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EndoTODAY ³»½Ã°æ ±³½Ç


[±â»ýÃæÇÐ ÃÑ·Ð]

1. ±â»ýÃæÇÐ ÇнÀÀÇ Á߿伺

WHOÀÇ 6´ë ¿­´ëÁúȯ

  1. ¸»¶ó¸®¾Æ
  2. ÁÖÇ÷ÈíÃæÁõ
  3. ÆÄµ¿Æí¸ðÃæÁõ
  4. ¸®½´¸¸Æí¸ðÃæÁõ
  5. »ç»óÃæÁõ
  6. ³ªº´ : À¯ÀÏÇÏ°Ô ±â»ýÃæÁúȯ (-)

ÇâÈÄ ±¹³» º¯µ¿»óȲÀÇ ¿¹Ãø

  1. ¿Ü·¡¼º, ¼öÀÔ¼º ÁúȯÀÇ Áõ°¡
  2. Àμö°øÅë°¨¿°ÁõÀÇ Áõ°¡
  3. ±âȸ°¨¿°ÀÇ Áõ°¡
  4. ÀÚÀ¯»ýȰÁ¾ÀÇ º´¿ø¼º ȹµæ
  5. ½ÅÁ¾ ¹ß°ßÀ¸·Î ÀÎÇÑ »õ·Î¿î ÀÎü ±â»ýÃæÁõÀÇ ÃâÇö
  6. °ü¸®µÇ¾ú´ø ±â»ýÃæÁõÀÇ ÀçÀ¯Çà

±â»ýÃæ °¨¿°ÀÌ »çȸ¿¡ ¹ÌÄ¡´Â ¿µÇâ

  1. Á÷Á¢ÀûÀÎ ¿µÇâ
  2. °£Á¢ÀûÀÎ ¿µÇâ

°úÇבּ¸´ë»óÀ¸·Î¼­ÀÇ ±â»ýÃæ

±â»ýÃæÇÐÀÇ ¿¬±¸´ë»óÀº ºÐ·ùÇлó ³ÐÀº ¹üÁÖÀÇ ´ë»óÀ» Æ÷ÇÔÇϹǷΠ¿¬±¸ÀÇ ÆøÀÌ ³Ð°í ´Ù¾çÇÏ´Ù. ºÐÀÚ¼öÁغÎÅÍ Áý´ÜÀÇ »ýÅ¿¡ À̸£±â±îÁö ¹«±Ã¹«ÁøÇÑ ¿¬±¸¸¦ ÇÒ ¼ö ÀÖÀ¸¸ç °úÇÐÀûÀ¸·Î ¾ÆÁÖ Áø±ÍÇÑ µ¶Ã¢¼ºÀ» ÀÎÁ¤¹Þ´Â´Ù. ±â»ýÃæÇÐÀÇ »õ·Î¿î Áö½ÄÀº ¿ì¸®ÀÇ Çö½ÇÀûÀÎ ¹®Á¦ÀÇ ÇØ°á(±â»ýÃæ °¨¿°ÀÇ ÅðÄ¡)¿¡ Á÷Á¢ÀûÀ¸·Î ÀÌ¿ëµÈ´Ù.

ÇöÀç ±¹³» ÀÎü ±â»ýÃæÁõÀÇ ÇöȲÀ» ¼³¸íÇϽÿÀ

1966³â '±â»ýÃæÁúȯ ¿¹¹æ¹ý'ÀÌ °øÆ÷ ½ÃÇàµÇ°í ÀÌ¿¡ µû¸¥ ÁýÁßÀûÀÎ Áý´Ü°ü¸®»ç¾÷ÀÌ È°¹ßÈ÷ ÁøÇàµÇ¾úÀ¸¸ç, ¾Æ¿ï·¯ ±¹¹Î ±³À°¼öÁØ Çâ»ó ¹× »ýȰ°³¼±ÀÌ ÇÔ²² ÀÌ·ç¾îÁü¿¡ µû¶ó ±â»ýÃæ°¨¿°ÀÌ °Ý°¨ÇÏ¿´´Ù. ¸Å 5³â¸¶´Ù Àü±¹ÀûÀ¸·Î ½ÃÇàµÇ°í ÀÖ´Â 'Àå³» ±â»ýÃæ°¨¿° ½ÇÅÂÁ¶»ç'¿¡ µû¸£¸é 1971³â¿¡ ÃÑ Ãæ¶õ¾ç¼ºÀÚ°¡ 84.3%ÀÌ°í ´©Àû°¨¿°·üÀÌ 147.1%¿´À¸³ª ¸¶Áö¸· ½ÃÇàµÇ¾ú´ø 1997³â¿¡´Â ÃÑ Ãæ¶õ¾ç¼ºÀÚ°¡ 2.4% Á¤µµ·Î ÇöÀúÈ÷ °¨¼ÒÇÏ¿´´Ù. 1997³âÀÇ Ãæ¶õ¾ç¼º·üÀ» ÃæÃ¼º°·Î »ìÆìº¸¸é °£ÈíÃæÀÌ 1.4%·Î °¡Àå ¸¹¾Ò°í ¿äÃæÀÌ 0.6%, ¿äÄÚ°¡¿ÍÈíÃæÀÌ 0.3%¿´´Ù. °ú°Å¿¡ À¯ÇàÇÏ¿´´ø È¸Ãæ, ±¸Ãæ, ÆíÃæ µîÀÇ Åä¾ç¸Å°³¼º¼±Ãæ(soil-transmitted nematodes)Àº ¸ðµÎ 0.1% ÀÌÇÏ·Î °ÅÀÇ ¹ß°ßµÇÁö ¾Ê¾Ò´Ù.

¿ì¸®³ª¶ó¿¡¼­ ÇâÈÄ ±â»ýÃæÇÐÀÌ ³ª¾Æ°¥ ¹æÇâÀ» Àü¸ÁÇϽÿÀ

1960³â´ë ±îÁöÀÇ ¿ì¸®³ª¶ó ±â»ýÃæÇÐÀÇ ¿¬±¸¹æÇâÀº (1)±â»ýÃæÀÇ ´ë»ç¿Í »ýȰ»ç¿¡ °üÇÑ °úÇÐÀû Áö½ÄÀÇ Ã¢Ãâ°ú (2)¿ªÇÐÀû, ÀÓ»óÀûÀ¸·Î Áß¿äÇÑ °¢ ±â»ýÃæ¿¡ ´ëÇÑ Áø´Ü¹æ¹ý, Ä¡·áÁ¦, À¯ÇàÁö Á¶»ç¿¡ ´ëÇÑ ¿¬±¸¿´´Ù. 1970³â´ë¿¡´Â ü°èÀûÀÎ Çѱ¹ÀÎ Àå³» ±â»ýÃæ ½ÇÅÂÁ¶»ç°¡ 5³â °£°ÝÀ¸·Î ½Ç½ÃµÇ±â ½ÃÀÛÇÏ¿´´Ù ¶ÇÇÑ °£ÈíÃæÀÇ Ä¡·áÁ¦·Î¼­ÀÇ praziquantelÀÇ È¿°ú¸¦ ¼¼°è ÃÖÃÊ·Î Æò°¡ÇÏ¿´°í ±â»ýÃæÀÇ ¼÷ÁÖÁý´Ü¿¡¼­ÀÇ ºÐÆ÷¾ç»ó¿¡ ´ëÇÑ ±âº»°³³ä(negative binomial distribution)À» È¸ÃæÀÇ °¨¿°ÃæÃ¼¼öÀÇ ºÐÆ÷Á¶»ç·Î °ËÁõÇÏ¿´´Ù. 1980³â´ë¿¡´Â ELISA, ÃÊÀ½ÆÄ, CT, MRI µîÀ» ÀÌ¿ëÇÑ °úÇÐÀûÀÎ ±âÃÊ¿¬±¸°¡ °­È­µÇ¾ú°í ¼­¿ïÁÖ°ÆÈíÃæ°ú Âü±¼Å«ÀÔÈíÃæ°ú °°Àº Á¾ÀÇ ÀÎü°¨¿°À» ¼¼°èÃÖÃÊ·Î È®ÀÎÇÏ¿´´Ù. 1989³â ºÎÅÍ Index Medicus/MedlineÀÌ ±¹¿µ¹®È¥¿ë ±¹³»ÀâÁö·Î´Â óÀ½À¸·Î ±â»ýÃæÇÐÀâÁö¸¦ ÀοëÇϱ⠽ÃÀÛÇÏ¿´´Ù. 1990³â´ëÀÇ ¿¬±¸¿¡´Â SDS-PAGE, immunoblot, ¼¼Æ÷¹è¾ç¹ý, °¢Á¾ È¿¼ÒÇÐ, ¼¼Æ÷»ý¹°ÇÐ, ºÐÀÚ»ý¹°ÇÐ ±â¹ýµîÀÌ È°¹ßÇÏ°Ô ÀÌ¿ëµÇ¾ú´Ù. °ú°Å ¾Æ½Ã¾Æ¿¡¼­ À¯ÇàÇÏ´Â °íÀ¯ ±â»ýÃæÀ» ¿¬±¸ÇÔÀ¸·Î½á ±× ±¹¼Ò¼º¶§¹®¿¡ ÁÖ¸ñ¹Þ´ø ´Ü°è¿¡¼­ Áö±ÝÀº ¼¼°èÀûÀ¸·Î ¿¬±¸´ë»óÀÌ µÇ´Â ±â»ýÃæÀ» ¿¬±¸ÇÏ°í °¢ ³ª¶óÀÇ ÀÏ·ù ¿¬±¸ÆÀ°ú °æÀïÇÏ´Â ½Ã´ë·Î µé¾î¼¹´Ù.

