著者

水本 潤希 小松 真成 長嶺 由衣子 長谷田 真帆 藤原 和成

出版者

一般社団法人 日本プライマリ・ケア連合学会

雑誌

日本プライマリ・ケア連合学会誌 (ISSN:21852928)

巻号頁・発行日

vol.45, no.1, pp.36-39, 2022-03-20 (Released:2022-03-23)

参考文献数

9

被引用文献数

1

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新・家庭医療専攻医制度では,新たなポートフォリオ領域として「健康の社会的決定要因(SDH)とアドボカシーおよびアクセス」が追加された.様々なSDH上の臨床課題とその対応についてセッティングごとに具体例を示すことで,SDHポートフォリオ執筆のコツを伝えることが本稿の目的である.日本のプライマリケアが健康格差に対してその社会的責務を果たすために,SDHに関する学習の機会と質を担保することが重要である.

著者

山口 浩樹 小松 真成 佐伯 裕子

出版者

一般社団法人 日本感染症学会

雑誌

感染症学雑誌 (ISSN:03875911)

巻号頁・発行日

vol.92, no.4, pp.552-555, 2018-07-20 (Released:2019-11-02)

参考文献数

13

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A 69-year-old woman received a diagnosis of multiple abscesses. Abscess drainage was performed, and methicillin-susceptible Staphylococcus aureus was isolated from blood and pus cultures. On post-operative day 4, she developed proteinuria and haematuria. She also complained of abdominal pain, and areas of purpura were seen over her extremities. CT scans showed ascites and ileum wall thickening. Leukocytoclastic vasculitis was observed on skin biopsy. Findings on renal biopsy were compatible Immunoglobulin A(IgA) nephropathy, therefore we diagnosed her illness as IgA vasculitis. She recovered following administration of antibiotics and steroids. The genes encoding for staphylococcal enterotoxin E and staphylococcal toxic shock syndrome toxin-1 were detected on the pathogen. Staphylococcal enterotoxins might have been involved in the pathogenesis of IgA vasculitis. Clinicians should bear IgA vasculitis in mind if patients with S. aureus infection develop abdominal pain, urine abnormality, and purpura.

著者

沖中 友秀 山口 浩樹 小松 真成 佐伯 裕子

出版者

一般社団法人 日本感染症学会

雑誌

感染症学雑誌 (ISSN:03875911)

巻号頁・発行日

vol.94, no.6, pp.839-843, 2020-11-20 (Released:2021-06-10)

参考文献数

21

被引用文献数

1

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Klebsiella pneumoniae subsp. ozaenae (K. ozaenae) has been reported to cause urinary tract infections and rhinosclerosis, but it has rarely been reported as a cause of lung abscess. Therefore, the clinical course and optimal antimicrobial treatment for lung abscess caused by K. ozaenae remain unclear. It has also been reported that infections caused by hyperviscous Klebsiella species are more likely to become invasive. We report a case of lung abscess caused by hyperviscous K. ozaenae. A 68-year-old woman presented with fever and right shoulder pain, and was referred to our hospital as a suspected case of pneumonia. Chest CT showed an abscess in the right S3, and we started the patient on intravenous ceftriaxone (CTRX) treatment. However, as the fever persisted and the patient became delirious, the antimicrobial agent was changed to meropenem (MEPM), based on the findings of sputum smear examination. K. ozaenae was isolated on sputum culture, with a positive string test. Although this bacterial strain is considered to be susceptible to CTRX and MEPM, the patientʼs fever and delirium failed to improve. The symptoms eventually improved with the addition of levofloxacin (LVFX). The patient was discharged without any sequelae on day 48 of hospitalization.