WordNet

spherical Gram-positive parasitic bacteria that tend to form irregular colonies; some cause boils or septicemia or infections (同)staphylococci, staph

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ブドウ状球菌

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/05/14 23:19:11」(JST)

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Staphylococcus (from the Greek: σταφυλή, staphylē, "grape" and κόκκος, kókkos, "granule") is a genus of Gram-positive bacteria. Under the microscope, they appear round (cocci), and form in grape-like clusters.^[1]

The Staphylococcus genus includes at least 40 species. Of these, nine have two subspecies and one has three subspecies.^[2] Most are harmless and reside normally on the skin and mucous membranes of humans and other organisms. Found worldwide, they are a small component of soil microbial flora.^[3]

Taxonomy

The taxonomy is based on 16s rRNA sequences,^[4] and most of the staphylococcal species fall into 11 clusters:

S. aureus group – S. aureus, S. simiae
S. auricularis group – S. auricularis
S. carnosus group – S. carnosus, S. condimenti, S. massiliensis, S. piscifermentans, S. simulans
S. epidermidis group – S. capitis, S. caprae, S. epidermidis, S. saccharolyticus
S. haemolyticus group – S. devriesei, S. haemolyticus, S. hominis
S. hyicus-intermedius group – S. chromogenes, S. felis, S. delphini, S. hyicus, S. intermedius, S. lutrae, S. microti, S. muscae, S. pseudintermedius, S. rostri, S. schleiferi
S. lugdunensis group – S. lugdunensis
S. saprophyticus group – S. arlettae, S. cohnii, S. equorum, S. gallinarum, S. kloosii, S. leei, S. nepalensis, S. saprophyticus, S. succinus, S. xylosus
S. sciuri group – S. fleurettii, S. lentus, S. sciuri, S. stepanovicii, S. vitulinus
S. simulans group – S. simulans
S. warneri group – S. pasteuri, S. warneri

A twelfth group – that of S. caseolyticus – has now been moved to a new genus Macrococcus, the species of which are currently the closest known relatives of the Staphylococci.^[5]

Subspecies

S. aureus subsp. aureus
S. aureus subsp. anaerobius

S. capitis subsp. capitis
S. capitis subsp. urealyticus

S. carnosus subsp. carnosus
S. carnosus subsp. utilis

S. cohnii subsp. cohnii
S. cohnii subsp. urealyticus

S. equorum subsp. equorum
S. equorum subsp. linens

S. hominis subsp. hominis
S. hominis subsp. novobiosepticus

S. saprophyticus subsp. bovis
S. saprophyticus subsp. saprophyticus

S. schleiferi subsp. coagulans
S. schleiferi subsp. schleiferi

S. sciuri subsp. carnaticus
S. sciuri subsp. rodentium
S. sciuri subsp. sciuri

S. succinus subsp. casei
S. succinus subsp. succinus

Notes

As with all generic names in binomial nomenclature, Staphylococcus is capitalized when used alone or with a specific species. Also, the abbreviations Staph and S. when used with a species (S. aureus) are correctly italicized and capitalized (though often errors in this are seen in popular literature). However, Staphylococcus is not capitalized or italicized when used in adjectival forms, as in a staphylococcal infection, or as the plural (staphylococci).^[6]

The S. saprophyticus and S. sciuri groups are generally novobiocin-resistant, as is S. hominis subsp. novobiosepticus.

Members of the S. sciuri group are oxidase-positive due to their possession of the enzyme cytochrome c oxidase. This group is the only clade within the Staphylococci to possess this gene.

The S. sciuri group appears to be the closest relations to the genus Macrococcus.

Staphylococcus pulvereri has been shown to be a junior synonym of Staphylococcus vitulinus.^[7]

Within these clades, the S. haemolyticus and S. simulans groups appear to be related, as do the S. aureus and S. epidermidis groups.^[8]

S. lugdunensis appears to be related to the S. haemolyticus group.

S. croceolyticus may be related to S. haemolyticus, but this needs to be confirmed.

The taxonomic position of S. croceolyticus, S. leei, S. lyticans and S. pseudolugdunensis has yet to be clarified. The published descriptions of these species do not appear to have been validly published to date (2010).

Biochemical identification

Assignment of a strain to the genus Staphylococcus requires it to be a Gram-positive coccus that forms clusters, produces catalase, has an appropriate cell wall structure (including peptidoglycan type and teichoic acid presence) and G + C content of DNA in a range of 30–40 mol%.

Staphylococcus species can be differentiated from other aerobic and facultative anaerobic, Gram-positive cocci by several simple tests. Staphylococcus spp. are facultative anaerobes (capable of growth both aerobically and anaerobically). All species grow in the presence of bile salts.

It was believed that all species were coagulase-positive however it is now known that not all Staphylococcus are coagulase positive.^[1]^[9]^[10]

Growth can also occur in a 6.5% NaCl solution. On Baird Parker medium, Staphylococcus spp. grow fermentatively, except for S. saprophyticus, which grows oxidatively. Staphylococcus spp. are resistant to bacitracin (0.04 U disc: resistance = < 10 mm zone of inhibition) and susceptible to furazolidone (100 μg disc: resistance = < 15 mm zone of inhibition). Further biochemical testing is needed to identify to the species level.

