PCR을 이용한 해외 유입 설사질환 원인 세균성 병원체의 분포 및 특성 연구
Detection of the Causative Agents of Traveler’s Diarrhea Using a Real-Time PCR Screening Method
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배경: 최근 들어 감염성 설사질환의 국내발생은 증가가 둔화된 추세를 보이는데 비하여 해외여행을 통해 유입되는 설사 환자의 수는 계속 증가하고 있다. 본 연구에서는 이처럼 증가추세에 있는 해외유입 설사질환의 원인병원체 중 세균성 원인병원체의 분포를 알아보고자 하였다. 방법: 2007년 9월부터 2008년 3월까지 김해국제공항을 통해 입국한 여행객 중 설사환자 검체 132건을 채취한 후, 이들 검체에 대해 Real time PCR을 이용하여 ETEC 등 12종의 세균성 병원체의 존재를 먼저 탐색하였다. PCR 양성일 경우 해당 병원체 분리를 시도하였고, 분리된 경우 필요에 따라 병원성 요소의 보유 여부를 확인하였다. 결과: PCR 탐색결과는 총 93개의 검체에서 양성을 보여 70.5%의 양성률을 보였으며, 이들로부터 V. parahaemolyticus가 18주, ETEC 17주, S. sonnei 4주 등 총 9종의 병원체 50주가 분리되어 37.9%의 원인 규명률을 보였다. 그러나 L. monocytogens와 C. jejuni는 PCR 양성인 검체도 없었고, B. cereus는 병원성 요소를 가진 균이 분리되지 않았다. 결론: 대상병원체에서 바이러스와 EAEC가 배제되었음에도 불구하고 본 연구에서의 높은 규명률은 다른 연구에서 불 규명된 건들이 세균성 원인병원체일 것이라는 가설을 간접적으로 증명하였으며, 또한 PCR을 이용한 탐색방법의 사용이 규명률 향상에 도움이 됨을 밝혔다고 판단된다. 또 본 연구는 국내 여행자설사의 주요 원인병원체가 ETEC와 V. parahaemolyticus임을 밝혀내어 해외유입 설사질환에 대한 예방 및 관리대책 수립에 중요한 자료를 제공하였다고 생각된다.
Abstract
Background: The incidence of infectious diarrheal disease in Korea has decreased over the past decade, but traveler's diarrhea (TD) is increasing in frequency. We therefore investigated the distribution of the causative agents of TD. Methods: A total of 132 rectal swab specimens were acquired from TD patients who entered the country via Gimhae International Airport. The specimens were screened for 12 bacterial pathogens by real- time PCR, and target pathogens were isolated from the PCR positive specimens using conventional microbiological isolation methods. Results: A total of 93 specimens (70.5%) showed positive PCR screening results, and of these specimens, nine species and 50 isolates (37.9%), including Vibrio parahaemolyticus (18 isolates) and ETEC (17 isolates), were isolated. No specimens were PCR positive for Listeria monocytogenes or Campylobacter jejuni, and no pathogenic Bacillus cereus were isolated. Conclusion: Even though viruses and EAEC were not included as target pathogens, the high isolation rate of these pathogens in this study provides indirect evidence that most cases of pathogen-negative TD are caused by undetected bacterial agents. Furthermore, our study results confirm the effectiveness of real-time PCR-based screening methods. This study is the first report in Korea to demonstrate that ETEC and V. parahaemolyticus are the major causative pathogens of TD, and this knowledge can be used to help treat and prevent TD.
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