3차 의료기관에 입원한 노숙자환자에서 감염질환의 유병율
Prevalence of Infectious Diseases in the Homeless Admitted to a Tertiary Care Center
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목 적 : 3차 의료기관에서 입원치료를 받았던 노숙자를 대상으로 감염성 질환의 유병율을 알아보고자 하였다. 재료 및 방법 : 2002년 1월부터 2004년 8월 사이에 국립의료원에서 입원 치료를 받았던 269명의 노숙자 환자들을 대상으로 의무기록을 조사하였다. 결 과 : 연구 기간동안 입원치료를 받은 총 269명의 노숙자 환자 중 남자가 249명(92.9%), 여자가 19명(7.1%)이었다. 감염질환의 유병율은 B형 간염이 228명 중 15명(6.6 %), C형 간염 113명 중 8명(7.1%), 결핵은 269명중 19명(7.1%), VDRL 양성인 경우는 234명 중 25명(10.7%), 항 사람면역결핍바이러스항체 양성은 130명중 2명(1.5%)이었다. B형 간염표면항원에 대한 항체 형성자는 118명(51.7 %), 항체 미형성자는 95명(41.7%)이었다. 결핵으로 진단된 19명 중 객담도말 및 배양검사와 조직검사로 확인된 경우가 14명, 균음성이나 임상적으로 의심되는 경우가 5명이었다. 간질환 및 관련된 합병증으로 입원한 환자 28명 중 B형 및 C형 간염바이러스에 관련된 경우는 5명(17.9%)에 불과하였고 결핵은 19명중 13명(68.4%)이 폐결핵 및 림프절종대의 증상으로 입원치료를 받았다. 복합 감염의 경우는 총 9명이었는데 후천면역결핍증후군 환자였던 2명중 1명이 결핵에 이환되어 있으면서 VDRL 양성소견을 보였고 다른 1명이 HIV와 결핵의 동시감염이었다. 결 론 : 노숙자 입원환자에서 결핵, C형 간염 및 매독의 유병율이 일반 인구에 비해 높았다. 노숙자환자를 담당하는 의료인력를 보호하고 환자의 감염질환 유무를 파악하기 위해 적절한 선별검사가 필요하며 감염질환의 확산을 방지하기 위한 정부의 적극적인 대책이 필요하다.
Abstract
Background : Despite the expected high prevalence of several infectious diseases among the homeless, a majority of them have not received screening test and early treatment. Materials and Methods : The subjects of this study were 269 homeless patients who had been hospitalized in the National Medical Center (Korea) between January 2002 and August 2004. Their medical histories and records were reviewed to analyze the prevalence and clinical characteristics of hepatitis B and C, syphilis, tuberculosis and HIV infection among them. Results : The entire 269 homeless patients being hospitalized during the period of this study consist of 249 male patients and 19 female patients. For the prevalence of infectious diseases, HBV was seen in 15 of 228 patients (6.6%); HCV in 8 of 113 patients (7.1%); VDRL positive in 25 of 234 patients (10.7 %); HIV antibody positive in 2 of 130 (1.5%); and tuberculosis in 19 of 269 (7.1%). The number of patients who had the antibody to hepatitis B was 118 (51.7%). Of 28 patients hospitalized with the chief complaints of liver diseases and/or their complications, the number of cases infected with hepatitis B and C viruses was only 5 (17.9%). On the other hand, for patients with tuberculosis, 13 of 19 cases (68.4%) were hospitalized with the chief complaints associated with symptoms of pulmonary tuberculosis or enlarged lymph nodes. The number of patients with multiple infectious diseases was 9 in total. Conclusion : As expected, the prevalence of some infectious diseases were higher among the homeless inpatients, than non-homeless population. Proper screening tests in order to determine the presence of any infectious diseases among the patients and protect involved medical staff are necessary. Further, the government should take proactive measures to prevent the spread of infectious diseases in the aspect of public health.
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