1
A 25-year-old carpenter notices the appearance of several hyperkeratotic papules (warts) on the palm side of his index finger. They do not change in size and cause him only minimal discomfort. After a year, they spontaneously disappear.
HPVによる疣贅（いぼ）。
自然消失することが多いが、感染は持続している。
疣贅を起こすタイプは1,2,3,4型など。
16,18型では子宮頸癌、6,11型では尖圭コンジローマ。
2
A 2-year-old child with fever for 2 days has not been eating and has been crying often. On examination, the physician notes that the mucous membranes of the mouth are covered with numerous shallow, pale ulcerations. A few red papules and blisters are also observed around the border of the lips. The symptoms worsen over the next 5 days and then slowly resolve, with complete healing after 2 weeks.
単純ヘルペスウイルス感染。
Tzanck試験やPapanicolau染色によりウイルスを確認する。
三叉神経などの神経に潜伏し、免疫低下時に活性化する。
治療薬はアシクロビル。DNA伸長を阻害することでウイルス増殖を抑える。副作用が少なく、よく使われるらしい。
3
A 17-year-old high school student has had low-grade fever and malaise for several days, followed by sore throat, swollen cervical lymph nodes, and increasing fatigue. The patient also notes some discomfort in the left upper quadrant of the abdomen. The sore throat, lymphadenopathy, and fever gradually resolve over the next 2 weeks, but the patient's full energy level does not return for another 6 weeks.
EBVによる伝染性単核球症。
リンパ節腫脹、発熱、咽頭痛が三主徴である（巨脾?）。
成人期でのEBV初感染が激しい感染症を引き起こす（kissing disease）。
CMVによってもこの病気は起こる。その場合の鑑別は、
EBV：症状が激しい、異型T細胞、heterophil Ab、抗EBV Ab
CMV：ふくろうの目（封入体）、抗CMV Ab
4
An 18-year-old college freshman complained of a cough, runny nose, and conjunctivitis. The physician in the campus health center noticed small white lesions inside the patient's mouth. The next day, a confluent red rash covered his face and neck.
麻疹。
白い斑点（コプリック斑）が特徴的。
二峰性の発熱経過をたどる。感染力は発疹が出る前のカタル期が一番強いらしい。
（国試的には）融合する発疹、後に色素沈着。
ワクチン接種のため激減。
5
In late December, a 22-year-old man suddenly experienced headache, myalgia, malaise, dry cough, and fever. He basically felt lousy. After a couple of days, he had a sore throat, his cough had worsened, he started to feel nauseated, and he began vomiting. Several of his family members had experienced similar symptoms during the previous 2 weeks.
症状からインフルエンザ。症状が出始める前が感染力が強い。
インフルエンザウイルスのワクチンがなぜ難しいか。
インフルエンザウイルスはRNAウイルスであり、変異がバシバシはいる。
ドリフトとシフトが抗原の多様性に寄与している。A型は両者起こるが、B型は前者しか起こらない。
6
A 28-year-old man had several complaints. He had a bad case of thrush (oral candidiasis) and low-grade fever, had serious bouts of diarrhea, had lost 20 pounds in the past year without dieting, and most seriously, he complained of difficulty breathing. His lungs showed a bilateral infiltrate on radiographic examination, characteristic of Pneumocystis carinii pneumonia. A stool sample was positive for Giardia organisms. He was a heroin addict and admitted to sharing needles at a "shooting gallery.”
HIV感染からのAIDS、日和見感染症（ニューモシスチス肺炎など）。
共有針や性行為は感染リスクが高い。
7
A: A 55-year-old man was admitted to the hospital with fatigue, nausea, and abdominal discomfort. He had a slight fever, his urine was dark yellow, and his abdomen was distended and tender. He had returned from a trip to Thailand within the previous month.
B: A 28-year-old woman was admitted to the hospital complaining of vomiting, abdominal discomfort, nausea, anorexia, dark urine, and jaundice. She admitted that she was a former heroin addict and that she had shared needles. In addition, she was 3 months pregnant.
C: A 65-year-old man was admitted with jaundice, nausea, and vomiting 6 months after undergoing coronary artery bypass grafting.
ウイルス性肝炎の症例。それぞれ、HAV、HBV、HCVによる肝炎。
それぞれの肝炎ウイルスにかかるリスク行為
A：海外渡航、飲水、食事
B：血液、体液、母子垂直、針
C：血液、輸血
慢性化するのはC型肝炎。肝炎・肝硬変・肝細胞癌のシークエンス。
ワクチンがあるのはAとB。Cのワクチン開発はホットトピック。
バックナンバー
