeare uses the image of Proteus to establish the character of his great royal villain Richard III in the play Henry VI, Part Three, in which the future usurper boasts:

I can add colors to the chameleon,

Change shapes with Proteus for advantages,
And set the murderous Machiavel to school.
Can I do this, and cannot get a crown?
Tut, were it farther off, I'll pluck it down.

— William Shakespeare, Henry VI, Part Three, Act III, Scene ii

Shakespeare also names one of the main characters of his play The Two Gentlemen of Verona Proteus. Inconsistent with his affections, his deceptions have unraveled at the finale of the play as he is brought face-to-face with his friend Valentine and original love Julia:

O Heaven, were man

but constant, he were perfect: that one error
fills him with faults; makes him run through all sins

Inconstancy falls off, ere it begins.

In 1807, William Wordsworth finished his sonnet on the theme of a modernity deadened to Nature, which opens "The world is too much with us", with a sense of nostalgia for the lost richness of a world numinous with deities:

…I'd rather be

A Pagan suckled in a creed outworn;
So might I, standing on this pleasant lea,
Have glimpses that would make me less forlorn;
Have sight of Proteus rising from the sea.

Or hear old Triton blow his wreathèd horn.

The protagonist of Kurt Vonnegut's 1952 novel Player Piano is an engineer named Paul Proteus.

Proteus is the name of the submarine in the original story by Otto Klement and Jay Lewis Bixby, which became the basis for the 1966 film Fantastic Voyage and Isaac Asimov's novelization.

John Barth's novelette "Menelaiad" in Lost in the Funhouse is built around a battle between Proteus and Menelaus. It is told as a multiply-nested frame tale, and the narrators bleed into each other as the battle undermines their identities.

The alien character of Prot in the book trilogy by Gene Brewer and played by Kevin Spacey in the movie K-PAX, like Proteus was said to embody, was a modernized "shape shifter" and magical type of advanced mystical ET who "walked in" to humanoid bodies, and shared wisdom and insights into the human condition.

The crew of the Jupiter 2 in the 1998 film Lost in Space encounter and board a derelict space station named the Proteus.

In the Harry Potter series, Hermione Granger casts a Protean charm (named after Proteus) on galleons (a form of wizarding currency) to inform members of Dumbledore's Army of meetings. When she changes the properties of the original coin, the amendments are reflected on those she has given to other people to display the date.

"Proteus: The City" is the title of Book Four of Thomas Wolfe's autobiographical novel "Of Time and the River".

See also

• USS Proteus
• Proteus in popular culture
• Oresteia, section Proteus

Notes

References

• Karl Kerenyi, The Gods of the Greeks
• Robert Graves, The Greek Myths
• E. Prioux, «Géographie symbolique des errances de Protée : un mythe et sa relecture politique à l’époque impériale», in A. Rolet (dir.), Protée en trompe-l'œil. Genèse et survivances d'un mythe, d'Homère à Bouchardon (Paris, P.U.R., 2009), p. 139-164 (Interférences).
• A. Scuderi, Il paradosso di Proteo. Storia di una rappresentazione culturale da Omero al postumano, Carocci, Collana Lingue e letterature n.147, Roma, 2012. ISBN 9788843067190
• The Mythology of All Races, Vol. 1, Greek and Roma, William Sherwood Fox, Ph.D., Princeton University

External links

• Media related to Proteus at Wikimedia Commons

Look up Proteus in Wiktionary, the free dictionary.

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

• 1. 尿路感染症における細菌付着およびその他の病原因子 bacterial adherence and other virulence factors for urinary tract infection
• 2. 成人におけるグラム陰性桿菌菌血症 gram negative bacillary bacteremia in adults
• 3. 女性における急性単純性膀胱炎および腎盂腎炎 acute uncomplicated cystitis and pyelonephritis in women
• 4. 急性複雑性膀胱炎および腎盂腎炎 acute complicated cystitis and pyelonephritis
• 5. カウデン症候群などのPTEN過誤腫症候群 pten hamartoma tumor syndrome including cowden syndrome

English Journal

• Impact of Gram-negative bacteria in interaction with a complex microbial consortium on biogenic amine content and sensory characteristics of an uncooked pressed cheese.

