定義、決定、限定、明確さ、解像力、解像度

関: clarity、confine、decide、decision、decisional、define、definite、determination、determine、limit、resolution、resolving power、restrict、restriction

WordNet

clarity of outline; "exercise had given his muscles superior definition"
a concise explanation of the meaning of a word or phrase or symbol
prevent from leaving or from being removed
deprive of freedom; take into confinement (同)detain
fix in scope; fix the boundaries of; "the tree determines the border of the property"
find out, learn, or determine with certainty, usually by making an inquiry or other effort; "I want to see whether she speaks French"; "See whether it works"; "find out if he speaks Russian"; "Check whether the train leaves on time" (同)check, find_out, see, ascertain, watch, learn
establish after a calculation, investigation, experiment, survey, or study; "find the product of two numbers"; "The physicist who found the elusive particle won the Nobel Prize" (同)find, find_out, ascertain
fix conclusively or authoritatively; "set the rules" (同)set
shape or influence; give direction to; "experience often determines ability"; "mold public opinion" (同)shape, mold, influence, regulate
(computer science) the number of pixels per square inch on a computer-generated display; the greater the resolution, the better the picture
finding a solution to a problem (同)solving
a decision to do something or to behave in a certain manner; "he always wrote down his New Years resolutions"
a formal expression by a meeting; agreed to by a vote (同)declaration, resolve
analysis into clear-cut components (同)resolving
(music) a dissonant chord is followed by a consonant chord
the subsidence of swelling or other signs of inflammation (especially in a lung)
restrict or confine, "I limit you to two visits to the pub a day" (同)circumscribe, confine
the mathematical value toward which a function goes as the independent variable approaches infinity (同)limit_point, point of accumulation
the greatest amount of something that is possible or allowed; "there are limits on the amount you can bet"; "it is growing rapidly with no limitation in sight" (同)limitation
the greatest possible degree of something; "what he did was beyond the bounds of acceptable behavior"; "to the limit of his ability" (同)bound, boundary
the boundary of a specific area (同)demarcation, demarcation line
as far as something can go
influence or determine; "The vote in New Hampshire often decides the outcome of the Presidential election"
reach, make, or come to a decision about something; "We finally decided after lengthy deliberations" (同)make up one''s mind, determine
bring to an end; settle conclusively; "The case was decided"; "The judge decided the case in favor of the plaintiff"; "The father adjudicated when the sons were quarreling over their inheritance" (同)settle, resolve, adjudicate
cause to decide; "This new development finally decided me!"
the act of giving a new definition; "words like `conservative require periodic redefinition"; "she provided a redefinition of his duties"
(mathematics) a definition of a function from which values of the function can be calculated in a finite number of steps
a television system that has more than the usual number of lines per frame so its pictures show more detail (同)HDTV
a definition that is stipulated by someone and that is not a standard usage
a definition that points out or exhibits instances of the term defined

PrepTutorEJDIC

〈C〉『定義』,語義の記述 / 〈C〉(本質・特徴を)明確にすること《+『of』+『名』》 / 〈U〉(映像・音声などの)鮮明度
(ある範囲に)…'を'『制限する』,限る(limit)《+『名』+『to』+『名』》 / (…に)〈人など〉'を'『閉じ込める』,監禁する《+『名』+『in』(『to』)+『名』》 / 《通例受動熊で》〈女性〉'を'お産の床につかせる / 境界,範囲,限界
(前もって)…‘を'『決定する』,はっきりさせる / …‘を'『決心する』,決意する / 《『determine』+『名』+『to』 do》〈物事が〉(…することを)〈人〉‘に'決心させる』,決意させる / …‘を'『左右する』,決定づける / 〈数量・位置・速度など〉‘を'測定する,確認する / (…を)決心する,決定する《+『on』+『名』(do『ing』)》
〈U〉『決心』(『決定』)すること;〈U〉『決意』,誓い / 〈C〉(集会・議会などの)『決議』,決議案 / 〈U〉強固な意志,不屈 / 〈U〉(問題などの)解決,解明,解答《+『of』+『名』》 / 〈U〉(…の)分解,分析《+『of』+『名』》
(空間・行為などの)『限界』,《+『of』+『名』》 / 《しばしば複数形で;単数扱い》『境界』,境界線範囲,区域 / (数量などの)許容量,制限 / 適度に / …‘を'『制限する』
〈人が〉〈論争・問題など〉'を'『解決する』 / 〈人が〉『決心する』 / 〈物事が〉…'を'決定する / 〈物事が〉〈人〉‘に'決意させる,決定させる / 『決定する』 / (…に不利な,有利な)判決を下す《+『against』(『for』,『in favor of』)+『名』》