ÇâÈÄ ¿ì¸®³ª¶ó°¡ Á÷¸éÇÏ°Ô µÉ °ÍÀ¸·Î ¿¹»óµÇ´Â ±â»ýÃæ °¨¿°ÀÇ º¯µ¿¾ç»óÀº (1)¿Ü·¡¼º, ¼öÀÔ¼º ÁúȯÀÇ Áõ°¡, (2)Àμö°øÅë°¨¿°ÁõÀÇ Áõ°¡, (3)±âȸ°¨¿°ÀÇ Áõ°¡, (4)ÀÚÀ¯»ýȰÁ¾ÀÇ º´¿ø¼º ȹµæ, (5)½ÅÁ¾ ¹ß°ßÀ¸·Î ÀÎÇÑ »õ·Î¿î ÀÎü ±â»ýÃæÁõÀÇ ÃâÇö, (6)°ü¸®µÇ¾ú´ø ±â»ýÃæÁõÀÇ ÀçÀ¯Çà µîÀ¸·Î ÀÌ¿¡ ´ëÇÑ ÀûÀýÇÑ Áغñ¿Í ´ëó°¡ ÇÊ¿äÇÏ´Ù. ÁöÀûÀÚ¿ø¸¶Àú Àü·«È­ÇÏ´Â ±¹Á¦°æÀï½Ã´ë¿¡¼­ ¿ì¸®ÀÇ ¹®Á¦¸¦ ¿ì¸®ÀÇ ÁöÇý·Î ÇØ°áÇÑ´Ù´Â Çй®Àû ÀÚ¸³Á¤½Å¿¡ ±âÃÊÇÑ ¿¬±¸¿Í ÇÔ²² ¼¼°è °¢Áö¿¡¼­ À¯ÇàµÇ°í ÀÖ´Â ±â»ýÃæ¿¡ ÀÇÇÑ º¸°Ç¹®Á¦¸¦ ÇØ°áÇϱâ À§ÇÏ¿© ´Ù¾çÇÑ ¿¬±¸±â¹ýÀ» µµÀÔÇÑ Æø³ÐÀº ÁÖÁ¦¿¡ ´ëÇÑ ±íÀÌ ÀÖ´Â ¿¬±¸°¡ ÇÊ¿äÇÑ ½ÃÁ¡ÀÌ´Ù.




2. °¢Á¾ »ýȰ¾ç½Ä°ú ±â»ýÃæ

»ýȰ¾ç½Ä

°ø¼­»ýȰ (symbiosis = mutualism)
»ó´ë¹æ »ý¹°ÀÌ ¾øÀÌ´Â »ýÁ¸ÇÒ ¼ö ¾øµµ·Ï ¼­·Î ÇùÁ¶ ÀÇÁ¸ (Èò°³¹Ì¿Í intestinal flagellate). definiteÇÏ°íµµ essentialÇÑ °ü°è
±â°Å»ýȰ (commensalism, Æí¸®°ø»ý, Raumparasitismus)
µÎ »ý¹°Ã¼°¡ ¼­½Äó¸¦ ÁÖ°í ¹Þ´Â ÀÌ¿ÜÀÇ Æ¯º°ÇÑ °ü°è°¡ ¾øÀ» ¶§
±â»ý»ýȰ (parasitism)
(1)ÇÑ »ý¹°Ã¼°¡ ´Ù¸¥ »ý¹°Ã¼ÀÇ (2)ü³», üǥ¿¡ (3)ÀϽÃÀû ¶Ç´Â ¿µ±¸ÀûÀ¸·Î ¼­½ÄÇϸ鼭 (4)¿µ¾çºÐÀ» Å»ÃëÇÏ´Â »ýȰ¾ç½Ä

¿ë¾î Á¤ÀÇ

infestation
¿ÜºÎ±â»ýÃæ°ú °°ÀÌ ¼÷ÁÖÀÇ Ã¼³»¿¡¼­´Â ºÐ¿­ Áõ½ÄÇÏÁö ¾Ê´Â °¨¿°
ÁÖ¼÷ÁÖ (principal host)
ÇÑ Á¾·ùÀÇ ±â»ýÃæÀÌ ¿©·¯ ¼÷ÁÖ¸¦ °¨¿°½Ãų ¼ö ÀÖ´Â °æ¿ì ±× Áß¿¡¼­ °¡Àå º¸ÆíÀûÀ¸·Î °¨¿°µÇ´Â ¼÷ÁÖ
Á¾¼÷ÁÖ
¼ºÃæÀ̳ª À¯¼º»ö½ÄÀÌ ¿µÀ§µÇ´Â ¼÷ÁÖ
Áß°£¼÷ÁÖ
À¯ÃæÀ̳ª ¹«¼º»ý½ÄÀÌ ¿µÀ§µÇ´Â ¼÷ÁÖ
¿î¹Ý¼÷ÁÖ (transport host)
Áß°£¼÷ÁÖÀÇ ´Ü°è¿¡ ÀÖÀ¸¸é¼­ ±â»ýÃæÀÌ ¼÷ÁÖ Ã¼³»¿¡¼­ ¼ºÀåÇÏÁö ¾Ê°í ÇÇÆ÷(encapsulation) ¶Ç´Â Çdz¶(encystation)ÀÇ »óÅ·Π´ÙÀ½ ¼÷ÁÖ¿¡ ¼·ÃëµÇ´Â °æ¿ì
¿¬Àå¼÷ÁÖ (paratenic host)
°¨¿°±â À¯ÃæÀ» °¡Áö°í ÀÖ´Â Áß°£¼÷ÁÖ¸¦ Á¾¼÷ÁÖ°¡ ¼·ÃëÇÏÁö ¸øÇÏ´Â °æ¿ì¿¡ »ýÅÂÇÐÀûÀÎ °£°ÝÀ» ¿¬°áÇÏ¿© ÁÖ´Â µ¿¹°, ¿¹·Î ¼­¿ïÁÖ°ÍÈíÃæÀÇ '¹ì', ¾Æ´Ï»çŰ½ºÀÇ 'ÇØ»ê¾î·ù, µÎÁ··ù'
º¸À¯¼÷ÁÖ (reservoir host)
»ç¶÷°ú µ¿Á¾ÀÇ ±â»ýÃæÀ» °¡Áö°í ÀÖ¾î »ç¶÷ °¨¿°ÀÇ ±Ù¿øÀ» Á¦°øÇÏ´Â µ¿¹°
¸Å°³Ã¼ (vector)
ÈíÇ÷¼º ÀýÁöµ¿¹°ÀÌ ±â»ýÃæÀ» ÇÑ ¼÷ÁÖ¿¡¼­ ´Ù¸¥¼÷ÁÖ·Î ÀüÆÄÇÏ´Â °æ¿ì
À±Ã漺 ¸Å°³Ã¼ (helminthic vector)
À±ÃæÀÌ ¾î¶² º´¿øÃ¼ÀÇ ¸Å°³Ã¼ ±¸½ÇÀ» ÇÏ´Â °æ¿ì. ¿¹; µÅÁöÆóÃæÀÌ swine influenza virus¸¦ ¸Å°³ÇÑ´Ù.
normal habitat (Á¤»ó ±â»ýºÎÀ§)
±â»ýÃæÀÌ ¼÷ÁÖ Ã¼³»¿¡¼­ °¡Áö´Â °íÀ¯ÇÑ ¼­½Ä Àå¼Ò
ecological niche (»ýÅÂÇÐÀû ±â»ýºÎÀ§)
±â»ýÃæÀÌ ¼÷ÁÖ¿ÍÀÇ ¹ÐÁ¢ÇÑ ¿¬°ü¼ºÀ» À¯ÁöÇϱâ À§ÇÏ¿© ¼­½Äó(Á¤»ó ±â»ýºÎÀ§)¿¡¼­ °¡Áö´Â ÇüÅÂÇÐÀû, »ý¸®ÇÐÀû, »ýÈ­ÇÐÀûÀ¸·Î º¸´Ù ÀûÇÕÇÑ ¼­½ÄºÎÀ§
´ë»çÀÇÁ¸µµ (metabolic dependence)
(1)¿µ¾çºÐÀÇ °ø±Þ (2)¹ßÀ°¿¡ ÇÊ¿äÇÑ ÀÚ±Ø (3)¼ÒÈ­È¿¼ÒÀÇ ÀÌ¿ë (4)¼º¼÷ Á¶Àý °£¿îµ¥ Çϳª ¶Ç´Â ±× ÀÌ»óÀ» ¼÷ÁÖ¿¡ ÀÇÁ¸ÇÏ´Â °Í. ¿ÏÀüÇÑ ±â»ý»ýȰÀº ´ë»çÀÇÁ¸µµ 100%, ÀÚÀ¯»ýȰÀº ´ë»çÀÇÁ¸µµ 0%.
Æí¼º±â»ýÃæ (obligatory parasitism)
ÀüÀûÀ¸·Î ¼÷ÁÖ¿¡ ÀÇÁ¸ÇÏ´Â ±â»ýÃæ
Å뼺±â»ýÃæ (facultative parasitism)
ºÎºÐÀûÀ¸·Î ÀÚÀ¯»ýȰÀ» Çϱ⵵ ÇÏ´Â ±â»ýÃæ
Áß±â»ý (hyperparasitism)
µ¿Á¾ ±â»ýÃæÀÇ ¾Ï¼ö°¡ ȤÀº ÇÑ ±â»ýÃæÀÌ ´Ù¸¥ ±â»ýÃæ¿¡ ±â»ý (ÈÄÀÚ¸¦ ƯÈ÷ epiparasitismÀ̶ó°í ÇÑ´Ù)
º¸À¯¼÷ÁÖ (reservoir)
±â»ýÃæÀ» º¸À¯ÇÏ¿© ÀÚ¿¬°èÀÇ ±â»ýÃæ °ø±Þ¿øÀÇ ¿ªÇÒÀ» ÇÏ´Â µ¿¹°

