3년간 한 대학병원의 말라리아 환자의 임상 분석

권혁중 최신의학사 2000 最新醫學 Vol.43 No.5-6

기니에서 유입된 사일열말라리아 감염 1예

강윤정,심문정,김정연,지소영,이원자,양진영 대한진단검사의학회 2015 Laboratory Medicine Online Vol.5 No.1

Recently, the number of Korean travelers and workers to malaria-endemic regions has increased, and the number of patients with imported malaria cases has increased as well. In Korea, most cases of imported malaria infections are caused by Plasmodium falciparum and P. vivax. Only one report of imported P. malariae infection has been published thus far. Here, we describe a case of imported P. malariae infection that was confirmed by peripheral blood smear and nested PCR targeting the small subunit ribosomal RNA (SSU rRNA) gene. A 53-yr-old man, who had stayed in the Republic of Guinea in tropical West Africa for about 40 days, experienced fever and headache for 3 days before admission. The results of rapid malaria test using the SD Malaria Antigen/Antibody Kit (Standard Diagnostics, Korea) were negative, but Wright-Giemsa stained peripheral blood smear revealed Plasmodium. To identify the Plasmodium species and to examine if the patient had a mixed infection, we performed nested PCR targeting the SSU rRNA gene. P. malariae single infection was confirmed by nested PCR. Sequence analysis of the SSU rRNA gene of P. malariae showed that the isolated P. malariae was P. malariae type 2. Thus, our findings suggest that when cases of imported malaria infection are suspected, infection with P. malariae as well as P. falciparum and P. vivax should be considered. For the accurate diagnosis and treatment of imported malaria cases, we should confirm infection with Plasmodium species by PCR as well as peripheral blood smear and rapid malaria antigen test. 최근 말라리아 풍토병 지역으로 한국인 여행자나 해외 근무자의 수가 증가하였고 그에 따라 해외유입형 말라리아 감염자의 수도 증가하고 있다. 국내에서 해외유입형 말라리아는 열대열말라리아와 삼일열말라리아에 의해 대부분 발생하고 있으며 지금까지 사일열말라리아 감염에 대한 보고는 한 증례가 유일하다. 저자들은 말초혈액 도말검사와 small subunit ribosomal RNA (SSU rRNA) 유전자를 표적으로 하는 이중중합효소연쇄반응을 이용하여 확진된 유입형 사일열말라리아 1예를 보고하는 바이다. 환자는 53세 남자 환자로 서아프리카 기니에서 약 40일간 체류하였고, 입원 3일 전부터 발열과 두통을 호소하였다. SD Malaria Antigen/Antibody Kit (Standard Diagnostics, Korea)를 이용한 말라리아 신속항원검사에서 음성의 결과가 나왔으나 Wright-Giemsa로 염색한 말초혈액도말검사에서 말라리아원충이 관찰되었다. 종 확진 및 혼합감염 여부를 확인하기 위해 SSU rRNA 유전자를 표적으로 한 이중중합효소연쇄반응을 시행하여 사일열말라리아 단독 감염을 확인하였다. 사일열말라리아의 SSU rRNA 유전자를 염기서열 분석한 결과, 분리된 사일열말라리아는 사일열말라리아 type 2로 확인되었다. 그러므로 해외유입형 말라리아로 의심 시 열대열말라리아나 삼일열말라리아뿐만 아니라 사일열말라리아도 염두에 두고 진단을 하여야 하며, 정확한 진단과 치료를 위해 말초혈액도말검사 및 신속항원검사 외에 중합효소연쇄반응검사로 말라리아의 종을 확진하는 것이 필요할 것으로 사료된다.

論文 : 학질(?疾)의 종류(種類)와 병인(病因)ㆍ병기(病機)에 대한 고찰(考察)

강효진 ( Hyo Jin Kang ),정창현 ( Chang Hyung Jeong ),장우창 ( Woo Chang Jang ),류정아 ( Jeong Ah Lyu ),백유상 ( You Sang Baik ) 대한한의학원전학회(구 대한원전의사학회) 2013 대한한의학원전학회지 Vol.26 No.2