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/08/29 00:24:23」(JST)

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For other uses of the word "definition" itself, see Definition (disambiguation)

A definition states the meaning of a word using other words. This is sometimes challenging. Common dictionaries contain lexical, descriptive definitions, but there are various types of definition - all with different purposes and focuses.

A definition is a statement of the meaning of a term (a word, phrase, or other set of symbols).^[a] The term to be defined is the definiendum. The term may have many different senses and multiple meanings. For each meaning, a definiens is a cluster of words that defines that term (and clarifies the speaker's intention). As an example: To successfully define the word "Vegan", the definiendum (the word "Vegan" itself) must be given a definiens (actually vegan has at least two definiens: One is "someone who avoids using animal products", and another definiens is "someone from a place called Vega, Norway").

A definition will vary in aspects like precision or popularity (e.g. globally, the word "Vegan" rarely refers to the definiens "someone from Vega, Norway"). There are also different types of definitions with different purposes and focuses (e.g. intensional, extensional, descriptive, stipulative, and so on).

A chief difficulty in the management of definitions is the necessity of using other terms that are already understood or whose definitions are easily obtainable or demonstrable (e.g. a need, sometimes, for ostensive definitions).

A dictionary definition typically contains additional details about a word, such as an etymology and the language or languages of its origin, or obsolete meanings.

1 Basic considerations
2 Intension and extension
- 2.1 Divisio and partitio
3 Definition by genus and differentia
- 3.1 Rules for definition by genus and differentia
- 3.2 Essence
4 Recursive definitions
5 Working definitions
6 Limitations of definition
7 In medicine
8 See also
9 Notes
10 References
11 External links

Basic considerations

In formal languages like mathematics, a "stipulative" definition guides a specific discussion. A stipulative definition can only be disproved by showing a logical contradiction.^[1] A stipulative definition might be considered a temporary, working definition. On the other hand, a "descriptive" definition can be shown to be "right" or "wrong" with reference to general usage.

A precising definition extends the descriptive dictionary definition (lexical definition) of a term for a specific purpose by including additional criteria, which narrow the set of things that meet the definition.

C.L. Stevenson has identified persuasive definition as a form of stipulative definition which purports to state the "true" or "commonly accepted" meaning of a term, while in reality stipulating an altered use (perhaps as an argument for some specific belief). Stevenson has also noted that some definitions are "legal" or "coercive" – their object is to create or alter rights, duties, or crimes.^[2]

Intension and extension

An intensional definition, also called a connotative definition, specifies the necessary and sufficient conditions for a thing being a member of a specific set. Any definition that attempts to set out the essence of something, such as that by genus and differentia, is an intensional definition.

An extensional definition, also called a denotative definition, of a concept or term specifies its extension. It is a list naming every object that is a member of a specific set.

Thus, the "seven deadly sins" can be defined intensionally as those singled out by Pope Gregory I as particularly destructive of the life of grace and charity within a person, thus creating the threat of eternal damnation. An extensional definition would be a list of the seven. In contrast, while an intensional definition of "Prime Minister" might be "the most senior minister of a cabinet in the executive branch of government in a parliamentary system", an extensional definition is not possible since it is not known who future prime ministers will be.

One important form of the extensional definition is ostensive definition. This gives the meaning of a term by pointing, in the case of an individual, to the thing itself, or in the case of a class, to examples of the right kind. So one can explain who Alice (an individual) is by pointing her out to another; or what a rabbit (a class) is by pointing at several and expecting another to understand. The process of ostensive definition itself was critically appraised by Ludwig Wittgenstein.^[3]

An enumerative definition of a concept or term is an extensional definition that gives an explicit and exhaustive listing of all the objects that fall under the concept or term in question. Enumerative definitions are only possible for finite sets and only practical for relatively small sets.^{[citation needed]}

Divisio and partitio

Divisio and partitio are classical terms for definitions. A partitio is simply an intensional definition. A divisio is not an extensional definition, but an exhaustive list of subsets of a set, in the sense that every member of the "divided" set is a member of one of the subsets. An extreme form of divisio lists all sets whose only member is a member of the "divided" set. The difference between this and an extensional definition is that extensional definitions list members, and not sets.^[4]

Definition by genus and differentia

A genus–differentia definition is a type of intensional definition, and it is composed by two parts:

a genus (or family): An existing definition that serves as a portion of the new definition; all definitions with the same genus are considered members of that genus.
the differentia: The portion of the new definition that is not provided by the genera.