toxonomy (ºÐ·ùÇÐ)

  1. ͣ (kingdom)
  2. Ú¦ (phylum)
  3. ˵ (class)
  4. ÙÍ (order)
  5. Ρ (family) °ú¸í '-idae'. »ó°ú¸í '-oidea'
  6. áÕ (genus)
  7. ðú (species)




3. ¼÷ÁÖ ±â»ýÃæ »óÈ£°ü°è

host specificity

±â»ýÃæ°ú ¼÷ÁÖ°£ÀÇ ¾ö°ÝÇÑ ¶Ç´Â °ü´ëÇÑ °ü°è¸¦ ƯÀ̼ºÀ̶ó°í Çϸç (1)±â»ýÃæÀÇ °¨¿°·Â (2)¼÷ÁÖÀÇ °¨¼ö¼º, ½À¼º µî º¹ÇÕ ¿äÀο¡ ÀÇÇÏ¿© °áÁ¤µÈ´Ù.

specificity¸¦ °áÁ¤ÇÏ´Â ¿äÀÎ --> ¼±ÃµÀúÇ×ÀÌ °¡Àå Áß¿äÇÏ´Ù

  1. genetic resistance; ÇǺÎÀÇ µÎ²²...
  2. physiologic factor
  3. behavioral factor; ÈùµÎ±³µµµéÀº ¼Ò°í±âÀÇ ¾È ¸Ô°í, ȸ±³µµµéÀº µÅÁö°í±â¸¦ ¸ÔÁö ¾ÊÀ¸¹Ç·Î Á¶Á¶ÃæÀÇ °¨¿°ÀÌ µå¹°´Ù. Åä³¢´Â C.sinensis¿¡ ½ÇÇè½Ç¿¡¼­´Â °¨¿°µÉ ¼ö ÀÖÀ¸³ª ÀÚ¿¬°è¿¡¼­´Â »ý¼±À» ¸ÔÁö ¾ÊÀ¸¹Ç·Î °¨¿°µÇÁö ¾Ê´Â´Ù.

±â»ýÃæÀÇ ÁøÈ­°úÁ¤

°³Ã¼³ª Á¾Á·ÀÇ »ýÁ¸À» À§ÇÏ¿© ÀÚÀ¯»ýȰº¸´Ù ´Ù¸¥µ¿¹°¿¡ ÀÇÁ¸ÇÏ´Â °ÍÀÌ À¯¸®ÇÑ °æ¿ì¿¡ ±× ¼÷ÁÖ¿¡ ÀûÀÀÇÑ °Í. ¼÷ÁÖ¿¡ ÃÖ¼ÒÇÑÀÇ ÇÇÇØ¸¦ Áָ鼭 ±â»ýÃæ ÀÚ½ÅÀÇ ¼ö¸íÀÌ ´ÙÇÒ ¶§ ±îÁö ÃÖ´ëÇѵµÀÇ ÀÌÀÍÀ» ´©¸®¸é¼­ »ì¾Æ³²´Â °ÍÀÌ ¼º°øÀûÀÎ ±â»ý»ýȰÀÌ´Ù.

ÀÚÀ¯»ýȰ --> ´Ü¼ø¿î¹Ý(phoresis) --> ±â°Å»ýȰ(commensalism) --> ±â»ý»ýȰ --> °ø¼­»ýȰ ÀÇ ¼ø¼­·Î ÁøÈ­

»ý½Ä¹æ¹ý

  1. ¹«¼º»ý½Ä
  2. À¯¼º»ý½Ä
  3. ¿õ¼º»ý½Ä±â ¼±¼÷¼º ÀÚ¿õµ¿Ã¼ (protandrous hermaphroditism): ºÐ¼±ÃæÀº ÀÎü¿¡¼­ º¸Åë ¾ÏÄÆ¸¸ ¹ß°ßµÈ´Ù. ¿õ¼º»ý½Ä±â°¡ ¸ÕÀú ¹ßÀ°ÇÏ¿© Á¤ÀÚ¸¦ »ý¼ºÇÑ ÈÄ ÀÚ¼º »ý½Ä±â°¡ ¼º¼÷, ¼öÁ¤Çϰí Ãæ¶õÀ» Çü¼ºÇÑ´Ù.

ÀüÆÄ¹æ½Ä¿¡ µû¸¥ À±Ãæ·ùÀÇ ºÐ·ù

  1. Åä¾ç¸Å°³¼º: Èë ¼Ó¿¡¼­ °¨¿°ÇüÀ¸·Î ¹ßÀ°ÇÑ´Ù.

  2. ÆÐ·ù¸Å°³¼º: ÆÐ·ù¸¦ Áß°£¼÷ÁÖ·Î ÇÑ´Ù.

  3. ÀýÁöµ¿¹° ¸Å°³¼º; ÀýÁöµ¿¹°¿¡¼­ °¨¿°ÇüÀ¸·Î ¹ßÀ°, À¯±Ø¾Ç±¸ÃæÀº ¹°º­·è¿¡¼­ °¨¿°ÇüÀ¸·Î µÇÁö ¾ÊÀ¸¹Ç·Î ¿©±â¿¡ ¼ÓÇÏÁö (-)

  4. ½Ä¿ëµ¿¹° ¸Å°³¼º; ½Ä¿ëÀÌ µÇ´Â °¡Ãà, ¾î·ù¿¡¼­ °¨¿°ÇüÀ¸·Î ¹ßÀ°. ¸¹Àº ÈíÃæÀÌ ½Ä¿ë ¾î·ù¿¡ ÀÇÇØ ¸Å°³µÇÁö¸¸ ÆíÀÇ»ó ÈíÃæÀº ÆÐ·ù¸Å°³¼º À±ÃæÀ¸·Î ºÐ·ùÇÑ´Ù.

