{"created":"2023-05-25T05:26:12.752467+00:00","id":4926,"links":{},"metadata":{"_buckets":{"deposit":"76e774e5-9e04-476e-af97-af53431e4ec4"},"_deposit":{"created_by":17,"id":"4926","owners":[17],"pid":{"revision_id":0,"type":"depid","value":"4926"},"status":"published"},"_oai":{"id":"oai:yamagata.repo.nii.ac.jp:00004926","sets":["29:31:176:187"]},"author_link":["14968","14958","14961","14974","14960","14970","14966","14975","14969","14972","14967","14962","14963","14965","14964","14959","14973","14971"],"item_3_alternative_title_18":{"attribute_name":"その他の言語のタイトル","attribute_value_mlt":[{"subitem_alternative_title":"A Case of Bacteremia with Pasteurella multocida due to Licking Contact by a Domestic Dog"}]},"item_3_alternative_title_19":{"attribute_name":"タイトル（ヨミ）","attribute_value_mlt":[{"subitem_alternative_title":"シイクケン ニ ナメラレテ ハッショウシタ Pasteurella multocida ニヨル ハイケツショウ ノ イチレイ"}]},"item_3_biblio_info_6":{"attribute_name":"書誌情報","attribute_value_mlt":[{"bibliographicIssueDates":{"bibliographicIssueDate":"2020-08-15","bibliographicIssueDateType":"Issued"},"bibliographicIssueNumber":"2","bibliographicPageEnd":"102","bibliographicPageStart":"99","bibliographicVolumeNumber":"38","bibliographic_titles":[{"bibliographic_title":"山形大学紀要. 医学 : 山形医学 "},{"bibliographic_title":"Bulletin of the Yamagata University. Medical science : Yamagata medical journal","bibliographic_titleLang":"en"}]}]},"item_3_description_42":{"attribute_name":"資源タイプ","attribute_value_mlt":[{"subitem_description":"論文(Article) ","subitem_description_type":"Other"}]},"item_3_description_5":{"attribute_name":"内容記述","attribute_value_mlt":[{"subitem_description":"症例は65歳男性。既往歴で大動脈解離による片腎梗塞と脳梗塞があり、高血圧、脂質異常症、高尿酸血症の内服治療を受けていた。Ｘ日に交通事故を起こし当院へ救急搬送されたところ、38.9℃の発熱とJCSⅠ-1の軽度の意識障害が認められたが、項部硬直なく、胸腹部にも異常所見は認められなかった。WBC22,840/μl（好中球88.1％）、BUN31mg/dl、Crea2.33mg/dl、eGFR23.2ml/min/1.73m2、CRP13.07mg/dl、プロカルシトニン30.01ng/ml、尿所見は尿路感染症を示唆する所見無く、脳脊髄液検査では髄膜炎を示唆する初圧上昇、細胞数増加、蛋白濃度上昇、糖低下は認められず、頭部MRIでも異常は認められなかった。細菌感染を念頭に、Empiric therapyとしてスルバクタム・アンピシリン（SBT/AMPC）1.5gを経静脈的に12時間毎に投与した。Ｘ＋１日に血液培養検査で人畜共通感染症の起因菌、グラム陰性桿菌であるPasteurella multocidaが分離された。動物接触歴を問診すると、飼育犬が日常的に患者の乾燥した皮膚の掻把痕を舐めていたことが判明し同菌の敗血症を来したと推察された。意識障害は翌日に軽快、数日で解熱し炎症反応も改善、抗菌薬の点滴を11日間継続後、内服の抗菌薬を14日間継続して後遺症なく軽快した。本菌は、日本国内でのペット犬・猫の口腔内で75－100％と高保有率であり、ヒトに対して経皮/経気道感染を来し、免疫抑制患者では咬傷などなくても敗血症を来し20％程度の致死率を示す。本症例でも心血管病歴や慢性腎臓病と易感染性の要因を持っていたため、飼育犬に舐められ経皮感染し、敗血症をきたし意識が混濁し、交通事故に至ったと推察された。原因不明の発熱時には、ペットの飼育、接触状況や患者の皮疹にも注意を払うべきである。","subitem_description_type":"Other"}]},"item_3_full_name_2":{"attribute_name":"著者(ヨミ)","attribute_value_mlt":[{"nameIdentifiers":[{"nameIdentifier":"14970","nameIdentifierScheme":"WEKO"}],"names":[{"name":"ウエマツ　, ケン"}]},{"nameIdentifiers":[{"nameIdentifier":"14971","nameIdentifierScheme":"WEKO"}],"names":[{"name":"イセキ, チフミ"}]},{"nameIdentifiers":[{"nameIdentifier":"14972","nameIdentifierScheme":"WEKO"}],"names":[{"name":"コンドウ, トシユキ"}]},{"nameIdentifiers":[{"nameIdentifier":"14973","nameIdentifierScheme":"WEKO"}],"names":[{"name":"サトウ, 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