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서울에 있어서의 불현성(不顯性) 및 비정형적 장내전염(腸內傳染)에 대한 세균학적 연구

Other Titles
 Bacteriological studies of subclinical and atypical enteric infection in seoul in 1958-1959 
Issue Date
1959
Description
의학과/석사
Abstract
調査件數
分離數
+--------+-----------------+-----+------+--------+-------+------+------------+--------+--------+---------+ 3. 腸內 病原菌중 살모넬라 와 시겔라 의 菌種이 數多하고 各菌種으로 惹起되는 臨床 症狀이 구구하고 均一하지 않아서 臨床 診斷이 客 하지 않다는 것. 4. 抗生物質을 不適當하게 使用하여 腸內 傳染病이 治療되지 않고 不定型으로 長期間 繼續되고 또 傳染菌이 漸次 耐性을 獲得하고 不定型의 症狀을 惹起한다는 것. 5. 一般 病院에서 臨床的 治療에만 置重하고 細菌學的 檢査를 疏忽히 하고 있다는 것. 6. 韓國人 食性이 生食을 좋아하며 野菜類를 充分히 씻어 먹지 않는다는 것. BACTERIOLOGICAL STUDIES OF SUBCLINICAL AND ATYPICAL ENTERIC INFECTION IN SEOUL IN 1958 - 1959 Approximately 70 per cent of the isolated strains had acquired resistance against antibiotics, such as penicillin, streptomycin, tetracycline, erthromycin and neomycin, etc. The group distribution of the strains which were isolated during the study were almost identical with these form patients with enteric infections previously reported. It might be commented upon that the high percentage and wide range of distribution of subclinical and atypical enteric bacterial infections is due to: 1. Seoul City is equipped with a poor water and a poor sewage disposal system. 2. The living conditions of most of the citizens in Seoul are unsanitary. 3. The clinical diagnosis of enteric bacterial infection is not easily made because enteric bacteria are of numerous types and clinical symptoms for each type are not identical. 4. In Seoul, many mutant strains have acquired resistance against antibiotics due to inappropriate treatment. Those strains may cause atypical symptoms of enteric infections. 5. As a rule general practitioners do not request a laboratory examination before treating enteric infections. 6. The eating of unwashed vegetables and fruits exposed on the street must be a frequent cause. A bacteriological study of subclinical and atypical enteric infections was undertaken in 1958. Three thousand one hundred seventy four persons were examined from February 1958 to February 1959 in Yonsei University, Severance Hospital, Seoul, Korea. Each person was given a physical examination. Enquiries were made regarding of fever, nausea, vomiting, gastrointestinal disturbances, anemia, lymphadenopathy, rash and hepathomegaly. Specimens of stool and blood were obtained and examined for enteric bacteria according to Edwards and Ewing's Procedures for the isolation of Salmonellae and by Widal Test for the detection of enteric fever antibodies. Reference to the table reveals that 50 of the 3.174, or 1.58 per cent, were infected with pathogenic bacteria. Of these 29, or 0.91 per cent, were infected with Salmonellae and 21, or 0.66 per cent, with Shigellae. There was a marked uniformity in the incidence of infection in the group of healthy person (6 of 358, or 1.68 per cent) and in patients (30 of 1,726, or 1.73 per cent). In the patient group there were 9 out 239, or 3.76 per cent, who had fever of unknown origin and 8 out of 256, or 3.14 per cent, whose disease was not diagnosed. Most of the patients had atypical symptoms of enteric disease, but this disease was not suspected. Those, however, who were given appropriate treatment for enteric infection recovered completely. POSITIVE ISOLATION OF ENTERIC PRTHOGENS BY THE GROUPS (Fed. 1958-Fed.1959) ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━ Group Number Organisms Isolated ------------------------------------------- Examined No. % Organism No. % ------------------------------------------------------------------------------ HEALTH PERSONS 358 6 1.68 S. 5 1.40 Sh. 1 0.28 a.Applicants of 148 4 2.70 S. 3 2.02 physical exam. Sh. 1 0.63 for visa b.Preganacie 135 1 0.73 S. 1 0.73 Sh. 0 0 c.Medical staff in 75 1 1.33 S. 1 1.33 *ROK Naval Hosp. Sh. 0 0 ------------------------------------------------------------------------------ PATIENTS 1,726 30 1.73 S. 15 0.87 Sh. 15 0.87 a.Non-enteric 1,231 13 1.06 S. 6 0.49 infection Sh. 7 0.57 b.Fever of 269 9 3.76 S. 7 2.92 unknown orgin Sh. 2 0.84 c.Undiagnosed 256 8 3.14 S. 2 0.78 Sh. 6 2.34 ------------------------------------------------------------------------------ STOOL SPECIMENS FROM THE PERSONS 1,094 14 1.28 S. 9 0.82 FOR PARASITE Sh. 5 0.46 ------------------------------------------------------------------------------ TOTAL 3,174 50 1.58 S. 29 0.91 Sh. 21 0.66 ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
[영문] Approximately 70 per cent of the isolated strains had acquired resistance against antibiotics, such as penicillin, streptomycin, tetracycline, erthromycin and neomycin, etc. The group distribution of the strains which were isolated during the study were almost identical with these form patients with enteric infections previously reported. It might be commented upon that the high percentage and wide range of distribution of subclinical and atypical enteric bacterial infections is due to: 1. Seoul City is equipped with a poor water and a poor sewage disposal system. 2. The living conditions of most of the citizens in Seoul are unsanitary. 3. The clinical diagnosis of enteric bacterial infection is not easily made because enteric bacteria are of numerous types and clinical symptoms for each type are not identical. 4. In Seoul, many mutant strains have acquired resistance against antibiotics due to inappropriate treatment. Those strains may cause atypical symptoms of enteric infections. 5. As a rule general practitioners do not request a laboratory examination before treating enteric infections. 6. The eating of unwashed vegetables and fruits exposed on the street must be a frequent cause. A bacteriological study of subclinical and atypical enteric infections was undertaken in 1958. Three thousand one hundred seventy four persons were examined from February 1958 to February 1959 in Yonsei University, Severance Hospital, Seoul, Korea. Each person was given a physical examination. Enquiries were made regarding of fever, nausea, vomiting, gastrointestinal disturbances, anemia, lymphadenopathy, rash and hepathomegaly. Specimens of stool and blood were obtained and examined for enteric bacteria according to Edwards and Ewing's Procedures for the isolation of Salmonellae and by Widal Test for the detection of enteric fever antibodies. Reference to the table reveals that 50 of the 3.174, or 1.58 per cent, were infected with pathogenic bacteria. Of these 29, or 0.91 per cent, were infected with Salmonellae and 21, or 0.66 per cent, with Shigellae. There was a marked uniformity in the incidence of infection in the group of healthy person (6 of 358, or 1.68 per cent) and in patients (30 of 1,726, or 1.73 per cent). In the patient group there were 9 out 239, or 3.76 per cent, who had fever of unknown origin