목적 : 국내에서 대규모의 말라리아 환자를 대상으로 한 재발병에 대한 연구는 미비한 현실이다. 저자들은 군병원에 반복입원한 삼일열 말라리아 환자를 대상으로 임상특징, 감염양상, 재입원률을 조사하여 향후 말라리아 환자의 치료에 도움이 되고자 한다. 대상 및 방법 : 1997년부터 2003년까지 군병원에서 말초혈액도말검사에 의해 말라리아로 확진된 반복입원 환자를 대상으로 하여 의무기록을 분석하였다. 치료는 클로르퀸 2 g 투여 후 프리마퀸 210 mg 투여하였으며 완치 판정은 임상 증상이 호전되고 말초혈액도말검사에서 음성을 보인 경우로 정의하였다. 말라리아 감염 위험시기는 5월∼10월까지 정의하였으며 1차 발병 완치 후 2차 발병 시점 까지 1개월 전후로 발병한 경우를 recrudescence, 2개월∼5개월 미만의 간격으로 발병한 경우를 recrudescence 혹은 relapse, 5개월 이상의 간격으로 발병한 경우를 relapse로 정의하였다.결과 : 1997년에서 2003년까지 말라리아로 입원한 환자수 6,566명 중 반복 입원한 환자는 64명이었으나 의무기록이 확인된 45명을 대상으로 하였다. 모두 발열이 있었으며, 48시간 간격의 주기적 발열을 나타낸 환자는 1차 발병시 25명(55.5%), 2차 발병시 22명(48.8%)이었다. 그 외 두통, 오한, 오심, 근육통, 어지러움, 구토 등의 다양한 임상양상을 보였으며, 발병시기를 살펴보면 1차 발병시 말라리아 위험시기에 41명(91.1%), 2차 발병시 39명(86.6%)으로 조사되었다. 감염양상을 살펴보면 1차 발병시 완치 후 2차 발병까지 1개월 전후인 경우 20명(44.4%), 2개월에서 5개월 미만인 경우 3명, 5개월 이상인 경우 22명(48.8%)이었다. 재입원률은 0.68%를 보였다.

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.(Korean J Med 68:611-618, 2005)

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.(Korean J Med 68:611-618, 2005)

Plasmodium vivax, Malaria, Patient readmission