長崎県長与村集団赤痢の記録

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An outbreak of bacillary dysentery occurred at Nagayo Village near Nagasaki City the end of January 1967. The epidemic was recognized by sudden increasing of diarrheal cases. The Nagasaki Health Center carried out the bacteriological examination of specimens from rectal swab on almost the whole population of the village, approximately ten thousand people. Among them, about 800 cases were found as positive for Shigella sonnei. The outbreak was proved as water born by contaminating water of the water system of the Nagayo Village with Shigella sonnei by reason of the facts that the majority of patients and carriers was found in the area with the water service and Shigella sonnei was discovered from water in the source of the water system. The Shigella sonnei which was isolated from this epidemic was highly resistant to chloramphenicol, tetracycline and streptomycin; it belonged to type 14 by Colicine typing. About two third of the cases with positive stool culture revealed mild symptom of bacillary dysentery and one third of those did'nt show any clinical manifestation. The symptom was so mild and atypical that patients were not able to be clinically diagnosed unless stool culture was done. The various kinds of the antimicrobial drug were used for treatment of patients and carriers instead of the above mentioned three antibiotics. The combined use of two drugs as kanamycin and nalidixic acid, colimycin and furatrizine, etc. seemed to be more effective than the treatment with the single use of one drug. In connection with the report of this epidemic, the authors discussed the recent trends of bacillary dysentery in Japan. During the last two decades, the mortality rate in Shigella infection have gradually decreased and in the recent it was extremely low, while the number of reported cases has showed no marked difference. In the last three years, Shigella sonnei suppressed Shigella flexneri which had been predominant for long time. The majority of strains of Shigella sonnei and flexneri isolated recently in Japan is highly resistant to the above mentioned antibiotics. In general, symptom of patient with bacillary dysentery has become markedly mild and on the other hand the number of carrier has increased. The authors emphasized that the preventive measure against bacillary dysentery in Japan should be investigated in the point of view corresponding the recent trends of the disease.昭和42年(1967)1月下旬から2月上旬にかけて,長崎県長与村にソンネ菌による集団赤痢が発生した.患者および保菌者の大多数が水道の配水区域から発生していること,水道原水よりソンネ菌を発見したこと,水道管理に欠陥があったことなどから水道水の汚染によるものと推定された.菌のコリシシ型は14,Cp,Tc,Sm3剤に耐性であった.全村民の検便の結果,800名に近い菌陽性者が発見された.うち,約2/3が軽症患者,1/3が保菌者であった.症状は極度に軽く,個々にみるならば臨床的に赤痢と診定することは不可能と思われる例が多かった.治療はKm,Co,Ft,Fz,NAなどを用い,主として2剤併用した.治療後少数の再排菌例がみられた.最近の赤痢は極度に軽症化した.赤痢対策として,患者の強制隔離などの感染源対策には期待がもてない.感染経路対策により関心を払われるべきである.最も手近かに取上げられる問題として水道管理は重要な課題の一つであろう.本集団発生の処理,特に細菌学的検索に関しては,長崎大学医学部細菌学教室青木義勇教授ならびに教室の方々の御教導と御援助に負うところが多かった.ここに厚く謝意を表する.
長崎大学熱帯医学研究所,Institute of Tropical Medicine, Nagasaki Universityの論文

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小張一峰
琉大一内

長崎県長与村集団赤痢の記録

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