When the bacterium divides it divides along two axes, so forming clumps of bacteria. This is as opposed to streptococci which divide along one axis and so form chains (strep. meaning twisted or pliant).

Coagulase production

One of the most important phenotypical features used in the classification of staphylococci is their ability to produce coagulase, an enzyme that causes blood clot formation.

Six species are currently recognised as being coagulase-positive: S. aureus, S. delphini, S. hyicus, S. intermedius, S. lutrae,S. pseudintermedius and S. schleiferi subsp. coagulans. These species belong to two separate groups – the S. aureus (S. aureus alone) group and the S. hyicus-intermedius group (the remaining five). S. aureus can also be found as being coagulase-negative.

A seventh species has also been described – Staphylococcus leei – from patients with gastritis.^[11]

S. aureus is coagulase-positive, meaning it produces coagulase. However, while the majority of S. aureus strains are coagulase-positive, some may be atypical in that they do not produce coagulase. S. aureus is catalase-positive (meaning that it can produce the enzyme catalase) and able to convert hydrogen peroxide (H₂O₂) to water and oxygen, which makes the catalase test useful to distinguish staphylococci from enterococci and streptococci.

S. pseudintermedius inhabits and sometimes infects the skin of domestic dogs and cats. This organism, too, can carry the genetic material that imparts multiple bacterial resistance. It is rarely implicated in infections in humans, as a zoonosis.

S. epidermidis, a coagulase-negative species, is a commensal of the skin, but can cause severe infections in immune-suppressed patients and those with central venous catheters. S. saprophyticus, another coagulase-negative species that is part of the normal vaginal flora, is predominantly implicated in genitourinary tract infections in sexually active young women. In recent years, several other Staphylococcus species have been implicated in human infections, notably S. lugdunensis, S. schleiferi, and S. caprae.

Common abbreviations for coagulase-negative staphylococcus species are CoNS and CNS.

Genomics and molecular biology

The first S. aureus genomes to be sequenced were those of N315 and Mu50 in 2001. Many more complete S. aureus genomes have been submitted to the public databases, making it one of the most extensively sequenced bacteria. The use of genomic data is now widespread and provides a valuable resource for researchers working with S. aureus. Whole genome technologies, such as sequencing projects and microarrays, have shown an enormous variety of S. aureus strains. Each contains different combinations of surface proteins and different toxins. Relating this information to pathogenic behaviour is one of the major areas of staphylococcal research. The development of molecular typing methods has enabled the tracking of different strains of S. aureus. This may lead to better control of outbreak strains. A greater understanding of how the staphylococci evolve, especially due to the acquisition of mobile genetic elements encoding resistance and virulence genes is helping to identify new outbreak strains and may even prevent their emergence.^[12]

The widespread incidence of antibiotic resistance across various strains of S. aureus, or across different species of Staphylococcus has been attributed to horizontal gene transfer of genes encoding antibiotic/metal resistance and virulence. A recent study demonstrated the extent of horizontal gene transfer among Staphylococcus to be much greater than previously expected, and encompasses genes with functions beyond antibiotic resistance and virulence, and beyond genes residing within the mobile genetic elements.^[13]

Various strains of Staphylococcus are available from biological research centres, such as the National Collection of Type Cultures (NCTC).

Host range

Unknown variety of Staphylococcus, Gram-stained - numbered ticks on the scale are 11 µm apart.

Members of the genus Staphylococcus frequently colonize the skin and upper respiratory tracts of mammals and birds. Some species specificity has been observed in host range, such that the Staphylococcus species observed on some animals appear more rarely on more distantly related host species.^[14] Some of the observed host specificity includes:

S. arlattae – chickens, goats
S. aureus - humans^{[clarification needed]}
S. auricularis – deer, dogs, humans
S. capitis – humans
S. caprae – goats, humans
S. cohnii – chickens, humans
S. delphini – dolphins
S. devriesei – cattle
S. epidermiditis – humans
S. equorum – horses
S. felis – cats
S. fleurettii – goats
S. gallinarum – chickens, goats, pheasants
S. haemolyticus – humans, Cercocebus, Erythrocebus, Lemur, Macca, Microcebus, Pan
S. hyicus – pigs
S. leei – humans
S. lentus – goats, rabbits, sheep
S. lugdunensis – humans, goats
S. lutrae – otters
S. microti – voles (Microtus arvalis)
S. nepalensis – goats
S. pasteuri – humans, goats
S. pettenkoferi – humans
S. pseudintermedius – dogs
S. rostri – pigs
S. schleiferi – humans
S. sciuri – humans, dogs, goats
S. simiae – South American squirrel monkeys (Saimiri sciureus)
S. simulans – humans
S. warneri – humans, Cercopithecoidea, Pongidae
S. xylosus – humans

Clinical

Staphylococcus can cause a wide variety of diseases in humans and animals through either toxin production or penetration. Staphylococcal toxins are a common cause of food poisoning, for they can be produced by bacteria growing in improperly stored food items. The most common sialadenitis is caused by staphylococci, as bacterial infections.^[15]

