쯔쯔가무시병에서 상부위장관 병변의 임상 특징과 발생기전에 관한 연구
The clinical feature and pathogenesis of gastroduodenal lesion in patients with scrub typhus
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Background/Aims : The aim of the study was to investigate the gastric involvement of Orientia tsutsugamushi and the relationship between the clinical features and gastritis in patients with scrub typhus. Methods : The study included 98 patients who had been diagnosed with scrub typhus between January 2003 and December 2006. Sixteen patients were selected to undergo gastroduodenoscopy with endoscopic biopsy for molecular study. The clinical severity index score (CSIS) was evaluated. Rickettsial DNA was amplified using the paraffin- embedded biopsy tissue by performing nested PCR. The expressions of ICAM-1 and VCAM-1 were investigated by immunohistochemistry to evaluate their roles in the pathogenesis of scrub typhus. Results : The endoscopic findings were gastritis (n=1), erosion (n=4) and ulcer (n=11). The average CSIS was 3.65±1.09. Four cases of nested PCR of the 16 gastric mucosal biopsies were positive. The gastric samples that were taken earlier after therapy tended to be PCR-positive (2.00±00 days vs. 3.83±1.27 days, p<0.001). There was no difference of the clinical features and the CSISs between the PCR-positive and PCR-negative patients. The biopsied tissue revealed no vasculitis findings. Staining for ICAM-1 was more expressed in the scrub typhus group as compared with the normal control group. Staining for VCAM-1 was sporadically expressed in the scrub typhus group and normal control group. In comparison with the patients with Helicobacter pylori-associated gastritis, the immunohistochemical staining showed no difference of expression in the patients with O. tsutsugamushi-infected gastritis. Conclusions : The gastritis seen in scrub typhus patients could be typhus that is related to the direct involvement of O. tsutsugamushi. The increased expression of ICAM-1 may be related with gastric mucosal endothelial injury due to direct infection. (Korean J Med 74:648-657, 2008)
Abstract
Background/Aims : The aim of the study was to investigate the gastric involvement of Orientia tsutsugamushi and the relationship between the clinical features and gastritis in patients with scrub typhus. Methods : The study included 98 patients who had been diagnosed with scrub typhus between January 2003 and December 2006. Sixteen patients were selected to undergo gastroduodenoscopy with endoscopic biopsy for molecular study. The clinical severity index score (CSIS) was evaluated. Rickettsial DNA was amplified using the paraffin- embedded biopsy tissue by performing nested PCR. The expressions of ICAM-1 and VCAM-1 were investigated by immunohistochemistry to evaluate their roles in the pathogenesis of scrub typhus. Results : The endoscopic findings were gastritis (n=1), erosion (n=4) and ulcer (n=11). The average CSIS was 3.65±1.09. Four cases of nested PCR of the 16 gastric mucosal biopsies were positive. The gastric samples that were taken earlier after therapy tended to be PCR-positive (2.00±00 days vs. 3.83±1.27 days, p<0.001). There was no difference of the clinical features and the CSISs between the PCR-positive and PCR-negative patients. The biopsied tissue revealed no vasculitis findings. Staining for ICAM-1 was more expressed in the scrub typhus group as compared with the normal control group. Staining for VCAM-1 was sporadically expressed in the scrub typhus group and normal control group. In comparison with the patients with Helicobacter pylori-associated gastritis, the immunohistochemical staining showed no difference of expression in the patients with O. tsutsugamushi-infected gastritis. Conclusions : The gastritis seen in scrub typhus patients could be typhus that is related to the direct involvement of O. tsutsugamushi. The increased expression of ICAM-1 may be related with gastric mucosal endothelial injury due to direct infection. (Korean J Med 74:648-657, 2008)
참고문헌 (33)
- 질병관리본부, "쯔쯔가무시병 연도별 발생 통계" (2007), 질병관리본부 전염병정보망
- 송호연, "Rickettsia tsutsugamushi 감염에 의한 혈관 내피세포의 손상기전에 관한 연구", 대한미생물학회지, 29, pp.65~78 (1994)
- 인경수, "Orientia tsutsugamushi의 유핵세포내 감염능 분석 및 기전", 대한미생물학회지, 34, pp.435~444 (1999)
