呼吸器感染症―その軌跡をふり返って―

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  • Respiratory Infections a chronological view
  • a chronological view
  • その軌跡をふり返って

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The classical term “pneumonia” was first noted by Hippocrates in the 4th century BC, as a seriousillness in the thorax. In 1819, Laennec recorded the physical findings of chest abnormalities obtained by percussion and auscultation with the stethoscope he invented, and compared them with the post mortemfindings. Then, the pneumonia and pneumonic consolidation, were differentiated from pleural effusion, and the criteria for pneumonia were classified anatomically into lobar and lobular pneumonia.<BR>The causative bacteria of infectious diseases, including pneumonia, were discovered inlate the19th.century. This fact induced at least three important things, (1) evidence that pneumonia is clearly caused by invasion of microorganisms into lung through airway or bloodstream.(2) analysis of serotyping of bacterial capsules of pneumococci led to development of type specific serotherapy and (3) synthesis of chemotherapeutic agents based on the idea that dyestuffs enter bacterial bodies.<BR>In the1920s-1930s, along with increasing popularity of type specific serotherapy, an accurate determination of the causative organisms was attached importance to diagnosis of pneumonia, because the Type specific serotherapy was only the way to get a favorable prognosis of the patients withpneumococcal pneumonia At the sametime, bacteriology-baseddiagnosis, such as “pneumococcal pneumonia”, became more popular than anatomy-based diagnosis. Such an active observation toward the bacteriologic examination, on the other hand, led to postulation of the existence of a different type ofpneumonia, “atypicalpneumonia”, whosecausative organisms were speculated to be viruses or transfilterable agents.Mycoplasma pneumoniae (1962), Legionella pneumophila (1976), Chlamydia pneumoniae (1980s) and SARS-Co-V (2002) were later discovered.<BR>In the late20th century, the incidence of opportunistic pneumonia increased in association with the aging of society and the increased longevity of immunodeficient patients. Also, the incidenceofPneumocystis carinii pneumonia re-emerged, parallel with the spread ofHIV infection, and pneumonia caused by antibacterial agent resistant strains, for instance MRSA or PRSP emerged. In this situation, a new concept of the community acquiredpneumonia (CAP) and the hospital acquiredpneumonia (HAP) was populariged (1980s). Since the point of this criteria was well reflected the correlation between preference for the causativeorganisms and thepatients background, this classification was convenient for the choice of antimicrobial agent based on empirical evidence. Recently, however, the close relationship between pathogens and patient background has sometimes became unclear, because patients with immunodeficiency diseases, patients withchronic intractable diseases and elderly patients are increasingly living in community. It indicates that the terminology of CAP or HAP has to reconsider to go back the starting point.<BR>Although the purulent exacerbation of chronic bronchitis was postulated by the infection with numerous microorganisms, the bacterial analysis of chronic bronchitis remained incomplete until 1940s. In the 1950s, asignificant role of Haemophilus influenza, e wasprevailed.

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