高CPK 血症を伴い，筋炎が疑われた ヒトパレコウ …

1 HPeV human parecho - virus 1999 Picornavirus parechovirus RNA 17 1 3 HPeV 3 1999 1 2 3 1 CPK HPeV 3 CPK HPeV 3 3 5 5 5 7 I 2 37 3,257 g Vol. 29 No. 1 552017 CPK 3 1 1 1 2 CPK 3 human parechovirus type 3 HPeV 3 2 CPK 909 IU/l 4 7 HPeV 3 HPeV 3 HPeV 3 5 CPK HPeV 3 Key words 3 CPK 1 041 8680 1 10 2 2014 8 19 1 39 C 6 kg C 171 / 84/42 mmHg SpO2 96 room air 1 CPK 909 IU/l 1 8 21 3

2 RS X 1 2 1 1 2 180 190 / 39 40 C WBC CRP CPK 2 1,016 IU/l 4 329 IU/l Staphylo-coccus sp 8 2 3 4 7 CPK X 562017 1 WBC 7,300/ l Neut Lym Mono Eos RBC 362 104/ lHb g/dlHt Plt 104/ l TP 6 g/dlAlb g/dlAST 32 IU/lALT 17 IU/lLDH 273 IU/lCPK 909 IU/lBUN mg/dlCre mg/dlNa 137 mEq/lK mEq/lCl 102 mEq/lCa mg/dlCRP mg/dl 1 RSV hMPV 2 1/ l 1/ l 65 mg/dl mg/dlCl 118 mEq/l C41403938 HPeV-3 PCR HPeV-3 3712 3456736 WBC / l CRP mg/dl CPK IU/l 7, , ,0167.

3 1 HPeV cytopathic effect CPE High Pure Viral RNA Kit Roche total RNA RNA van der Sanden 8 5 UTR Ito 9 VP1 HPeV BLAST Enterovirus Genotyp-ing Tool 2 4 4 RNA HPeV 2 RNA RD 3 CPE Vero HPeV CPE RD Vero RNA HPeV 2 BLAST 5 UTR 100 VP1 99 HPeV 3 HPeV 3 2 II 1999 HPeV 3 2 3 2008 2011 2014 1 LDH CPK Vol.

4 29 No. 1 572017 2 HPeV 3 4 2 Staphylococcus sp Enterococcus faecalis 103 /ml5 UTR-PCR 280bp VP1-PCR 750bp 12 MNCPC 2 CSF cell isolates 1 CSF RD A isolate2 CSF Vero isolatePC Positive Ctrl. HPeV1 NC Negative 100 bp Marker 10 PCR 11 CPK HPeV 1 12 HPeV 3 CPK 2 1,016 IU/l 4 329 IU/l 4 CK MB IU/l ng/ml I ng/ml X Mizuta 3,4 2008 2011 HPeV 3 2008 CPK 22 14 HPeV 3 2011 5 HPeV 3 5 1 HPeV 3 Mizuta HPeV 3 2014 2 9 12 HPeV 3 2 5 HPeV 3 Wata-nabe 6 8 1 2014 6 2 7 CPK 9 3,719 IU/l5 6 2 4,807 IU/l 5,613 IU/l7 CPK HPeV 3 1999 1 2 HPeV 3 5,12.

5 13 CPK 10 HPeV 3 CPK LDH 3 210 ng/ml 2 CPK HPeV 3 HPeV 3 PCR HPeV 3 HPeV 3 PCR RNA 1 15 2 PCR 3 HPeV 3 582017 HPeV 3 HPeV 3 CPK CPK HPeV 3 CPK HPeV 3 2 1 65 17 26 2015 2 Ito M, et al Isolation and identification of a novel human parechovirus .

6 J Gen Virol 85 391 398, 2004 3 Mizuta K, et al Epidemic myalgia in adults asso-ciated with human parechovirus type 3 infec-tion, Yamagata, Japan, 2008. Emerg Infect Dis 18 1787 1793, 2012 4 Mizuta K, et al Epidemic myalgia associated with human parechovirus type 3 infection among adults occurs during an outbreak among children findings from Yamagata, Japan, in 2011. J Clin Virol 58 188 193, 2013 5 Mizuta K, et al Epidemic myalgia and myositis associated with human parechovirus type 3 infections occur not only in adults but also in children findings in Yamagata, Japan, 2014. Epidemiol Infect 20 1 5, 2015 6 Watanabe K, et al Isolation and characterization of novel human parechovirus from clinical sam-ples. Emerg Infect Dis 13 889 895, 2007 7 Yamamoto SP, et al human parechovirus infec-tions and child myositis cases associated with genotype 3 in Osaka City, Japan, 2014. J Med Microbiol 64 1415 1424, 2015 8 van der Sanden S, et al Prevalence of human parechovirus in the Netherlands in 2000 to 2007.

7 J Clin Microbiol 46 2884 2889, 2008 9 Ito M, et al Detection of human parechoviruses from clinical stool samples in Aichi, Japan. J Clin Microbiol 48 2683 2688, 2010 1 0 3 1 27 89 93 2015 1 1 Wildenbeest JG, et al The need for treatment against human parechoviruses how, why and when? Expert Rev Anti Infect Ther 8 1417 1429, 2010 1 2 Maller HM, et al Fatal myocarditis associated with ECHO virus , type 22, infection in a child with apparent immunological deficiency. J Pedi-atr 71 204 210, 1967 1 3 Yamamoto M, et al Epidemic of human parechovirus type 3 in Hiroshima city, Japan in 2008. Jpn J Infect Dis 62 244 245, 2009 1 4 3 HPeV 3 5 66 1729 1733 2013 1 5 3 2014 43 206 212 2015 Vol. 29 No. 1 592017602017 human parechovirus type 3 infection complicated by high serum CPK value in early infancySaho HONJO1 , Yoshiyuki SAKAI1 , Minami YODA1 , Hiroyuki TSUTSUMI2 1 Department of Pediatrics, Hakodate Municipal Hospital2 Department of Pediatrics, Sapporo Medical University School of Medicine This study reported a 2 month old boy with high serum creatine phosphokinase CPK levels associated with HPeV 3 infection.

8 He was admitted to hospital presenting fever and poor sucking. His CPK level was elevated at 909 IU/l, but no abnormality was found in other blood analyses or his cerebrospinal fluid or urine. Various rapid antigen tests were negative, thus no possibility of bacterial infection was considered. The patient s fever decreased on the fourth hospital day, and he was discharged on the sev-enth day. The serum CPK value decreased to within the natural level after several days. The virus was isolated from cerebrospinal fluid with tissue culture, and classified as HPeV 3 by genomic analysis. In 1999, HPeV 3 was first isolated in Japan from a stool specimen of a 1 year old infant with transient paralysis. A relationship between myalgia and HPeV 3 infection has been reported in many adult cases, but in only 5 child cases. Evaluation of muscle pain and weakness in early infants is difficult, due to its dependence on only clinical symptoms.

9 It was considered that myalgia and myositis caused high serum CPK. The possibility of HPeV 3 infection associated myalgia and myositis needs to be considered as differential diagnosis when early infants develop an acute febrile disease and high serum CPK value. 2016 6 30 2017 2 2