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[Parasitology (11) ÈçÇÏ°í Áß¿äÇÑ Á¶ÃæÀº ¹«¾ùÀԴϱî?]

À¯±¸Á¶Ãæ (Taenia solium, pork tapeworm, °¥°í¸®ÃÌÃæ), ¹«±¸Á¶Ãæ (Taenia saginata, beef tapeworm, ¹ÎÃÌÃæ), ¾Æ½Ã¾ÆÁ¶Ãæ (Taenia asiatica), ±¤Àý¿­µÎÁ¶Ãæ (Diphyllabothrium latum, fish tapeworm, ±äÃÌÃæ) Á¤µµ´Â ¾Æ¼Å¾ß ÇÕ´Ï´Ù.

À¯±¸Á¶ÃæÀÇ À¯Ãæ(metacestode)¿¡ ÀÇÇÑ cysticercosis¿Í ±¤Àý¿­µÎÁ¶Ãæ¿¡ ÀÇÇÑ megaloblastic anemia Á¤µµ°¡ ¹®Á¦ÀÔ´Ï´Ù. ±× ÀÌ¿Ü¿¡´Â ´ëºÎºÐ Ç×¹®À¸·Î ±æ°í Èò tape°°Àº °ÍÀÌ ³ª¿Í º´¿øÀ» ã½À´Ï´Ù.

´ëÀå³»½Ã°æ¿¡¼­ ¹ß°ßµÈ ¾Æ½Ã¾ÆÁ¶Ãæ

¾Æ½Ã¾ÆÁ¶ÃæÀ» Ç×¹®À¸·Î Á¶½É½º·´°Ô ²¨³»´Â Àå¸é

´ëÀå³»½Ã°æÀ» À§ÇØ bowel preparationÇÏ´Â µµÁß¿¡ ¹è¼³µÈ D. latum (±¤Àý¿­µÎÁ¶Ãæ) ȤÀº D. nihonkaiense


1. À¯±¸Á¶Ãæ (Taenia solium, pork tapeworm, °¥°í¸®ÃÌÃæ)

ÀÎüÀÇ ¼ÒÀå¿¡ ±â»ýÇÏ´Â ¿ø¿±Á¶ÃæÀÇ Çϳª·Î Àü¼¼°èÀûÀ¸·Î ºÐÆ÷ÇÑ´Ù. ÃæüÀÇ ÆíÀýÀÌ 1,000°³ ³»¿ÜÀÌ°í ÀüüÀÇ ±æÀÌ°¡ 2-3 m¿¡ À̸¥´Ù. ¼ºÃæÀº »ç¶÷ÀÇ ¼ÒÀå¿¡ ±â»ýÇÏ°í ¼öÅÂÆíÀýÀÌ ¶³¾îÁö¸é¼­ ÀÚ±ÃÀÌ Âõ¾îÁ® »ê¶õÇÑ´Ù. Áß°£¼÷ÁÖ(µÅÁö)°¡ Ãæ¶õÀ» ¼·ÃëÇϸé À°±¸À¯ÃæÀÌ Å»°¢ÇÏ°í ³ª¿Í Ç÷¾× ¶Ç´Â ¸²ÇÁ¸¦ Ÿ°í ±ÙÀ°À¸·Î ¿Å°Ü°¡ À¯±¸³¶¹ÌÃæ (cysticerus cellulosae)À¸·Î ÀÚ¶õ´Ù. µÅÁö°í±â¸¦ »ç¶÷ÀÌ ³¯·Î ¸ÔÀ¸¸é ³¶¾×¼ÓÀ¸·Î ¿õÅ©¸®°í ÀÖ´ø µÎÀýÀÌ ¹ÛÀ¸·Î µ¹ÃâÇÏ¿© °æºÎ¿¡¼­ ²÷¾îÁö°í µÎÀý°ú °æºÎ¸¸ À庮¿¡ °íÁ¤ÇÏ¿© ±â»ýÇϸ鼭 ÆíÀýÀ» ¸¸µç´Ù. ¼ºÃæÀÌ µÇ´Âµ¥ ¾à 10ÁÖ°¡ ¼Ò¿äµÈ´Ù.