For example, consider these two definitions:

a triangle: A plane figure that has three straight bounding sides.
a quadrilateral: A plane figure that has four straight bounding sides.

Those definitions can be expressed as a genus and two differentiae:

a genus: A plane figure.
Two differentiae:
- the differentia for a triangle: that has three straight bounding sides.
- the differentia for a quadrilateral: that has four straight bounding sides.

When multiple definitions could serve equally well, then all such definitions apply simultaneously. For instance, given the following:

a rectangle: a quadrilateral that has interior angles which are all right angles.
a rhombus: a quadrilateral that has bounding sides which all have the same length.

both of these definitions of "square" are equally acceptable:

a square: a rectangle that is a rhombus.
a square: a rhombus that is a rectangle.

Thus, a "square" is a member of both the genus "rectangle" and the genus "rhombus". In such a case, it is notationally convenient to consolidate the definitions into one definition that is expressed with multiple genera (and possibly no differentia, as in the following):

a square: a rectangle and a rhombus.

or completely equivalently:

a square: a rhombus and a rectangle.

Rules for definition by genus and differentia

Certain rules have traditionally been given for this particular type of definition.^[5]^[6]^[7]

A definition must set out the essential attributes of the thing defined.
Definitions should avoid circularity. To define a horse as "a member of the species equus" would convey no information whatsoever. For this reason, Locking^[specify] adds that a definition of a term must not consist of terms which are synonymous with it. This would be a circular definition, a circulus in definiendo. Note, however, that it is acceptable to define two relative terms in respect of each other. Clearly, we cannot define "antecedent" without using the term "consequent", nor conversely.
The definition must not be too wide or too narrow. It must be applicable to everything to which the defined term applies (i.e. not miss anything out), and to nothing else (i.e. not include any things to which the defined term would not truly apply).
The definition must not be obscure. The purpose of a definition is to explain the meaning of a term which may be obscure or difficult, by the use of terms that are commonly understood and whose meaning is clear. The violation of this rule is known by the Latin term obscurum per obscurius. However, sometimes scientific and philosophical terms are difficult to define without obscurity. (See the definition of Free will in Wikipedia, for instance).
A definition should not be negative where it can be positive. We should not define "wisdom" as the absence of folly, or a healthy thing as whatever is not sick. Sometimes this is unavoidable, however. One cannot define a point except as "something with no parts", nor blindness except as "the absence of sight in a creature that is normally sighted".

Essence

In classical thought, a definition was taken to be a statement of the essence of a thing. Aristotle had it that an object's essential attributes form its "essential nature", and that a definition of the object must include these essential attributes.^[8]

The idea that a definition should state the essence of a thing led to the distinction between nominal and real essence, originating with Aristotle. In a passage from the Posterior Analytics,^[9] he says that the meaning of a made-up name can be known (he gives the example "goat stag"), without knowing what he calls the "essential nature" of the thing that the name would denote, if there were such a thing. This led medieval logicians to distinguish between what they called the quid nominis or "whatness of the name", and the underlying nature common to all the things it names, which they called the quid rei or "whatness of the thing". (Early modern philosophers like Locke used the corresponding English terms "nominal essence" and "real essence"). The name "hobbit", for example, is perfectly meaningful. It has a quid nominis. But one could not know the real nature of hobbits, even if there were such things, and so the real nature or quid rei of hobbits cannot be known. By contrast, the name "man" denotes real things (men) that have a certain quid rei. The meaning of a name is distinct from the nature that thing must have in order that the name apply to it.

This leads to a corresponding distinction between nominal and real definitions. A nominal definition is the definition explaining what a word means, i.e. which says what the "nominal essence" is, and is definition in the classical sense as given above. A real definition, by contrast, is one expressing the real nature or quid rei of the thing.