Notes and references

^ ^a ^b Ryan KJ, Ray CG, ed. (2004). Sherris Medical Microbiology (4th ed.). McGraw Hill. ISBN 0-8385-8529-9.
^ Harris L.G, Foster S.J, Richards S. G. (2002). "An introduction to Staphylococcus aureus, and techniques for identifying and quantifying S. aureus adhesins in relation to adhesion to biomaterials: review" (PDF). European cells and materials 4: 39–60. PMID 14562246.
^ Madigan M, Martinko J, ed. (2005). Brock Biology of Microorganisms (11th ed.). Prentice Hall. ISBN 0-13-144329-1.
^ Takahashi T, Satoh I, Kikuchi N. (1999). "Phylogenetic relationships of 38 taxa of the genus Staphylococcus based on 16S rRNA gene sequence analysis" (PDF). Int. J. Syst. Bacteriol. 49 (2): 725–728. doi:10.1099/00207713-49-2-725. PMID 10319495.
^ Kloos WE, Ballard DN, George CG, Webster JA, Hubner RJ, Ludwig W, Schleifer KH, Fiedler F, Schubert K (1998). "Delimiting the genus Staphylococcus through description of Macrococcus caseolyticus gen. nov., comb. nov. and Macrococcus equipercicus sp. nov., and Macrococcus bovicus sp. nov. and Macrococcus carouselicus sp. nov" (PDF). Int J Syst Bacteriol 48 (3): 859–877. doi:10.1099/00207713-48-3-859. PMID 9734040.
^ See genus and species capitalization.
^ Svec P., Vancanneyt M., Sedláek I., Engelbeen K., Stetina V., Swings, J. & Petrá, P. (2004). "Reclassification of Staphylococcus pulvereri Zakrzewska-Czerwiska et al. 1995 as a later synonym of Staphylococcus vitulinus Webster et al 1994" (PDF). Int. J. Syst. Evol. Microbiol 54 (6): 2213–2215. doi:10.1099/ijs.0.63080-0. PMID 15545460.
^ Ghebremedhin B, Layer F, König W, König B (2008). "Genetic classification and distinguishing of Staphylococcus species based on different partial gap, 16S rRNA, hsp60, rpoB, sodA, and tuf gene sequences". J. Clin. Microbiol. 46 (3): 1019–1025. doi:10.1128/JCM.02058-07. PMC 2268370. PMID 18174295.
^ PreTest, Surgery, 12th ed., p. 88
^ Matthews KR, Roberson J, Gillespie BE, Luther DA, Oliver SP (1997). "Identification and Differentiation of Coagulase-Negative Staphylococcus aureus by Polymerase Chain Reaction". Journal of Food Protection 60 (6): 686–8.
^ Jin M, Rosario W, Watler E, Calhoun DH (2004). "Development of a large-scale HPLC-based purification for the urease from Staphylococcus leei and determination of subunit structure" (PDF). Protein Expr. Purif. 34 (1): 111–117. doi:10.1016/j.pep.2003.10.01. PMID 14766306.
^ Lindsay J (editor). (2008). Staphylococcus: Molecular Genetics. Caister Academic Press. ISBN 1-904455-29-8. [1].
^ Chan CX, Beiko RG, Ragan MA (2011). "Lateral transfer of genes and gene fragments in Staphylococcus extends beyond mobile elements". J Bacteriol 193 (15): 3964–3977. doi:10.1128/JB.01524-10. PMC 3147504. PMID 21622749.
^ Kloos WE (1980). "Natural Populations of the Genus Staphylococcus". Annual Review of Microbiology 34: 559–592. doi:10.1146/annurev.mi.34.100180.003015. PMID 7002032.
^ "Sialoadenitis: inflammation of the salivary glands". The Medical Consumer's Advocate. 2001-01-04. Retrieved 2011-01-04.

External links

Staphylococcus genomes and related information at PATRIC, a Bioinformatics Resource Center funded by NIAID

UpToDate Contents

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1. 成人におけるメチシリン耐性黄色ブドウ球菌による皮膚および軟部組織感染症の治療 treatment of skin and soft tissue infections due to methicillin resistant staphylococcus aureus in adults
2. 成人における黄色ブドウ球菌菌血症の治療 treatment of staphylococcus aureus bacteremia in adults
3. 成人におけるブドウ球菌随伴糸球体腎炎 staphylococcus associated glomerulonephritis in adults
4. 小児におけるメチシリン耐性黄色ブドウ球菌による皮膚軟部組織の感染が疑われる患者の
評価およびマネージメント evaluation and management of suspected methicillin resistant staphylococcus aureus skin and soft tissue infections in children
5. 小児における黄色ブドウ球菌菌血症の治療 treatment of staphylococcus aureus bacteremia in children

English Journal

Dense coating of surface mounted CuBTC Metal-Organic Framework nanostructures on silk fibers, prepared by layer-by-layer method under ultrasound irradiation with antibacterial activity.

Abbasi AR, Akhbari K, Morsali A.SourceDepartment of Chemistry, Faculty of Sciences, Tarbiat Modares University, P.O. Box 14155-4838 Tehran, Islamic Republic of Iran.
Ultrasonics sonochemistry.Ultrason Sonochem.2012 Jul;19(4):846-52. Epub 2011 Dec 10.
The growth of Cu(3)(BTC)(2) (BTC=1,3,5-benzenetricarboxylate), also known as CuBTC and HKUST-1, Metal-Organic Framework (MOF) nanostructures on silk fibers were achieved by layer-by-layer technique in alternating bath of Cu(OAc)(2)·2H(2)O and H(3)BTC solutions under ultrasound irradiation. The effe
PMID 22204978

Use of deodorized yellow mustard powder to control Escherichia coli O157:H7 in dry cured Westphalian ham.