µÅÁö¸¦ ³¯°ÍÀ¸·Î ¼ÒºñÇÏ´Â Áö¿ª¿¡ °¨¿°ÀÚ°¡ ¸¹´Ù. ƯÈ÷ µÅÁö¿¡°Ô »ç¶÷ÀÇ ´ëº¯À» ¸ÔÀÌ´Â Áö¿ª¿¡ ¸¹´Ù. °ú°Å¿¡´Â Á¦ÁÖµµ¿¡ ¸¹¾ÒÀ¸³ª ÃÖ±Ù¿¡´Â °ÅÀÇ Ã£±â ¾î·Á¿öÁ³´Ù. 1997³âµµ Á¦ 6Â÷ ½ÇÅÂÁ¶»ç¿¡¼­ Àü±¹ÀûÀ¸·Î Á¶Ãæ¶õ ¾ç¼ºÀÚ°¡ 11,000¸íÀ̾ú´Âµ¥ À̵é Áß ¾à 15%°¡ À¯±¸Á¶Ãæ °¨¿°ÀÚÀÏ °ÍÀ¸·Î ÃßÁ¤µÈ´Ù. °¨¿°ÀÚ¿¡¼­´Â ¼ÒÈ­±âÁõ»óµµ °¡´ÉÇÏÁö¸¸, ¼ºÃæÀÇ °¨¿°º¸´Ù´Â À¯Ãæ(metacestode)ÀÇ °¨¿°¿¡ ÀÇÇÑ À¯±¸³¶¹ÌÃæÁõ(cysticercosis)ÀÌ ´õ ¹®Á¦°¡ µÈ´Ù. ´ëº¯¿¡¼­ Ãæ¶õÀ» º¸°í Áø´ÜÇÒ ¼ö ÀÖÀ¸³ª ¹«±¸Á¶Ãæ°ú °¨º°µÇÁö ¾ÊÀ¸¹Ç·Î, Á¾ÀÇ Áø´ÜÀ» À§Çؼ­´Â ¼öÅÂÆíÀýÀ» ¾ò¾î¾ß ÇÑ´Ù. Praziquantel·Î Ä¡·áÇÑ´Ù.


2. ¹«±¸Á¶Ãæ (Taenia saginata, beef tapeworm, ¹ÎÃÌÃæ)

ÃæüÀÇ ÆíÀýÀÌ ¾à 2,000°³ ÀÌ»óÀ¸·Î Àüü ±æÀÌ´Â 12 m¿¡ ´ÞÇÒ ¼ö ÀÖ´Ù. ¸¹Àº ¸é¿¡¼­ À¯±¸Á¶Ãæ°ú ºñ½ÁÇÏÁö¸¸ Áß°£¼÷ÁÖ°¡ '¼Ò'ÀÎ Á¡ÀÌ ´Ù¸£´Ù. ±¹³»¿¡¼­ ¹ß°ßµÇ´Â À¯¹«±¸Á¶Ãæ °¨¿°ÀÚÀÇ 70-90%°¡ ¹«±¸Á¶Ãæ°¨¿°ÀÚÀÌ´Ù. ´ëºÎºÐ º° Áõ»óÀÌ ¾øÀ¸¸ç ÆíÀýÀÌ ºüÁ® ³ª¿Ã ¶§ À̹°°¨, Ç×¹®¼Ò¾çÁõÀÌ ¹ß»ýµÇ°í µå¹°°Ô ÀåÆó»ö µîÀÌ °¡´ÉÇÏ´Ù. Praziquantel·Î Ä¡·áÇÑ´Ù.

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3. ¾Æ½Ã¾ÆÁ¶Ãæ (Taenia asciatica)

¾Æ½Ã¾Æ Á¶ÃæÀº °ú°Å ¹«±¸Á¶ÃæµÇ´ø °ÍÀÌ »õ·Ó°Ô ºÐ·ùµÈ Á¶ÃæÀÌ´Ù.12 ¿ø·¡ ¹«±¸Á¶ÃæÀÇ Áß°£¼÷ÁÖ´Â ¼ÒÀ̸ç, ¼Ò°í±â À°È¸ µîÀ» ¸Ô¾î¼­ °¨¿°µÇ¸ç cysticercosis¸¦ ÀÏÀ¸Å°Áö´Â ¾Ê´Â´Ù. ±×·¯³ª ÀÌ»óÇÏ°Ôµµ ¿ì¸®³ª¶ó¸¦ ºñ·ÔÇÑ ¾Æ½Ã¾Æ ¿©·¯ ³ª¶ó¿¡ ºÐÆ÷ÇÏ´Â ¹«±¸Á¶ÃæÀº ¼Ò°¡ ÀüÇô ¾ø´Â Áö¿ª¿¡¼­ ¹ß°ßµÇ¾î ¿À·§µ¿¾È Àǹ®À¸·Î ³²¾Æ ÀÖ¾ú´Ù. ±×·¯ÇÑ ¹Ì½ºÅ͸®¿¡ ´ëÇÏ¿© ÁÖ·Î ´ë¸¸¿¡¼­ ¿¬±¸°¡ È°¹ßÇÏ°Ô ÁøÇàµÇ¾ú°í, ¸¶Ä§³» Áß°£¼÷ÁÖ¸¦ µÅÁö·Î ÇÏ´Â ¹«±¸Á¶ÃæÀÇ ¾ÆÇü(Taenia saginata taiwanensis)À¸·Î ºÐ·ùµÇ¾ú´Ù°¡ ÃÖÁ¾ÀûÀ¸·Î ¾Æ½Ã¾ÆÁ¶ÃæÀ¸·Î ¸í¸íµÇ¾ú´Ù. ¿ì¸®³ª¶ó¿¡¼­´Â ÁÖ·Î µÅÁö °£À» ³¯·Î ¸Ô´Â ½À¼ºÀÌ ÀÖ´Â Áö¿ª¿¡¼­ ¹ß°ßµÈ´Ù. Praziquantel 10 mg/kg·Î Àß Ä¡·áµÈ´Ù.