• Delbès-Paus C, Pochet S, Helinck S, Veisseire P, Bord C, Lebecque A, Coton M, Desmasures N, Coton E, Irlinger F, Montel MC.SourceINRA, UR545 Recherches Fromagères, 20 Côte de Reyne, 15000 Aurillac, France.
• Food microbiology.Food Microbiol.2012 May;30(1):74-82. Epub 2011 Dec 14.
• The impact of Gram-negative bacteria on sensory characteristics and production of volatile compounds as well as biogenic amines (BA) in the core of an uncooked pressed type model cheese was investigated in the presence of a defined complex microbial consortium. Eleven strains of Gram-negative bacter
• PMID 22265286

• Acinetobacter baumannii is Able to Gain and Maintain a Plasmid Harbouring In35 Found in Enterobacteriaceae Isolates From Argentina.

• Ramírez MS, Merkier AK, Quiroga MP, Centrón D.SourceLaboratorio de Investigaciones de los Mecanismos de Resistencia a Antibióticos, Facultad de Medicina, Departamento de Microbiología, Parasitología e Inmunología, Universidad de Buenos Aires, Paraguay, 2155, Buenos Aires, Argentina.
• Current microbiology.Curr Microbiol.2012 Mar;64(3):211-3. Epub 2011 Nov 27.
• The aim of this study was to determine the presence of bla (CTX-M-2) in our A. baumannii population and their putative role as an alternative mechanism of resistance to third-generation cephalosporins in this species. The bla (CTX-M-2) gene is widespre
• PMID 22119898

• Ion mobility spectrometry for microbial volatile organic compounds: a new identification tool for human pathogenic bacteria.

• Jünger M, Vautz W, Kuhns M, Hofmann L, Ulbricht S, Baumbach JI, Quintel M, Perl T.SourceDepartment of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany, melanie.juenger@med.uni-goettingen.de.
• Applied microbiology and biotechnology.Appl Microbiol Biotechnol.2012 Feb 12. [Epub ahead of print]
• Presently, 2 to 4 days elapse between sampling at infection suspicion and result of microbial diagnostics. This delay for the identification of pathogens causes quite often a late and/or inappropriate initiation of therapy for patients suffering from infections. Bad outcome and high hospitalization
• PMID 22327321

• Using Nucleic Acid Microarrays to Perform Molecular Epidemiology and Detect Novel β-Lactamases: a Snapshot of ESBLs Throughout the World.

• Lascols C, Hackel M, Hujer AM, Marshall SH, Bouchillon SK, Hoban DJ, Hawser SP, Badal RE, Bonomo RA.SourceInternational Health Management Associates, Schaumburg, IL, 60173, USA.
• Journal of clinical microbiology.J Clin Microbiol.2012 Feb 8. [Epub ahead of print]
• The worldwide dissemination of extended-spectrum β-lactamase (ESBL)- and carbapenemase-producing Enterobacteriaceae is a major concern in both hospital and community settings. Rapid identification of these resistant pathogens and the genetic determinants they possess is needed to assist in clinical
• PMID 22322349

Japanese Journal

• Clinical Features and Long-Term Follow-Up of Quasi-Moyamoya Disease in Children.

• Hayashi Kentaro,Horie Nobutaka,Suyama Kazuhiko,Nagata Izumi
• Pediatric Neurosurgery 47(1), 15-21, 2011-09
• … Associated disorders were: craniosynostosis, dwarfism with coarctation of aorta, Proteus syndrome, and cranial irradiation for brain tumor. …
• NAID 120003238493

• Acidic environments induce differentiation of Proteus mirabilis into swarmer morphotypes

• Fujihara Masatoshi,Obara Hisato,Watanabe Yusaku [他]
• Microbiology and immunology 55(7), 489-493, 2011-07
• NAID 40018916560

• 施設園芸の主要害虫に対するオオメカメムシおよびヒメオオメカメムシ（カメムシ目：オオメカメムシ科）の捕食量

• 大井田 寛,上遠野 冨士夫
• 日本応用動物昆虫学会誌 55(4), 217-225, 2011
• 広食性天敵オオメカメムシおよびヒメオオメカメムシの3齢および5齢幼虫にナミハダニ雌成虫，ミカンキイロアザミウマ2齢幼虫，ワタアブラムシ無翅成虫，およびオオタバコガの卵または孵化直後の1齢幼虫を個別に異なる密度で与えて24時間当たり捕食数を比較するとともに，その結果から各餌種に対する最大捕食量を比較した．オオメカメムシの3齢幼虫にナミハダニまたはワタアブラムシを与えた場合を除くすべての捕食者種，捕食 …
• NAID 130001333014