and 8 out of 256, or 3.14 per cent, whose disease was not diagnosed. Most of the patients had atypical symptoms of enteric disease, but this disease was not suspected. Those, however, who were given appropriate treatment for enteric infection recovered completely. POSITIVE ISOLATION OF ENTERIC PRTHOGENS BY THE GROUPS (Fed. 1958-Fed.1959) ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━ Group Number Organisms Isolated ------------------------------------------- Examined No. % Organism No. % ------------------------------------------------------------------------------ HEALTH PERSONS 358 6 1.68 S. 5 1.40 Sh. 1 0.28 a.Applicants of 148 4 2.70 S. 3 2.02 physical exam. Sh. 1 0.63 for visa b.Preganacie 135 1 0.73 S. 1 0.73 Sh. 0 0 c.Medical staff in 75 1 1.33 S. 1 1.33 *ROK Naval Hosp. Sh. 0 0 ------------------------------------------------------------------------------ PATIENTS 1,726 30 1.73 S. 15 0.87 Sh. 15 0.87 a.Non-enteric 1,231 13 1.06 S. 6 0.49 infection Sh. 7 0.57 b.Fever of 269 9 3.76 S. 7 2.92 unknown orgin Sh. 2 0.84 c.Undiagnosed 256 8 3.14 S. 2 0.78 Sh. 6 2.34 ------------------------------------------------------------------------------ STOOL SPECIMENS FROM THE PERSONS 1,094 14 1.28 S. 9 0.82 FOR PARASITE Sh. 5 0.46 ------------------------------------------------------------------------------ TOTAL 3,174 50 1.58 S. 29 0.91 Sh. 21 0.66 ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
1.58
0.66
0.91
50
21
29
3174
總計
+--------+-----------------+-----+------+--------+-------+------+------------+--------+--------+---------
1.28
0.46
0.82
14
5
9
1094
寄生蟲調査??者
其他
3.14
2.34
0.78
256
診斷不確定者
1.73
3.76
0.84
2.92
30
2
1726
239
原因不明熱者
1.06
0.57
0.49
7
1231
非腸內細菌性患者
患者
1.33
75
海軍病院職員
1.68
0.73
6
0
358
135
姙産婦
+-----------------+-----+ +--------+-------+ +------------+--------+--------+
2.70
0.63
2.02
1
3
148
海外旅券手續者
健康人
+--------+-----------------+-----+------+--------+-------+------+------------+--------+--------+---------+
小計
[한글] 韓國에는 年中 어느 때나 腸內 細菌性 疾患이 蔓延 猖獗되고 있다. 腸內 細菌性 疾患의 傳染 經路의 眞相을 追究하여 臨床家의 診斷에 指針이 되고, 疾患 의 防疫 對策에 좋은 參考 資料를 寄與하기 爲하여 腸內 細菌의 不顯性 및 非定型的 患者를 調査하였다. 西紀 1958年(檀紀 4291年) 2月부터 西紀 1959年(檀紀 4292年) 2月 間에 延世大學校 醫科大學 附屬病院에 찾아온 사람들( 主로 서울地域에 살고있는 사람들) 中 健康한 者로서 海外旅券 手續者, 姙産婦와 서울 海軍病院 職員, 그리고 患者로서는 臨床的으로 非腸內菌性 疾患者, 原因 不明 熱 또는 診斷이 不確定된 者 3,174名에 限하여 ?便? 血液에서 一般腸內 細菌 檢査法 主로 EDWARDS AND EWING'S法에 準하여 腸內 病原菌을 分離하였다. 全調査 3,174 例中 病原菌이 分離된 것이 50例(1.58 퍼-센트)이고 그中 살모넬라 SALMONELLA가 29例(0.91 퍼-센트)이고 시겔라 SHIGELLA가 21例(0.66퍼-센트)였다. 調査의 對象者別로 보건대 다음 表에서와 같이 健康人(1.68 퍼-센트)과 患者(1.73 퍼-센트)間에 別差 없이 大同小異하였고 患者間에서도 保菌率이 비슷하였다. 原因 不明 熱 患者와 診斷不確定者에서는 多少高率로 分離되었으며, 患者들은 腸內 細菌性 疾患의 治療를 하여 完治되었다. 이러한 患者들의 症狀은 모두 一定하지 않고 구구하여 臨床家들이 腸內 細菌性 疾患으로서 診斷하기는 困難하였다. 分離된 菌株의 70 퍼-센트 가량이 抗生 物質에 對한 抵抗力이 獲得되어 있어서 感受性 試驗을 行하지 않고는 治療하기 困難하였다. 分離 菌株들은 지금껏 韓國內 腸內 細菌性 疾患者에서 分離 報告된 菌株들과 그 分布相이 비슷하였다. 이같이 腸內 細菌性 傳染病은 年中 猖獗하고 그 傳染이 不顯性 또는 不定型 症狀으로 廣範圍하고 高率로 分布하고 있는 것은 다음 몇가지 理由를 들어 說明할 수 있다. 1. 서울市內의 上下水道 施設이 不完全한 것. 2. 市民의 大部分이 貧困하고 無知하여 非衛生的 生活을 하고 있다는 것. 腸內 病菌의 檢出 成績 (1958年 2月부터 1959年 2月까지) +--------------------------+------------+-----------------------+----------------------------------------+
시겔라
살모넬라
小 計
件數
硏究調査群 +---------------------+-------+------+------------+--------+------------------
分離率
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/117158
Appears in Collections:
2. 학위논문 > 1. College of Medicine > 석사
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