Clinical Studies of Typhoid Fever in Children

의학과/석사[영문] [한글] 수인성 질환의 일종인 장티푸스는 Salmonlla typhi의 감염을 말하며 장티푸스는 1년 사 시절 언제나 흔히 볼 수 있는 질병이고 경험있는 의사까지도 당혹케하는 이상경과를 나타 내 보이는 다양성을 가진 질병이다. 장티푸스의 발생율이 한국에서 아직도 높아 법정 제1 종 전염병으로 분류되는 중요한 질병이다. 저자는 1973년 4월부터 1983년 3월까지 만 10년간 연세대 학교부속 세브란스병원과 원 주기독병원 소아과에 장티푸스로 입원한 321명의 환아를 대상으로 임상적 관찰을 하여 다 음과 같은 결과를 얻었다. 1. 연도별 발생빈도는 최근 3년간 증가하는 경향이 뚜렷하였다. 2. 남녀 비는 약 1.5:1 이었으며 최연소 연령은 생후 10일된 남아 이었다. 계절별 발생 빈도는 일년 사시절 모두 볼 수 있었으며 하절기 보다 오히려 동절기인 12, 1, 2월에 31. 2%로 가장 많았다. 3. 입원 당시 주소는 발열, 복통, 오심 및 구토, 두통, 설사의 순 이었다. 이학적 소견은 발열, 인후발적, 간비대, 복부압통의 순 이었다. 4. 검사 소견상 빈혈은 67예(20.9%), 백혈구 감소는 58예(18.1%)에서 보였고, Widal 반 응 양성율은 총 474검사예중 371예로 78.3%를 보였고, 병기간에 비례하여 양성율이 증가 하였다. 세균배양은 혈액배양 85예(38.8%), 대변배양 45예(26%), 뇨배양 2예(1.5%)에서 양성이 었다. 5. 혈액배양으로 검출된 균의 항생제 감수성은 최근에 사용되기 시작 co-trimoxazole에 대한 감수성이 100%로 가장 높았고, chloramphenicol, gentamicin, amikacin, tobramyci n, ampicillin의 순 이었으며 chloramphenicol에 대한 내성균은 없었다. 6. 항생제 사용 후 평균 해열기간은 chloramphenicol과 co-trimoxazole 병용군이 2.71 일로 가장 짧았고, chloramphenicol 단독 사용군이 4.18일, ampicillin 단독 사용군이 4. 24일을 보였다. 7. 합병증 및 동반된 질환은 54예(16.8%)이었으며 폐염, 간염, 장천공, 복막염, 장출혈 등 이었고, 사망률은 1.6% 이었다. Clinical Studies of Typhoid Fever in Children Young Gun Kim Department of Medical Science The Graduate School, Yonsei University (Directed by Professor Duk Jin Yun, M.D.) Clinical studies on the 321 cases of typhoid fever who were admitted to the pediatric department of Severance Hospital and Wonju Christian Hospital from April, 1973 to March, 1983 were the subjects in this study. The results were as follows: 1. The incidental ratio to total admission was 0.6%, and the incidence of typhoid fever has remarkably increased annually during the past 3 years. 2. The peak incidence was noted in winter, although there were occurrences throughout the year. 3. Age incidence disclosed that there were 18 cases under 1 year(5.6%), 92 cases 1 to 5 years (28.7%), 136 cases 5 to 10 years (42.4%), 75 cases over 10 years(23.3%). 4. One hundred ninety-five cases(60.7%) were male and 126 cases (39.3%) were female, with a male to female ratio of 1.5:1. 5. The clinical symptoms on admission were as follows: fever (92.2%), abdominal pain(42.7%), nausea and vomiting(25.5%), headache(22.1%), diarrhea(20.6%) and cough(14.4%). The physical findings were as follows: fever(85.0%), injected throat(57.6%), hepatomegaly(49.5%), abdominal tenderness(36.1%), dried lips or coated tongue(27.4%), splenomegaly(16.5%), and abdominal distension(14.3%). 6. The laboratory findings were as follows: Leukopenia was noted in about 18.1 percent of the cases, anemia was noted in about 20.9 percent, however, in 7 cases a hemoglobin level of less than 8g/dl was noted. Widal test, results showed 78.3 percent had positive result in 474 test cases. The percentage of positive cases increased according to the duration of illness. S. typhi was isolated from 38.8 percent of the blood cultures, 26 percent of the stool cultures and 1.5 percent of the urine cultures. 7. In sensitivity tests to antibiotics against the organism isolated from the blood culture, the most sensitive antibiotic was co-trimoxazole, followed by chloramphenicol, gentamicin, amikacin, tobramycin and ampicillin. There was no annual variation in sensitivity to chloramphenicol, but there was resistance to ampicillin in 5 cases since the year of 1982. 8. The average duration from the onset to clinical improvement including defervescence was 4.24 days with ampicillin, 4.18 days with chloramphenicol, 2.80 days with chloramphenicol combined with ampicillin and 2.71 days with chloramphenicol comined with co-trimoxazole. 9. Complications and associated diseases were noted in 54 cases (16.8%), including pneumonia (11 cases), hepatitis(11 cases), peritonitis(9 cases), intestinal perforation (6 cases) and intestinal bleeding (3 cases). Five of the 321 cases expired and the mortality rate was 1.6 percent.restrictio