Related Links

• Proteus/FF11用語辞典

銀海航路での戦闘となるので必然的に目的地へと到着するまでがタイムリミットとなり、 また銀海航路は他の機船航路と違い到着までの所要時間が短く、戦闘可能時間は最大 でも10分程度となる。 よって、Proteusを撃破するにはその熾烈な攻撃に耐えうる盾役 ...

• E-MU、1000種類以上の音色を同梱したサンプリング音源「Proteus VX ...

2008年8月11日 ... 米E-MU Systemsは、同社製のオーディオデバイスなどにバンドルされていた サンプリング音源「Proteus VX」v2.0を無償公開した。Windows XPに対応しており、 編集部にてWindows Vistaでの動作も確認した。現在、同社のWebサイトから ...

• Proteus Biomedical

Related Pictures

---

★リンクテーブル★

リンク元	「100Cases 10」「腸内細菌科」「尿路感染症」「日和見感染菌」「プロテウス属」
拡張検索	「Proteus感染症」「Proteus属」「Proteus infection」「Proteus症候群」「Proteus syndrome」

「100Cases 10」

　　[★]

☆case10　背痛

■症例

27歳　女性

主訴：背中に突き抜ける？痛み(pain across her back)

現病歴：背中に広がる痛みを訴えて、27歳の女性が救急部に運ばれてきた。２日前に熱が出て背部痛が始まり、以降調子が悪い。痛みは増強している。6時間前に2度嘔吐した。

既往歴：3ヶ月前に合併症のない胆嚢炎。

・身体診断

調子が悪そうであり、紅潮している。体温：39.2℃。脈拍：120/分。血圧：104/68 mmHg。心血管系、呼吸器系に異常を認めず。腹部：全体的に圧痛。両側の腰部で著明な圧痛。

・検査

(血液生化学)

白血球↑、血清尿素↑、CRP↑

(尿検査)

タンパク：++、鮮血：+++、亜硝酸塩：++

尿の顕微鏡検査：(おそらく400倍の一視野に)赤血球>50、白血球>50

腹部X線：正常

■glossary

loin n. (pl)腰、腰部(→(adj.)lumbar)。(獣の)腰肉、ロイン。(pl)陰部、生殖器、性器

腸雑音、腸音、intestinal murmur、intestinal sound、bowel sound

urine microscopy 尿の顕微鏡検査

dysuria 排尿障害

urgency n. 切迫、急迫、危急。緊急、火急、焦眉の急。[pl]しつこい要求、懇願。せき立てる力、刺激

hydronephrosis 水腎症

-nephros 腎臓

-stomy 開口術

nephrostomy n. 腎瘻造設術、腎造瘻術、腎瘻術

obstructive urophathy 閉鎖性尿路疾患

intravenous fluid 静脈内輸液

commence vt. 始める、開始する。 vi. ～から始める、始まる(with)

urgently

eradication n. 根絶、撲滅

mimic vt. ～の物まねをする、まねて馬鹿にする。そっくりに[卑屈に]まねる。～によく似る

renal ultrasound 腎臓超音波検査

obstructive uropathy 閉塞性尿路疾患

polycystic kidney disease 多発性嚢胞腎

medullary sponge kidney 海綿腎

loin-pain hematuria syndrome 腰痛血尿症候群

■解説

(第1パラグラフ)疫学

　急性腎盂腎炎：男性より女性でmore common。尿路からの細菌の上行感染。リスク：妊娠、糖尿病、免疫低下者、尿路奇形(尿の腎臓への逆流。そして多分、狭窄していたりして結石で閉塞されやすいこともあると思う)