Objective : Malaria(?疾) is a disease that`s main symptom is paroxysm - a cyclical occurrence of sudden coldness followed by rigor and then fever. Since the introduction of the cause and mechanism of malaria(?疾) in the ?Suwen(素問)?, including Cold malaria(寒?), Warm malaria(溫?), Heat malaria(??) and Wind malaria(風?), there has been over 20 different kinds of malaria, each of which are introduced in multiple medical texts. Method : Through comparison between ?Suwen(素問)? and other medical texts, the categories, causes and mechanisms of malaria can be analysed and organized to overview the whole feature of it. Results & Conclusion : External pathogens of malaria(?疾) are wind(風), cold(寒), summerheat (暑), dampness(濕), miasmic toxin(?), pestilence(疫), ghost(鬼). Internal pathogens of malaria(?疾) are dietary irregularities(飮食不節), overexertion and fatigue(勞倦), phlegm(痰), seven emotion(七情). Malaria can be categorized into four groups according to the pathological mechanism that leads to paroxysm. They are latency of disease(伏 氣), external contraction(外感), internal damage(內傷), and combination of disease(合病). Malaria-Paroxysm(?疾發作) occurs when the three following factors collide strongly : defense qi(衛氣), latent qi(伏邪) and external pathogen(新邪). When collision of the three factors takes place in the interior(裏), the body experiences chills. When it takes place in the exterior(表), the body experiences fever. The cyclical occurrence of Malaria-Paroxysm follows the circulation of defense qi.

한국에서의 말라리아 환자 발생

심재철,신이현 대한감염학회 2002 감염 Vol.34 No.2

Chloroquine 내성 유입 말라리아 14 예에 대한 Halofantrine 의 치료효과

조현장(Hyun Jang Cho),노성민(Sung Min Noh),이상도(Sang Do Lee),부철수(Cheol Su Poo),김성일(Sung Il Kim),김두형(Du Hyeong Kim),김승영(Seung Young Kim),박병엽(Byeung Yeub Park) 대한내과학회 1997 대한내과학회지 Vol.53 No.4

N/A Objectives: The prevalence of malaria is increasing in recent years and also multidrug resistant malaria is increasing around the world and there is an increasing concern about imported malaria in nonendemic areas. Now many drugs are tried to find out effect on multidrug resistant malaria. We performed this study to investigate the thrapeutic effect of halofantrine in the treatment of chloroquine resistant imported malaria. Methods: From Feb. 1992 to May 1995, we experienced 35 patients infected with malaria and treated 14 patients among 35 patients with halofantrine. Results: 1) All 14 patients were sailor with a mean age of 39.4 years and infected with malaria. 2) The majority of patients were infected with malaria at Africa. 3) 10 patients were infected with Plasmodium falciparum and the remainder were undetermined. 4) In the 11 cases of chloroquine resistant malaria treated with quinine plus tetracycline combination therapy or Fansidar, 4 cases could not be tolerable due to side effects and resistance to the therapy, we substituted halofantrine for above regimens. 5) In the 10 cases, treated after May 1994, halofantrine was the first choice of treatment because they were the cases of malaria infected in the mid-Africa where the prevalence of chloroquine resistant malaria is high. 6) With halofantrine, all 14 cases were treated with minimal side effects suc4 as nausea, vomiting, anorexia, abdominal pain and fatigue. Conclusion: We think halofantrine is a simple and effective regimen against chloroquine resistant malaria and consider this agent as an alternative therapeutic regimen on chloroquine resistant malaria.

