경기도 남부 지역에서 발생한 쯔쯔가무시병 212예의 임상적 특성 및 초기 단순 흉부 엑스선 사진의 의의
Clinical Features of 212 Cases of Scrub Typhus in Southern Region ofGyeonggi-Do and The Significance of Initial Simple Chest X-Ray
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목 적 : 쯔쯔가무시병의 임상 양상은 적절한 항균제 투여에 의해 쉽게 치료될 수 있는 경미한 경우에서 생명을 위협하는 합병증을 동반하는 중증 질환까지 다양하다. 발열, 발진, 가피 등 특징적인 임상 증상을 통해 조기에 진단하는 것이 예후에 중요하며 중증도를 예측할 수 있는 임상적인 지표를 조기에 확인하는 것도 효과적인 치료를 위해 매우 중요하다. 재료 및 방법 : 2000년 1월부터 2004년 12월까지 가톨릭대학교 성빈센트병원에 쯔쯔가무시병으로 입원한 18세 이상의 환자 212명에 대한 의무 기록을 후향적으로 검토하여 임상 양상, 실험실 소견 및 단순 흉부 엑스선 사진의 판독 소견을 분석하였다. 결 과 : 환자들의 평균 연령은 59.7세였고, 여성이 145명, 남성이 67명이었다. 총 212명의 쯔쯔가무시병 환자들에게 7일간 독시사이클린을 투여하였고, 사망한 1명을 제외한 211명(99.5%)에서 후유증이나 재발 없이 치료에 성공하였다. 총 212명 중 59명(27.8%)에서 단순 흉부 엑스선 상 흉막 삼출, 간질성 폐렴 및 폐침윤 등의 비정상 소견이 관찰되었는데, 정상 소견을 보인 환자군에 비해 혈청 C-반응 단백이나 ADA 수치가 더 높았고, 혈색소 수치나 혈청 알부민 수치는 더 낮았다. 그러나 항균제 투여 후 체온이 정상화되는데 걸린 시간이나 치료 실패율에서는 통계적으로 의미 있는 차이를 보이지 않았다. 결 론 : 쯔쯔가무시병 환자들에게 독시사이클린을 하루 200 mg씩 7일간 투여하여 효과적으로 치료할 수 있었다. 향후 내원 초기 환자들의 실험실적 결과를 예측하는 지표로서 단순 흉부 엑스선 소견이 이용될 수 있을 것이다.
Abstract
Background : Scrub typhus may cause complications such as pneumonia, meningoencephalitis, liver failure, and renal failure, although most of patients with scrub typhus are treated with appropriate antibiotics. Scrub typhus has varying degree of disease severity, from mild to fatal, therefore, early recognition of the clinical parameters representing the severity of the disease is a very important factor for effective treatment. Materials and Methods : We investigated clinical, laboratory results and simple chest X-ray images retrospectively by reviewing the medical records of 212 scrub typhus patients, admitted to Catholic University St. Vincent's Hospital from September 2000 to November 2004. Results : Patients demographics revealed a mean age of 59.7, (age: 18 to 90), and 145 of the 212 patients were female (68.4%). Cure was achieved in 211 (99.5%) of the 212 patients with the 1-week course of daily 200 mg doses of doxycycline. Fifty-nine (27.8%) of the patients revealed the abnormal findings, such as interstitial, pneumonic infiltrations, or pleural effusions, in the results of simple chest X-ray images, and cure was achieved in 58 (98.3%) of 59 patients. The median time to defervescence was 27.1 h for the group showing abnormal simple chest X-ray findings, 23.3 h for the group showing normal chest X-ray findings. The titers of serum C-reactive protein and adenine deaminase were significantly higher, and initial hemoglobin and serum albumin levels were lower, in the group with abnormal simple chest X-ray findings, compared to the group with normal simple chest X-ray findings. Conclusion : The 1-week course of daily 200-mg doses of doxycycline was effective for the treatment of scrub typhus. Initial simple chest X-ray findings may be useful in the selection of patients, who might show more favorable laboratory findings.
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