This preoccupation with essence dissipated in much of modern philosophy. Analytic philosophy in particular is critical of attempts to elucidate the essence of a thing. Russell described it as "a hopelessly muddle-headed notion".^[10]

More recently Kripke's formalisation of possible world semantics in modal logic led to a new approach to essentialism. Insofar as the essential properties of a thing are necessary to it, they are those things it possesses in all possible worlds. Kripke refers to names used in this way as rigid designators.

Recursive definitions

A recursive definition, sometimes also called an inductive definition, is one that defines a word in terms of itself, so to speak, albeit in a useful way. Normally this consists of three steps:

At least one thing is stated to be a member of the set being defined; this is sometimes called a "base set".
All things bearing a certain relation to other members of the set are also to count as members of the set. It is this step that makes the definition recursive.
All other things are excluded from the set

For instance, we could define a natural number as follows (after Peano):

"0" is a natural number.
Each natural number has a unique successor, such that:
- the successor of a natural number is also a natural number;
- distinct natural numbers have distinct successors;
- no natural number is succeeded by "0".
Nothing else is a natural number.

So "0" will have exactly one successor, which for convenience can be called "1". In turn, "1" will have exactly one successor, which could be called "2", and so on. Notice that the second condition in the definition itself refers to natural numbers, and hence involves self-reference. Although this sort of definition involves a form of circularity, it is not vicious, and the definition has been quite successful.

Working definitions

A working definition is chosen for an occasion and may not fully conform with established or authoritative definitions. Not knowing of established definitions would be grounds for selecting or devising a working definition. Or it refers to a definition being developed; a tentative definition that can be tailored to create an authoritative definition.

Limitations of definition

Given that a natural language such as English contains, at any given time, a finite number of words, any comprehensive list of definitions must either be circular or rely upon primitive notions. If every term of every definiens must itself be defined, "where at last should we stop?"^[11]^[12] A dictionary, for instance, insofar as it is a comprehensive list of lexical definitions, must resort to circularity.^[13]^[14]^[15]

Many philosophers have chosen instead to leave some terms undefined. The scholastic philosophers claimed that the highest genera (the so-called ten generalissima) cannot be defined, since a higher genus cannot be assigned under which they may fall. Thus being, unity and similar concepts cannot be defined.^[6] Locke supposes in An Essay Concerning Human Understanding^[16] that the names of simple concepts do not admit of any definition. More recently Bertrand Russell sought to develop a formal language based on logical atoms. Other philosophers, notably Wittgenstein, rejected the need for any undefined simples. Wittgenstein pointed out in his Philosophical Investigations that what counts as a "simple" in one circumstance might not do so in another.^[17] He rejected the very idea that every explanation of the meaning of a term needed itself to be explained: "As though an explanation hung in the air unless supported by another one",^[18] claiming instead that explanation of a term is only needed to avoid misunderstanding.

Locke and Mill also argued that individuals cannot be defined. Names are learned by connecting an idea with a sound, so that speaker and hearer have the same idea when the same word is used.^[19] This is not possible when no one else is acquainted with the particular thing that has "fallen under our notice".^[20] Russell offered his theory of descriptions in part as a way of defining a proper name, the definition being given by a definite description that "picks out" exactly one individual. Saul Kripke pointed to difficulties with this approach, especially in relation to modality, in his book Naming and Necessity.

There is a presumption in the classic example of a definition that the definiens can be stated. Wittgenstein argued that for some terms this is not the case.^[21] The examples he used include game, number and family. In such cases, he argued, there is no fixed boundary that can be used to provide a definition. Rather, the items are grouped together because of a family resemblance. For terms such as these it is not possible and indeed not necessary to state a definition; rather, one simply comes to understand the use of the term.

In medicine

In medical dictionaries, definitions should to the greatest extent possible be:

simple and easy to understand,^[22] preferably even by the general public;^[23]
useful clinically^[23] or in related areas where the definition will be used;^[22]
specific,^[22] that is, by reading the definition only, it should ideally not be possible to refer to any other entity than the definiendum;
measurable;^[22]
reflecting current scientific knowledge.^[22]^[23]

Notes

^ Depending on the domain of discourse, for example in a translation or a review, a definition serves to set the scene. In mathematics, a definition serves to sharpen, clarify, or point out the objects of discourse.

