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A study on leptospiral infection among cows and pigs by culture and microagglutination test
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Joung Soon Kim, Hee Jung Kim, Yong Heo, Sun Il Park, Byung Chun Lee, Hyun Chil Mun, Sung Sam Kim, Young Hee Oh
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Korean J Epidemiol. 1989;11(2):191-197.
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Abstract
This study of leptospiral infections among cows and pigs were carried out to find out possible role of these domestic animals as an infection source for humans, and the magnitude of economic loss due to abortions caused by leptospiral infections among these domestic animals.
Blood samples of 459 cows in May and 446 heads in November 1989 were collected from 19 villages of Kyunggi Province. These samples were cultured and serologically tested.
Kidney of 200 pigs from all over the country were collected from a governmental slaughter house and cultured for isolation of leptospires.
Results obtained are as followings:
1. Only one strain of leptospires, most strongly reactive to Pomona antibody, was isolated from duplicated cultures of 905 cow blood samples in EMJH medium.
2. Serological test by MAT with seven reference strains and three locally isolated strains was positive in 12% of the sample in May and 26% in November samples; positive rate increased slightly as the age of cows increased, however, there was no difference in positive rate by sex, type of cow and area.
3. There was no statistically significant association between abortion history among cows(one year-period) and positive MAT.
4. No leptospires was isolated from 200 pig kidneys cultured, probably because they were all too young to be infected; most of them were around six-month old and raised in professional pig farms.
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Discriminant analysis on symptoms and signs and HFRS in Korea for early diagnosis
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Joung Soon Kim, Young Joon Kim, Yong Heo, Won Young Lee, Cheong Dae Suh, Hae Kong Byun
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Korean J Epidemiol. 1988;10(2):246-253.
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Abstract
The major diseases causing hemorrhagic feb rile syndrome in Korea are Leptospirosis, Scrul Typhus, and HFRS (Hemorrhagic Fever with Renal Syndrome).
Therefore, methods to provide a correct differ ential diagnosis is urgently required for the selection of adequate treatment in the early stage of infection, which will definitely help to reduce the mortality and/or the occurance of complications and duration of illness.
At present, a differential diagnosis in early stage in very difficult because the epidemiological and clinical characteristics of them are much alike.
Although the only reliable way of differentiation is antibody test, it is not applicable for those in early stage since a rise in specific antibody levels to be detectable requires 1 week after infection.
The purpose of this study is to provide criteria which may help to specify Leptospirosis, Scrub Typhus, and HFRS for the early diagnosis and selection of proper treatment.
One hundred and forty eight hospitalized patients because of high fever (more than 38°C) and similar symptoms with above mentioned diseases were studied for one year (Sep. 1987-Oct. 1988).
Isolation of Leptospire and serologic test were done. Serologic test results for HFRS was obtained from medical record. Micro Agglutination Test(MAT) for Leptospirosis and Indirect Fluorescent Antibody test(IFAT) for Scrub Typhus were employed.
The major findings are summarized as follows;
1) Four strains of leptospire were isolated. Sero-positive rates were 32.5 for Leptospire and 12.2% for Scrub Typhus.
Among 148 patients, 24 cases (16.2%) were confirmed to be leptospiral infection by the bacterial isolation and/or serology. And 13 cases (8.8%) were confirmed to be R. tsutsugamushi infection by the serologic test. Among 25 patients who were transfered because of their suspicious symptoms of HFRS, only 9 patients were identified as Korea Antigen positives.
2) The majority (69%) of the Leptospiral positive sera reacted with locally isolated L. icterohamorragiae and canicola. The majority (77%) of the Rickettsial positive sera reacted with Gilliam strain. Among positive sera for Gilliam strain, 18% were found to cross-react with Kato strain.
3) The average duration of illness due to the infections were 71 days by HFRS (the longgest), 36 days by Leptospirosis, and 20 days scrub typhus, which was statistically significant.
4) Chi-square analysis and discriminant analysis were done to clarify the differences in clinico-physical findings of these infections which may differ from each other.
Discriminant analysis was done by use of 37 symptoms, 27 physical signs and 4 vital signs as independent variables and 3 groups (Leptospirosis, scrub typhus, HFRS) as dependent variables.
Chi-square analysis revealed that sputum and hemathemesis in Leptospirosis, abdominal reflect¬ed tenderness in scrub typhus and oliguria in HFRS were selected as the significant variables.
Discriminant analysis also revealed that chest pain in Leptospirosis, CVA tenderness and high respiration rate in scrub typhus and oliguria, flask pain and peak diastolic blood pressure in HFRS were the significant variables.
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Summary
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Epizootiology of canine leptospirosis in a rural area in Korea
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Joung Soon Kim, Yong Heo, Byung Cheon Lee
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Korean J Epidemiol. 1988;10(2):254-258.