Nilson AM, Holley RA.SourceDepartment of Food Science, Faculty of Agriculture and Food Sciences, University of Manitoba, Winnipeg, Manitoba R3T 2N2, Canada.
Food microbiology.Food Microbiol.2012 Jun;30(2):400-7. Epub 2011 Nov 4.
Dry cured (uncooked) hams with low water activity and pH ≥5.6 seem a likely food vehicle for Escherichia coli O157:H7. In previous work, isothiocyanates produced from mustard glucosinolates by bacterial myrosinase-like activity converted deodorized mustard into a potent antimicrobial in dry sausag
PMID 22365353

Japanese Journal

Caspase-1 protein induces apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC)-mediated necrosis independently of its catalytic activity

Motani Kou,Kushiyama Hiroko,Imamura Ryu,Kinoshita Takeshi,Nishiuchi Takumi,Suda Takashi
Journal of Biological Chemistry 286(39), 33963-33972, 2011-10-30
… Knockdown of caspase-1, but not Ac-YVAD-CMK, suppressed the monocyte necrosis induced by Staphylococcus and Pseudomonas infection. …
NAID 120003479727

小児頸部膿瘍の臨床的検討

古瀬寛子,大塚康司,長谷川達哉,河口幸江,本橋玲,野本剛輝,井谷茂人,鈴木衞
耳鼻咽喉科臨床 104(5), 379-386, 2011-05-01
… Bacteria detected in 10 cases were 4 of Streptococcus pyogenes (Group A), 3 of Staphylococcus aureus, and 1 each of Group F Streptococcus, Peptostreptococcus sp. …
NAID 10027972710

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★リンクテーブル★

リンク元	「細菌の鑑別」「髄膜炎」「100Cases 16」「急性尿細管間質性腎炎」「ブドウ球菌」
拡張検索	「Staphylococcus epidermidis」「Staphylococcus haemolyticus」「Staphylococcus saprophyhcus」

「細菌の鑑別」

Staphylococcus
	SEM micrograph of S. aureus colonies; note the grape-like clustering common to Staphylococcus species.
Scientific classification
Kingdom:	Bacteria
Phylum:	Firmicutes
Class:	Bacilli
Order:	Bacillales
Family:	Staphylococcaceae
Genus:	Staphylococcus; Rosenbach 1884
Species
	S. arlettae; S. agnetis; S. aureus; S. auricularis; S. capitis; S. caprae; S. carnosus; S. caseolyticus; S. chromogenes; S. cohnii; S. condimenti; S. delphini; S. devriesei; S. epidermidis; S. equorum; S. felis; S. fleurettii; S. gallinarum; S. haemolyticus; S. hominis; S. hyicus; S. intermedius; S. kloosii; S. leei; S. lentus; S. lugdunensis; S. lutrae; S. massiliensis; S. microti; S. muscae; S. nepalensis; S. pasteuri; S. pettenkoferi; S. piscifermentans; S. pseudintermedius; S. pseudolugdunensis; S. pulvereri; S. rostri; S. saccharolyticus; S. saprophyticus; S. schleiferi; S. sciuri; S. simiae; S. simulans; S. stepanovicii; S. succinus; S. vitulinus; S. warneri; S. xylosus

　　[★]

関: 細菌

グラム陽性菌の鑑別 LAB.994

菌種	形態	抗酸性	芽胞	運動性	空気中での発育	嫌気条件下での発育	カタラーゼ	オキシダーゼ	ブドウ糖分解	OF試験
Micrococcus	C	－	－	－	＋	－	＋	－	D	O/－
Staphylococcus	C	－	－	－	＋	＋	＋	－	＋	F
Aerococcus	C	－	－	－	＋	W	W/－	－	＋	F
Streptococcus	C	－	－	＋/－	＋	＋	－	－	＋	F
Pediococcus	C.	－	－	－	＋	＋	－	－	＋	F
Gemella	C.	－	－	－	＋	＋	－	－	＋	F
嫌気性球菌*1	C	－	－	－	－	＋	－	－	＋/－	F/－
Kurthia	R	－	－	＋	＋	＋	＋	－	－	－
Corynebacterium	R	－	－	－	＋	＋	＋	－	＋/－	F/－
Listeria	R	－	－	＋	＋	＋	＋	－	＋	F
Erysipelothnx	R		－	－	＋	＋			＋	F
Lactobacillus
Arachnia*2
Rothia	R	－	－	－	＋	－	＋	●	＋	F
Propiombacterium	R	－	－	－	－	＋	＋	.	＋	F
Achnomyces	R	－	－	－	－	＋	－	●	＋	F
Bifidobacterium
Eubacterium	R	－	－	－	－	＋	－	.	＋/－	F/－
Clostridium	R	－	<＋>	D	－	＋	－	●	D	F/－
Bacillus	R	－	<＋>	D	＋	D	＋	d	D	F/O/－
Nocardia	R	W	－	－	＋	－	＋	－	＋	O
Mycobacterium	R	＋	－	－	＋	.	＋	－	＋	O/NT
1:Peptococcus, Peptostreptococus(あるいは Leuconostoc) 2:あるいはActinomyces odontolyticus D:その属の菌種によって反応が異なる。　d: 菌種によって反応が異なる。 F:発酵 O:酸化 W:弱反応・:不明 NT:テストできない <＋>:芽胞非形成筋もある C:球菌 R:桿菌

