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<<   作成日時 : 2009/05/24 01:20   >>

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 MRSAの新種がインフルエンザの肺炎による死亡を引きおこしている可能性がある。病院の外、地域で発生したタイプでcommunity acquired MRSA (CA-MRSA)と呼ばれ、重大な脅威となる可能性がある。
 しかし、専門家によれば英国でのCA-MRSA肺炎は非常に稀であるという。
 アトランタのEmory大研究者によれば死亡率は50%以上の可能性があるという。
 MRSA感染は従来病院内感染が問題であったが、最新の研究で地域感染型が増大し始めていると警告している。
 最貧の研究は米国での2症例の分析による。肺炎から敗血症性ショックとなったが、完全に回復した。
 1990年代にオーストラリアから出現し、皮膚や軟部組織の比較的軽度な感染だった。標準的なMRSAよりも抗生物質に効果がある。
 インフルエンザに続発する細菌性肺炎は非常に重症で致死性となる可能性がある。従来、MRSA気道感染は病院内の高齢者に出やすい傾向があった。ウイルス感染後に弱まった免疫システムと抗生物質抵抗性のため、効果的な治療が困難となる。
 CA種は若年者に対して増大した毒性を示す特性がある。
 インフルエンザ流行時に72時間以内で50%の死亡率となる壊死性肺炎がCA−MRSAにより引きおこされるとすれば、極めて重大な問題である。
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Page last updated at 08:01 GMT, Wednesday, 20 May 2009 09:01 UK
Warning over new threat from MRSA
http://news.bbc.co.uk/2/hi/health/8058841.stm

画像MRSA
MRSA is usually a threat in healthcare settings

A new strain of MRSA seems to be triggering a deadly form of pneumonia in people who catch flu, experts say.

Researchers believe the new strain of the antibiotic-resistant bacterium is becoming more widespread.
It is known as community acquired MRSA, (CA-MRSA) because, unlike most forms of the superbug, it poses a significant risk outside hospitals.
The potential threat is detailed in a study appearing in the journal Lancet Infectious Diseases.
However, experts stressed cases of pneumonia caused by CA-MRSA in the UK were very rare.

CA-MRSA pneumonia is particularly dangerous due to the rapid, aggressive nature of the infection
Professor Mark Enright
Imperial College London

The researchers, from Emory University School of Medicine in Atlanta, say death rates following infection may be higher than 50%.
They warn the emergence of swine flu could intensify the problem, as CA-MRSA appears to strike people who are already ill with flu.
However, the just how common infections are remains unknown.
MRSA infections can range from boils to more severe infections of the blood, lungs and sites of surgery.
Most occur in healthcare settings, such as hospitals or nursing homes.
But the latest study warns that community-acquired cases are beginning to increase.
Writing in the journal, the researchers said: "Community-acquired MRSA infections are no longer restricted to certain risk groups or to the geographic areas where outbreaks first occurred."
"They now occur widely both in the community as well as health care facilities and have been reported on every continent."

Septic shock
The latest study is based on an analysis of two cases from the US.

It is important to note that these infections remain uncommon in the UK
Dr Angela Kearnes
Health Protection Agency

In both, the patients developed bacterial pneumonia, high fever and low blood pressure, and rapidly progressed to septic shock, a widespread infection that requires urgent medical attention.
They both made a full recovery.
The reason why the bacterium appears so lethal remains unclear.
It was thought to have emerged from Australia in the 1990s, but initially only triggered relatively trivial skin and soft tissue problems.
However, antibiotics do appear to have more effect than in standard MRSA infections.
Professor Mark Enright, an expert in MRSA at Imperial College London, said: "Bacterial pneumonia following influenza can be very serious and in some cases fatal.
"CA-MRSA pneumonia is particularly dangerous due to the rapid, aggressive nature of the infection and the difficulty in providing effective chemotherapy.
"The emergence of pandemic influenza and increased prevalence of CA-MRSA in many countries may cause increased morbidity and mortality in infected individuals."
Professor Ron Cutler, of Queen Mary University Of London, said: "In the past respiratory tract infections with MRSA tended to be in the elderly in a hospital ward.
"These infections could have been post viral and with a weakened immune system and a poor response to antibiotics were and still are difficult to treat successfully.
"The CA strains are able because of their increased toxic potential to infect a younger population."

Serious concern
Professor Richard James, of the University of Nottingham, said: "The threat from CA-MRSA in the USA is very serious concern, especially if there is a flu epidemic as this could trigger a large number of cases of necrotizing pneumonia, which has a mortality rate of more than 50% in 72 hours.
"The concern is that this may be the start of an exponential increase as we saw with hospital MRSA infections in the 1990s.
"It took the UK 13 years to get to grips with hospital-acquired MRSA infections, we are not equipped to deal with large numbers of CA-MRSA infections in the community."
However, the Health Protection Agency stressed that in the UK only a tiny fraction of Staphylococcus aureus bacteria carried the relevant disease-causing toxin, know as PVL.
And of these, most were more likely to cause minor infections, rather than pneumonia.
Dr Angela Kearnes, head of the HPA's Staphylococcus aureus reference lab, said: "Although several other countries have encountered serious problems, it is important to note that these infections remain uncommon in the UK."
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The Lancet Infectious Diseases, Volume 9, Issue 6, Pages 384 - 392, June 2009
doi:10.1016/S1473-3099(09)70133-1Cite or Link Using DOI
Emergence of community-acquired meticillin-resistant Staphylococcus aureus strain USA300 as a cause of necrotising community-onset pneumonia

Alicia I Hidron MD a Corresponding AuthorEmail Address, Cari E Low MD b, Eric G Honig MD c, Henry M Blumberg MD a d

Summary
Meticillin-resistant Staphylococcus aureus (MRSA), usually known as a nosocomial pathogen, has emerged as the predominant cause of skin and soft-tissue infections in many communities. Concurrent with the emergence of community-acquired MRSA (CA-MRSA), there have been increasing numbers of reports of community-acquired necrotising pneumonia in young patients and others without the classic health-care-associated risk factors. Community-onset necrotising pneumonia due to CA-MRSA is now recognised as an emerging clinical entity with distinctive clinical features and substantial morbidity and mortality. A viral prodrome (eg, influenza or influenza-like illness) followed by acute onset of shortness of breath, sepsis, and haemoptysis is the most frequent clinical presentation. The best treatment of this partly toxin-mediated disease has not been clearly defined. Whereas cases of CA-MRSA pneumonia have now been reported from almost every continent, the overall burden of disease of this emerging syndrome remains incompletely described. We report two related cases of community-onset pneumonia due to the MRSA USA300 genotype and review the literature regarding the emergence of CA-MRSA pneumonia.

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