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Inspite of the fact that studies on human Leptospirosis in Korea has been accumulated especially following the year 1984 when the disease was firstly confirmed in this country by Kim et.al., recent reports on the Leptospirosis in animals are not available enough. As a part of the major research works designed to study the Leptospirosis in farm animals, the results were obtained from studies on 231 dogs in Hwasung-gun area. Bacterial isolation and determination of serum antibody levels were attempted. These results were then comparatively studied with the age, sex, species, general conditions, and the types of animal keeping.
The findings are summarized as follows;
1) Two isolates were confirmed to be Leptospire by culturing the blood specimen in EMJH media. The dogs from which the bacteria were isolated were Korean native, female, 4 month old, and has been released without special care. And the rectal temperature of these animals were significantly higher than normal, which suggested that the animals were sick.
2) Anti-leptospire antibody positive rate for the dogs confirmed by MAT tests was 19.5%, 23% of these reacted with local L. icterohaemorrhagiae Copenhageni and 40% of them with local L. canicola.
3) Serum antibody positive rates were not significantly varied by sex and age. The antibody positive rates of the street dogs were significantly higher than those of dogs cared strictly at house. And all of the sero-positive dogs were native breed.
These facts suggest that chance of exposure to the risky environment would be the key factor for the leptospirial infection.
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A study on epidemiology of leptospirosis in military personnel in Korea: bacterial isolation and serologic analysis
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Joung Soon Kim, Yong Heo, Won Young Lee, Sang Soo Bae, Hae Kong Byun
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Korean J Epidemiol. 1988;10(2):259-262.
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This report is a part of study results on Leptospirosis Control Campaign in Army. Total number of persons subjected in this study was 1, 889 which were studied in two seasons, 860 in autumn (October-November 1987) and 1029 in early summer (May-June 1988).
The studies were mainly divided in two parts which includes epidemiological analysis and char acterization of the subjected population by interview survey and microbiological analysis including serologic studies on the same subjects to provide base line data for the Leptospirosis control which is an important health problem not only in military but also in general population in this country.
The results are summarized as follows;
1) In bacterial isolation studies only 2 isolates were confirmed to be Leptospire and these two isolates demonstrated strong reaction with anti-L. icterohaemorrhagiae lai serum.
2) The percent of antibody positives serum to Leptospire confirmed by microagglutination tests(MAT) were 10.1% in autumn (1987) and 9.3% in early summer (1988). The difference in two study periods was not significant.
3) The seroconversion rate after the exposure to the field (military trainings) was 8.4%, which were tested a month after the exposure. No significant changes in seroconversion rates observed in 3 consecutive years since 1986(7.6%) were recognized.
4) The differences in antibody positive rates by their ranks, duration in military, their specialties and present military activities were not significant. Especially, those who served in military for a long time were found to have almost the same antibody positive rate compare to those served for shorter period of time.
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An epidemiological investigation of typhoid fever outbreaks in a hot spring resort town and its satellite rural villages
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Joung Soon Kim, Yong Heo, Sung Soo Lee, Duk Hyoung Lee, Kun Young Shon, Sung Woo Lee
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Korean J Epidemiol. 1988;10(1):92-101.
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An epidemiological investigation was carried out to identify source of infection and mode of transmission of typhoid fever outbreak, which has occurred in a hot spring resort town and its satellite rural villages from the begining of the march 1988. The investigation was carried out for two days, April 16th and 17th, on hospitalized patients and the villages where confirmed cases had been reported. The results obtained are as followings：
1. The S. Typhi isolated from 47 patients were all the same phage type that was untypable phage Type.
2. The incidence rate of typhoid fever among surveyed population, the populations belong to the same Ban (about 20-50 households) of the patients re¬ported, was 13.2% in hot spring resort town and 9.8% for the satellite villagers.
3. The incidence showed no difference between male and female population as a whole although for the age groups of 0-9 years old and 10-19 years old the incindence rates were much higher among males, and for the age groups of 20-29 years old, 30-39 years, and 40-49 years the rates were higher among females; for the age group of 20-29 years, female’s rate was as high as 5 times of males. The lowest rate was found among older ages.
4. The study results suggested that the source of infection was primarily water supply contaminated by sewage; the central water supply has been under repair for replacement of broken pipes almost for a month, from the end of February and the begining of April, in on and off fashion.
Supportive data are presented in the text.
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Epidemiologic characteristics of leptospirosis and febrile disease in population in special service at high risk of infection
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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
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Korean J Epidemiol. 1987;9(2):278-287.
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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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A study on the validity of vasectomy status for both the husband vasectomized and his spouse
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Joung Soon Kim, Yong Heo, Jin Soo Lee, I-cheng Chi
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Korean J Epidemiol. 1984;6(1):54-61.
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The objective of this study is to validate the vasectomy status reported by both the husband vasectomized and his spouse prior to the main epidemiological study of cardiovascular diseases in Korean men with special concern for vasectomy as a risk factor of the disease.
The study was carried out in Choonchun city and Chunseong county which have been served by the Community Health Program of Seoul National University for more than ten years. The records of vasectomy for the men living in these areas have been kept accurate by the local family planning association since 1972 providing an unique opportunity for this type of study.