(第2パラグラフ)病態

　食欲不振、悪心、嘔吐と共に40℃の発熱が出ることがある。

　腎盂腎炎患者の中には膀胱炎の先行症状(排尿障害、頻尿、尿意切迫、血尿)がある人がいるけど、こういう下部尿路症状がいつも出現するわけではない。

　多くの腎盂腎炎患者は、先行する6ヶ月以内の膀胱炎の既往がある。

　老人の場合、非典型的な症状を示し、そして混乱した状態でやってくる。

　腎盂腎炎は他の病態によく似ている：急性虫垂炎、急性胆嚢炎、急性膵炎、下葉の肺炎

　普通、体表から見て腎臓の直上に前からも後ろからも圧痛を感じる。

　未治療の腎盂腎炎では敗血症になるかもしれない。

(第3パラグラフ)本ケースについて

　・CRP上昇は急性感染症を示唆

　・顕微鏡的血尿・タンパク尿、白血球増多は尿路の炎症を示す。

　・硝酸塩(nitrate, HNO3と何かの塩)から亜硝酸塩(nitrite, HNO2と何かの塩)への還元により細菌の存在が確認される。

　　覚え方：亜硝酸は(Oが一つ)足らないi(愛)

　　でも複雑です。

　　　HNO2　亜硝酸 nitrous acid, nitrite　。亜硝酸塩 nitrite

　　　HNO3　硝酸 nitric acid, nitrate　　 。硝酸塩 nitrate

(第4パラグラフ)管理

　・女性は入院すべき。

　・血液と尿の採取

　・静脈内輸液＋抗生物質で治療開始。微生物が同定されたら、感受性のある抗菌薬を使用する。初期治療ではゲンタマイシン、アンピシリン、シプロフロキサシンを用いる

　・腎臓エコー検査：尿路閉塞を除外するため。閉塞性尿路疾患では、激しい痛み、発熱、敗血症ショック、腎不全を伴う脳腎症を起こしうる。

　・尿路敗血症の経過で水腎症が疑われたら、合併症を防ぐために緊急に腎瘻を造設すべき

(第5パラグラフ)薬物治療

　・(腎結石など合併していない)腎感染症(ucomplicated renal infection)患者は抗生物質2週間のコースで治療すべき。

　・感染の根絶を確実にする治療が終わった後10-14日間は、反復して細菌培養をする。＜

　・尿路結石を有する感染症や腎瘢痕を有する患者では抗生物質6週間のコースが用いられる。

■鑑別診断のポイント

　腎盂腎炎は片側性、あるいは両側性の腰痛を引き起こす。

　腰部痛の鑑別診断：

　　閉塞性尿路疾患

　　腎梗塞：心疾患などで生じた血栓が腎動脈またはその分枝を閉塞し、その血管の支配領域が虚血性壊死に陥った状態。

　　腎細胞癌：腎尿細管上皮細胞より発生する悪性腫瘍

　　腎乳頭壊死：腎乳頭より腎髄質にかけて、その支配動脈の虚血により壊死を来したもの。 主として基礎疾患に糖尿病を有する人にみられ、しばしば急性腎盂腎炎などの尿路感染に伴って発症する。

　　腎結石：

　　糸球体腎炎：

　　多発性嚢胞腎：先天性かつ両側性に腎実質内に大小無数の嚢胞を発生する。 ほとんどが両側性で、貧血、顕微鏡的血尿、蛋白尿、高血圧といった症状を呈しながら腎機能が低下し、最終的には腎不全となる疾患

　　海綿腎：腎錐体における集合管の先天性嚢状拡張症。症状としては拡張した集合管に尿の停滞　→　感染・細かな結石ができる。

　　腰痛血尿症候群：若年女性に好発し、反復して出現する腰部から側腹部の強い疼痛と血尿を主徴とする病因不明の疾患。肉眼的血尿や軽度の蛋白尿がみられることもあるが、特異的な検査所見はなく、診断は他疾患の除外診断による

■KEYPOINT

・急性腎盂腎炎は下部尿路症状があったり無かったりする。

・腎臓超音波検査は尿路閉塞を否定するために、入院24時間後に行うべき。

・抗菌薬は、再発のリスクを最小限にするために、少なくとも2週間継続すべき。

□閉塞性尿路疾患(http://merckmanual.jp/mmpej/sec17/ch229/ch229a.htmlより引用)

