한국 군장병 삼일열 말라리아(P. vivax) 진단에 OptiMAL 검사와 GENEDIA Malaria (P. vivax) Ab Rapid I, II 검사의 비교

조덕,임재균,이상오,소병조,임채승,양동욱 대한감염학회 2001 감염 Vol.33 No.4

Background : The diagnosis of malaria has been usually made using microscopic examination of Wright stained thin blood films in Korean army. This method is labor-intensive, time consuming and requires the microscopic expertise. Therefore, the alternative techniques, rapid diagnostic test, have been sought for use in Korean army. We performed a comparison of the OptiMAL test with GENEDIA Malaria (P. vivax) Ab Rapid I, II to assess its sensitivity and specificity of Plasmodium vivax malaria. Methods : Blood specimen were collected from 51 patients who were presented and initially diagnosed for P. vivax by the microscopy of blood smears and from 30 control patients without malaria infection at the Capital Armed Forces General Hospital (CAFGH) between October 2000 and February 2001. Among the 51 patients, we also collected 24 samples from 24 patients at 2 or 3 days after therapy. The OptiMAL test and GENEDIA Malaria (P. vivax) Ab Rapid I, II were performed according to the manufacturer's instructions on all samples respectively. Results : Compared with the blood firm, sensitivities and specificities of the OptiMAL test, GENEDIA Malaria (P. vivax ) Ab Rapid I and GENEDIA Malaria (P. vivax) Ab Rapid II were 94.1∼100% (29/29), 80.4∼83.3%, 96.1 ∼96.7% respectively. One case was interpreted as 'undetermined' by OptiMAL test. In 24 patients during therapy, the sensitivities of the OptiMAL test, GENEDIA Malaria (P. vivax) Ab Rapid I and GENEDIA Malaria (P. vivax) Ab Rapid II on 8 specimens with mean 120/□ parasitemia and 16 specimens with negative parasitemia were 75∼43.8%, 87.5∼81,3%, 100∼100% respectively. Conclusion : Our data demonstrated that the sensitivity and specificity of the GENEDIA Malaria (P. vivax) Ab Rapid I were not satisfactory, but the sensitivity and specificity of the OptiMAL test and GENEDIA Malaria (P. vivax) Ab Rapid II were relatively high and useful diagnostic tests for diagnosis of , P. vivax in areas like the militaries where laboratory facilities are poor or non-existent. (Korean J Infect Dis 33:267∼272, 2001)

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.

소아에 발생한 삼일열 말라리아의 임상적 특성

이은진,이종국,조종래,Lee, Eun Jin,Lee, Chong Guk,Cho, Chong Rae 대한소아감염학회 2003 Pediatric Infection and Vaccine Vol.10 No.2

