INTESTINE Vol.15 No.1(2-10)


特集名 知っておくべき腸管感染症
題名 [各論]HIV感染症にみられる腸管感染症
発刊年月 2011年 01月
著者 為我井 芳郎 国立国際医療研究センター国府台病院消化器科
著者 菊池 嘉 国立国際医療研究センター病院エイズ治療・研究開発センター
【 要旨 】 HIV(human immunodeficiency virus)感染に由来するAIDS(acquired immunodeficiency syndrome)患者は世界的に増加している.AIDS患者ではKaposi肉腫などの消化管腫瘍と同時に,cytomegalovirus(CMV)感染症,カンジダ真菌症,アメーバ腸炎,Cryptosporidium,Mycobacterium avium comlex(MAC)感染症,herpes simplex virus(HSV)感染症,結核などの日和見感染症が高頻度に発症する.Kaposi肉腫の初期病変では,小腸絨毛は鮮やかな赤みをおびて棍棒状に腫大し,直腸微小病変では軽度の発赤,間質の開大と疎なⅠ型pitがみられた.また,HIV関連の腸炎では多彩な形態を呈する潰瘍や隆起性病変がみられ,これらの病変は原因疾患によって特徴的なびらんや潰瘍の形状,潰瘍辺縁,潰瘍底の所見を呈する.潰瘍底や辺縁,そして周囲からの生検が診断上重要となる.すなわちHIV感染症自体が消化管の炎症性疾患や悪性腫瘍の高危険群であり,その早期診断は予後に大きく関連するため,詳細な通常および拡大内視鏡観察が重要となる.
Theme Recent trend in infectious diseases of the intestine
Title Endoscopic diagnosis of intestinal diseases related to HIV infection
Author Yoshiro Tamegai Department of Gastroenterology, National Center for Global Health and Medicine, Kohnodai Hospital
Author Yoshi Kikuchi AIDS Clinical Center, National Center for Global Health and Medicine
[ Summary ] The number of AIDS patients infected with HIV is on the increase worldwide. Because of the number of malignant tumors and enterocolitis accompanying HIV infections is so high, an early diagnosis is very important.
We examined endoscopic findings and differential diagnosis in regard to HIV infection. In cases of Kaposi's sarcomas, a blood blister or bright red imbricate pattern is often observed. Employing magnifying endoscopy, minute Kaposi's sarcoma lesions exhibiting swollen intestinal villi, sparse type I pit patterns, and red mucosa, with clear boundaries may be observed. We may also observe candidiasis, CMV infections, amebiasis, HSV infections or MAC infections in conjunction with AIDS. In these cases, we were able to formulate a differential diagnosis by fully examining erosions, ulcerations or protruded areas with endoscopy (including magnifying endoscopy) in detail. We should realize that patients infected with HIV are a high risk group in relation to malignant tumors and infectious enterocolitis. These patients also need to be examined endoscopically, employing screening for early diagnosis.
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