グラム陰性菌の鑑別 LAB.995

(再編集の時に－*に注意)

菌種	形態	運動性	空気中での発育	嫌気条件下での発育	カタラーゼ	オキシダーゼ	ブドウ糖(酸)	OF試験
Bacteroides	R	－	－	＋	d	－	D	F/－
Veillonella	C	－	－	＋	D	・	－	－
Neissena	C	－	＋	－	＋	＋	＋	O
Branhamella	C	－	＋	－	＋	＋	－	－
Acinetobacter	C/R	－	＋	－	＋	－	＋	O
Moraxella	R	－	＋		＋	＋	－
Brucella
Bordetella
Chromobacterium lividum	R	＋	＋	－	＋	＋	＋	O
Alcahsenes	R	＋	＋	－	＋	＋	－	－
Flavobacterium	R	－	＋	－	＋	＋	＋	O
Pseudomonas	R	＋	＋	＋	＋	＋	＋	O
Actinobacillus	R	－	＋	＋	＋	＋	＋	F
Pasteurella
Necromonas
Cardiobacterium	R	－	＋	＋	－	＋	＋	F
Chromobacterium violaceum
Beneckea	R	＋	＋	＋	＋	＋	＋	F
Vibrio
Plesiomonas
Aeromonas
腸内細菌	R	D	＋	＋	＋	－	＋	F
Haemophilus	R	－	＋	＋	D	－	D	NT
Eikenella	R	－	－*	＋	－	＋	－	－
Campylobacter	R	＋	－+1	－	D	＋	－	－
Streptobacillus+2	R	－	＋	＋	－	－	＋	F
マイコプラズマ	R	－	＋	＋	－	－	＋	F
1:Peptococcus, Peptostreptococus(あるいは Leuconostoc) 2:あるいはActinomyces odontolyticus D:その属の菌種によって反応が異なる。　d: 菌種によって反応が異なる。 F:発酵 O:酸化 W:弱反応・:不明 NT:テストできない <＋>:芽胞非形成筋もある C:球菌 R:桿菌・: 不明 *: 空気中では発育せず。空気CO2で発育。+1: 好気的または嫌気的には発育せず。5-6%O2中で発育。+2: あるいはShigella dysenteriae 1

「髄膜炎」

　　[★]

英: meningitis
同: 脳脊髄膜炎、
関: 蛋白細胞解離

病因

感染症(細菌、ウイルス、真菌など)、悪性腫瘍の浸潤　→　髄膜の炎症

分類

病原体

細菌性髄膜炎

菌血症→脳脈絡叢→髄腔
菌体成分(LPSなど)→BBB, 上衣細胞、脳細胞の障害。神経膠細胞による炎症サイトカインの分泌

無菌性髄膜炎

血行性、あるいは神経軸索によりウイルスが髄腔に波及。

細菌性髄膜炎：様々
ウイルス性髄膜炎：コクサッキーウイルス、エコーウイルス、ムンプスウイルス、単純ヘルペスウイルス、風疹ウイルス、麻疹ウイルス、水痘・帯状疱疹ウイルス
真菌性髄膜炎：クリプトコッカス髄膜炎
結核性髄膜炎：結核菌
梅毒性髄膜炎：梅毒菌

臨床経過

宿主要因と髄膜炎に関わる病原体

頻度・年齢階層が資料によって異なるため混乱しないように注意。

YN.J-137改変

4ヶ月未満	B群溶連菌(50%)	大腸菌(25%)	インフルエンザ菌(20%)	リステリア菌(1%)
4ヶ月～6歳未満	インフルエンザ菌(70%)	肺炎球菌(25%)
6歳～50歳未満	肺炎球菌(65%)	インフルエンザ菌(10%)	髄膜炎菌
50歳以上	肺炎球菌(80%)	黄色ブドウ球菌
免疫不全者	クレブシエラ	連鎖球菌	緑膿菌	黄色ブドウ球菌	真菌

first aid step1 2006 p.161

Newborn (0–6 mos)	Children (6 mos–6 yrs)	6–60 yrs	60 yrs +
Streptococcus agalactiae	Streptococcus pneumoniae	Neisseria meningitidis	Streptococcus pneumoniae
Escherichia coli	Neisseria meningitidis	Enteroviruses	Gram-negative rods
Listeria	Haemophilus influenzae type B	Streptococcus pneumoniae	Listeria
	Enteroviruses	HSV

HIV: Cryptococcus, CMV, toxoplasmosis (brain abscess), JC virus (PML)

incidence of H. influenzae meningitis has ↓ greatly with introduction of H. influenzae vaccine in last 10–15 years.