  5. Á¢Ã˰¨¿°¼º

±â»ýÃæÀÇ °¨¿°°æ·Î

  1. ¼ÒÈ­±â (oral infection): ´ëºÎºÐÀÇ ±â»ýÃæ

  2. ÇǺΠ(cutaneous infection)

  3. Ç÷¾×

  4. ¸ðü ³» °¨¿° (transplacental infection; °æÅ¹ݰ¨¿°)

  5. ±âŸ

Àμö°øÅë°¨¿°Áõ

·Á¤ÀÇ: ôÃßµ¿¹°°ú »ç¶÷ »çÀ̸¦ ÀÚ¿¬Àû Á¶°ÇÇÏ¿¡¼­ »óÈ£ ÀÌÇàÇÏ´Â ÀÏüÀÇ °¨¿° ¶Ç´Â Áúȯ

·accidental host: ÀÎü¿¡¼­ º¸ÆíÀûÀ¸·Î ¹ß°ßµÇÁö ¾Ê´Â µ¿¹°ÀÇ ±â»ýÃæÀÌ ¾ÆÁÖ µå¹°Áö¸¸ °¨¿°µÇ´Â °æ¿ì ·aberrant host: ÀÎü¿¡ ħÀÔÇÑ ±â»ýÃæÀÌ ¼ºÃæÀ¸·Î ¹ßÀ°ÇÏÁö ¸øÇÏ´Â °æ¿ì ·abnormal host: À§ µÎ °¡Áö °æ¿ì¸¦ ÇÕÇÑ °³³ä

ÁßÃ߽Űæ°è¸¦ ħ¹üÇÏ´Â ±â»ýÃæ

  1. ¼±Ãæ; ¼±ÃæÀÇ °æ¿ì ¸ðµÎ À¯Ãæ¿¡ ÀÇÇÑ´Ù.
  2. ÈíÃæ
  3. Á¶Ãæ
  4. ¿øÃæ

¾È±¸¸¦ ħ¹üÇÏ´Â ±â»ýÃæ

±â»ýÃæ ±¹³» ÇöȲ

¹ìÀÌ ¸Å°³ÇÏ´Â ±â»ýÃæ

ÆóÀÌÇà

  1. ÆóÀÌÇàÀ» ÇÏ´Â ÀÌÀ¯; À¯ÃæÀÌ ¼ºÀå º¯ÅÂÇϴµ¥ °í»ê¼ÒºÐ¾Ð ȯ°æÀÌ ÇÊ¿äÇϱ⠶§¹®
  2. ÆóÀÌÇàÀ» Çϸ鼭 Æó¿¡ º´º¯À» ÀÏÀ¸Å°´Â Á¾·ù
  3. ÆóÀÌÇàÀ» ÇÏÁö ¾Ê´Â Á¾·ù




4. ±â»ýÃæ °¨¿°ÀÇ ¿ªÇÐ

ÅäÂø¼º

±â»ýÃæ °¨¿°Àº ±× ¸¸¼ºÀûÀÎ ¼º°ÝÀ̳ª ±âÈÄÁ¶°Ç, Áß°£¼÷ÁÖ, ¸Å°³Ã¼ µî »ýŰè¿ÍÀÇ ¿¬°ü, ȯ°æ¿äÀÎ, »çȸ°æÁ¦Àû ¿©°Ç µî ¿ªÇаè¿ÍÀÇ ¿¬°üÀ¸·Î ÀÎÇÏ¿© ºñ±³Àû ¾ÈÁ¤µÈ ¿ªÇÐÀû ÆòÇüÀ» ÀÌ·ç¸é¼­ ƯÁ¤Áö¿ª¿¡ ÅäÂøÈ­ÇÏ´Â °æÇâÀÌ ÀÖ´Ù. Áö¿ªÀûÀ¸·Î ÅäÂøÈ­µÈ ¸¸¼ºÁúȯÀ» dzÅ亴À̶ó°í ÇÒ ¶§, ±â»ýÃæ ÁúȯÀº dzÅ亴ÀÇ ´ëºÎºÐÀ» Â÷ÁöÇÑ´Ù.

±â»ýÃæ °¨¿°ÀÇ °¨¿°·ü

°¨¿°·ü, À¯º´·ü, prevalence rate
¹ßº´½Ã±â¿Í °ü°è¾øÀÌ ÇöÀç °¨¿°µÈ »ç¶÷ÀÇ ºñÀ²
¹ß»ý·ü, ÀÌȯÀ², incidence rate
ÀÏÁ¤ ±â°£¿¡ »õ·Î ¹ß»ýÇÑ È¯ÀÚÀÇ ºñÀ²
°¨¿°°­µµ, intensity of infection
°¨¿°ÀÚ°¡ °¡Áö°í ÀÖ´Â ±â»ýÃæÀÇ ¼ö(worm burden)À¸·Î Ç¥½Ã. Ãæ¶õ°è»ê¹ýÀ¸·Î ´ëüÇϱ⵵ ÇÑ´Ù.
endemic
ÀÏÁ¤Áö¿ªÀÇ Àΰ£Áý´Ü ³»¿¡ Áúº´ÀÌ Å« º¯µ¿¾øÀÌ Áß°£Á¤µµ·Î »ó½Ã ¹ß»ýÇÒ ¶§
hyperendemic
ÀÏÁ¤Áö¿ªÀÇ Àΰ£Áý´Ü ³»¿¡ Áúº´ÀÌ »ó´çÈ÷ ¸¹ÀÌ ¹ß»ýÇÒ ¶§
epidemic
ÀÏÁ¤Áö¿ªÀÇ Àΰ£Áý´Ü ³»¿¡ Áúº´ÀÌ Æø¹ßÀûÀ¸·Î ¹ß»ýÇÒ ¶§
pandemic
Àü ¼¼°è·Î ÀüÆÄµÇ¾î ³ª°¥ ¶§
enzootic, hyperenzootic, epizootic
µ¿¹°°è¿¡¼­ endemic, hyperendemic, epidemic¿¡ ´ëÀÀÇÏ´Â °³³ä
soil nature (ÅäÁú)
È¸ÃæÀº Á¡ÅäÁú(clay soil), ±¸ÃæÀº »çÅäÁú(sandy soil)¿¡¼­ Àß ÀÚ¶õ´Ù.




5. ±â»ýÃæ °¨¿°ÀÇ º´ÀηÐ

Áúº´¹ß»ý¿äÀÎ

  1. ±â»ýÃæÀÇ ¼ö
  2. ±â»ýÃæÀÇ º´¿ø¼º
  3. Å©±â ¹× Ȱµ¿¼º
  4. Ä§ÇØºÎÀ§: ü°­±â»ýÇü(coelozoic) º¸´Ù´Â Á¶Á÷±â»ýÇüÀ̳ª ¼¼Æ÷³»±â»ýÇüÀÌ À§Çè.
  5. °¨¿°È¸¼ö
  6. ¼÷ÁÖÀÇ ÀúÇ×¼º

¼÷ÁÖ¿¡ ´ëÇÑ ÀåÇØ

  1. ¿µ¾ç¹°ÁúÀÇ À¯½Ç
  2. Á¶Á÷°ú ¼÷ÁÖ¼¼Æ÷ÀÇ ÆÄ±«
  3. ±â°èÀû Àå¾Ö
  4. Àڱذú ¿°Áõ
  5. µ¶¼º¹°ÁúÀÇ »êÃâ: ÆÄµ¿Æí¸ðÃæÀÇ ´ë»ç»ê¹°ÀÌ ½Å°æµ¶À¸·Î ÀÛ¿ë
  6. ¹Ì»ý¹° ħÀÔÀÇ Á¶Àå

º´¸®Á¶Á÷ÇÐÀû ¼Ò°ß

  1. inflammation
  2. hyperplasia
  3. metaplasia
  4. neoplasia: granuloma, ÁÖÇ÷ÈíÃæÀÌ ¹æ±¤º®¿¡ Á¾¾ç, °£ÈíÃæÀÌ ´ã°ü¼¼Æ÷¾ÏÀ» Á¶Àå




6. ±â»ýÃæ °¨¿°ÀÇ ¸é¿ª

¼±Ãµ¸é¿ª

  1. physiologic resistance
  2. behavioral resistance: habit, ecological, climatic barrier
  3. genetic resistance: Duffy(-) Ç÷¾×Çü¿¡ vivax ¸»¶ó¸®¾Æ °¨¿°ÀÚ°¡ ¾ø´Ù.