With assistance of the community health program staff, the list of vasectomized subjects including the address was obtained from the family planning association. The total number of eligibles were 512 in Choonchun city and 142 in Chunseong county. The principle of sample selection was based on the longer duration since the vasectomy among eligibles who were available for the interview. Fifty couples from Choonchun city and fifty couples from Chunseong county were selected for the study and matched by their neighborhood control couples for whom the husbands were not vasectomized. Starting from the December of 1983, ten MPH students, five male-female pairs visited these 200 couples home and interviewed. The husbands and wives were interviewed at the same time but separately by the same sex interviewer to avoid communication barrier between the interviewees and interviewers, and the bias that could occur due to opinion exchange between the husband and wife prior to the interview.
The results obtained are as followings:
1. The mean age at the time of vasectomy was 34.4±5.0 years while the age at the time of interview was 42.9±5.9 years with about 8 years of duration from the vasectomy to the interview. The duration of marriage till the vasectomy was 8.8 years average
2. In reporting of vasectomy status, the sensitivity and the sensitivity were 0.99 and 1.0 respectively in both husbands and wives. Kappa, an index value of agreement between husband and wife on vasectomy status, was also 0.99. The agreement rate between the year recorded and the year stated on the year of vasectomy was 36.4% in husband and 31.0% in wife. The agreement rate, however, within two year difference between recorded and stated year of vasectomy was 79.2% in husband and 84.4% in wife. These agreement rates were lower than that of the year of marriage (p < 0.01)
3. In multiple regression analysis using the duration since the vasectomy recorded (A) as dependent variable and the duration stated (B), age (C), level of education (D) as independent variables, the coefficient of determination (R2) was the higher when they were transformed to natural logarithm. The regression models duration of vasectomy from the data provided by interview are as follows:
LNA(husband) = -0.199+0.760LNB+0.144LNC+0.101LND :R2=0.57
LNA(wife) = 1.311+0.725LNB-0.203LNC :R2=0.54
The scatergram between the records duration and the estimated duration by the model fitted better than the duration stated, when 20 samples randomly selected from the data were tried.
(This study was supported by the Family Health International, Research Triangle Park, N.C.)
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Case-control study on psychosexual impact of vasectomy
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Yong Heo, Joung Soon Kim, Hee Sup Yoon, Sook Ja Yang, In Sook Lee
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Korean J Epidemiol. 1984;6(1):124-136.
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The objective of this research is to study psychosexual impacts of vasectomy by means of case-control study in order to provide more valid information on the subject because most of the similar studies have been criticized as having various methodological defects.
In this study one hundred vasectomized men and their wives were randomly selected from a rural and semi-urban communities and matched with non-vasectomized neighbors of the cases to achieve higher validity of the data by isolating the impacts of vasectomy from a set of other possible confounding variables such as age, socioeconomic status and occupation.
The study was carried out from the December 1983 to the January 1984. The most cases were vasectomized during the period between 1972 and 1979 according to the record obtained from the local family planning association.
The information were collected by interviewing husband and wife at the same time but separately to minimize bias that might occur from mutual communication prior to the interview.
The summary of the results obtained are as followings:
1. General characteristics of the subjects studied
1) At the time of vasectomy the mean age was 34.4 years and the average number of children and son was 3.2 and 1.7 respectively. The mean duration of marriage till the vasectomy was 8.9 year. The average number of son at the time of the study was 1.7 for the case group contrast to 1.5 for the control group of which difference was statistically significant (p=0.035) although the total number of children was the same.
2) There was no difference between the case and control groups in the level of education and occupation.
3) The motivation of the sterilization stated by the cases of vasectomy was enough number of children and economic reason in 70.8%. The reason of selecting vasectomy among other contraceptive methods were the simplicity, low failure rate and less complication of the vasectomy in the majority of the cases (85.2%).
2. Psychosexual impacts of vasectomy
1) In psychosexual impacts classified into four categories, i.e. tiredness of sex, sxiness, frequency of coitus and sexual satisfaction, the proportion of husband reporting ‘No Change’ was significantly less at the time of interview than the time 2-3 years right after the vasectomy. On the other hand, in both sexiness and coitus frequency the proportion of husband reporting ‘Decreased’ were significantly higher at the time of interview than the time 2-3 years after the vasectomy.
2) Responses of husband and wife on the husband’s psychosexual change at the time of interview in case and control groups showed that the proportion of couples reporting ‘No Change’ was higher, and reporting 'Decreased' was lower in case group than in control group. Particularly the differences in the sexiness and frequency of coitus between the case and control groups were statistically significant (p=0.005) being decreased more in control group.
3) The proportion of husband reporting 'Decreased’ in sexual activities was positively in proportion to the age whereas the proportion reporting ‘No Change’ was negatively in proportion to the age for both case and control groups.
4) The agreement rate between the responses of husband and wife on the husband’s psychosexual change was low for both case and control couples (overall value of kappa=0.21-0.37).
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