쯔쯔가무시병의 단독감염과 신증후군 출혈열과의 혼합감염 비교

Abstract

쯔쯔가무시병과 신증후군 출혈열은 가을철 유행하는 급성열성질환이다. 쯔쯔가무시병과 급성열성질환과의 혼합감염 유병률이 증가하고 있으며, 심각한 합병증을 유발할 위험이 있어 본 연구는 전라남도 일개종합병원에서 2006년 1월부터 2010년 12월까지 최근 5년간 쯔쯔가무시병으로 진단받은 환자로 혈청학적 검사에서 항체역가가 1:80이상인 확진 환자 221명을 연구대상으로 하여 쯔쯔가무시병과 신증후군 출혈열과의 혼합감염 환자들의 일반적인 특성을 분석하고, 임상증상 및 혈액검사를 비교 분석하였다. 연구결과 쯔쯔가무시병과 신증후군 출혈열과의 혼합감염환자는 5년간 38명으로 가을에 유행하고, 70세 이상의 여성 노령 환자에게 많이 발생한다. 임상증상의 경우 쯔쯔가무시병의 단독감염보다 신증후군 출혈열과의 혼합감염 시 발열과 가려움증, 근육통 증상이 높게 나타나며, 혈액검사에서는 AST, ALT, 혈액요소질소, 크레아티닌, 총 빌리루빈수치가 단독감염보다 혼합감염 시 높게 나타났다. 이들 결과는 선행연구 및 증례가 없어 비교할 수 없지만, 본 연구가 쯔쯔가무시병과 신증후군 출혈열과의 혼합감염에 대한 임상적 양상에 대한 기초자료가 될 수 있을 것이며, 신속한 확진검사로 질환의 합병증을 예방, 입원기간을 줄이고, 적극적인 예방활동의 유용한 지표와 혼합감염에 대한 인식을 높이는데 도움이 될 수 있을 것이다.|ABSTRACT

A Comparative Study Between Tsutsugamushi Single Infection and Concomitant Infection with Hemorrhagic Fever

0h, Hye Jong Advisor : Seong-Woo Choi, M.D., Ph.D. Department of Public Health Graduate School of Health Science, Chosun University

Object : In this study, for comparing clinical signs and blood tests when autumn sudden fevered disease, Tsutsugamushi Disease is infected with mixing hemorrhagic fever with renal syndrom, 211 positive patients, who have antibody titer more than 1:80 in serologic examination of Tsutsugamushi Disease from January 1st, 2006 to December 31th, 2010 in a general hospital, Jeollanam-do province, were adopted as a studying objects.

Method : Through the research data, the medical records of the objects were analyzed retrospectively and compared clinical signs and blood tests.

Result : In respect of frequency, attack rate of Tsutsugamushi Disease was highest in 2010. Single infection patients of Tsutsugamushi Disease were 183 and mixed infection patients with Hemorrhagic Fever with Renal Syndrom were 38. In respect of age, patients over the 70's were mostly infected. In respect of sex, male patients were 70(31.7%) and female patients were 151(68.3). Women were more infected than men. In respect of outbreak time, the more than 70% disease occurrence of all was charged in October and November and it also occurred in spring, summer and winter. In the clinical signs, fever(p=0.045), itcing(p=0.001) and myalgia(p=0.001) of mixed infection was more higher than single infection. And in the blood tests, AST(p=0.001), ALT(p=0.001), blood urea nitrogen(p=0.002), total bilirubin(p=0.001) value of mixed infection was more higher than single infection.

Conclusion : These results would be the basic data on the clinical signs and by early detection of mixed infection, it could be possible to prevent the complications of diseases, shorten the hospitalization period and increase public awareness on the mixed infection.

Key words : Tsutsugamushi Diseases, Hemorrhagic Fever with Renal Syndrom