목 적 : 말라리아는 국내에서 1970년대 말에 소멸된 것으로 알려져 있었으나, 1993년 비무장지대에 근무하던 군인에서 첫 환자가 발생한 이후, 지속적으로 증가되어 2000년에는 4,142명, 2001년에는 2,556명, 2002년에는 1,797명의 말라리아 환자가 보고되었다. 1999년부터는 민간인의 비율이 점차 증가되고 있고, 토착형 말라리아 환자가 늘어남에 따라 국내에 존재하는 매개숙주(중국 얼룩날개 모기)에 의해 주민간에 전파될 가능성도 높아진다. 저자들은 말초혈액 도말 검사 및 말라리아 항체 검사에서 말라리아로 확진된 소아 환자 13명을 조사하여 역학적 분석 및 임상적 특성을 알아보고자 하였다. 방 법 : 2000년 1월부터 2003년 8월까지 일산백병원에 내원한 소아 환자 중 말초혈액 도말 검사 및 말라리아 항체 검사로 확진된 15세 이하의 소아 환자 13명에 대하여 의무기록을 후향적으로 조사하였다. 결 과 : 13례 모두 토착형 말라리아 감염이었고, 원인 원충은 삼일열 말라리아(Plasmodium vivax)였다. 13례 중 남아와 여아의 비율은 9 : 4이었고, 발병 당시 평균 연령은 $9.5{\pm}3.6$세였다. 지역별로는 13례 중 9례가 일산 시내였으며, 11례의 발병 시기가 6~8월로 여름에 주로 발생했다. 13례 중 2례만이 3일 주기의 발작적인 발열을 보였고 나머지 11례는 지속적인 발열 및 불규칙한 발열 양상을 보였다. 혈소판 감소증은 가장 두드러진 소견으로 13례 중 12례에서 동반되었으며, 3례에서는 범혈구 감소증을 보였다. 신생아를 제외한 12례에서 hydroxychloroquine과 primaquine을 투약했고, 이후 시행한 혈액 도말 검사상 더 이상의 원충은 발견되지 않았고 혈액학적 이상 소견 역시 호전되었다. 결 론 : 저자들이 경험한 소아 말라리아 환아는 모두 Plasmodium vivax에 의해 발병되고 일부 환아는 유행외 지역에서 발병된 것으로 보아 이 원충에 의한 토착화의 확산을 추정할 수 있었다. 또한 전형적 삼일열 말라리아의 발열 양상이 없다하여도 혈소판 감소증 소견이 동반된 발열 환아에서 이 질환을 의심하여야 하며 말라리아 항체 검사가 선별 검사로 유용한 것으로 추정된다. Purpose : Malaria is known to have been eradicated for a few decades through persistent national health program in South Korea. However, malaria caused by Plasmodium vivax has started to reappear incidiously among military personnel near to DMZ since 1993. After then, the number of malarial cases have been increased abruptly year by year. We analyzed the children of indigenous malaria who were diagnosed by peripheral blood smear and malarial antibody test with regards to epidemiologic and clinical manifestations. Methods : The study 13 cases below 15 years of age, who were confirmed as vivax malaria during from January 2000 to August 2003. We retrospectively analyzed epidemiologic data, clinical manifestations, laboratory findings and therapeutic responses. Results : All of 13 cases were indigenous and tested positive for Plasmodium vivax. Of 13 patients, 9 were male and 4 were female. Mean age of onset was $9.5{\pm}3.6$ years old. Ilsan(n=9) was the most prevalent area, the most patients(n=11) were presented in summer (from June to August). A characteristic feature of periodic 3 day fever in patients with P.vivax infection was reported in only 2 among 13 cases. Thrombocytopenia was most prominent findings, which was accompanied by 12 of 13 patients and pancytopenia was appeared in 3 patients on this study. The therapeutic responses of hydroxycholoquine were very good in all cases, and abnormal laboratory findings were recovered and no relapse during follow-up period. Conclusion : Vivax malaria is indigenous in Korea near to DMZ, but recently endemic area seemed to be extended southward. Plasmodium vivax is the cause of indigenous malaria of children. As for children with high fever accompanying thrombocytopenia in endemic area of Korea, malaria must be included in differential diagnosis whether the type of fewer is periodic 3 day fever or not. Malaria antibody test is helpful as a screening test for malaria.

최근 5년간(1993년~1997년) 국군장병에서 발생한 말라리아의 역학과 그 관리

이무식 啓明大學校 醫科大學 1998 계명의대학술지 Vol.17 No.2

최근 5년간 (1993∼1997년) 삼일열 말라리아로 확진된 국군장병을 대상으로 조사한 결과, 우리나라 삼일연ㄹ 말라리아는 경기북부지역을 중심으로 매년 약 3∼5배로 증가하고 지역적으로 확산되고 있다. 1997년에 들어서는 계절적 특이성이 없이 연중 지속적인 발행을 보였다. 지역적으로 1995년 대비 1996년 현황에서는 철원군이 10배 증가하여 가장 발생이 왕성했던 반면에 1997년에는 파주군이 1996년에 비하여 5.9배로 가장 활발한 양상을 보였다. 발생자들의 근무형태 및 근무지별로 살펴보면 비무장지대 철책 근무 등 최일선 휴전선 남방한계선에서 약 10Km 내외세서의 근무경력자가 1993년에서 1996년 사이에서는 343명으로 88.2%였으며 1997년도에는 840명으로 72.7%로 비무장지대 관련성이 다소 감소된 경향을 보여 확산 및 토착화 양상을 시사하였다. 말라리아 다발지역을 중심으로 국군장병에게 대한 클로로퀸 및 프리마퀸의 병합 예방요법을 실시한 결과, 예방약의 복용 기준 및 일정에 맞게 먹었을 경우에 발생한 예는 없었으나, 여러 가지 이유로 불충분, 불규칙 또는 일시적으로 투여중단한 경우에 126명 (11%)이 발생하였다. 약물에 대한 내성을 보인 예나 예방요법을 실시하는 가운데 특이할 만한 부작용이 발생한 예는 없었다. 본 연구를 통해서 볼 때, 지금 시점이 최근 경기 복부지역을 중심으로 유행하는 삼일열 말라리아의 효율적이고 체계적인 근절 대책의 수립과 실행 등 토착화, 전파, 확산방지를 위한 구체적인 대책들이 필요한 시점으로 판단된다. The author evaluated the cases of vivax malaria in Korean soldiers for the last 5 years (1993-1997). Vivax malaria have been rapidly increasing and spreading about 3-5 times each year in northern area of Kyunggi province in Korea. The incidence of vivax malaira occured in August, September, July in order, and was peaked from August to September in 1997. Especially the phenomenon that vivax malaria occurred all through in year 1997 was very interesting. The counties of high incidence were Yonchon (45%),Paju(33.2%) and Chorwon (13.1%). Incidence of ChorwonGun was increased 10 times extremely in 1996, but PajuGun was increased extremely in 1997. About 88% of malaria cases (n=343) were the army soldiers, who were residing in Demilitarized Zone areas (About 10 Km distance from southern demarcation line. of DMZ) from 1993 to q996. But about 73% of malaria cases (n=840) were related with DMZ in 1997. So relation between malaria incidence and DMZ slightly decreased and that aspects suggest spreading and becoming indigenous of vivax malaria. We administered chloroquine and primaquine for chemoprophylaxis of vivax malaria to soldiers who served in high incident region in 1997, so we could not find incident case who took medicine regularly and tolerant cases. But identified 126 malaria cases were due to inadequate, irregular taking medicine or stopped taking medicine for a time. All of the patient who affected with vivax malaria were hospitalized and treated with standardized regimen of chloroquine and primaquine (WHO, 1973), resistant cases were not seen. The duration of diagnosis that period between confirmed and symptom developed was 9.5 days in 1997. We concluded the necessity of an efficient and a systematic countermeasure for eradicating vivax malaria in northern areas of Kyunggi province in Korea.