4. ±¤Àý¿­µÎÁ¶Ãæ (Diphyllabothrium latum, fish tapeworm)

¼ºÃæÀÇ ±æÀÌ°¡ 10 m³ª µÉ ¼ö ÀÖ´Ù°í ÇÏ¿© '±äÃÌÃæ'À¸·Îµµ ºÒ¸°´Ù. ÀÎü¿¡ °¨¿°µÇ´Â ÀÇ¿±Á¶Ãæ Áß¿¡¼­ °¡Àå ÈçÇÑ °ÍÀÌ°í ºÐÆ÷µµ ¼¼°èÀûÀÌ´Ù. ÀÎü°¡ °¡Àå Áß¿äÇÑ Á¾¼÷ÁÖÀÌ¸ç ¼ÒÈ­±â Áõ»óÀ» ÃÊ·¡Çϱ⵵ ÇÏÁö¸¸ ºñ±³Àû ÀûÀÀÀÌ Àß µÈ ±â»ýÃæÀ̾ º´¿ø¼ºÀº ±×´ÙÁö °­ÇÏÁö ¾Ê´Ù. ÀÎüÀÇ ¼ÒÀå (ȸÀå »óºÎ)¿¡ ±â»ýÇϸç ÇÏ·ç¿¡ »ê¶õ·®ÀÌ 100¸¸°³ ÀÌ»óÀÌ´Ù. ÀÎü °¨¿°Àº ¿¬¾î, ¼Û¾î, ³ó¾î µî ¾î·ù¸¦ ³¯·Î ¸ÔÀ» ¶§ ÀϾ´Ù. ÈÆÁ¦ ¿¬¾î¸¦ Áñ°Ü ¸ÔÀº »ó·ùÃþ ÀλçµéÀÇ °¨¿°µµ ÀÚÁÖ º¸°íµÇ°í ÀÖ´Ù. ¿ì¸® ³ª¶óÀÇ ¸¹Àº °¨¿°ÀÚ°¡ ³ó¾îȸ¸¦ ¸Ô¾ú´Ù°í Çϳª ½ÇÁ¦·Î ³ó¾î¿¡¼­ À¯ÃæÀÌ ¹ß°ßµÈ ÀûÀº ¾ø´Ù. ¼Û¾î ¾ç½ÄÀåÀÌ ¸¹Àº °­¿øµµ Ãáõ½Ã¿¡¼­ µå¹°Áö ¾Ê°Ô Áø´ÜµÈ´Ù´Â º¸°íµµ ÀÖ´Ù.

¹«±â·ÂÁõ, ¼³»ç, º¹Åë, ºóÇ÷ µîÀÌ ¿Ã ¼ö ÀÖÀ¸¸ç È­Àå½Ç¿¡¼­ ´ëº¯°ú ÇÔ²² ¹«½¼ ÁÙ°ú °°Àº °ÍÀÌ ¸Å´Þ·Á ¶³¾îÁöÁö ¾Ê¾Æ ±ô¦ ³î¶ó ´ç°Ü¼­ ²÷¾î¼­ º´¿ø¿¡ °¡Á®¿À´Â ÀÏÀÌ ¸¹´Ù. ¼ºÃæÀÌ ´Ù·®ÀÇ ºñŸ¹Î B12¸¦ Èí¼öÇÏ°í ȸÀå¿¡¼­ ºñŸ¹Î B12ÀÇ Èí¼ö¸¦ ¾ïÁ¦ÇÏ¿© ºñŸ¹Î B12ÀÇ °áÇÌÀ» ÃÊ·¡ÇÒ ¼ö ÀÖ´Ù. °¨¿°µÈ ȯÀÚÀÇ 2%¿¡¼­ °Å´ëÀûÇ÷¸ð±¸ºóÇ÷(megaloblastic anemia)À̳ª ºñŸ¹Î B12ÀÇ °áÇÌ°ú °ü·ÃµÈ ½Å°æÇÐÀû ÀÌ»óÀ» µ¿¹ÝÇÒ ¼ö ÀÖ´Ù°í ±â¼úµÇ¾î ÀÖÀ¸³ª ±¹³»¿¡¼­ ÀÌ ±â»ýÃæ¿¡ ÀÇÇÑ °Å´ëÀûÇ÷±¸ºóÇ÷Àº º¸°íµÈ ¹Ù ¾ø´Ù. Áø´ÜÀº ´ëº¯°Ë»ç¿¡¼­ Ãæ¶õÀ» È®ÀÎÇϰųª ȯÀÚ°¡ °¡Á®¿Â Ãæü ÀýÆíÀ» È®ÀÎÇÏ¸é °¡´ÉÇÏ°í praziquantel·Î Ä¡·áÇÑ´Ù.

