日本新生児成育医学会雑誌　第29巻　第1号　78～84頁（2017年）

日本新生児成育医学会雑誌　29(1)：78-84；2017　

受付日：平成26．09．24

受理日：平成28．07．08

先天梅毒の3症例

Three Cases of Congenital Syphilis

＊1北里大学　医学部　小児科, ＊2同　北里生命科学研究所　ウイルス感染制御学研究室Ⅰ

＊1Department of Pediatrics, Kitasato University School of Medicine, ＊2Laboratory of Viral Infection I, Kitasato University Kitasato Institute for Life Science

永盛裕佳子＊1・伊藤尚志＊2・髙梨　学＊1・山口綾乃＊1・大岡麻理＊1・秋山和政＊1・横関祐一郎＊1・狐﨑雅子＊1・釼持　学＊1・野渡正彦＊1・石井正浩＊1

Yukako NAGAMORI＊1，Takashi ITOH＊2，Manabu TAKANASHI＊1，Ayano YAMAGUCHI＊1，Mari OHOKA＊1，Kazumasa AKIYAMA＊1，Yuichiro YOKOZEKI＊1，Masako KITSUNEZAKI＊1，Manabu KENMOCHI＊1，Masahiko NOWATARI＊1，Masahiro ISHII＊1

Key Words：congenital syphilis，Treponema pallidum，no prenatal care

　臨床像が異なる3例の先天梅毒を経験した。症例1，2は妊娠中に産婦人科の定期受診がなく，それぞれ在胎32週4日で出生体重1,566gと在胎36週（推定）で出生体重は1,984gだった。治療は奏功し治癒している。3例目は定期健診を受けていたが，妊娠20週後半に梅毒反応陽性が判明した。母体治療が開始されたが，治療開始3日目に在胎33週5日，出生体重2,234gで出生した。播種性血管内凝固症候群（disseminated intravascular coagulation：DIC）となり日齢10に死亡した。梅毒患者は抗菌薬による治療で一時激減したものの，近年先進国，後進国にかかわらず日本も含め世界的に増加傾向にある。現在梅毒がヒト免疫不全ウイルス（human immunodeficiency virus：HIV）の感染リスクを高めるとの指摘もあり，他の性感染症と同様に先天梅毒に注意が必要である。

　We observed three newborns with congenital syphilis. The mothers of these 3 neonates all had different clinical pregnancy courses. In case 1 and 2, the two mothers did not consult an obstetrician before birth. Case 1 weighed 1,566g at 32 weeks of gestation, while Case 2 weighed 1,984g at 36 weeks of gestation. Both cases were successfully treated.
　For case 3, the mother had periodically undergone prenatal medical examinations；however, syphilis was positively identified in the latter half of the pregnancy at 20 weeks. Treatment for the syphilis infection was started and the baby was born 3 days after the start of treatment. The child weighed 2,234g at 33 weeks of gestation. For case 3, the newborn child died 10 days after birth due to DIC.
　The number of syphilis patients has decreased sharply due to effective medical treatment using antibacterial therapy； however, the incidence of such cases has recently been increasing worldwide, including Japan, in both developed and underdeveloped countries. In addition, such patients presenting with syphilis are also considered to have an increased infection risk for human immunodeficiency virus（ HIV）. Therefore, it is necessary to pay attention to the possibility of congenital syphilis, as well as other sexually transmitted infections.