Estimated Effect of Climatic Variables on the Transmission of <i>Plasmodium vivax</i> Malaria in the Republic of Korea

Kim, Young-Min,Park, Jae-Won,Cheong, Hae-Kwan National Institute of Environmental Health Science 2012 Environmental health perspectives Vol.120 No.9

<P>Background: Climate change may affect <I>Plasmodium vivax</I> malaria transmission in a wide region including both subtropical and temperate areas.</P><P>Objectives: We aimed to estimate the effects of climatic variables on the transmission of <I>P. vivax</I> in temperate regions.</P><P>Methods: We estimated the effects of climatic factors on <I>P. vivax</I> malaria transmission using data on weekly numbers of malaria cases for the years 2001–2009 in the Republic of Korea. Generalized linear Poisson models and distributed lag nonlinear models (DLNM) were adopted to estimate the effects of temperature, relative humidity, temperature fluctuation, duration of sunshine, and rainfall on malaria transmission while adjusting for seasonal variation, between-year variation, and other climatic factors.</P><P>Results: A 1°C increase in temperature was associated with a 17.7% [95% confidence interval (CI): 16.9, 18.6%] increase in malaria incidence after a 3-week lag, a 10% rise in relative humidity was associated with 40.7% (95% CI: –44.3, –36.9%) decrease in malaria after a 7-week lag, a 1°C increase in the diurnal temperature range was associated with a 24.1% (95% CI: –26.7, –21.4%) decrease in malaria after a 7-week lag, and a 10-hr increase in sunshine per week was associated with a 5.1% (95% CI: –8.4, –1.7%) decrease in malaria after a 2-week lag. The cumulative relative risk for a 10-mm increase in rainfall (≤ 350 mm) on <I>P. vivax</I> malaria was 3.61 (95% CI: 1.69, 7.72) based on a DLNM with a 10-week maximum lag.</P><P>Conclusions: Our findings suggest that malaria transmission in temperate areas is highly dependent on climate factors. In addition, lagged estimates of the effect of rainfall on malaria are consistent with the time necessary for mosquito development and <I>P. vivax</I> incubation.</P>