ÀÏÀü¿¡ EndoTODAY ¾Öµ¶ÀÚ²²¼­ Ç×¹®¿¡¼­ ¹º°¡ ±â¾î³ª¿À°í ´ç±â¸é ²÷¾îÁö´Â Áõ»óÀ¸·Î º´¿øÀ» ãÀº ȯÀÚ¿¡¼­ D. latumÀ» Áø´ÜÇÏ¿´´Ù´Â ÆíÁö¸¦ ¹ÞÀº ÀûÀÌ ÀÖ½À´Ï´Ù. ´ç½Ã Àú´Â ¹«Â÷º° ¹Ýº¹Çü ÁÖÀÔ½Ä ±³À°ÀÎ EndoTODAY¸¦ °è¼ÓÇÏ°Ú´Ù°í ¾à¼ÓÇÏ¿´½À´Ï´Ù. ¹Ýº¹ÇÏÁö ¾ÊÀ¸¸é Àر⠶§¹®ÀÔ´Ï´Ù.

[2014-2-26. °æÇâ½Å¹®]13¼¼ ³²¾Æ ¸ö¿¡¼­ ±æÀÌ 3.5m ±â»ýÃæ ³ª¿Í


[±¤Àý¿­µÎÁ¶Ãæ Q and A]

[µ¿±¹´ëÇб³ ±èÀçÇÐ] ¸î ³â Àü¿¡ D.latumÀ» º¸°í ºñµð¿À¸¦ Âï¾î ³õÀº °Ô À־ Ȥ½Ã Âü°íµÇ½Ç±î ÷ºÎÇÏ¿© µå¸³´Ï´Ù (NEJM¿¡ º¸°íµÈ Áõ·Ê).

[ÀÌÁØÇàÀÇ ´äº¯] °¨»çÇÕ´Ï´Ù. Á¤¸» ÁÁÀº ÀÚ·áÀÔ´Ï´Ù. EndoTODAY µ¶Àڵ鿡°Ô ¼Ò°³ÇÏ°íÀÚ ÇÏ¿À´Ï ¾çÇØÇÏ¿© Áֽñ⠹ٶø´Ï´Ù. Àü¹®À» ¿Å±â°Ú½À´Ï´Ù.

"A 46-year-old woman presented with a history of 3 days of pruritus in the anal area and 1 day of excretion of tapelike materials. During the year before presentation, she had reported intermittent colicky abdominal pain and loose stool, which had been attributed to irritable bowel syndrome. Laboratory evaluation was unremarkable, with no evidence of anemia. Colonoscopy revealed a long, moving tapeworm, Diphyllobothrium latum, located in the terminal ileum and extending to the sigmoid colon (see video). D. latum is a fish tapeworm that can infect humans after they consume infected undercooked or raw fish. The patient had a history of eating raw fish and recalled eating raw trout most recently 2 months before presentation. She was treated with a single dose of praziquantel. After administration, the abdominal pain resolved, but she continued to have intermittent loose stool."


[¾Öµ¶ÀÚ Áú¹®] ±¤Àý¿­µÎÁ¶ÃæÀÌ À庮À» ÆÄ°íµì´Ï±î?