±â»ýÃæ °¨¿°¿¡ ´ëÇÑ ¸é¿ª¹ÝÀÀÀÌ È¿°úÀûÀÌÁö ¸øÇÑ ÀÌÀ¯

  1. ±â»ýÃæÀÇ Å©±â
  2. ±â»ýÃæÀÇ ¿îµ¿¼º
  3. ¸é¿ªµµÇDZâÀü: ¿À·£ ÁøÈ­°úÁ¤À» ÅëÇÏ¿© ¼÷ÁÖ¿¡ ÀûÀÀµÇ¾î ÀÖ´Ù.
  4. ±â»ýÃæ Ç׿øÀÇ º¹À⼺: ±â»ýÃæÀÇ ±¸¼º°ú »ý¸®°¡ º¹ÀâÇÏ¿© ÃæÃ¼Ç׿øÀ̳ª ´ë»çÇ׿øÀÌ °­·ÂÇÏÁö ¸øÇÏ´Ù. °¢ ¹ßÀ°´Ü°è¸¶´Ù Ç׿ø¼ºÀÌ º¯ÇÑ´Ù. ºñ±³Àû ¹Ì¾àÇÑ Ç׿øÀÚ±ØÀ¸·Î ÀÎÇÏ¿© ¼÷ÁÖ°¡ °¨¿°µÇ¾î ÀÖ´Â µ¿¾È µ¿Á¾ÀÇ Àç°¨¿°À̳ª Áß°¨¿°¿¡ ´ëÇØ ¾î´À Á¤µµÀÇ ÀúÇ×À» ³ªÅ¸³»´Â °ÍÀ» °¨¿°¸é¿ª(premunition)À̶ó°í ÇÑ´Ù.
  5. ºÐºñ Ç׿øÀÇ ÁÖ Ç׿ø¼º
  6. ¼÷ÁÖ ¸é¿ª±Û·ÎºÒ¸°ÀÇ ÆÄ±«
  7. ¸é¿ª°ü¿ëÀÇ À¯µµ: ¿­¿øÃæ, ÆÄµ¿Æí¸ðÃæ, ȸ¼±»ç»óÃæ µîÀÇ °¨¿°½Ã¿¡ ¸²ÇÁ±¸ÀÇ ºÐÈ­°¡ ¾ïÁ¦µÇ°í, È¿°úÀûÀÎ ¼¼Æ÷¸é¿ªÀ̳ª ü¾×¸é¿ªÀÌ ¹Ì¾àÇÏ°Ô ³ªÅ¸³­´Ù.

¸é¿ªÀÛµ¿±âÀü

  1. T ¼¼Æ÷ ¹ÝÀÀ
  2. ƯÀÌÇ×üÀÇ ÀÛ¿ë
  3. ºñƯÀÌÀû ¹ÝÀÀ

±â»ýÃæÀÇ ¸é¿ª µµÇÇ ±âÀü

  1. ¼÷ÁÖ¼¼Æ÷ ³» ±â»ýºÎÀ§ ¼±Åà (intracellular parasitism, lumen dwelling)
  2. ¼÷ÁÖÇ׿ø °¡Àå (antigenic mimicray; ÁÖÇ÷ÈíÃæÀº coated with blood group antigen of the host)
  3. Ç׿ø¼ºÀÇ º¯È­ (antigenic variation)
  4. ¸é¿ª¾ïÁ¦ÀÛ¿ë (immunosupression)
  5. ¼÷ÁÖ ¸é¿ª¹ÝÀÀ °£¼· (interference of host immune reaction)

½ÇÁ¦¹æ¾îÈ¿°úÀÇ ÃøÁ¤ = ±â»ýÃæ°¨¿°¿¡ À־ ¸é¿ªÈ¹µæÀ» ³ªÅ¸³»´Â ÁöÇ¥

  1. °¨¿°ÃæÃ¼ ¼öÀÇ °¨¼Ò
  2. ÃæÃ¼ÀÇ ¼ºÀå ¹× ¹ßÀ° ¾ïÁ¦
  3. ¼÷ÁÖ Ã¼³» ÀÌÇØÀÇ ¾ïÁ¦
  4. »ý½ÄÀÛ¿ë ¹× »ê¶õÀÛ¿ëÀÇ ÀúÇÏ
  5. Àç°¨¿°¿¡ ´ëÇÑ ÀúÇ×

°ú¹Î¹ÝÀÀ

  1. ¾Æ³ªÇʶô½ºÇü: È¸ÃæÀÇ Ã¼°­¾×Àº À§ÀåÆòȰ±ÙÀÇ ¼öÃà°ú ¸Æ°ü½Å°æºÎÁ¾À» °¡Á®¿Â´Ù. Æ÷ÃæÁõ¿¡¼­ ³¶¾×ÀÌ À¯ÀÔµÇ¸é ¼ïÀ» ÀÏÀ¸Å²´Ù.
  2. ¼¼Æ÷µ¶¼ºÇü: ¸»¶ó¸®¾Æ¿¡ ´ëÇÑ Ç÷°ü³» ¿ëÇ÷
  3. ¸é¿ªº¹ÇÕü Áß°³Çü: »çÀÏ¿­¿øÃæ °¨¿°½Ã ½ÅÁõÈıº
  4. ¼¼Æ÷¸Å°³Çü: ÁÖÇ÷ÈíÃæÀÇ À¯ÃæÀ̳ª Ãæ¶õÀ» Áß½ÉÀ¸·Î À°¾ÆÁ¾ÀÌ Çü¼ºµÈ´Ù.

¸é¿ªÇÐÀû Áø´Ü

  1. Ãæ¶õ, ÃæÃ¼ÀÇ ¹èÃⱸ°¡ ¾ø´Â Á¶Á÷ ±â»ýÃæÀÇ °æ¿ì
  2. À̼ұâ»ý
  3. À¯Ãæ ¹× ¼öÄÆ¸¸ ±â»ý
  4. ¼±º°°Ë»ç°¡ ÇÊ¿äÇÒ ¶§
  5. Ç÷û¿ªÇÐÁ¶»ç

Sarles' phenomenon

±â»ýÃæ °¨¿°ÀÇ Æ¯À¯ÇÑ ¸é¿ªÁø´Ü¹ýÀ¸·Î, »ì¾ÆÀÖ´Â ÃæÃ¼³ª Ãæ¶õÀ» Ç×Ç÷û°ú ÀÛ¿ë½ÃÄ×À» ¶§ ±× ÁÖÀ§¿¡ ¸é¿ªº¹ÇÕüÀÇ Ä§Àü¹°ÀÌ »ý±ä´Ù.

È£»ê±¸ÀÇ µ¿¿ø±âÀü

  1. ECF-P (±â»ýÃæÀ¸·ÎºÎÅÍÀÇ eosinophil chemotatic factor)
  2. mast cell·ÎºÎÅÍÀÇ ECF
  3. Th2¿¡¼­ eoxinophi stimulating promoter(ESP); ÁÖ·Î IL-5ÀÌ´Ù.

