인도네시아에서 유입된 클로로퀸 내성 삼일열 말라리아 1예
A Case of Chloroquine-resistant Plasmodiumvivax Malaria Imported from Indonesia
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열대열 말라리아에서 항말라리아에 대한 내성은 세계적인 현상이지만, 삼일열 말라리아에서 클로로퀸 내성은 1989년부터 뉴기니 주변 지역에서 주로 발생하고 있다. 이들 지역으로 여행하는 여행객이 증가하면서 클로로퀸 내성 삼일열 말라이아 예들 보고가 늘고 있다. 저자들은 인도네시아의 망골 섬 여행 후 발생한 클로로퀸 내성 삼일열 말라리아를 경험했으며, P. vivax의 apical membrane antigen-1을 코딩하는 polymorphic region 분석에서 환자의 삼일열 말라리아 원충은 국내 발생주와는 다른 것을 증명했고, P. vivax mdr1 gene의 염기서열 분석에서 1076 코돈이 L에서 F로 변한 것을 확인하였다. 경구 퀴니딘으로 치료하여 증상과 원충혈증이 호전되었다.
Abstract
Resistance of falciparum malaria to antimalarial agents is prevalent in many areas, whereas chloroquine-resistant vivax malaria has been reported mainly around New Guinea since 1989. Concomitant with the spread of chloroquine-resistant P. vivax and increase in number of international travelers, imported cases of chloroquine-resistant vivax malaria in travelers returning from these areas has been reported. We experienced a case of chloroquine resistance P. vivax infection imported from Mangole Island, Indonesia. Its origin is confirmed not to be indigenous by the gene encoding analysis for the polymorphic region of apical membrane antigen-1 in P. vivax. Gene sequencing of the P. vivax mdr1 gene revealed only one substitution located at the codon 1076 (F1076L). The case was managed with oral quinidine with successful outcomes.
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