• 閉塞性尿路疾患は正常な尿流を構造的または機能的に妨げ，ときに腎機能不全（閉塞性腎症）を起こすことがある。症状は，慢性の閉塞では認められないこともあるが，T11からT12にかけての皮膚分節に放散する疼痛，無尿，夜間頻尿または多尿がある。診断は閉塞のレベルによって，膀胱カテーテル法，超音波検査，CT，膀胱尿道鏡検査，膀胱尿道撮影または腎盂造影に基づく。治療は原因によって異なり，迅速なドレナージ，器具使用，外科手術（例，内視鏡法，砕石術）および/またはホルモン療法を必要とする場合がある。

□KUBの陰影から尿路結石成分の推定

　リン酸カルシウム(22.0)

　シュウ酸カルシウム(10.8)：シュウ酸カルシウム結石は，尿路結石のうちで最も頻度が高く（70～80％），シュウ酸カルシウム結石の約半数はリン酸カルシウムとの混合結石である。

　リン酸マグネシウムアンモニウム(4.1)：ストラバイト結石：尿素分解菌(Proteus　、Klebsiella　、Pseudomonas　)による尿路感染が原因で、尿素が分解されアンモニアとなると尿がアルカリ性となり、リン酸マグネシウムアンモニウム結石が形成される。

　シスチン(3.7)：ホモシスチン尿症

　尿酸(1.4)：痛風

　キサンチン(1.4)：プリン体

□多嚢胞腎

　常染色体劣性多発性嚢胞腎：ARPKD

　　旧名：幼児型嚢胞腎

　常染色体優性多発性嚢胞腎：ADPKD

　　旧名：成人型嚢胞腎

「腸内細菌科」

　　[★]

英

Enterobacteriaceae

関

細菌

• 代表的なもの８つを覚ておく！

エンテロバクター属 Enterobacter
エシェリキア属  Escherichia
クレブシエラ属 Klebsiella
プロテウス属 Proteus
サルモネラ属 Salmonella
セラチア属 Serratia
シゲラ属 Shigella
エルシニア属 Yersinia

腸内細菌科 (SMB.163)

属	菌種	日和見 感染菌	感染症
Citrobacter	Citrobacter freundii		尿路感染、骨髄炎、下痢
Edwardsiella	Edwardsiella tarda	○	腸管外感染症
Enterobacter	Enterobacter aerogenes	○	肺炎、尿路感染
	Enterobacter cloacae
	Enterobacter gergoviae
	Enterobacter sakazakii		新生児敗血症、髄膜炎
Escherichia	Escherichia coli		下痢、腸炎、腸管外感染症(尿路感染症、骨髄炎)
Hafnia	Hafnia alvei		腸管外感染症
Klebsiella	Klebsiella oxytoca		下痢
	Klebsiella pneumoniae	○	肺炎、尿路感染
Kluyvera	Kluyvera ascorbata	○
	Kluyvera cryocrescens
Morganella	Morganella morganii		尿路感染症
Proteus	Proteus mirabilis	○	尿路感染症
	Proteus vulgaris
Providencia	Providencia alcalifaciens		尿路感染症、下痢
	Providencia rettgeri		尿路感染症、下痢
	Providencia stuartii		尿路感染症
Salmonella	Salmonella enterica		腸チフス、急性胃腸炎(食中毒)
Serratia	Serratia liquefaciens	○
	Serratia marcescens
Shigella	Shigella boydii		細菌性赤痢
	Shigella dysenteriae
	Shigella flexneri
	Shigella sonnei
Yersinia	Yersinia enterocolitica		急性胃腸炎(食中毒)、回腸末端炎、結節性紅斑
	Yersinia pestis		ペスト
	Yersinia pseudotuberculosis		腸間膜リンパ節炎、関節炎

「尿路感染症」

　　[★]

英

urinary tract infection, UTI, urinary tract infections, UTIs

関

尿路感染

定義

• 尿路(腎、尿管、膀胱、尿道など)の感染症。尿道炎は別に取り扱われるらしい

疫学

• 尿路感染症は特に女性に多く、30歳になるまでに4人に1人が罹患。
• 入院患者の1/3は尿路感染症であり、さらにその3/4以上は膀胱カテーテルを留置されいる患者で起こる。