CBT QB vol2 p.562

	1位	2位	3位
新生児	大腸菌	B群溶連菌	リステリア菌
小児期(6歳以下)	インフルエンザ菌	肺炎球菌
成人	肺炎球菌	髄膜炎菌

IMD.1042

年齢	病原体
3ヶ月未満	B群溶連菌	大腸菌	リステリア菌
3ヶ月以上の乳小児	インフルエンザ菌	肺炎球菌
成人	肺炎球菌	髄膜炎菌
高齢者	肺炎球菌	グラム陰性桿菌	リステリア菌

小児細菌性髄膜炎起炎菌(PED.606)

		<3か月	3か月≦
グラム陽性	球菌	Streptococcus agalactiae Streptococcus pneumoniae Staphylococcus Enterococcus faecalis	Streptococcus pneumoniae(PSSP/PISP/PRSP)
グラム陽性	桿菌	Listeria monocytogenes	Listeria monocytogenes
グラム陰性	球菌	Neisseria meningitidis	Neisseria meningitidis
グラム陰性	桿菌	Escherichia coli Enterobacter cloacae Serratia marcescens	Haemophilus influenzae type b

新生児

Streptococcus agalactiaeは産道感染
Escherichia coliもおそらく産道感染

新生児と老人

Listeria monocytogenesは産道感染するので新生児に多い。新生児と老人に多いのは通性細胞内寄生菌で細胞性免疫の弱い宿主に感染やすいため？

乳児～幼児

Haemophilus influenzae type B

乳児～大人

Enteroviruses
Neisseria meningitidis

小児～大人

Herpes simplex virus

乳児～老人

Streptococcus pneumoniae

老人

グラム陰性桿菌は老人

髄膜炎の鑑別

	細菌性髄膜炎	ウイルス性髄膜炎	結核性髄膜炎	真菌性髄膜炎	癌性髄膜炎
外観	混濁	clear	水様～キサントクロミー日光微塵	clear～日光微塵	clear～キサントクロミー
圧 70-180 (mmH2O)	↑↑ 200～800以上	↑ 200～300	↑ 200～800	↑ 200～800	↑ 200～300
細胞 0-5 (/mm3)	500～数百万	10～1,000	25～1,000	25～1,000	25～500
細胞 0-5 (/mm3)	好中球	リンパ球	リンパ球	リンパ球	好中球
タンパク 15-45 mg/dl	↑↑ 50～1,500	↑ 正常～100	↑ 50～500	↑ 100～500	↑ 50～500
糖 50-80 mg/dl	↓↓ 0～40	→ 正常	↓↓ ～40	↓↓ ～40	↓ ～40

予後不良因子

入院時の状態に依存する：痙攣、意識レベルの変化、低血圧 (IRE.407)

国試

100F048

「100Cases 16」

　　[★]

☆case16　膝の痛み

■glossary

indigestion 消化障害、消化不良

■症例

80歳　男性

主訴：左膝の痛みと腫脹

現病歴：左膝の痛みを2日前から認めた。膝は発熱・腫脹しており、動かすと疼痛を生じる。時々胸焼けと消化不良が見られる。6ヶ月前のhealth checkで、高血圧(172/102mmHg)と血中クレアチニンが高い(正常高値)こと以外は正常といわれた。その4週間数回血圧を測定したが、高値が継続したため、2.5mg bendrofluamethizide(UK)/ベンドロフルメチアジド bendroflumethiazide(US)で治療を開始した。最近の血圧は138/84 mmHgであった。

喫煙歴：なし。

飲酒歴：一週間に平均4unit。

既往歴：股関節に中程度(mild)の変形性関節症

家族歴：特記なし

服薬歴：アセトアミノフェン(股関節の疼痛に対して)

身体所見 examination

　血圧 142/86mmHg。体温37.5℃。脈拍88/分。grade 2 hypertensive retinopathy(高血圧症性網膜症)。心血管系、呼吸器系に検査場異常なし。手にDIPにヘバーデン結節なし。

　左膝が発熱し腫脹している。関節内に液、patellar tap陽性。90℃以上膝関節を屈曲させると痛みを生じる。右の膝関節は正常に見える。

検査　 investigation

　生化学：白血球増多、ESR 上昇、尿素高値、グルコース高値

　単純X線：関節間隙やや狭小。それ以外に異常は認めない。

■problem list

　#1 左膝の痛み

　#2 胸焼け

　#3 消化不良

　#4 高血圧

　#5 クレアチニン正常高値

　#6 股関節の変形性リウマチ

　#7 高血圧性網膜症

■考え方

　・関節痛の鑑別診断を考える。

　・VINDICATEで考えてみてもよいでしょう。

　・関節痛の頻度としては　外傷＞慢性疾患(OAなど)＞膠原病＞脊椎疾患＞悪性腫瘍

■関節痛の鑑別疾患

DIF 282

V Vascular 血友病 hemophilia, 壊血病 scurvy, 無菌性骨壊死 aseptic bone necrosis (Osgood-Schlatter diseaseとか)

I Inflammatory 淋疾 gonorrhea, ライム病 lyme disease, 黄色ブドウ球菌 Staphylococcus, 連鎖球菌 Streptococcus, 結核 tuberculosis, 梅毒 syphilis, 風疹 rubella, 単純ヘルペス herpes simplex, HIV human immunodeficiency virus, サイトメガロウイルス cytomegalovirus

N Neoplastic disorders 骨原性肉腫 osteogenic sarcoma, 巨細胞腫 giant cell tumors

D Degenerative disorders degenerative joint disease or 変形性関節症 osteoarthritis

I Intoxication 痛風 gout (uric acid), 偽痛風 pseudogout (calcium pyrophosphate), ループス症候群 lupus syndrome of hydralazine (Apresoline) and procainamide, gout syndrome of diuretics

C Congenital and acquired malformations bring to mind the joint deformities of tabes dorsalis and syringomyelia and congenital dislocation of the hip. Alkaptonuria is also considered here.