Clinical Characteristics of Vivax Malaria and Analysis of Recurred Patients

곽예경,이효근,김민경,엄태현,조종래 대한감염학회 2013 Infection and Chemotherapy Vol.45 No.1

Background: Plasmodium vivax malaria is an acute debilitating illness characterized by recurrent paroxysmal fever and relapses from hypnozoites in the liver. Although a few studies reported clinical characteristics of vivax malaria in civilians after reemergence in the Republic of Korea, only a small group of patients was analyzed. Materials and Methods: We retrospectively reviewed the medical records of patients who had been diagnosed with vivax malaria by peripheral blood smear in a university-affiliated hospital located in a malaria-endemic area between January 2005 and December 2009. Results: During the study period, a total of 352 malarial cases from 341 patients were diagnosed. Vivax malaria was most commonly developed in July and August, 24.7% (87/352), and 21.9% (77/352), respectively. The mean (SD) age was 42.5(14.7) years and the number of male patients was 243 (71.3%). Six patients had a previous history of vivax malaria from 6months to 10 years before. A total of 337 patients (98.8%) had fever and the mean (SD) body temperature was 38.3 (1.4)°C. Common associated symptoms were chills (213/341, 62.5%), headache (115/341, 33.7%), and myalgia (85/341, 24.9%). Laboratory findings included thrombocytopenia (340/341, 99.7%), anemia (97/341, 28.5%), leukopenia (148/341, 43.4%),increase of aspartate transaminase (177/341, 51.9%), and increase of alanine transaminase (187/341, 54.8%). Hypotension (14/341, 4.1%), altered mentality (3/341, 0.9%), azotemia (3/341, 0.9%), spleen infarction (2/341, 0.6%), and spleen rupture (1/341, 0.3%) developed as complications. Chloroquine was administered to all patients and primaquine was administered with mean (SD) 3.39 (0.82) mg/kg to 320 patients. There were 11 recurrent infections during the study period. The median (range) time to recurrent infection was 100 (32–285) days. Platelet counts were higher (86,550 vs. 56,910/mm3) and time to treatment of malaria was shorter (5 vs. 7 days) in relapsed cases compared with first occurrence cases (P =0.046). Conclusions: The overall recurrence rate of vivax malaria was 3.2% (11/341) in this study. In recurred cases, malaria was diagnosed earlier and thrombocytopenia was less severe. To evaluate the risk factors associated with recurrence and adequate dose of primaquine in Korean patients, further large-scale prospective studies will be needed.

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.

한국에서의 말라리아 환자 발생

심재철,신이현 대한감염학회 2002 감염 Vol.34 No.2

경기지역 소아에서 발생된 삼일열 말라리아의 역학 및 임상적 특성

김종호,이윤경,김종현,허재균,장기영,강혜련,강진한,Kim, Jong Ho,Lee, Yoon Kung,Kim, Jong Hyun,Hur, Je Kyun,Chang, Ki Young,Kang, Hye Rhyun,Kang, Jin Han 대한소아감염학회 2000 Pediatric Infection and Vaccine Vol.7 No.2