È£»ê±¸ÀÇ ¿ªÇÒ

  1. ADCC via degranulation
  2. mast cell ÀÚ±Ø ¶Ç´Â ÅëÁ¦(by histaminase, phospholipase B)




7. ±â»ýÃæ °¨¿°ÀÇ Áø´Ü

Áø´Ü¹ý

  1. ¿ÜºÎ ±â»ýÃæÀÇ Áø´Ü
  2. ³»ºÎ ±â»ýÃæÀÇ Áø´Ü
    1. ÃæÃ¼ °Ë»ç: È¸Ãæ, ¹«±¸Á¶Ãæ, °³Á¶Ãæ, ¾Æ½Ã¾ÆÁ¶Ãæ(ÀÌ·± Á¶ÃæµéÀº ÆíÀýÀÇ ¿îµ¿¼ºÀÌ °­ÇÏ¿© ´Éµ¿ÀûÀ¸·Î ±â¾î ³ª¿Â´Ù)
    2. °Ëº¯: Á÷Á¢µµ¸», ÈÄÃþµµ¸», Áý¶õ¹ý
    3. Ç×¹®ÁÖÀ§ µµ¸»¹ý: ¹èº¯°ú °ü°è¾øÀÌ ¹èÃâµÇ´Â Á¾ (¿äÃæ, ¹«±¸Á¶Ãæ)
    4. °¡·¡°Ë»ç: ÆóÈíÃæ, ÆóÆ÷ÀÚÃæ
    5. Ç÷¾×°Ë»ç: ¿­¿øÃæ, »ç»óÃæ(´Ü, ȸ¼±»ç»óÃæÀº Á¦¿Ü), ÆÄµ¿Æí¸ðÃæ(ÁÖ·Î ±Þ¼º±â¿¡) . ÁÖÇ÷¼±Ãæ, ÁÖÇ÷ÈíÃæ, ¸®½´¸¸Æí¸ðÃæ µîÀº Ç÷¾×°Ë»ç·Î Áø´ÜµÇÁö ¾Ê´Â´Ù.
      ·È¸¼±»ç»óÃæ; ¼ºÃæÀº ÇÇÇÏ¿¡¼­ onchocercoma¸¦ ¸¸µé°í ÀÚÃæÀº ´«¿¡ ¸ð¿© blindness¸¦ À¯¹ßÇÑ´Ù. ÀÚÃæÀÇ Ç÷¾×³» Á¤±â ÃâÇö¼ºÀÌ ¾øÀ¸¹Ç·Î Ç÷¾×µµ¸»°Ë»ç´Â µµ¿òÀÌ µÇÁö ¾Ê°í ÇÇÇÏ Á¾¾ç ÁÖÀ§¿¡¼­ »ý°ËÀ» ½Ç½ÃÇÑ´Ù.
      ·±¤µ¿ÁÖÇ÷¼±Ãæ; ³ú½ÇÁú µî¿¡¼­ À¯Ãæ »óÅ·Π¸Ó¹«¸£¸ç CSF °Ë»ç¸¦ ÇÑ´Ù.
      ·ÄÚ½ºÅ¸¸®Ä«ÁÖÇ÷¼±Ãæ; Àå°£¸· µ¿¸Æ¿¡¼­ ¼ºÃæÀ¸·Î ¹ßÀ°Çϰí Ãæ¶õÀº Àå°£¸· ¼¼µ¿¸Æ¿¡¼­ À¯ÃæÀÌ µÇÁö¸¸ »ç¶÷ÀÇ ´ëº¯À¸·Î Ãæ¶õÀ̳ª À¯ÃæÀÌ ³ª¿ÀÁö ¾Ê´Â´Ù (ÀÚ¿¬°è¿¡¼­´Â ÁãÀÇ ´ëº¯À¸·Î À¯ÃæÀÌ ³ª¿Í Áß°£¼÷ÁÖ·Î ¿¬°áµÈ´Ù). endemicÇÑ Áö¿ª¿¡¼­ eosinophilia¿Í appendiceal abscess°¡ ÀÖÀ» ¶§ ÀǽÉÇϰí Áø´ÜÀº ¼ö¼ú·Î ÀýÁ¦ÇÑ Á¶Á÷¿¡¼­ ¼ºÃæ, Ãæ¶õ, À¯ÃæÀ» È®ÀÎÇÏ´Â °ÍÀÌ´Ù.
      ·ÀϺ»/¸¸¼ÕÁÖÇ÷ÈíÃæ; Àå°£¸·µ¿¸ÆÀ̳ª ¹®¸Æ¿¡¼­ ¼ºÃæÀÌ µÇ¸ç ±Þ¼º±âÀÇ Ç÷¾×Á¡¾×¼º ´ëº¯¿¡¼­ Ãæ¶õÀ» °ËÃâÇÒ ¼ö ÀÖ´Ù. ¸¸¼ÕÁÖÇ÷ÈíÃæÁõ¿¡¼­´Â »ê¶õµÇ´Â Ãæ¶õÀÇ ¼ö°¡ Àû±â ¶§¹®¿¡ AMS III ¿Í °°Àº Áý¶õ¹ýÀ» ÀÌ¿ëÇÑ´Ù. ¸¸¼º±â¿¡´Â Ãæ¶õÀÌ Àß ³ª¿ÀÁö ¾ÊÀ¸¹Ç·Î Á÷Àå°æÀ» ÀÌ¿ëÇÑ Á¡¸·»ý°ËÀ̳ª °£»ý°ËÀ» ÇÏ¿© Ãæ¶õÀ» È®ÀÎÇÑ´Ù.
      ·¹æ±¤ÁÖÇ÷ÈíÃæ; °ñ¹ÝÁ¤¸ÆÃÑÀ̳ª ¹æ±¤Á¤¸ÆÃÑ¿¡¼­ ¼ºÃæÀÌ µÇ¸ç ¼Òº¯¿¡¼­ Ãæ¶õÀ» È®ÀÎÇÏ´Ù. ¼Òº¯¿¡¼­ Ãæ¶õÀÌ ³ª¿ÀÁö ¾ÊÀ¸¸é ¹æ±¤Á¡¸·»ý°ËÀ» ÇÏ¿© Ãæ¶õÀ» È®ÀÎÇÑ´Ù.
      ·¸®½´¸¸Æí¸ðÃæ; ´ë½Ä¼¼Æ÷¿Í °°Àº reticuloendothelial system ¼¼Æ÷ÀÇ ¼¼Æ÷Áú ¼Ó¿¡¼­ ±â»ýÇÑ´Ù. ÇǺÎ/ÇǺÎÁ¡¸·¸®½´¸¸Æí¸ðÃæÀÇ °æ¿ì º´¼ÒÀÇ °æ°èºÎ¸¦ »ý°ËÇÏ¿© ´ë½Ä¼¼Æ÷ ¼¼Æ÷Áú³»ÀÇ ÃæÃ¼¸¦ È®ÀÎÇϰųª ¹è¾ç°Ë»ç¸¦ ÇÑ´Ù. ³»À帮½´¸¸Æí¸ðÁõ¿¡¼­´Â °¢Á¾ Ç÷û°Ë»ç¿Í Çdz»¹ÝÀÀ°Ë»ç (leishmanin reaction)ÀÌ ÀÖÀ¸³ª È®ÁøÀº °ñ¼ö³ª ¸²ÇÁÀý »ý°ËÀ» ÇÑ´Ù. °£À̳ª ºñÀå¿¡¼­ »ý°ËÇϱ⵵ ÇÑ´Ù.
      ·¾ÆÇÁ¸®Ä«¼ö¸éº´; ±Þ¼º±â¿¡´Â ¸»ÃÊÇ÷¾×, Á¾´ëµÈ ¸²ÇÁÀý, ³úô¼ö¾×¿¡¼­ ¿øÃæÀ» º¼ ¼ö ÀÖ´Ù. ¸»±â ȯÀÚ´Â ¸»ÃÊÇ÷°üÀ̳ª ü¾× ¼Ó¿¡ ¿øÃæÀÌ Àû°Ô ³ªÅ¸³ª¹Ç·Î ÀϹÝÁõ»ó°ú ³úô¼ö¾×ÀÇ ´Ü¹éÁú, ¼¼Æ÷¼öÀÇ Áõ°¡ µîÀ¸·Î ÀǽÉÇÑ´Ù.
      ·»þ°¡½ºº´; ±Þ¼º±â¿¡ ¸»ÃÊÇ÷¾×¿¡¼­ ¿øÀÎ ¿øÃæÀÎ T. cruzi ÀÇ trypomastigote°¡ °ËÃâµÈ´Ù. N.N.N. ¹èÁö¿¡ ¹è¾çÇϰųª °ïÃæÁ¢Á¾¹ý(xenodiagnosis)À» ÀÌ¿ëÇϱ⵵ ÇÑ´Ù. Ç×ü°Ë»ç°¡ µµ¿òÀÌ µÇ³ª ±Þ¼º±â¿¡´Â Ç×ü°¡ °ËÃâµÇÁö ¾Ê±âµµ ÇÑ´Ù.
    6. ¿ä°Ë»ç; ÁúÆí¸ðÃæ, ¹æ±¤ÁÖÇ÷ÈíÃæ, °Å´ë½ÅÃæ
    7. »ý°Ë; ¼±¸ðÃæ, ȸ¼±»ç»óÃæ(»ç»óÃæ Áß¿¡¼­ À¯ÀÏÇÏ°Ô Ç÷¾× ³» Á¤±âÃâÇö¼ºÀÌ ¾ø´Ù), °£¸ð¼¼¼±Ãæ(Àå¸ð¼¼¼±ÃæÀº ´ëº¯¿¡¼­ Ãæ¶õÀ» È®ÀÎÇÒ ¼ö ÀÖ´Ù), À¯±¸³¶¹ÌÃæ, ÆóÈíÃæÀÇ À̼ұâ»ý, ¸®½´¸¸Æí¸ðÃæ
    8. ³úô¼ö¾×°Ë»ç; ÆÄµ¿Æí¸ðÃæ(ÁÖ·Î ¾ÆÇÁ¸®Ä« ¼ö¸éº´¿¡¼­), Åå¼ÒÆ÷ÀÚÃæ(Ç÷¾×À̳ª CSFÀÇ ¸¶¿ì½º º¹°­³» Á¢Á¾¹ýÀ̳ª ¼¼Æ÷¹è¾ç±â ³» Á¢Á¾¹ý), ¾Æ¸Þ¹Ù¼º ¼ö¸·³ú¿°, ³úÆóÈíÃæÁõ, ³ú³¶¹ÌÃæÁõ
    9. ¹è¾ç°Ë»ç; ¾Æ¸Þ¹Ù, ¸®½´¸¸Æí¸ðÃæ, ¶÷ºíÆí¸ðÃæÀÇ ¿øÃæÀº ¹èÁö¿¡¼­ ¹è¾çµÉ ¼ö ÀÖ´Ù. Å©·ç½ºÆÄµ¿Æí¸ðÃæÀº °ïÃæÁ¢Á¾¹ýÀ» »ç¿ëÇϱ⵵ ÇÑ´Ù.Åå¼ÒÆ÷ÀÚÃæÀº ¸¶¿ì½ºº¹°­À̳ª ¼¼Æ÷¹è¾ç±â¿¡¼­ ¹è¾çÇÑ´Ù. ±¸ÃæÀÇ Á¾ µ¿Á¤À» À§ÇÏ¿© ¿©°úÁö ¸Å¾ç¹ýÀ» ÀÌ¿ëÇÑ´Ù.
    10. Ç÷û°Ë»ç¹ý; ELISA°¡ °¡Àå ¸¹ÀÌ »ç¿ëµÈ´Ù. Åå¼ÒÆ÷ÀÚÃæÀÇ Ç÷û°Ë»ç Áß¿¡¼­´Â indirect latex agglutinationÀÌ °¡Àå ½Åºù¼ºÀÌ ³ô´Ù
    11. µ¿¹°½ÇÇèÁ¢Á¤¿¡ ÀÇÇÑ Áø´Ü: Åå¼ÒÆ÷ÀÚÃæÁõ
    12. ¹æ»ç¼±À» ÀÌ¿ëÇÑ Áø´Ü; ³ú³¶¹ÌÃæÁõ, ½ºÆÄ¸£°¡´®Áõ, Æ÷ÃæÁõ, °£ÈíÃæÁõ
  3. ÀÓ»óÁõÈÄ¿¡ ÀÇÇÑ Áø´Ü; ¸»¶ó¸®¾Æ, »óÇÇÁõ(elephantiasis)