[ÀÌÁØÇàÀÇ ´äº¯] ±¤Àý¿­µÎÁ¶ÃæÀº ȸÀå(ileum)¿¡¼­ »ç´Â °ÍÀÌ Á¤»óÀÔ´Ï´Ù. °£È¤ ±â»ýÃæ Á¶°¢À» ¹èÃâÇß´ø ȯÀÚÀÇ ´ëÀå³»½Ã°æ¿¡¼­ ¹ú·¹¸¦ ãÁö ¸øÇÑ °æ¿ìµµ ÀÖ´Ù°í ÇÕ´Ï´Ù (reference). Á¶ÃæÀº À庮¿¡ ºÙ¾îÀÖ´Â °ÍÀÌÁö ÆÄ°íµå´Â °ÍÀº ¾Æ´Õ´Ï´Ù. Á¶ÃæÀº µÎÀý(scolex)ÀÇ Èí¹Ý À¯¹«¿¡ µû¶ó µÎ Á¾·ù·Î ³ª´©¾îÁý´Ï´Ù. µÎÀý¿¡ Èí¹Ý(sucker)°¡ ÀÖ´Â °ÍÀ» ¿ø¿±Á¶Ãæ(cyclophyllidean tapeworm)À̶ó°í Çϴµ¥ ¹«±¸Á¶Ãæ, À¯±¸Á¶Ãæ, ¾Æ½Ã¾ÆÁ¶Ãæ µîÀÌ ÀÌ¿¡ ¼ÓÇÕ´Ï´Ù. µÎÀý¿¡ Èí¹ÝÀÌ ¾ø°í Èí±¸(suchking groove)¸¸ ÀÖ´Â °ÍÀ» ÀÇ¿±Á¶Ãæ(pseudophyllidean tapeworm)À̶ó°í Çϴµ¥ ±¤Àý¿­µÎÁ¶Ãæ°ú ¸¸¼Õ¿­µÎÁ¶ÃæÀÌ ÀÌ¿¡ ¼ÓÇÕ´Ï´Ù. Èí¹ÝÀ̳ª Èí±¸ ¸ðµÎ À§Ä¡¸¦ °íÁ¤½ÃÅ°´Â ¿ªÇÒÀ» ÇÕ´Ï´Ù.


[¾Öµ¶ÀÚ Áú¹®] ±¤Àý¿­µÎÁ¶ÃæÀÌ megaloblastic anemiaÀ» ¾ó¸¶³ª Àß ÀÏÀ¸Åµ´Ï±î?

[ÀÌÁØÇàÀÇ ´äº¯] ¾Õ¼­ ±¹³»¿¡¼­ ±¤Àý¿­µÎÁ¶Ãæ¿¡ ÀÇÇÑ megalobastic anemia°¡ º¸°íµÈ ¹Ù ¾ø´Ù°í ¸»¾¸µå·È½À´Ï´Ù. ±×·±µ¥ ¿Ü±¹¿¡¼­µµ µå¹® ¸ð¾çÀÔ´Ï´Ù. ±â»ýÃæ ±³°ú¼­ÀÇ ÀϺθ¦ ¿Å±é´Ï´Ù (Gerald D. Schmidt & Larry S. Roberts' Foundations of Parasitology. 7th. 2005. page 343).

"For reasons that remain unclear, possibly due to improved nutritional level, tapeworm pernicious anemia has not been reported for several decades."


[¾Öµ¶ÀÚ Áú¹®] ´ëÀå³»½Ã°æÀ¸·Î ±¤Àý¿­µÎÁ¶ÃæÀ» Ä¡·áÇÒ ¼ö ÀÖ½À´Ï±î?

[ÀÌÁØÇàÀÇ ´äº¯] ´ëÀå³»½Ã°æÀ¸·Î ±ä ¹ú·¹¸¦ ¸ðµÎ Á¦°ÅÇÒ ¼ö ÀÖ´Ù¸é Ä¡·á°¡ µË´Ï´Ù. ±×·¯³ª ´ëÀå³»½Ã°æÀ¸·Î ¹ú·¹¸¦ ²¨³»´Ù°¡ Áß°£¿¡¼­ ²÷°Ü¹ö¸®´Â ¿¹°¡ ¸¹½À´Ï´Ù. ¸Ó¸®ºÎºÐÀÎ scolex¸¦ Á¦°ÅÇÏÁö ¸øÇϸé Àç¹ßÇÕ´Ï´Ù. µû¶ó¼­ ´ëÀå³»½Ã°æÀ¸·Î ¿Ïº®È÷ Ä¡·áÇϱâ´Â ¾î·Æ´Ù°í »ý°¢µË´Ï´Ù. ´Ù Á¦°ÅÇß´Ù°í »ý°¢ÇÏ´õ¶ó°í ²À praziquantelÀ» Åõ¾àÇϽñ⠹ٶø´Ï´Ù.


[¾Öµ¶ÀÚ Áú¹®] ±¤Àý¿­µÎÁ¶ÃæÀ» Ä¡·áÇϱâ À§ÇÏ¿© praziquantelÀ» ¾ó¸¶³ª Åõ¾àÇÏ´Â °ÍÀԴϱî?