국내 말라리아 환자의 헌혈력 분석

서동희,조영희,황병갑,황유정,김상인,여운희,정현진 대한임상병리학회 1999 대한임상병리학회지 Vol.19 No.5

국내 말라리아 퇴치사업의 현황 분석과 개선 방안

박재원,오대규,홍지영,염준섭,조성래 대한감염학회 2009 Infection and Chemotherapy Vol.41 No.1

Background : Vivax malaria had spread rapidly in areas adjacent to the Demilitarized Zone to reach more than 4,000 cases in 2000 in the Republic of Korea (ROK). After year 2000, annual cases decreased rapidly to reach less than 1,000 cases in 2004. However, the number increased again since 2005. Epidemiological characteristics of vivax malaria in the ROK are different before and after 2000. This article was aimed to evaluate the current status of malaria elimination project in the ROK for providing suggestions for its improvement. Materials and Methods : We analyzed the total reported malaria cases during 2005 to 2007 and reviewed the record on the malaria eradication project performed by the authorizations including the Korea Center for Disease Control and Prevention. Results : During 2005 to 2007, 45% of all the vivax malaria occurred in patients living in the non-prevalent areas; the interval between first symptom onset and diagnosis was longer in the non-prevalent areas compared to that in the prevalent areas. Education and publicity on malaria has not been properly performed in the non-prevalent areas. The military didn't take part in the control of the malaria infected discharged soldiers, most of whom might have been infected with malaria during their military service. Conclusion : For the efficient control of malaria and thus improving the effectiveness of the elimination project, education and publicity on malaria in the non-prevalent areas should be strengthened and cooperation between private and military sector regarding the ex-soldiers infected with malaria is essential. In addition, there should be bilateral communication among malaria- related teams within the Korea Centers for Disease Control and Prevention and also among all the malaria-related sectors. Furthermore, a common database on malaria patients and vector mosquitoes should be formed to grant access to all the malaria-related sectors. Improvement on report and surveillance system is also necessary. Background : Vivax malaria had spread rapidly in areas adjacent to the Demilitarized Zone to reach more than 4,000 cases in 2000 in the Republic of Korea (ROK). After year 2000, annual cases decreased rapidly to reach less than 1,000 cases in 2004. However, the number increased again since 2005. Epidemiological characteristics of vivax malaria in the ROK are different before and after 2000. This article was aimed to evaluate the current status of malaria elimination project in the ROK for providing suggestions for its improvement. Materials and Methods : We analyzed the total reported malaria cases during 2005 to 2007 and reviewed the record on the malaria eradication project performed by the authorizations including the Korea Center for Disease Control and Prevention. Results : During 2005 to 2007, 45% of all the vivax malaria occurred in patients living in the non-prevalent areas; the interval between first symptom onset and diagnosis was longer in the non-prevalent areas compared to that in the prevalent areas. Education and publicity on malaria has not been properly performed in the non-prevalent areas. The military didn't take part in the control of the malaria infected discharged soldiers, most of whom might have been infected with malaria during their military service. Conclusion : For the efficient control of malaria and thus improving the effectiveness of the elimination project, education and publicity on malaria in the non-prevalent areas should be strengthened and cooperation between private and military sector regarding the ex-soldiers infected with malaria is essential. In addition, there should be bilateral communication among malaria- related teams within the Korea Centers for Disease Control and Prevention and also among all the malaria-related sectors. Furthermore, a common database on malaria patients and vector mosquitoes should be formed to grant access to all the malaria-related sectors. Improvement on report and surveillance system is also necessary.

국내 말라리아 퇴치사업의 현황 분석과 개선 방안

박재원,홍지영,염준섭,조성래,오대규 대한감염학회 2009 감염과 화학요법 Vol.41 No.1

Background : Vivax malaria had spread rapidly in areas adjacent to the Demilitarized Zone to reach more than 4,000 cases in 2000 in the Republic of Korea (ROK). After year 2000, annual cases decreased rapidly to reach less than 1,000 cases in 2004. However, the number increased again since 2005. Epidemiological characteristics of vivax malaria in the ROK are different before and after 2000. This article was aimed to evaluate the current status of malaria elimination project in the ROK for providing suggestions for its improvement. Materials and Methods : We analyzed the total reported malaria cases during 2005 to 2007 and reviewed the record on the malaria eradication project performed by the authorizations including the Korea Center for Disease Control and Prevention. Results : During 2005 to 2007, 45% of all the vivax malaria occurred in patients living in the non-prevalent areas; the interval between first symptom onset and diagnosis was longer in the non-prevalent areas compared to that in the prevalent areas. Education and publicity on malaria has not been properly performed in the non-prevalent areas. The military didn't take part in the control of the malaria infected discharged soldiers, most of whom might have been infected with malaria during their military service. Conclusion : For the efficient control of malaria and thus improving the effectiveness of the elimination project education and publicity on malaria in the non-prevalent areas should be strengthened and cooperation between private and military sector regarding the ex-soldiers infected with malaria is essential, In addition, there should be bilateral communication among malaria-related teams within the Korea Centers for Disease Control and Prevention and also among all the malaria-related sectors. Furthermore a common database on malaria patients and vector mosquitoes should be formed to grant access to all the malaria-related sectors, Improvement on report and surveillance system is also necessary.

U.S. Military Administration’s Malaria Control Activities (1945-1948)

YEO In-sok 대한의사학회 2015 醫史學 Vol.24 No.1

To prevent and control infectious diseases was one of the major concerns of U.S. military government when they stationed in Korea in 1945. It was because the spread of various infectious diseases can cause social unrest and they can also affect the U.S. military. Malaria was one of the most important infectious diseases to which the U.S. military had been paying special attention. The U.S. military received a severe damage during the Pacific war with Japan due to malaria. It was said that more soldiers were lost by malaria than by battle itself. The bitter experience they had during the war made them accumulate more systematic and practical knowledge against malaria. As a result, by the end of the war, the U.S. military could run more than hundreds of units specialized in controlling malaria. Thanks to such a preparation, they could immediately begin their anti-malaria activities in Korea soon after the World War II. Although the vivax malaria, which is the dominant type in Korea, is not as much a fatal type as that in the Pacific areas, it was damaging enough to the infected. The 207th Malaria Survey Detachment carried out collecting and identifying the kinds of mosquitos in Korea. In addition, they also surveyed the prevalence of malaria among school children in Seoul. In terms of controlling malaria, DDT played a decisive role. Vector control is the most effective and ideal measurements against malaria. Before the development of DDT, it was practically impossible to eradicate mosquitos which arise from extremely broad areas. However, DDT could not be used as it had been expected in the rural area, because spraying DDT in the rice paddies which is the breeding place of mosquitos kills rice. Despite such a limitation in anti-malaria activities of the US military government, it should be noted that a significant turn in controlling malaria was possible thanks to the development of DDT.