목 적 : 1970년대 이후 약 20년간 발생이 없었던 삼일열 말라리아가 1993년부터 발생되어 점차 확산되는 추세에 있어 과거와 같은 토착화에 대한 우려가 높다. 국내에서 말라리아의 토착화를 막기 위하여는 현재 발생되는 말라리아 대한 역학 및 임상 특성에 관한 연구가 제일 우선되어야 할 것이다. 한편 성인에 비해 발생율은 낮으나 소아에서도 환자가 증가되는 추세에 있어 소아에서도 동일한 관점에서 역학 및 임상 연구가 요구되고 있다. 이와 같은 배경에서 말라리아 다발생 지역인 경기지역의 소아에 발생된 말라리아의 역학 연구를 후향적으로 실시하였다. 방 법 : 1998년 9월부터 1999년 8월까지 경기지역 종합병원 및 국공립 의료기관에서 말초 혈액도말 검사상 말라리아로 진단된 15세 이하의 소아 환자를 대상으로 발생 연령 및 성별, 발생 시기, 발생 지역, 발생 역학적 배경, 발열의 양상, 동반 증상, 진찰상 특이 소견, 일반검사 소견, 말초혈액 도말검사 소견, 치료와 연관된 사항 및 예후에 관한 내용의 의무기록을 통하여 후향적 연구를 시행하였다. 결 과 : 연구대상수는 총 21명으로서 남녀비는 2:1이었고 5세 이하에서도 삼일열 말라리아가 발생되었으나 11세 이상 15세 이하의 연령에서제일 많이 발생(14명;66.7%)되었다. 발생시기는 2월, 5,월, 6월, 10월에 각 1명씩 발생하였고 4월, 9월에 각 2명이 그리고 8월에 4명, 7월에 9명이 발생되었다. 환아가 발생된 동일 거주지역과 가족내에서 성인 환자 발생이 있었고, 지역적으로 파주, 의정부, 부평, 연천, 동두천, 포천, 철원, 부천의 순으로 다발생하였다. 임상적으로 발열의 양상은 48시간 간격의 주기성 발열이 15명, 24시간 간격의 주기성 발열이 4명, 비주기성 발열이 2명에서 보였고 발열외에 두통, 구토, 식욕부진, 오심, 오한, 권태감, 복통, 설사 등의 증상이 동반되었다. 진찰 소견상 비장비대가 제일 흔히 발현되었고, 검사 소견상 빈혈, 혈소판 감소증, 비정상 간기능, 백혈구 감소, 혈뇨의 순으로 이상 소견이 나타났다. 말초혈액 도말검사에서 Plasmodium vivax의 원충 단계는 young trophozite, gametocyte, schizont순으로 확인되었다. 전 예에서 chlorquine 약제의 치료반응이 좋았고 합병증이 없었으며 추적 가능한 8례에서도 재발은 없었다. 결 론 : 1998년 9월부터 1999년 8월 사이에 경기지역 소아에서 발생된 말라리아는 경기 북부지역의 10세 이상 고연령 소아에서 주로 하계절에 발생되며, 주기성 발열이 임상적으로 주된 증상이며 진찰상 비장비대가 주된 양성 소견이었으며 말초 혈액 도말검사상 young trphozoite가 제일 많이 발견됨을 알 수 있었다. 전반적으로 소아 환자에서의 치료 약제 반응은 좋고 합병증이 없이 양호한 경과를 보이며 재발도 거의 없는 것을 확인하였다. Purpose : In Korea, vivax malaria has been reemerged since 1993 after being abscent for more than 10 years. There are several possibilities of casuality of recent epidemic, although it is still unclear. The epidemiologic studies including case analysis and entomological reseach have been undertaken for a successful control measure. But, unfortunately those studies have been rarely dealt with cases of children. Therefore, this study was designed to figure out the characteristics of epidemiolgic and clinical features in children with indigenous vivax malaria. Methods : The study 21 cases below 15 years of age, who were diagnosed as vivax malaria and resided in kyounggi-do province area during 1998. 9~1999. 8. We retrospectively analyzed epidemiologic data concernig with occurrence of vivax, and clinical manifestations, abnormal laboratory findings and outcomes including therapeutic responses. Results : All cases were inhabitants of the endemic areas for vivax malaria in northwestern part of Kyonggi-do or western Kangwon-do, and Paju-gun was the most prevalent. Indigenous malaria cases of this study were more prevalent in children above 10 years old age, and in male. Seasonally, vivax malaria in children occurred throughout the year except January, March and November, and the incidence was the highest in July. Clinical manifestations revealed that 48 hour cyclic fever pattern was the major fever pattern, and other symptoms such as headache, vomiting, poor appetites, chilling, abdominal pain and diarrhea were concomitantly developed. And splenomegaly revealed the main abnormal findings on physical examination, and anemia was the most frequent abnormal finding in laboratory examinations. Young trophozoite was frequently observed on peripheral blood smears. The therapeutic responses of chlorquine were very good in all cases, and no recurrence developed in follow up cases. Conclusion : Geographical and seasonal occurrence distributions of indigenous vivax malaria cases in children were very similar to those of adults as followings; Inhabitants of the endemic region, more prevalent in male, and more common during the summer season. Clinically, 48 hour cyclic fever pattern, splenomegaly and anemia were most frequent and important manifestations in children cases, and clinical courses were not serious. On blood smears, young trophozoite was most dominantly examined in children. Generally, the therapeutic outcomes were excellent, and recurrences were not observed.

일개 지역응급의료센터에서 삼일열말라리아의 진단을 위한 말라리아 신속항원 및 항체검사의 임상적 유용성 평가

백선희,신동운,박준석,노준영,김훈,박준민,김혜진,김경환 대한응급의학회 2010 대한응급의학회지 Vol.21 No.6

Purpose: A positive finding on a peripheral blood smear is the gold standard for the diagnosis of malaria. However,even for an expert microscopist, this test is a laborious and time consuming procedure. Therefore, it is crucial to have available a rapid and simple test that can be used in an emergency department environment. The aim of this study was to evaluate the usefulness of a rapid diagnostic kit for vivax malaria antigen and antibody among febrile patients visiting a local emergency medical center. Methods: Peripheral blood smears, and malaria antigen and antibody tests were evaluated for 593 patients with fever and other commonly associated symptoms of malaria who visited our local emergency medical center between August 2008 and December 2009. Results: Sixty nine cases of vivax malaria were confirmed by peripheral blood smear. Sensitivities of malaria antigen and antibody in patients of malaria were, respectively,94.20% (65/69) and 76.81% (53/69); specificities were 100% (524/524) and 99.24% (520/524). Conclusion: Considering rapidity, high sensitivity and specificity, the rapid malaria antigen test is useful as an adjunctive diagnostic tool for detection of malaria infection in an emergency department environment.