[ÀÌÁØÇàÀÇ ´äº¯] Kg´ç 5-10 mgÀ» ÁÖ¸é µË´Ï´Ù. º¸Åë proziquantelÀÌ 600 mgÀ̹ǷΠÇѾËÀ̸é Á·ÇÕ´Ï´Ù. ¼ÒÈ­±â ±â»ýÃæ Ç¥ÁØ Ã³¹æÀ» Âü°íÇϽñ⠹ٶø´Ï´Ù.


[¾Öµ¶ÀÚ Áú¹®] Praziquantel·Î Ä¡·áµÇÁö ¾Ê´Â D. latumÀº ¾î¶»°Ô Ä¡·áÇմϱî?

PraziquantelÀÌ ¸Å¿ì ÁÁÀº ¾àÀÌÁö¸¸ °£È¤ ÀÌ ¾à¿¡ ÀúÇ×¼ºÀ» º¸ÀÌ´Â Á¶ÃæÀÌ ÀÖ´Ù°í ÇÕ´Ï´Ù. Ã¥¿¡´Â ¾Æ·¡ µÎ ¾àÀÌ ¼Ò°³µÇ¾î ÀÖ½À´Ï´Ù. ±¹³»¿¡¼­ ±¸Çϱ⠾î·Á¿î ¾àÀÔ´Ï´Ù. (2014³â 2¿ù 26ÀÏ)

1. Niclosamide

Taenia solium Ä¡·á¿¡ praziquantel ´ëü¾àÀÎ niclosamideÀÇ °æ¿ì, Ÿ³ì½ºÁ¤(½ÅdzÁ¦¾à, 500 mg/tablet)À̶ó´Â »óÇ°¸íÀ¸·Î 1970³â´ë ÈÄ¹Ý ±¹³» Çã°¡¸¦ ¹Þ°í ½ÃÆǵǾú½À´Ï´Ù. ¼ö¿ä°¡ Áپ 1980³â´ë ÈÄ¹Ý °æ »ý»êÀ» ÁߴܵǾú½À´Ï´Ù. ÇöÀç ±¹³»¿¡ ½ÃÆÇ ÁßÀÎ niclosamide´Â ¾ø½À´Ï´Ù.

ÇöÀç Çѱ¹Èñ±ÍÀǾàÇ°¼¾ÅÍ¿¡¼­µµ º¸À¯ÇÏ°í ÀÖÁö ¾Ê´Ù°í ÇÕ´Ï´Ù. Èñ±ÍÀǾàÇ°¼¾Å͸¦ ÅëÇØ ±¸ÀÔÀº °¡´ÉÇÕ´Ï´Ù. ½ºÀ§½º (500 mg/Á¤, 40Á¤/package, 25¸¸¿ø/package)¿Í ¿µ±¹(500 mg/Á¤, 4Á¤/package, 15¸¸¿ø/package)¿¡¼­ package ´ÜÀ§·Î ±¸ÀÔÇÒ ¼ö ÀÖ½À´Ï´Ù.

2. Nitazoxanide

±¹³»¿¡¼­ Çã°¡¹ÞÀº ÀûÀÌ ¾ø´Â ¼ººÐÀ̳ª, ÇöÀç Çѱ¹Èñ±ÍÀǾàÇ°¼¾ÅÍ¿¡¼­ º¸À¯ÇÏ°í ÀÖ½À´Ï´Ù (»óÇ°¸í:Alinia(R), 500 mg/Á¤, 30Á¤/package, ¾à 100¸¸¿ø/packge). ³¹¾Ë·Î ±¸ÀÔÀÌ °¡´ÉÇÑÁö´Â È®ÀÎÇÏÁö ¸øÇÏ¿´½À´Ï´Ù.


[2014-3-27. ¾Öµ¶ÀÚ Áú¹®] Æò¼Ò ȸ¸¦ Áñ°Ü ¸Ô´Â ¿©ÀÚ È¯ÀÚÀÔ´Ï´Ù. ¿Ã 2¿ù¿¡ ¹èº¯ ÈÄ Ç×¹®¿¡¼­ tapewormÀÌ ³ª¿Í¼­ Àα٠º´¿øÀ» ¹æ¹®ÇÏ¿´½À´Ï´Ù. ´ëÀå³»½Ã°æ °Ë»ç¿¡¼­ ±â»ýÃæÀº ¾ø¾ú½À´Ï´Ù. Á¦ ¿Ü·¡¿¡ ¿À¼Ì±â¿¡ praziquantel 600mg 1¾ËÀ» º¹¿ëÇϵµ·Ï ÇÏ¿´½À´Ï´Ù. º¹¾à ÈÄ ¼Ò·®ÀÇ ±â»ýÃæÀÌ ´õ ³ª¿À°í ÀÌÈÄ¿¡´Â ³ª¿ÀÁö ¾Ê¾Ò´Ù°í ÇÕ´Ï´Ù. D. latum (±¤Àý¿­µÎÁ¶Ãæ)À¸·Î »ý°¢µÇ¾ú½À´Ï´Ù. ±×·±µ¥ ÀÌ °æ¿ì ´ëÀå³»½Ã°æÀÌ ÇÊ¿äÇÒ±î¿ä?