한국인에서 발생한 말라리아의 임상적 특징

김은옥,이미숙,이상오,이선화,김양수,우준희,지현숙,류지소 대한감염학회 1998 감염 Vol.30 No.5

목적: 1993년 이후 우리나라에서 말라리아 환자가 급격하게 증가하는 추세이며, 말라리아의 임상 경과가 환자의 유전적인 요인에 영향을 받는 것으로 알려져 있기 때문에 한국인에서 말라리아의 임상 양상 및 예후의 특징을 조사하고자 하였다. 방법: 1989년 6월부터 1997년 10월까지 서울중앙병원에 입원하여 말초 혈액 도말 검사로 말라리아가 확진된 환자를 대상으로 의무 기록을 후향적으로 검토하였다. 토착형 삼일열 말라리아와 열대열 말라리아 임상 양상 및 합병증, 예후를 비교하였고, 이를 종합한 한국인에서 말라리아의 임상상을 서양인에서의 meta-analysis 결과와 비교하였다. 결과: 전체 말라리아 환자는 28예로 매년 증가하는 추세를 보였으며, 삼일열 말라리아 17예, 열대열 말라리아 11예이었다. 토착형 말라리아 15예 모두가 삼일열 말라리아이었고, 이 중 9예는 전방 근무 후 제대한 지 1년 이내의 전역 군인이었다. 유입형 말라리아 13예 중 열대열 말라리아 11예이었고, 이중 8예가 아프리카 여행 후 발병하였다. 임상 양상을 보면 환자 모두에서 발열이 있었으며, 주기적인 발열은 토착형 삼일열 말라리아 환자 6예에서만 관찰할 수 있었다. 혈액학적 이상이 토착형 삼일열 말라리아와 열대열 말라리아 환자 모두에서 가장 흔한 검사 소견이었으며, 혈소판 감소, 빈혈, 백혈구 강의의 빈도는 양군 사이에 차이가 없었다. 열대열 말라리아에서는 의식 변화의 소견이 흔하였고 간효소, 빌리루빈과 혈청 크레아티닌이 상승된 경우가 더 많았으며 뇌말라리아, 급성 신부전 등의 합병증이 더 흔히 발생하였다. 본 연구에 포함된 환자와 서양인에서의 임상 양상을 비교하여 보면 한국인 환자에서 빈혈, 혈소판 감소, 백혈구 감소, 혈청 간효소치의 상승을 더 흔하게 관찰할 수 있었으나 황달, 뇌말라리아, 신부전 등 합병증에 있어서는 양군 사이에 차이가 없었다. 결론: 최근 말라리아 환자는 지속적으로 증가하고 있었으며, 한국인 말라리아 환자 모두 발열이 관찰되었고, 혈소판 감소, 빈혈, 백혈구 감소가 가장 흔한 검사 소견이었다. Background: Vivax malaria has been a reemerging disease since 1993 in Korea, and the number of cases are rapidly increasing. Clinical manifestations of malaria are affected by genetic factors and individual patient's characteristics. In this study, we evaluated clinical manifestations and prognosis of malaria in Korean patients. Methods: Medical records of the patients confirmed as malaria by peripheral blood smear in Asan Medical Center from June, 1989 to October, 1997 were reviewed retrospectively. The patients with vivax malaria and falciparum malaria were compared with respect to clinical manifestations, complications, and prognosis. We also compared our data to meta-analysis reports from western countries. Results: Twenty-eight cases of malaria were included. The number of cases increases by year. Seventeen of them were diagnosed as vivax malaria, and 11 as falciparum malaria. Fifteen indigenous malaria were all vivax malaria, 9 of which had finished the military service in the border between North and South Korea several months before the onset. Eleven of 13 imported malaria were falciparum malaria, 8 of which were acquired in Africa. All 28 patients had fever, but cyclic pattern was shown only in 6 patients of vivax malaria. Hematologic abnormalities were the most common laboratory findings, and there were no significant differences in the frequency of thrombocytopenia, anemia, and leukopenia between vivax malaria and falciparum malaria. Altered mentality, elevated transaminase, total bilirubin, and serum creatinine were more frequent in falciparum malaria than in vivax malaria. Korean patients showed anemia, thrombocytopenia, leukopenia, and elevation of transaminase more frequently than western patients. Conclusion: The number of malaria cases has been increasing by year. All Korean patients with malaria had fever, and the most common laboratory findings were thrombocytopenia, anemia, and leukopenia.