References

^ http://www.sfu.ca/philosophy/swartz/definitions.htm#part5.1
^ Stevenson, C.L., Ethics and Language, Connecticut 1944
^ Philosophical investigations, Part 1 §27–34
^ Katerina Ierodiakonou, "The Stoic Division of Philosophy", in Phronesis: A Journal for Ancient Philosophy, Volume 38, Number 1, 1993 , pp. 57–74.
^ Copi 1982 pp 165–169
^ ^a ^b Joyce, Ch. X
^ Joseph, Ch. V
^ Posterior Analytics, Bk 1 c. 4
^ Posterior Analytics Bk 2 c. 7
^ A history of Western Philosophy, p. 210
^ Locke, Essay, Bk. III, Ch. iv, 5
^ This problem parallels the diallelus, but leads to scepticism about meaning rather than knowledge.
^ Generally lexicographers seek to avoid circularity wherever possible, but the definitions of words such as "the" and "a" use those words and are therefore circular. [1] [2] Lexicographer Sidney I. Landau's essay "Sexual Intercourse in American College Dictionaries" provides other examples of circularity in dictionary definitions. (McKean, p. 73–77)
^ An exercise suggested by J. L. Austin involved taking up a dictionary and finding a selection of terms relating to the key concept, then looking up each of the words in the explanation of their meaning. Then, iterating this process until the list of words begins to repeat, closing in a "family circle" of words relating to the key concept.
(A plea for excuses in Philosophical Papers. Ed. J. O. Urmson and G. J. Warnock. Oxford: Oxford UP, 1961. 1979.)
^ In the game of Vish, players compete to find circularity in a dictionary.
^ Locke, Essay, Bk. III, Ch. iv
^ See especially Philosophical Investigations Part 1 §48
^ He continues: "Whereas an explanation may indeed rest on another one that has been given, but none stands in need of another – unless we require it to prevent a misunderstanding. One might say: an explanation serves to remove or to avert a misunderstanding – one, that is, that would occur but for the explanation; not every one I can imagine." Philosophical Investigations, Part 1 §87, italics in original
^ This theory of meaning is one of the targets of the private language argument
^ Locke, Essay, Bk. III, Ch. iii, 3
^ Philosophical Investigations
^ ^a ^b ^c ^d ^e McPherson, M.; Arango, P.; Fox, H.; Lauver, C.; McManus, M.; Newacheck, P. W.; Perrin, J. M.; Shonkoff, J. P.; Strickland, B. (1998). "A new definition of children with special health care needs". Pediatrics 102 (1 Pt 1): 137–140. doi:10.1542/peds.102.1.137. PMID 9714637. edit
^ ^a ^b ^c Morse, R. M.; Flavin, D. K. (1992). "The Definition of Alcoholism". JAMA 268 (8): 1012–1014. doi:10.1001/jama.1992.03490080086030. PMID 1501306.

Copi, Irving (1982). Introduction to Logic. New York: Macmillan. ISBN 0-02-977520-5.
Joseph, Horace William Brindley (1916 repr. 2000). An Introduction to Logic, 2nd edition. Clarendon Press repr. Paper Tiger. ISBN 1-889439-17-7. Check date values in: |date= (help) (full text of 1st ed. (1906))
Joyce, George Hayward (1926). Principles of logic, 3d ed., new impression. London, New York: Longmans, Green and co. (worldcat) (full text of 2nd ed. (1916))
Locke, John (1690). An Essay Concerning Human Understanding. ISBN 0-14-043482-8. (full text: vol 1, vol 2)
McKean, Erin (2001). Verbatim: From the bawdy to the sublime, the best writing on language for word lovers, grammar mavens, and armchair linguists. Harvest Books. ISBN 0-15-601209-X.
Robinson, Richard (1954). Definition. Oxford: At The Clarendon Press. ISBN 978-0-19-824160-7.
Simpson, John; Edmund Weiner (1989). Oxford English Dictionary, second edition (20 volumes). Oxford University Press. ISBN 0-19-861186-2.
Wittgenstein, Ludwig (1953/2001). Philosophical Investigations. Blackwell Publishing. ISBN 0-631-23127-7. Check date values in: |date= (help)

External links

Look up definition in Wiktionary, the free dictionary.

