第5回北海道小児消化器病フォーラム 教育講演 散 …

1 O 5 1) 2) 2)1) 2) 25 9 7 O O O 6 2 4 1 CRP 6 2005 2010 1046 0501001502002502005 2006 2007 2008 2009 2010 175 2005 2010 ) O = 6 1046 396 2005 2010 010203040506070802005 2006 2007 2008 2009 2010 SalmonellaKlebsiella oxytocaCampylobacter 4 6 76% O CampylobacterKlebsiella oxytocaSalmonella O 2005 2010 6 ) 0510152025303540123456789101112 4 O 2005 2010 6 ) 2 EHEC) 2 26 1 4 O 2005 2010 6 )

2 05101520252005 2006 2007 2008 2009 2010 O-1O-18O-25O-74 6 2 5 O 184 H 53 EnteropathogenicE. coli EPEC Enteroinvasive E. coli: EIEC) EnterotoxigenicE. coli ETEC EnterohemorrhagicE. coli: EHEC) EnteroaggregativeE. coli: EAEC) DEC Diffusely Adherent E. coli, DAEC EAEC 1 EAST1 EAST1 EAST1EC (EPEC) ( (EIEC) (ETEC) ( ) (EHEC) ( HUS) (EAEC) (DAEC) Mobile DNA elements Pathogenicity islands (PAI) : chromosome LEE( kb) locus of enterocyte effacement: EPEC, EHEC eae(intimin) Tir (translocated intimin receptor) Plasmid bfp(bundle forming pilus): EPEC aggregative adherence fimbria: EAEC Enterotoxin (ST, LT): ETEC inv E: EIEC Bacteriophage Shiga-toxin: EHECE volution of E.

3 ColiThe uptake of mobile genetic elements (phages, virulence plasmids and pathogenicityislands)ETECEIECEPECEHECEAE CE nteroaggregative E. colipAAenterotoxin-encoding plasmidaggregative adherence fimbriaencoding plasmidinvasion plasmidenteropathogenicE. coliadhesion-factor plasmidShiga-toxin-encoding bacteriophageLEE: locus of enterocyteeffacementNat Rev Micro 2008; 6: 387 Epidemic Profile of Shiga-Toxin Producing Escherichia coli O104:H4 Outbreak in Germany Preliminary ReportN EnglJ Med 2011 2011 4200 1/5 HUS 50 Bean and seed sprouts EAEC 6 2 2008 12 2010 11 2 347 33 314 Campylobacter 18 Klebsiellaoxytoca 7 Salmonella 6 Aeromonassobria 1 Yersiniaenterocolitica 1 O 98 31%) O O DNA 10 (stx1 stx2 eae elt est-p est-h astA aggR afaB virB) TaqMan PCR PCR [eae](EPEC)( )

4 (EIEC)( ) ( )(ETEC) -p& -h ( ) [eae] [ ] 1 )(EHEC)( )[stx2]( 2 ) (EAEC)( ) (DAEC) :EAEC : ( EAST1EC O aggReaeastA 1 126++EAEC3 153+EAST1EC4 111++EAEC5 111+EAEC25 26+EPEC26 6+EPEC28 15+EPEC31 25+EPEC39 153+EPEC75 25+EAEC80 55+EPEC83 127a++EAEC87 111++EAEC89 127a++EAEC90 166++EAEC95 55+EPEC 98 16 ( ) aggR EAEC 8 8 6 astA eae EPEC 7 astA EAST1EC 1 aggR eae astA O 2009 -June 2013 6/83/7 EPEC EPEC O 051015202530O-1O-6O-8O-15O-18O-25O-26O-5 5O-74O-103O-111O-112acO-126O-127aO-143O- 153O-166 O EAST1 ECEAECEPEC 3 O 4 O O 61% 16 82 125365 42933 O 024681012141618201 16 1 13 6 O 1

5 110 ++ 34 +++ 42 + 56 ++252 +++ 2610 +++2813 +++318 +++ 391 +++ 758 ++802 +++831 ++876 ++891 ++906 ++ 953 ++ 4 11 8 AMPCPIPCMINOCCLCTMCTXCTRXCFDNCDTR-PIFOMF RPMMEPM 6/163/161/164/162/160/160/163/164/161/16 1/160/16 AMPC FOM FRPM CTX CTRX MEPM O O 10 20% 5 10 O O O O 314 216 98 2:1 = = O O EAEC EPEC O O O EAEC EPEC EHEC