±â»ýÃæ °¨¿° Áø´Ü½Ã À¯ÀÇ»çÇ×

  1. °ú°Å ¹× ÇöÀçÀÇ °ÅÁÖÁö È®ÀÎ
  2. ¿ÏÀüÇÑ ÃæÃ¼¸¦ È®º¸ÇÏ·Á°í ³ë·Â
  3. Ãæ¶õ °ËÃâÀº Â÷¼±Ã¥ÀÌ¸ç ¸é¿ªÇ÷ûÇÐÀû Áø´ÜÀº º¸Á¶ÀûÀÎ ¼ö´ÜÀÌ´Ù.
  4. °¡°Ë¹°Àº °íÁ¤ÇÏÁö ¾Ê´Â °ÍÀÌ ÁÁ°í »ý°ËÁ¶Á÷µµ ÀýÆíÀ» ¸¸µéÁö ¾Ê´Â´Ù. »ý¸®½Ä¿°¼ö¿¡ ³Ö¾î 4µµ¿¡¼­ ³ÃÀ庸°üÇÑ.
  5. Ä¡·áÀü Áø´Ü¿¡ µµ¿òÀÌ µÇ´Â °¡°Ë¹°À» È®º¸ÇÑ´Ù.

°Ëº¯»ó À§¾ç¼º

À§°¨¿°(spurious infection)ÀÇ °æ¿ì·Î À½½Ä¹°¿¡ Æ÷ÇÔµÈ Ãæ¶õÀ̳ª À¯ÃæÀÌ ÀϽÃÀûÀ¸·Î °Ëº¯¿¡¼­ ¹ß°ßµÇ´Â ¼ö°¡ ÀÖ´Ù. ¿¹; °£Áú Ãæ¶õ, ºÐ¼±Ãæ À¯Ãæ, °£¸ð¼¼¼±Ãæ Ãæ¶õ

°Ëº¯»ó À§À½¼º

  1. ¼öÄÆ¸¸ ±â»ýÇϰí ÀÖ´Â °æ¿ì
  2. »ê¶õ ÀÌÀüÀÇ ¹Ì¼º¼÷ ¾ÏÄÆ
  3. »ê¶õ¼ö°¡ ÃæºÐÇÏÁö ¾ÊÀ» ¶§
  4. »ê¶õÀÌ ÀϽÃÀûÀ¸·Î Á¤ÁöµÇ¾úÀ» ¶§
  5. »ê¶õÀÌ ³¡³­ ´ÄÀº ¾ÏÄÆ¸¸ ±â»ýÇÒ ¶§

¿ì¸®³ª¶ó¿¡¼­ Àü¹ÝÀûÀÎ ±â»ýÃæ °¨¿°ÀÌ ÁÙ¾îµé¾î »ý±â´Â Áø´Ü»óÀÇ ¹®Á¦Á¡À» ¼³¸íÇϽÿÀ

À±Ãæ°ú ¿øÃæÀ» Æ÷ÇÔÇÏ¿© ¾ÆÁ÷µµ 1-2%ÀÇ ¾ç¼ºÀÚÀÌ Àִµ¥µµ °ÅÀÇ ´ëºÎºÐÀÇ °Ëº¯ °á°ú°¡ À½¼ºÀ¸·Î ÆÇÁ¤µÇ°í ÀÖ´Ù. ÀÌ·¯ÇÑ °Ë»ç»óÀÇ ¹®Á¦Á¡ÀÇ ¿øÀÎÀº ´ÙÀ½°ú °°´Ù

  1. ¸ðµç °úÁ¤ÀÌ Àη¿¡ ÀÇÇÏ¿© ¼öµ¿ÀûÀ¸·Î ÀÌ·ç¾îÁö°í ÀÖ´Â ±â»ýÃæ °Ë»ç¿¡ ¼÷·ÃµÈ ÀηÂÀÌ ºÎÁ·ÇÏ´Ù.
  2. °¨¿°ÀÚÀÇ ¼ö°¡ ÁÙ°í °¨¿°·®µµ °¨¼ÒÇÏ¿© ¾ÆÁÖ ²Ä²ÄÇÏ°Ô °Ë»çÇÏ¿©¾ß¸¸ ¾ç¼ºÀÚ¸¦ ãÀ» ¼ö ÀÖ´Ù.
  3. ¼­¿ïÁÖ°ÆÈíÃæ, Àå¸ð¼¼¼±Ãæ, Âü±¼Å«ÀÔÈíÃæ µîÀÇ »õ·Î¿î ±â»ýÃæÀÇ ÃâÇö
  4. Ç÷û°Ë»çÀÇ ÃâÇöÀ¸·Î ´ëº¯°Ë»ç¸¦ ¼ÒȦÈ÷ ÇÏ´Â °æÇâ
  5. ÇǰËÀÚÀÇ ºñÇùÁ¶
  6. ÀÓ»óº´¸®°ú ³»ÀÇ ÇàÁ¤ÀûÀΠǪ´ëÁ¢; °Ë»ç·áÀÇ ¼öÀÔÀÌ ³·°í °ü½É¹ÛÀÇ »ç¾ÈÀÌ µÇ±â ½±´Ù.




8. ±â»ýÃæ °¨¿°ÀÇ Ä¡·á

±â»ýÃæ°¨¿°¿¡ ´ëÇÑ È­Çпä¹ýÀÇ ¸ñÇ¥

·¼÷ÁַκÎÅÍ ÃæÃ¼ÀÇ Á¦°Å°¡ °¡Àå Áß¿äÇϸç parasiticidal°ú parasitifugal(ü¿Ü·Î ¹èÃâ½ÃŰ´Â °Í)À¸·Î ³ª´©¾îÁø´Ù.
·Ç׿øÃæÁ¦(antiprotozoal drugs); ´ëºÎºÐ Áõ½Ä¿¡ ÇÊ¿äÇÑ ÇÙ»ê ¹× ´Ü¹éÁúÀÇ Çü¼ºÀ» ÀúÇØÇÏ´Â °ÍÀÌ´Ù.
·±¸ÃæÁ¦(anthelmintics); À±ÃæÀº ¼÷ÁÖ³» ü·ù ¹× ¼ºÀåÀÌ ¹®Á¦°¡ µÇ¹Ç·Î (1)´çÀÇ Èí¼ö ÀúÁö, (2)ATPÇü¼º ¹æÇØ, (3)±Ù½Å°æ ¿¬ÇÕºÎÀÇ Â÷´Ü µî ÃæÃ¼ÀÇ ¼ºÀå°ú ¿îµ¿À» ¾ïÁ¦ÇÏ°í ¸¶ºñ½ÃÄÑ Ã¼¿Ü·Î ¹èÃâ½ÃŲ´Ù.
·È­Çп¹¹æ¿ä¹ý; ¸»¶ó¸®¾Æ¿¡¼­ ½Ç½Ã

È­Çпä¹ýÀÇ Æò°¡

Ãæ¶õÀ½ÀüÀ² (egg negative conversion rate), Ä¡À¯À² (cure rate)
2-4 ÈÄ¿¡ ½Ç½ÃÇÑ °Ëº¯¿¡¼­ Ãæ¶õÀÌ ¾øÀ¸¸ç Ä¡·áµÈ °ÍÀ¸·Î ÆÇ´Ü
Ãæ¶õ°¨¼ÒÀ² (egg reduction rate)
ºñ·Ï ¿ÏÀü±¸ÃæÀÌ µÇÁö ¾Ê¾Ò´Ù°í ÇÏ´õ¶óµµ ¹èÃâÇÏ´Â Ãæ¶õ ¼ö°¡ °¨¼ÒÇϸé Â÷±â °¨¿°ÀÇ ±Ù¿øÀ» ÁÙÀÌ´Â È¿°ú°¡ ÀÖ´Ù. Áý´Ü±¸ÃæÀÇ Æò°¡¿¡µµ ÀÌ¿ëµÈ´Ù.

