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A seroepidemiologic study on scrub typhus in Koje island
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Il Suh, Sang Nae Cho, Il Soon Kim, Young Joon Kim, Joon Yong Bang, Eun Cheol Park, Kyung Jong Lee, Ki Hong Jeun, Moon Shik Kim, Dae Kyu Oh
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Korean J Epidemiol. 1988;10(2):230-238.
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 Abstract
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Abstract
In order to examine the past infection rate an incidence of Scrub typhus a seroepidemiologi study was performed in Koje County. Paired serums were collected from 518 residents in Sadeung and Koje myun.
Serum were analyzed by ELISA for detection o IgG to R. tsutsugamushi, and were also analyzed by Microscopic Agglutination test for Leptospirosis.
First serum were collected from Aug. 25 to Aug. 31, 1987 and second serum were collected from Jan. 13 to Jan 31, 1988.
The result summarized as follows:
1. One hunderd seventy people(33.9%) had a experience of infection by R. tsutsugamushi： among 501 subjects. The past infection rate was significantly higher in female than that in male and it was increased according to age. By occupation farmers showed the highest infection rate.
2. The incidence rate of Scrub typhus was estimated 4.7%(19 people among 405 subjects) during the study period. The incidence rate was also significantly higher in female than that in male and 40-49 age group showed the highest incidence rate.
3. Two people(0.4%) were reacted to Microscopic Agglutnation test for Leptospirosis. Among 501 sujects and these two people were also reacted to ELISA for Scrub typhus.
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Summary
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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
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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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An epidemiologic study on scrub typhus in Koje island
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Il Suh, Il Soon Kim, Byung Yool Cheon, Young Joon Kim, Yun Sop Chong
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Korean J Epidemiol. 1987;9(1):17-27.
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Abstract
Scrub typhus was reported in 1986 for the first time among Korean. Koje island was suspected of an endemic area because many patients with symptoms like scrub typhus were reported. To identify endemicity and epidemiologic characteristics of the disease an epidemiologic survey was conducted from Oct. 1 to Nov. 30 in Koje island. Patients with similar symptoms and signs suspected of scrub typhus were reported from 7 clinics in Koje island during the survey period. Bloods were drawn from those suspected patients and interviews were followed.
Final diagnosis of scrub typhus was made by Indirect immunoperoxidase test in addition to clinical signs and symptoms.
The endemicity of scrub typhus was identified. Incidence rate of scrub typhus in Koje island in 1986 was estimated to be exceeding 14.4 per 100,000 population. The rate was slightly higher in woman than that of man and majority of patients were aged between 20 and 60. Any special findings in relation with occupation of patients were unable to identify with present study.
The major clinical symptoms were high fever, rash, loss of appetite, fatigue, headache and lymphnode enlargement. Eschar which is a pathognomonic finding of the disease was observed in 7 patients out of 15 serologically confirmed cases. The duration of illness was about 6 to 20 days.
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