分類

背景

• 一般細菌の上行性感染によって起こることがほとんどであり、
• 単純性尿路感染症：尿路に明らかな基礎疾患がない。

• 急性、20-30歳代の女性に多い

• 複雑性尿路感染症：尿路に感染を起こしやすくなる基礎疾患がある。

• 慢性、高齢の男性に多い

部位

• 上部尿路感染症：腎盂腎炎
• 下部尿路感染症：膀胱炎

病因

• 特異性尿路感染症
• 非特異性尿路感染症

• 一般的な尿路感染症

病原体

SMB.607

外来患者

• Escherichia coli(8割)
• Proteus mirabilis
• coagulase negative staphylococci
• Enterococcus faecalis
• Adenovirus 11(出血性膀胱炎)

院内感染患者

• Escherichia coli(4割)
• Klebsiella pneumoniae
• Enterobacter cloacae
• Proteus mirabilis
• Serratia marcescens
• Pseudomonas aeruginosa
• coagulase negative staphylococci
• Staphylococcus aureus
• Enterococcus faecalis
• Candida albicans

first aid p.162

• Ambulatory..E. coli (50-80%), Klebsiella (8-10%).

Staphylococcus saprophyticus (10-30%) is the 2nd most common cause of UTI in young ambulatory women.

• Hospital..E. coli, Proteus, Klebsiella, Serratia,Pseudomonas.

感染経路

• 外尿道口からの上行性感染

病因

• 冷え、過度の排尿自制、尿流の停滞、経尿道的操作など

症状

• 腎盂腎炎：発熱、腰痛など、
• 膀胱炎では頻尿、排尿痛、残尿感、頻尿など

小児科 SPE.615

• 年長児：

• 上部：発熱、腰痛
• 下部：排尿痛、頻尿、尿の混濁

• 乳幼児：発熱、嘔吐、下痢、食欲不振など非特異的な全身症状
• 新生児：乳幼児の症状　＋　脱水、体重減少、黄疸など。

検査

尿検査

• 尿：混濁
• 尿沈渣：1視野(400倍)5個以上の白血球(膿尿)
• 尿培養：1ml中10^5個以上の細菌　←　中間尿の定量培養

• 症状(頻尿、排泄痛、残尿感)ががあれば、これ以下の菌数でも病因的意義がある。

「日和見感染菌」

　　[★]

関

日和見感染、日和見感染症

腸内細菌科

属	菌種	感染症
Edwardsiella	Edwardsiella tarda	腸管外感染症
Enterobacter	Enterobacter aerogenes	肺炎、尿路感染
	Enterobacter cloacae
	Enterobacter gergoviae
Klebsiella	Klebsiella pneumoniae	肺炎、尿路感染
Kluyvera	Kluyvera ascorbata
	Kluyvera cryocrescens
Proteus	Proteus mirabilis	尿路感染症
	Proteus vulgaris
Serratia	Serratia liquefaciens
	Serratia marcescens

「プロテウス属」

　　[★]

ラ

Proteus

同

腐敗菌、Proteus属

関

細菌

• first aid step1 2006 p.135,140,142,143-144

• グラム陰性桿菌
• 腸内細菌科
• 通性嫌気性　←　腸内細菌科だからね
• ウレアーゼ活性を有する　←　腸内細菌との鑑別
• 人から分離されるのは主に、Proteus vulgaris、Proteus mirabilis
• 日和見感染菌、下部尿路感染、創傷感染、カテーテル留置患者の敗血症、火傷面の二次感染
• 周毛性鞭毛、運動性を有する

プロテウス属

• Proteus vulgaris
• Proteus mirabilis
• Proteus myxofaciens
• Proteus penneri

抗原交差性

• ワイル・フェリックス反応 Weil-Felix reaction

• リケッチア症の診断

「Proteus感染症」

　　[★]

英

Proteus infection

関

プロテウス感染症、プロテウス感染

「Proteus属」

　　[★]

ラ

Proteus

関

プロテウス属、プロテウス、腐敗菌

「Proteus infection」

　　[★]

プロテウス感染症、プロテウス感染、Proteus感染症

「Proteus症候群」

　　[★]

英

Proteus syndrome

関

プロテウス症候群

「Proteus syndrome」

　　[★]

プロテウス症候群、Proteus症候群