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Korean Journal of Epidemiology 1987;9(2): 278-287.
강원도 내륙 주둔 특수집단내 발열환자를 대상으로 한 렙토스피라 감염의 역학적 연구
김정순, 허용, 정해원, 이원영, 변해공, 서정대, 성천모, 안문영, 최중명, 이석재, 한용철
Epidemiologic characteristics of leptospirosis and febrile disease in population in special service at high risk of infection
Joung Soon Kim, Yong Heo, H.W Chung, W.Y Lee, H.G Byun, J.D Suh, C.M Sung, M.Y Ahn, J.M Choi, S.J Lee, Y.C Hahn
Abstract
This is a part of serial works on leptospirosis. In this study, a correct characterization of all of the hemorrhagic disease accompanying high fever which might be caused by various agents such as leptospira, rickettsia, viruses, and others if any was attempted by classifying the symptoms and identifing the etiologic agent which is responsible for the cases. And also serologic studies along with fundamental epidemiologic investigation on the clinical signs of the patients selected from the study area were done to draw a comprehensive conclusion. The specific aim which is the major focus of this part of study is to find out prevalence rate of true leptospira patients among patients with high fever and to characterize the clinical pictures, such as clinical signs and symptoms, which might be specific for the true cases of leptospiral infection which is confirmed by bacterial isolation from the cases. One hundred and nineteen patients hospitalized because of high fever (more than 38°C) for more than 24 hours were studied during 10 month (Aug., 1986-May 1987). The findings are summarized as follows; 1) At the time of admission, leptospira isolation rate was 5.8% (6/103) and this became 13.7% (7/44, average 8.4%) after one week of hospitalization. 2) The serum samples were testeded for the presence of the antibodies specific to 22 different servar in which 3 strains isolated in this laboratory from human blood employing microagglutination tests. The positive rate was 34.9% when the first blood samples which were collected at the time of admission tested. And it became 50.9% when the second samples were tested one after the first. The antibody conversion rate within one week was 32.4%. Only one out of 16 cases who were antibody positive at the first test was found to be negatively converted. When these were grouped by their antibody titer, 83.7% of whole antibody positive samples (64) demonstrated antibody titer 1.400 or lower and only 3.1% of them demonstrated higher than 1:3200. 3) Significantly higher positive rate were found when the sera were tested with the fresh strains isolated from that area. The majority (32.4%) of the sera from Chullwon area positively reacted with locally isolated L. icterhemorrhagiae lai and 17.1% of sera from Yangoo area with locally isollated L. canicola. In Chullwon area, 65% of the serum samples were identified belonging to 3 serovars, L. icterohemorrhagiae lai (32.4%), L. canicola (14.7%), and L. ictervhemorrhagiae copenhageni (17.6%). In Yangoo area, 54% of the scrum samples were positive for 4 serovars, L. icterohemorrhagiae lai (14.6%), L. hebdomadis (12.2%), L. icterohemorrhagiae copenhageni (9.8%) and above mentioned local isolate. 4) among 92 patients with high fever 19 cases (20.2%) were confirmed to be leptospiral infection by the both tests for bacterial isolation and serology. Sixteen cases (16%) were the suspicious cases of leptospirosis. The rest of them, 60 patients (63.8%) were found to be uninfected with the bacteria. 5) When the seasonal changes of incidence of the feverrile disease were comparatively analyzed, the cases belonged to confirmed as leptospirosis occured maily in Autumn whereas the others occured throughout the year except the spring in which time a slight decreased cases were recorded. The incidence of the confirmed cases were higher in groups which had been exposed to field trainings. Sore throat, runny nose, hematemesis, and muscle pain were found to be significantly frequent signs complained by the confirmed cases and diastolic blood pressure of the cases was higher. 6) amomg the confirmed cases only 5.3% of them were primarily diagnosed as leptospirosis and majority were diagnosed as fever with unknown reason (47.3%) when they were adimitted because of the high fever. Whereas among the cases confirmed as uninfected 25% was fever with unknown reason and 46.7% for the others. The proportion of cases diagnosed as leptospirosis was 5.0%.


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