È­Çпä¹ýÁ¦ÀÇ ±¸ºñ¿ä°Ç

¾àÁ¦¸¦ ã´Â ¹æ¹ý¿¡´Â empirical approach¿Í rational approach°¡ ÀÖ´Ù.

  1. ³ôÀº Ä¡·áÈ¿°ú
  2. ºÎÀÛ¿ë (-)
  3. Åõ¿©°¡ °£Æí
  4. È­ÇÐÀû, »ý¹°ÇÐÀû ¾ÈÁ¤¼ºÀÌ ³ôÀ» °Í
  5. °ªÀÌ ½Î¾ß ÇÑ´Ù.

È­Çпä¹ýÀÇ ±Ý±â

  1. ÀÓ»êºÎ³ª ³ë¾àÀÚ
  2. ¸¸ 1¼¼ ÀÌÇÏÀÇ ¾î¸°ÀÌ
  3. °ú¹Î¼ºÀÌ ÀÖ´Â °æ¿ì
  4. ¿µ¾ç»óŰ¡ ºÒ·®ÇÑ °æ¿ì
  5. °£, ½Å, ½É, ½Å°æÁúȯÀÌ ÀÖ´Â °æ¿ì

¾àÁ¦ÀÇ ÀÛ¿ë±âÀü

Pyrantel pamoate; Not vermicidal or ovicidal; acts as a depolarizing neuromuscular blocking agent, thereby causing sudden contraction, followed by paralysis, of the helminths; also acts as a cholinesterase inhibitor and ganglionic stimulant; helminths are rendered unable to maintain their position in the intestinal lumen and are expelled from the body in the fecal stream by peristalsis

Mebendazole: Vermicidal; may also be ovicidal for ova of most helminths; mebendazole causes degeneration of parasite's cytoplasmic microtubules and thereby selectively and irreversibly blocks glucose uptake in susceptible adult intestine-dwelling helminths and their tissue-dwelling larvae; inhibition of glucose uptake apparently results in depletion of the parasite's glycogen stores; this, in turn, results in reduced formation of adenosine triphosphate (ATP) required for survival and reproduction of the helminth; corresponding energy levels are gradually reduced until death of the parasite ensues; mebendazole does not appear to affect serum glucose concentrations in humans, however.

Ivermectin: Microfilaricidal; precise mechanism of action is unknown. Ivermectin is thought to act as an agonist of the neurotransmitter gamma-aminobutyric acid (GABA), thereby disrupting GABA-mediated central nervous system (CNS) neurosynaptic transmission. This results in paralysis of the parasite's nervous system and leads to death of the parasite. Although not macrofilaricidal, ivermectin may also impair normal intrauterine development of O. volvulus microfilariae and may inhibit their release from the uteri of gravid female worms. Action on microfilariae is less abrupt but more prolonged than that of diethylcarbamazine.

Praziquantel: Vermicidal; precise mechanism of action unknown, but may involve synergy between praziquantel and the host's humoral immune response in S. mansoni; praziquantel is rapidly taken up by helminths and also appears to increase permeability of helminth's cell membrane, leading to a loss of intracellular calcium; massive contraction and paralysis of the helminth's musculature rapidly result; after exposure to praziquantel, tegument in neck region of adult helminths develops blebs, which appear to burst and disintegrate; praziquantel also produces intense vacuolization at several sites in tegument of adult schistosomes; in S. mansoni, this is followed by phagocytic attachment to parasite and, ultimately, death.

niclosamide: inhibition of mitochondrial oxidative phosphrylation --> ATP °¨¼Ò

thiabendazole: inhibition of the helminth specific enzyme fumarate reductase




9. ±â»ýÃæ °¨¿°ÀÇ ¿¹¹æ ¹× °ü¸®

±â»ýÃæ °¨¿° ¹ß»ýÀÇ 3´ë ¿äÀÎ

  1. °¨¿°¿ø; ȯÀÚ, º¸ÃæÀÚ, º¸À¯¼÷ÁÖ
  2. ÀüÆÄ¿äÀÎ; Áß°£¼÷ÁÖ, ¸Å°³Ã¼, Åä¾ç, ¹°
  3. °¨¼ö¼º ¼÷ÁÖ; À¯ÀüÀû ¿äÀÎ, Áý´Ü¸é¿ª, »çȸÀû ¿äÀÎ

°¨¿°¿øÀÇ ºÀ¼â¹æ¹ý

  1. °¨¿°ÀÚ ¹× º¸À¯¼÷ÁÖÀÇ Ä¡·á
  2. ȯ°æ °³¼±; (1)¹èº¯½À°üÀÇ ±³Á¤, (2)ºÐ´¢ 󸮹æ¹ýÀÇ °³¼±, (3)Àκкñ·á »ç¿ëÀÇ ±ÝÁö, (4)ÇϼöµµÀÇ Áõ¼³

ÀüÆÄ¿äÀÎÀÇ Á¦°Å¹æ¹ý

  1. ȯ°æÀû °ü¸® (environmental control); ¹è¼ö, ¸Å¸ô, ÀâÃÊÁ¦°Å, Àΰø±¸Á¶¹°ÀÇ ¼³Ä¡
  2. È­ÇÐÀû °ü¸® (chemical control); »ìÃæÁ¦, ¼³ÆÐÁ¦
  3. »ý¹°ÇÐÀû °ü¸® (biological contral); (1)°æÀïÀÚ(competitor), (2)õÀû(predator), (3)±â»ýÃæÀÇ µµÀÔ, (4)°Å¼¼(castration)

°¨¼ö¼º ¼÷ÁÖÀÇ º¸È£

  1. À§»ý»óÅÂÀÇ °³¼±; À½½Ä¹°À̳ª À½·á¼öÀÇ ¼Òµ¶, ¹æÃæ¸Á°ú ¸ð±âÀåÀÇ ¼³Ä¡
  2. °¡¿­Ã³¸®
  3. ³Ãµ¿Ã³¸®; ¿µÇÏ 15µµ ÀÌÇÏ·Î
  4. ¹æ»ç´ÉÀÇ ÀÌ¿ëÇÏ¿© Áß°£¼÷ÁÖ ³»ÀÇ °¨¿°ÇüÀ» Á¦°Å
  5. °øÃæ±âÇÇÁ¦(insect repellent)³ª ¹æÃæ¿ë ÀǺ¹
  6. È­Çп¹¹æ¹ý
  7. ÁÖ°ÅÁöÀÇ ÀÌÀü

º¸°Ç±³À°ÀÇ Á߿伺

±â»ýÃæ °¨¿°Àº ±× Áö¿ªÀÇ ¹®È­Àû ¹è°æ, ƯÈ÷ dz½ÀÀÇ ¿µÇâÀÌ Áö¹èÀûÀÌ´Ù. µû¶ó¼­ ±â»ýÃæ¿¡ ´ëÇÑ Áö½ÄÀ» ¾Ë¸®°í °øÁߺ¸°ÇÀÇ Â÷¿ø¿¡¼­ »çȸ Àüü°¡ °øµ¿ ´ëÃ³ÇØ¾ß ½ÇÈ¿¸¦ °ÅµÑ ¼ö ÀÖ´Ù. ¿ì¸®³ª¶ó¿¡¼­ÀÇ ±â»ýÃæ °¨¿° °ü¸®ÀÇ ¼º°øµµ Áý´Ü°Ëº¯ - Áý´Ü±¸ÃæÀ» ½ÃÇàÇÏ¿´±â ¶§¹®ÀÌ´Ù.


[References]

1) EndoTODAY ±â»ýÃæÇÐ

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