[ÀÌÁØÇà ´äº¯] ÀÏÀü¿¡ EndoTODAY 20110409¿¡¼­ ¼Ò°³µå¸° ¹Ù¿Í °°ÀÌ D. nihonkaiense, À¯±¸Á¶Ãæ, ¾Æ½Ã¾ÆÁ¶Ãæ µîÀÌ ¸ðµÎ °¡´ÉÇÕ´Ï´Ù. ÆíÀýÀ» ºÁ¼­ ±¤Àý(ÎÆ ³ÐÀ» ±¤, ï½ ¸¶µð Àý)À̸é, Áï ¿·À¸·Î ³ÐÀ¸¸é D. nihonkaienseÀÇ °¡´É¼ºÀÌ °¡Àå ³ô½À´Ï´Ù. ÆíÀýÀÌ ±æ¸é, Áï ´ë³ª¹« ¸¶µðó·³ »ý°åÀ¸¸é À¯±¸Á¶ÃæÀ̳ª ¾Æ½Ã¾ÆÁ¶ÃæÀÏ È®·üÀÌ ³ô½À´Ï´Ù. °ú°Å D. latum (±¤Àý¿­µÎÁ¶Ãæ)À¸·Î Áø´ÜµÈ °ÍÀº À¯ÀüÀڰ˻縦 Çغ¸¸é ´ëºÎºÐ D. nihonkaiense·Î ³ª¿Â´Ù°í ÇÕ´Ï´Ù. ¿ì¸®³ª¶ó¿¡ ±¤Àý¿­µÎÁ¶ÃæÀº °ÅÀÇ ¾ø´Ù´Â °ÍÀÌ Á¤¼³ÀÌ µÇ¾úÀ¸¹Ç·Î D. nihonkaiense¶ó¸é ¸ð¸¦±î ±¤Àý¿­µÎÁ¶ÃæÀÏ °¡´É¼ºÀº ³·½À´Ï´Ù. ±×·¯³ª »ó°ü¾ø½À´Ï´Ù D. nihonkaiense³ª D. latumÀ̳ª praziquantel ÇÑ ¾Ë·Î Ä¡·áÇÏ´Â °ÍÀ̴ϱî¿ä.

PraziquantelÀ» ÇÑ ¾Ë¸¸ ÁֽŠ°ÍÀº Á¤¸» ÀßÇÑ ÀÏÀÔ´Ï´Ù. Ç¥ÁØ ¿ë·®ÀÌ ÇÑ ¾ËÀÔ´Ï´Ù. Praziquantel Åõ¾à ÈÄ Ãæü°¡ ³ª¿Ô´Ù¸é ´õ Ä¡·áÇÒ ÇÊ¿ä´Â ¾øÀ» °Í °°½À´Ï´Ù. ´Ù½Ã °¨¿°µÇ¸é ±×¶§ Ä¡·áÇÏ¸é µË´Ï´Ù. ¾îÂ¥ÇÇ Â¡±×·¯¿ö¼­ ¹®Á¦Áö º´µ¶¼ºÀº ¸Å¿ì ¾àÇϴϱî¿ä. ´ëÀå³»½Ã°æÀº ´ç¿¬È÷ ÇÊ¿ä¾ø½À´Ï´Ù. ¿ø·¡ D. latum (±¤Àý¿­µÎÁ¶Ãæ) ȤÀº D. nihonkaienseÀÇ Á¤»ó ±â»ýºÎÀ§°¡ ¼ÒÀå (ȸÀå »óºÎ)ÀÔ´Ï´Ù. ´ëÀå³»½Ã°æ¿¡¼­ º¸ÀÏ ¼ö ÀÖÁö¸¸ ¾È º¸ÀÌ´Â °æ¿ì°¡ ´õ ¸¹½À´Ï´Ù. ÁÁÀº Áú¹® Áּż­ °¨»çÇÕ´Ï´Ù.


´ëÀå³»½Ã°æÀ» À§ÇØ bowel preparationÇÏ´Â µµÁß¿¡ ¹è¼³µÈ D. latum (±¤Àý¿­µÎÁ¶Ãæ) ȤÀº D. nihonkaiense


[2013-9-29. Ãß°¡Á¤º¸] GastrograffinÀ» Á¶ÃæÀÇ Ä¡·á¿¡ »ç¿ëÇÒ ¼ö ÀÖ´Ù.