Wikiquote has quotations related to: Definition

Definitions, Stanford Encyclopedia of Philosophy Gupta, Anil (2008)
Definitions, Dictionaries, and Meanings, Norman Swartz 1997
Guy Longworth (ca. 2008) "Definitions: Uses and Varieties of". = in: K. Brown (ed.): Elsevier Encyclopedia of Language and Linguistics, Elsevier.
Definition and Meaning, a very short introduction by Garth Kemerling (2001).
Definitions and Meanings of the Words

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On control of singleton attractors in multiple Boolean networks: integer programming-based method

Qiu Yushan,Tamura Takeyuki,Ching Wai-Ki,Akutsu Tatsuya
BMC Systems Biology 8(Suppl 1), 2014-01-24
… Finally, we formulate a definition for finding a control for cancer cells with limited damaging effect on normal cells. …
NAID 120005367806

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リンク元	「100Cases 33」「resolution」「determine」「definite」「limit」
拡張検索	「Brönsted-Lowry definition」

「100Cases 33」

　　[★]

☆case33　頭痛と混乱

■glossary

accompany

vt.

(人)と同行する、(人)に随行する。(もの)に付随する。～と同時に起こる。～に加える(添える、同封する)(with)

slurred n. 不明瞭

強直間代痙攣 tonic-clonic convulsion

　意識消失とともに全身の随意筋に強直痙攣が生じ(強直痙攣期tonic convulsion)、次いで全身の筋の強直と弛緩とが律動的に繰り返される時期(間代痙攣期clonic convulsion)を経て、発作後もうろう状態を呈する一連の発作。

■症例

28歳、女性　黒人　南アフリカ　手術室看護師　ロンドン住在

主訴：頭痛と混乱

現病歴：過去3週間で頭痛が続いており、ひどくなってきた。現在も頭痛が持続しており、頭全体が痛い。友人曰く「過去六ヶ月で体重が10kg減っていて、最近、混乱してきたようだ」。発話は不明瞭。救急室にいる間に強直間代痙攣を起こした。

・診察 examination

やせている。55kg。38.5℃。口腔カンジダ症(oral candidiasis)。リンパ節腫脹無し。心血管、呼吸器系、消化器系正常。痙攣前における神経検査では時間、場所、人の見当識無し。神経局所症状無し(no focal neurological sign)。眼底両側に乳頭浮腫有り。

・検査 investigation

血算：白血球増多

血液生化学：ナトリウム低下

CT：供覧

■キーワード＆着目するポイント

・口腔カンジダ症(oral candidiasis)

・頭痛、精神症状、強直間代痙攣

・眼底両側に乳頭浮腫

・CT 所見

・低ナトリウム血症は二次的なもの

■アプローチ

・口腔カンジダ症(oral candidiasis)　→　細胞免疫低下状態(DM、免疫抑制、AIDSなど) or 常在細菌叢の攪乱(長期の抗菌薬の使用)

　・The occurrence of thrush in a young, otherwise healthy-appearing person should prompt an investigation for underlying HIV infection.(HIM.1254)

　・More commonly, thrush is seen as a nonspecific manifestation of severe debilitating illness.(HIM.1254)

・精神症状、強直間代痙攣　→　一次的、あるいは二次的な脳の疾患がありそう

・頭痛　→　漠然としていて絞れないが、他の症状からして機能性頭痛ではなく症候性頭痛っぽい。

・眼底両側に乳頭浮腫　→　脳圧亢進の徴候　→　原因は・・・脳腫瘍、ことにテント下腫瘍と側頭葉の腫瘍、クモ膜下出血、脳水腫など、そのほか、眼窩内病変、低眼圧などの局所的要因、悪性高血圧、血液疾患、大量出血、肺気腫などの全身的要因 (vindicate本のp342も参考になる)

　・頭痛と脳圧亢進　→　頭蓋内圧占拠性病変、脳炎(IMD.274)

・CT 所見　→　ringformの病変、脳浮腫、脳圧亢進

・低ナトリウム血症　→　脳ヘルニアに続発して起こることがあるらしい。実際には下垂体にトキソプラズマによる病変が形成されることにより起こりうる。

・そのほか出身地、体重減少もHIVを疑わせる点

パターン認識でHIV + 精神症状 + てんかん発作(強直間代痙攣) + 脳圧亢進 + CT 所見 = 一番ありそうなのはToxoplasma gondiiによるトキソプラズマ脳症 cerebral toxoplasosis (トキソプラズマ脳炎 toxoplasmic encephalitis)

