小児科からみた A 群β 溶血性レンサ球菌による咽頭 …

1 A A A 1998 A A A V I, J A A (group A -hemolytic streptococcus: GABHS) Streptococcus pyogenes GABHS GABHS 1970 1 5 GABHS A I.

2 1. 2. 3. 4. A II. 1. 2. 3. A 1. GABHS 5 10% 15 30% 1) 3 15 2 5 24 24 4 7 GABHS GABHS GABHS GABHS GABHS GABHS GABHS

3 Streptococcal pyrogenic exotoxin-A, C Dick GABHS EB A C G F

4 2. GABHS 10% GABHS 6 GABHS GABHS GABHS CRP 1 2 3

5 EB (EBV: Epstein-Barr Virus) EBV VCA VCA-IgG EBV EBNA EBNA VCA VCA-IgM GABHS 2) GABHS PFAPA periodic fever, aphthous stomatitis, pharyngitis and adenitis syndrome 3) PFAPA 4 5 4 5 5 A 1.

6 A GABHS GABHS 32 25% GABHS 50% 4) Streptococcus dysgalactiae subsp. equisimilis (group G) Streptococcus constellatus subsp. constellatus (group F) 1 C G F GABHS GABHS 5 10 GABHS 24 2.

7 GABHS 6 GABHS 10 2 43 90% A 3 6 3 1 3 10 2 3 19 2 5 ) 3 7 ) (5 15 ) M 49, 2, 55, 56, 57, 59, 60, 61 12, 1, 4, 25 1, 3, 5, 6, 14, 18, 19, 24 III II, IV CRP A 1.

8 (minimum inhibitory concentration MIC) 1990 1970 5) 6) recurrence relapse GABHS re-infection GABHS M 150 1 10 M GABHS M GABHS 7) GABHS PrtF1, Fbp54, SOF/SfbII 8) GABHS 9) GABHS 1 10 20% 10) 11) M GABHS GABHS GABHS GABHS 12) 13) 14) 15)

9 GABHS 12) GABHS 16) GABHS GABHS 17) 2. 1 90%18) 2 70% 19) 5 14 20) GABHS GABHS 5 14 GABHS A 1.

10 2. GABHS 2 20)-22) 1 2 15 GABHS 10 20 9) 3. 35 10 10 20) 22) 10 14 5 5 10 22 5 10 23) 24)