- 김동민, "Scrub Typhus:확진된 76예의 임상 소견에 대한 전향적 연구", 감염과화학요법, 38(4), pp.186~191 (2006), 대한감염학회
- 박정호, "쯔쯔가무시병 환자의 중증도와 관련된 상부 위장관 내시경 소견 및 예측인자들에 관한 연구", 대한내과학회지, 69(5), pp.518~527 (2005), 대한내과학회
- Kim SJ, "The clinical significance of upper gastrointestinal endoscopy in gastrointestinal vasculitis related to scrub typhus", Endoscopy, 32, pp.950~955 (2000)
- Aung-Thu, "Gastrointestinal manifestations of septic patients with scrub typhus in Maharat Nakhon Ratchasima hospital", Southeast Asian J Trop Med Public Health, 35, pp.845~851 (2004)
- Pai H, "Central nervous system involvement in patients with scrub typhus", Clin Infect Dis, 24, pp.436~440 (1997)
- 이현숙, "쯔쯔가무시병에 동반된 간질성 폐렴에 관한 연구", 대한내과학회지, 50, pp.77~86 (1996)
- Song Sun Wha, "Clinical Role of Interstitial Pneumonia in Patients with Scrub Typhus: A Possible Marker of Disease Severity", Journal of Korean Medical Science, 19(5), pp.668~673 (2004), 대한의학회
- Park JS, "Acute respiratory distress syndrome associated with scrub typhus: diffuse alveolar damage without pulmonary vasculitis", J Korean Med Sci, 15, pp.343~345 (2000)
- 김병수, "쯔쯔가무시병 환자에서 발생한급성신부전증의 임상적 고찰", The Korean Journal of Nephrology, 22(6), pp.10~705 (2003), 대한신장학회
- 김효열, "쯔쯔가무시병의 최근 국내동향", 대한내과학회지, 67, pp.516~522 (2004)
- 김경진, "쯔쯔가무시병 환자들의 합병증 발생과 관련 있는 임상 소견", 대한응급의학회지, 12, pp.268~276 (2001)
- 김준형, "중환자실로 입원한 쯔쯔가무시병 환자들의 임상상", 제 55차 대한내과학회 추계학술대회, pp.102~103 (2004)
- 김영옥, "쯔쯔가무시병 환자에서 질환의 중증도의 표지자로서의 저알부민혈증의 임상적 의의", 대한내과학회지, 59, pp.516~521 (2000)
- Jiang J, "Development of a quantitative real-time polymerase chain reaction assay specific for Orientia tsutsugamushi", Am J Trop Med Hyg, 70, pp.351~356 (2004)
- Kim DM, "Acute renal failure due to acute tubular necrosis caused by direct invasion of Orientia tsutsugamushi", J Clin Microbiol, 46, pp.1548~1550 (2007)
- Smith CW, "Adhesion molecules and receptors", J Allergy Clin Immunol, 121, pp.375~379 (2008)
- Jenkins N, "Plasmodium falciparum intercellular adhesion molecule-1 -based cytoadherence-related signaling in human endothelial cells", J Infect Dis, 196, pp.321~327 (2007)
- Staunton DE, "A cell adhesion molecule, ICAM-1, is the major surface receptor for rhinoviruses", Cell, 56, pp.849~853 (1989)
- 이은봉, "Orientia tsutsugamushi 감염에 의한 사람 제대정맥 내피세포에서 부착 분자 발현의 변화", 대한미생물학회지, 35, pp.159~169 (2000)
- 이흥범, "쯔쯔가무시병 환자에서 Soluble ICAM-1 농도의 변화", 대한내과학회지, 54, pp.1~6 (1998)
- Hatz RA, "Pattern of adhesion molecule expression on vascular endothelium in Helicobacter pylori- associated antral gastritis", Gastroenterology, 112, pp.1908~1919 (1997)
- Innocenti M, "Helicobacter pylori-induced activation of human endothelial cells", Infect Immun, 70, pp.4581~4590 (2002)
- Selvaraj SK, "Outer membrane protein A of Escherichia coli K1 selectively enhances the expression of intercellular adhesion molecule-1 in brain microvascular endothelial cells", Microbes Infect, 9, pp.547~557 (2007)
- Wilson SL, "Listeria monocytogenes infection and activation of human brain microvascular endothelial cells", J Infect Dis, 178, pp.1658~1666 (1998)
- Sellati TJ, "Borrelia burgdorferi upregulates expression of adhesion molecules on endothelial cells and promotes transendothelial migration of neutrophils in vitro", Infect Immun, 63, pp.4439~4447 (1995)
- Riley BS, "Virulent Treponema pallidum promotes adhesion of leukocytes to human vascular endothelial cells", Infect Immun, 62, pp.4622~4625 (1994)
- Vieira ML, "A novel leptospiral protein increases ICAM-1 and E-selectin expression in human umbilical vein endothelial cells", FEMS Microbiol Lett, 276, pp.172~180 (2007)
- Kim I, "Vascular endothelial growth factor expression of intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1), and E-selectin through nuclear factor- kappa B activation in endothelial cells", J Biol Chem, 276, pp.7614~7620 (2001)
- Min JK, "TNF-related activation- induced cytokine enhances leukocyte adhesiveness: induction of ICAM-1 and VCAM-1 via TNF receptor-associated factor and protein kinase C-dependent NF-kappaB activation in endothelial cells", J Immunol, 175, pp.531~540 (2005)
- Moreland JG, "Organism- specific neutrophil-endothelial cell interactions in response to Escherichia coli, Streptococcus pneumoniae, and Staphylococcus aureus", J Immunol, 172, pp.426~432 (2004)