■Toxoplasma gondii

　原虫　胞子原虫類

(感染予防学 080521のプリント、CASES p,92、HIM p.1305-)

・疫学：西洋では30-80%の成人がトキソプラズマの感染の既往がある・・・うぇ(CASES)。日本では10%前後(Wikipedia)。

・生活環

　・終宿主：ネコ：ネコの小腸上皮細胞で有性・無性生殖　糞便にオーシストの排泄

　・中間宿主：ヒト.ブタを含むほ乳類と鳥類：無性生殖で増殖、シストの形成

　　　急性期の増殖盛んな急増虫体 tachyzoiteとシスト内の緩増虫体 bradyzoite

・病原、病因 phathogenesis

　・緩増虫体(bradyzoite)、接合子嚢(oocyst)

・感染経路

　1. オーシストの経口摂取

　2. 中間宿主の生肉中のシストの経口摂取

　3. 初感染妊婦からの経胎盤感染。既感染なら胎盤感染しないらしい(HIM.1306)

　(4)移植臓器、輸血。確率は低い(at low rate)(HIM.1306)

・病態

　1. 先天性トキソプラズマ症　congenital toxoplasmosis

　　　①網脈絡膜炎、 ②水頭症、 ③脳内石灰化、 ④精神・運動障害

　2. 後天性トキソプラズマ症　acquired toxoplasmosis

　　(1) 健常者

　　　・多くは不顕性感染。発熱、リンパ節腫脹、皮疹(rash)

　　　・(少数例)筋肉痛、暈疼痛、腹痛、斑状丘疹状皮疹(maculopapular rash)、脳脊髄炎、混乱(HIM.1308)

　　　・(まれ)肺炎、心筋炎、脳症、心膜炎、多発筋炎

　　　・網膜、脈絡叢に瘢痕や、脳に小さい炎症性の病変を残すことあり(CASES)。

　　　・急性感染の症状は数週間で消失　筋肉や中枢神経系に緩増虫体が残存

　　(2)HIV 感染者、臓器移植例、がん化学療法例

　　　シスト内緩増虫体→急増虫体→播種性の多臓器感染

　　　AIDSでは、トキソプラズマ性脳炎が指標疾患 AIDS-defineing illness(CASES)

・治療

　(日本)アセチルスピラマイシン、ファンシダール(感染予防学 080521)

■トキソプラズマ脳炎 toxoplasmic encephalitis、トキソプラズマ脳症 cerebral toxoplasosis

・症状

　発熱、頭痛、混乱ｍ、痙攣、認知の障害、局所神経徴候(不全片麻痺、歯垢、脳神経損傷、視野欠損、感覚喪失)(CASES)

・画像検査

　(CT,MRI)多発性、両側性、ring-enhancing lesion、特に灰白質-白質境界、大脳基底核、脳幹、小脳が冒されやすい(CASES)

・鑑別診断(臨床症状・画像診断の所見で)

　リンパ腫、結核、転移性脳腫瘍(CASES)

・病歴と画像所見からの鑑別診断

　リンパ腫、結核、転移性腫瘍

？

このCTがcerebral toxoplasmosisに特徴的かは不明

□最後に残る疑問

　AIDSでWBC(leukocyte)の数はどうなるんだろう？？？AIDSの初診患者ではWBCが低い人が多いらしいし()、HIVはCD4+ T cellとmacrophageに感染して殺すから、これによってB cellは減るだろうし、CD8+ T cellも若干減少するだろうからWBCは減るんじゃないか？！好中球はAIDSとは関係ない？好中球は他の感染症に反応性に増加している？ちなみに、好酸球は寄生虫(原虫)の感染のために増える傾向にあるらしい(HIMのどこか)。

葉酸拮抗剤である。

サルファ剤と併用され、抗トキソプラズマ薬、抗ニューモシチス・カリニ薬として相乗的に働く。

ST 合剤

SMX-TMP

スルファメトキサゾール・トリメトプリム合剤 sulfamethoxazole and trimethoprim mixture

□AIDSの定義(http://en.wikipedia.org/wiki/CDC_Classification_System_for_HIV_Infection_in_Adults_and_Adolescents)