臨床検査60巻10号

2016年10月発行

今月の特集2 感染症の迅速診断—POCTの可能性を探る

細菌性呼吸器感染症

著者： 宮下修行¹

所属機関： ¹川崎医科大学総合内科学1

ページ範囲：P.1086 - P.1092

Point

●微生物検査で原因菌が検出されれば，狭域で有効な抗菌薬を選択することができ，耐性菌まん延の抑止につながる．

●実地医療で効果を発揮しているのは迅速診断法であるが，簡便性に欠ける検査法は有効活用されていない．

●簡便性を追求すると診断の正確性が劣り，臨床の現場では検査結果の解釈に悩むことも多い．このため，おのおのの疾患の特徴を理解し，臨床鑑別を加味する方法が実践的と考えられる．

参考文献

1）Mandell LA, Wunderink RG, Anzueto A, et al：Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis　44（Suppl2）：S27-S72，2007

2）日本呼吸器学会呼吸器感染症に関するガイドライン作成委員会：成人市中肺炎診療ガイドライン，杏林社，2007

3）Miyashita N, Shimizu H, Ouchi K, et al：Assessment of the usefulness of sputum Gram stain and culture for diagnosis of community-acquired pneumonia requiring hospitalization. Med Sci Monit　14：CR171-CR176，2008

4）Miyashita N, Kawai Y, Yamaguchi T, et al：Clinical potential of diagnostic methods for the rapid diagnosis of Mycoplasma pneumoniae pneumonia in adults. Eur J Clin Microbiol Infect Dis　30：439-446，2011

5）山崎勉，黒木春郎，板垣勉，他：肺炎マイコプラズマ感染症の診断におけるリボソームタンパクL7/L12抗原検出試薬の検討．感染症誌　89：394-399，2015

6）Miyashita N, Kawai Y, Tanaka T, et al：Diagnostic sensitivity of a rapid antigen test for the detection of Mycoplasma pneumoniae: Comparison with real-time PCR. J Infect Chemother　21：473-475，2015

7）Miyashita N, Kawai Y, Kato T, et al：Rapid diagnostic method for the identification of Mycoplasma pneumoniae respiratory tract infection. J Infect Chemother　22：327-330，2016

8）Miyashita N, Obase Y, Fukuda M, et al：Evaluation of serological tests detecting Chlamydophila pneumoniae-specific immunoglobulin M antibody. Intern Med　45：1127-1131，2006

9）Miyashita N, Ouchi K, Kawasaki K, et al：Evaluation of enzyme-linked immunosorbent assay for Chlamydophila pneumoniae-specific immunoglobulin M in acute respiratory tract infection. Respirology　13：299-302，2008

10）Miyashita N, Ouchi K, Kawasaki K, et al：Comparison of serological tests for detection of immunoglobulin M antibodies to Chlamydophila pneumoniae. Respirology　13：427-431，2008

11）Miyashita N, Kawai Y, Yamaguchi T, et al：Evaluation of false-positive reaction with ELISA for the detection of Chlamydophila pneumoniae-specific IgM antibody in adults. Jpn J Infect Dis　63：150-151，2010

12）Miyashita N, Akaike H, Teranishi H, et al：Evaluation of serological tests for diagnosis of Chlamydophila pneumoniae pneumonia in patients with nursing and healthcare-associated pneumonia. J Infect Chemother　19：249-255，2013

13）Miyashita N, Akaike H, Teranishi H, et al：Chlamydophila pneumoniae serology: cross-reaction with Mycoplasma pneumoniae infection. J Infect Chemother　19：256-260，2013

14）Miyashita N, Kawai Y, Tanaka T, et al：Antibody responses of Chlamydophila pneumoniae pneumonia: Why is the diagnosis of C. pneumoniae pneumonia difficult? J Infect Chemother　21：497-501，2015

15）Miyashita N, Ouchi K, Kishi F, et al：Rapid and simple diagnosis of Chlamydophila pneumoniae pneumonia by an immunochromatographic test for detection of immunoglobulin M antibodies. Clin Vaccine Immunol　15：1128-1131，2008

16）Miyashita N, Fukano H, Yoshida K, et al：Is it possible to distinguish between atypical pneumonia and bacterial pneumonia?: evaluation of the guidelines for community-acquired pneumonia in Japan. Respir Med　98：952-960，2004

17）Ishida T, Miyashita N, Nakahama C：Clinical differentiation of atypical pneumonia using Japanese guidelines. Respirology　12：104-110，2007

18）Miyashita N, Kawai Y, Akaike H, et al：Influence of age on the clinical differentiation of atypical pneumonia in adults. Respirology　17：1073-1079，2012

19）Miyashita N, Sugiu T, Kawai Y, et al：Radiographic features of Mycoplasma pneumoniae pneumonia: differential diagnosis and performance timing. BMC Med Imaging　9：7，2009

20）Miyashita N, Akaike H, Teranishi H, et al：Chest computed tomography for the diagnosis of Mycoplasma pneumoniae infection. Respirology　19：144-145，2014