A Autoimmune indicates (多い)関節リウマチ RA (可能性)血清病 serum sickness, 全身性エリテマトーデス lupus erythematosus, リウマチ熱 rheumatic fever, ライター症候群 Reiter syndrome, 潰瘍性大腸炎 ulcerative colitis, クローン病=限局性回腸炎 regional ileitis, 乾癬性関節炎 psoriatic arthritis (老人であり得る)リウマチ性多発筋痛症 polymyalgia rheumatica

T Trauma 外傷性滑膜炎 traumatic synovitis, tear or rupture of the collateral or cruciate ligaments, 亜脱臼 subluxation or laceration of the meniscus (semilunar cartilage), 脱臼 dislocation of the joint or patella, a 捻挫　 sprain of the joint, and fracture of the bones of the joint.

E Endcrine 先端肥大症 acromegaly, 閉経 menopause, 糖尿病 diabetes mellitus

■答え

　骨格筋系-関節炎-単関節炎-急性単関節炎

　痛風　尿酸　→　発熱、ESR↑、白血球↑

　偽痛風　ピロリン酸カルシウム

　高齢女性でチアジド系利尿薬の使用により痛風が誘発されやすい。特に腎機能低下、糖尿病の人はこのリスクが高まる。

■(BSTからの知識「)循環器領域での利尿薬

・心不全の治療において、循環血漿量を減らし、心臓の前負荷を軽減する。

・利尿薬は高尿酸血症を起こす。(けど、心不全の治療において高尿酸血症になったからといって痛風を発症している患者はみたことない)

・電解質異常を起こしやすいので、血液生化学の検査でモニタして注意する。たとえば低Kで不整脈のリスクが高まる。

・チアジド系の利尿薬は血糖を上げるし、尿酸を上げる

・長期の使用で腎機能を低下させる

■initial plan

　Dx 1. 関節液の吸引：関節液の一般検査、生化学検査、培養検査、

　　　　・白血球が増加していれば急性炎症性であることを示す。

　　　　・偏光顕微鏡で関節液を検鏡する。

　　　　　・尿酸の結晶：針状結晶。negatively birefringent

　　　　　・ピロリン酸カルシウムの結晶：positively birefringent

　Tx 1. 関節液の吸引：炎症が軽度改善

　　 2. NSAIDによる疼痛管理

　　 3. PPI：NSAID 潰瘍を予防するため

　　 4. ACE inhibitorの導入

「急性尿細管間質性腎炎」

　　[★]

英: acute tubulointerstitial nephritis
同: 急性間質性腎炎 acute interstitial nephritis, AIN
関: 尿細管間質性腎炎

原因

薬剤性

antibiotics (lactams, sulfonamides, quinolones, vancomycin, erythromycin, minocycline, rifampin, ethambutol, acyclovir)
NSAIDs,COX-2阻害薬
利尿薬(thiazides, furosemide, triamterene)
抗てんかん薬(フェニトイン、フェノバルビタール、カルバマゼピン、バルプロ酸)
その他(カプトプリル、H2受容体阻害薬、プロトンポンプ阻害薬、mesalazine、indinavir、アロプリノール)

感染症

細菌(Streptococcus、Staphylococcus、Legionella、Salmonella、Brucella、Yersinia、Corynebacterium diphtheriae)
ウイルス(Epstein-Barr virus、cytomegalovirus、Hantavirus、polyomavirus、HIV)
その他(レプトスピラ、リケッチア、マイコプラズマ)

特発性

「ブドウ球菌」

　　[★]

英: Staphylococcus
同: スタフィロコッカス属、ブドウ球菌属

属名なので、ブドウ球菌属(Staphylococcus属)
グラム陽性球菌
通性嫌気性
カタラーゼ産生　←　連鎖球菌との判別に利用
耐塩性が高い　→　マンニット食塩培地でコロニーを形成しうる
常在細菌

皮膚、鼻腔粘膜 (内科診療学)

Staphylococcus属

Staphylococcus aureus

コアグラーゼ陽性、マンニトール分解　、血液寒天培地で溶血性あり

Staphylococcus epidermidis

コアグラーゼ陰性、マンニトール非分解。γ溶血性(Kaplan Q book)

Staphylococcus saprophyticus

女性の尿路感染の原因となる

毒性 (SMB.236)

「Staphylococcus epidermidis」

　　[★]

関: ブドウ球菌

グラム陽性球菌
Staphylococcus属
γ溶血性
マンニット食塩培地で白色のコロニーを形成する。

「Staphylococcus haemolyticus」

　　[★]

スタフィロコッカス・ヘモリチカス

「Staphylococcus saprophyhcus」

　　[★] Staphylococcus saprophyticus

[Sherris-1] Ryan KJ, Ray CG, ed. (2004). Sherris Medical Microbiology (4th ed.). McGraw Hill. ISBN 0-8385-8529-9.