¼­¹Î ±³¼ö´Ô°ú ÃÖ±Ù »õ·Î ¸¸µç EndoTODAY ±â»ýÃæÇÐ link¿¡ ´ëÇÏ¿© ¸ÞÀÏÀ» ÁÖ°í ¹Þ´ø Áß ÀϺ»¿¡¼­´Â diatrizoic acid¸¦ ½á¼­ Ä¡·áÇÏ´Â ¹æ¹ýÀÌ ÀÖ´Ù´Â °ÍÀ» ¾Ë°Ô µÇ¾ú½À´Ï´Ù. Àå¿îµ¿À» È°¹ßÈ÷Çؼ­ Ãæü¸¦ ¿ÏÀüÈ÷ Á¦°ÅÇÏ´Â ¹æ¹ýÀ̶ó°í Çϼ̽À´Ï´Ù. Diatrizoic acid¶ó¸é bariumÀ» ¾²±â ¾î·Á¿ï ¶§ »ç¿ëÇÏ´Â radiocontrast agent (Gastrograffin)Àä...... °©Àڱ⠱ñÝÁõÀÌ ¹ßµ¿ÇÏ¿© ªÀº ÀÚ·á °Ë»öÀ» Çß½À´Ï´Ù.

1) WikipediaÀÇ D. latum Ä¡·áºÎºÐÀÔ´Ï´Ù. Duodenal tube¸¦ ÅëÇÏ¿© ¿©·¯ solutionÀ» ÁÖÀÔÇÏ¿© D. latum »Ó¸¸ ¾Æ´Ï¶ó ¿©·¯ Á¶ÃæÀ» ¹èÃâ½ÃÅ°´Â ¹æ¹ýÀÌ ¼Ò°³µÇ°í ÀÖ½À´Ï´Ù. ƯÈ÷ Gastrografin (diatrizoic acid)ÀÌ ¸¹ÀÌ »ç¿ëµÇ´Â ¸ð¾çÀÔ´Ï´Ù.

The standard treatment for diphyllobothriasis, as well as many other tapeworm infections is a single dose of Praziquantel, 5?10 mg/kg PO once for both adults and children. An alternative treatment is Niclosamide, 2 g PO once for adults or 50 mg/kg PO once. One should note that Praziquantel is not FDA approved for this indication and Niclosamide is not available for human use in the United States. Another interesting potential diagnostic tool and treatment is the contrast medium, Gastrografin (diatrizoic acid), introduced into the duodenum, which allows both visualization of the parasite, and has also been shown to cause detachment and passing of the whole worm.

2) Parasites in Humans¶ó´Â À¥ÆäÀÌÁöÀÇ D. latum Ä¡·á ºÎºÐ¿¡µµ °°Àº ¹æ¹ýÀÌ ¼Ò°³µÇ°í ÀÖ½À´Ï´Ù.

Diphyllobothriasis was previously treated with praziquantel or niclosamide. Praziquantel has some side effects that are very similar to diphyllobothriasis symptoms. Niclosamide is not absorbed in the gastrointestinal tract and has usually no side effects. However, these drugs are not reliable in cutting the scolex loose. If the head is left in the intestinal wall it will regrow. The best method is a diatrizoic acid injection into the duodenal wall. The diatrizoic acid causes all worms to detach leaving nothing behind. Niclosamide or praziquantel should only be used, if endoscopic treatment is not available.

Âü°í¹®Çå 1: Method for ejecting cestodes: duodenal tube injection of gastrografin (AJR Am J Roentgenol 1984) (¿ø¹® PDF) - The expulsive effect of Gastrografin on the cestode is not clear, but it seems that a cathartic effect is one of the main mechanisms. The direct effect of Gastrografin on the cestode may also play a role in expulsion. It is presumed that stimulation of the scolex by a hypertonic solution containing iodine may cause release of the cestode body from the intestinal wall, and that acceleration of peristalsis and the increase of intestinal contents may cause expulsion of the cestode.


A: T. saginata in jejunum, B: in ileum

Âü°í¹®Çå 2: Successful treatment of Diphyllobothrium latum and Taenia saginata infection by intraduodenal 'Gastrografin' injection. (Lancet 1986)


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[References]

1) EndoTODAY ±â»ýÃæÇÐ

2) D. latum in parasite sin humans.org

3) ºÐ·ùÇÐÀû Åä·Ð - D. latumÀΰ¡ D. nihonkaienseÀΰ¡?

4) D. latum ±¤Àý¿­µÎÁ¶Ãæ ȯÀÚ¼³¸í¼­

5) ºóÇ÷ȯÀÚ¿¡¼­ capsule endoscopy·Î Áø´ÜÇÑ Taenia (GIE 2016)

© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng.