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Korean Journal of Epidemiology 1988;10(2): 246-253.
우리나라 고열성, 출혈성질환 (렙토스피라증, 쯔쯔가무시병, 신증후출혈열)의 조기 감별진단을 위한 연구
김정순, 김영준, 허용, 이원영, 서정대, 변해공
Discriminant analysis on symptoms and signs and HFRS in Korea for early diagnosis
Joung Soon Kim, Young Joon Kim, Yong Heo, Won Young Lee, Cheong Dae Suh, Hae Kong Byun
The major diseases causing hemorrhagic feb rile syndrome in Korea are Leptospirosis, Scrul Typhus, and HFRS (Hemorrhagic Fever with Renal Syndrome). Therefore, methods to provide a correct differ ential diagnosis is urgently required for the selection of adequate treatment in the early stage of infection, which will definitely help to reduce the mortality and/or the occurance of complications and duration of illness. At present, a differential diagnosis in early stage in very difficult because the epidemiological and clinical characteristics of them are much alike. Although the only reliable way of differentiation is antibody test, it is not applicable for those in early stage since a rise in specific antibody levels to be detectable requires 1 week after infection. The purpose of this study is to provide criteria which may help to specify Leptospirosis, Scrub Typhus, and HFRS for the early diagnosis and selection of proper treatment. One hundred and forty eight hospitalized patients because of high fever (more than 38°C) and similar symptoms with above mentioned diseases were studied for one year (Sep. 1987-Oct. 1988). Isolation of Leptospire and serologic test were done. Serologic test results for HFRS was obtained from medical record. Micro Agglutination Test(MAT) for Leptospirosis and Indirect Fluorescent Antibody test(IFAT) for Scrub Typhus were employed. The major findings are summarized as follows; 1) Four strains of leptospire were isolated. Sero-positive rates were 32.5 for Leptospire and 12.2% for Scrub Typhus. Among 148 patients, 24 cases (16.2%) were confirmed to be leptospiral infection by the bacterial isolation and/or serology. And 13 cases (8.8%) were confirmed to be R. tsutsugamushi infection by the serologic test. Among 25 patients who were transfered because of their suspicious symptoms of HFRS, only 9 patients were identified as Korea Antigen positives. 2) The majority (69%) of the Leptospiral positive sera reacted with locally isolated L. icterohamorragiae and canicola. The majority (77%) of the Rickettsial positive sera reacted with Gilliam strain. Among positive sera for Gilliam strain, 18% were found to cross-react with Kato strain. 3) The average duration of illness due to the infections were 71 days by HFRS (the longgest), 36 days by Leptospirosis, and 20 days scrub typhus, which was statistically significant. 4) Chi-square analysis and discriminant analysis were done to clarify the differences in clinico-physical findings of these infections which may differ from each other. Discriminant analysis was done by use of 37 symptoms, 27 physical signs and 4 vital signs as independent variables and 3 groups (Leptospirosis, scrub typhus, HFRS) as dependent variables. Chi-square analysis revealed that sputum and hemathemesis in Leptospirosis, abdominal reflect¬ed tenderness in scrub typhus and oliguria in HFRS were selected as the significant variables. Discriminant analysis also revealed that chest pain in Leptospirosis, CVA tenderness and high respiration rate in scrub typhus and oliguria, flask pain and peak diastolic blood pressure in HFRS were the significant variables.
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