Studies on the vivax malaria readmitted in military hospital / 대한내과학회지

BACKGROUND: Vivax malaria reemerged in the Republic of Korea in 1993. Since 1993, many cases with malaria have been reported. But due to the antimalarial activities including chemoprophylaxis and repellents, the annual incidence of malaria has been decreased. Antimalarial chemoprophylaxis is effective to control disease, but will facilitate the spread of drug-resistance or drug-tolerance. Thus, it is needed to analyze the effect of treatment outcome. METHODS: We analyzed the patients diagnosed as vivax malaria who readmitted in military hospital from 1997 to 2003. All cases were confirmed as malaria by peripheral blood smear in military hospital. RESULTS: Forty-five cases were observed in second attack and three cases were observed in third attack. All cases were vivax malaria with fever, and tertian fever developed in 25 cases (55.5%) in first attack, 22 cases (48.8%) in second attack. Various distribution of the interval between first attack remission and second attack was observed (from 8 days to 37 months). Of the all cases, 41 cases (91.1%) developed malaria between May and October in first attack, 39 cases (86.6%) in second attack. Readmission rate were 0.68%. CONCLUSION: We observed that only 45 of 6,566 (0.68%) cases were readmitted. The treatment of vivax malaria in Korea Army is effective in controlling malaria and should be cotinued. But continued surveillance with veterans and with or without chemoprophylaxis are warranted to eliminate the spread of the disease.

Two Cases of Brugian Filariasis Diagnosed Incidentally on Peripheral Blood Smears / 대한진단검사의학회지

The Brugian filariasis in Korea was once endemic in several areas including Jeju-do and small remote islands located in the southwestern part of the Korean peninsula. But recently it has almost been controlled. The first patient was a 42-year-old man, who visited the hospital with the chief complaints of fatigue, jaundice and edema on the right low extremity. Examination of a peripheral blood smear revealed non-megaloblastic macrocytic anemia, thrombocytopenia and eosinophilia, and a parasite, which was identified as microfilaria of Brugia malayi on the glass slide of blood obtained from the patient at midnight. The second patient was a 23-year-old man, who visited the hospital with the chief complaints of cough, sputum and fever. A parasite resembling that of the first patient was found in a peripheral blood smear accompaning neutrophilia. No more parasites, however, were found in the peripheral blood obtained from the patient at midnight. These two clinical cases of Brugian filariasis indicate that the clinical laboratory in Korea should be able to detect microfilariae for the diagnosis of filariasis.

A Case of Community-acquired Legionnaires' Disease in a Renal Transplant Recipient / 감염

Legionella species are causative agents of both community-acquired and nosocomial pneumonia. The spectrum of disease ranges from asymptomatic infection to serious disease and two specific syndromes are identified, i.e., Legionnaires' disease and Pontiac fever. Legionnaires' disease tends to occur in patients with underlying illnesses, so Legionella pneumonia should be included in the differential diagnosis of severe community-acquired pneumonia, especially in immunocompromised patients. Herein we report a case of community- acquired Legionnaires' disease in a patient with renal transplantation. A 63-year old man was admitted because of fever, chills, and dyspnea. Thirteen years ago, he had undergone kidney transplantation and he had received immu-nosuppressive agents, including deflazacort and cyclosporin A. On physical examination crackles were heard in the middle area of the right lung and the chest radiograph showed multifocal patchy consolidations on both lung fields. Serologic tests for Legionella pneumophila antibody, urinary antigen assay for L. pneumophila serogroup 1, and polymerase chain reaction for Legionella DNA fragments (5S rRNA, IPC, mip target sequence) were positive. The patient was treated with roxithromycin for twenty eight days and recovered without complication.