[Harris_L.G.2C_Foster_S.J_2002-2] Harris L.G, Foster S.J, Richards S. G. (2002). "An introduction to Staphylococcus aureus, and techniques for identifying and quantifying S. aureus adhesins in relation to adhesion to biomaterials: review" (PDF). European cells and materials 4: 39–60. PMID 14562246.

[Brock-3] Madigan M, Martinko J, ed. (2005). Brock Biology of Microorganisms (11th ed.). Prentice Hall. ISBN 0-13-144329-1.

[Takahashi1999-4] Takahashi T, Satoh I, Kikuchi N. (1999). "Phylogenetic relationships of 38 taxa of the genus Staphylococcus based on 16S rRNA gene sequence analysis" (PDF). Int. J. Syst. Bacteriol. 49 (2): 725–728. doi:10.1099/00207713-49-2-725. PMID 10319495.

[Kloos1998-5] Kloos WE, Ballard DN, George CG, Webster JA, Hubner RJ, Ludwig W, Schleifer KH, Fiedler F, Schubert K (1998). "Delimiting the genus Staphylococcus through description of Macrococcus caseolyticus gen. nov., comb. nov. and Macrococcus equipercicus sp. nov., and Macrococcus bovicus sp. nov. and Macrococcus carouselicus sp. nov" (PDF). Int J Syst Bacteriol 48 (3): 859–877. doi:10.1099/00207713-48-3-859. PMID 9734040.

[6] See genus and species capitalization.

[Svec2004-7] Svec P., Vancanneyt M., Sedláek I., Engelbeen K., Stetina V., Swings, J. & Petrá, P. (2004). "Reclassification of Staphylococcus pulvereri Zakrzewska-Czerwiska et al. 1995 as a later synonym of Staphylococcus vitulinus Webster et al 1994" (PDF). Int. J. Syst. Evol. Microbiol 54 (6): 2213–2215. doi:10.1099/ijs.0.63080-0. PMID 15545460.

[Ghebremedhin2008-8] Ghebremedhin B, Layer F, König W, König B (2008). "Genetic classification and distinguishing of Staphylococcus species based on different partial gap, 16S rRNA, hsp60, rpoB, sodA, and tuf gene sequences". J. Clin. Microbiol. 46 (3): 1019–1025. doi:10.1128/JCM.02058-07. PMC 2268370. PMID 18174295.

[9] PreTest, Surgery, 12th ed., p. 88

[CNSA-10] Matthews KR, Roberson J, Gillespie BE, Luther DA, Oliver SP (1997). "Identification and Differentiation of Coagulase-Negative Staphylococcus aureus by Polymerase Chain Reaction". Journal of Food Protection 60 (6): 686–8.

[Jin2004-11] Jin M, Rosario W, Watler E, Calhoun DH (2004). "Development of a large-scale HPLC-based purification for the urease from Staphylococcus leei and determination of subunit structure" (PDF). Protein Expr. Purif. 34 (1): 111–117. doi:10.1016/j.pep.2003.10.01. PMID 14766306.

[LindsayJ-12] Lindsay J (editor). (2008). Staphylococcus: Molecular Genetics. Caister Academic Press. ISBN 1-904455-29-8. [1].

[13] Chan CX, Beiko RG, Ragan MA (2011). "Lateral transfer of genes and gene fragments in Staphylococcus extends beyond mobile elements". J Bacteriol 193 (15): 3964–3977. doi:10.1128/JB.01524-10. PMC 3147504. PMID 21622749.

[14] Kloos WE (1980). "Natural Populations of the Genus Staphylococcus". Annual Review of Microbiology 34: 559–592. doi:10.1146/annurev.mi.34.100180.003015. PMID 7002032.

[15] "Sialoadenitis: inflammation of the salivary glands". The Medical Consumer's Advocate. 2001-01-04. Retrieved 2011-01-04.

Staphylococcus

SEM micrograph of S. aureus colonies; note the grape-like clustering common to Staphylococcus species.
Scientific classification
Kingdom:	Bacteria
Phylum:	Firmicutes
Class:	Bacilli
Order:	Bacillales
Family:	Staphylococcaceae
Genus:	Staphylococcus Rosenbach 1884
Species
S. arlettae S. agnetis S. aureus S. auricularis S. capitis S. caprae S. carnosus S. caseolyticus S. chromogenes S. cohnii S. condimenti S. delphini S. devriesei S. epidermidis S. equorum S. felis S. fleurettii S. gallinarum S. haemolyticus S. hominis S. hyicus S. intermedius S. kloosii S. leei S. lentus S. lugdunensis S. lutrae S. massiliensis S. microti S. muscae S. nepalensis S. pasteuri S. pettenkoferi S. piscifermentans S. pseudintermedius S. pseudolugdunensis S. pulvereri S. rostri S. saccharolyticus S. saprophyticus S. schleiferi S. sciuri S. simiae S. simulans S. stepanovicii S. succinus S. vitulinus S. warneri S. xylosus

匿名

検索

案内

Staphylococcus