급성 신부전, 황달 및 혈소판 감소증이 병발된 일열 말라리아 1예

김현정 ( Hyun Jung Kim ),이서현 ( Seo Hyun Lee ),구태연 ( Tai Yeon Koo ),김경민 ( Kyung Min Kim ),장성수 ( Sung Soo Jang ),이상구 ( Sang Koo Lee ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.6

Purpose: Malaria is caused by four species of the genus Plasmodium. Plasmodium vivax malaria is the most common malarial infection in Korea and usually has benign clinical course. However, serious complications such as severe anemia, pulmonary edema, acute renal failure are reported in Plasmodium vivax malaria. We report a case of Plasmodium vivax malaria complicated with acute renal failure, jaundice and thrombocytopenia. A 56-year-old male was transferred to our hospital with acute renal failure, jaundice and thrombocytopenia. 10 days before admission, he had intermittent fever, chill, myalgia, and was treated with some medications under the impression of URI. Laboratory findings showed that hemoglobin was 11.5 g/dL, platelet 44,000/mm3, blood urea nitrogen 73 mg/dL, creatinine 4.0 mg/dL, total bilirubin 5.2 mg/dL, direct bilirubin 4.0 mg/dL. Serologic tests for leptospirosis, rickettsia, EB virus and CMV were negative. Ring form trophozoites were found in red blood cells, suggesting Plasmodium vivax malaria. Following anti-malarial therapy, acute renal failure, jaundice and thrombocytopenia were recovered to normal. From this case, malarial infection should be included as a differential diagnosis in a febrile patient with acute renal failure, jaundice and thrombocytopenia.

기니에서 유입된 사일열말라리아 감염 1예

강윤정,심문정,김정연,지소영,이원자,양진영 대한진단검사의학회 2015 Laboratory Medicine Online Vol.5 No.1

Recently, the number of Korean travelers and workers to malaria-endemic regions has increased, and the number of patients with imported malaria cases has increased as well. In Korea, most cases of imported malaria infections are caused by Plasmodium falciparum and P. vivax. Only one report of imported P. malariae infection has been published thus far. Here, we describe a case of imported P. malariae infection that was confirmed by peripheral blood smear and nested PCR targeting the small subunit ribosomal RNA (SSU rRNA) gene. A 53-yr-old man, who had stayed in the Republic of Guinea in tropical West Africa for about 40 days, experienced fever and headache for 3 days before admission. The results of rapid malaria test using the SD Malaria Antigen/Antibody Kit (Standard Diagnostics, Korea) were negative, but Wright-Giemsa stained peripheral blood smear revealed Plasmodium. To identify the Plasmodium species and to examine if the patient had a mixed infection, we performed nested PCR targeting the SSU rRNA gene. P. malariae single infection was confirmed by nested PCR. Sequence analysis of the SSU rRNA gene of P. malariae showed that the isolated P. malariae was P. malariae type 2. Thus, our findings suggest that when cases of imported malaria infection are suspected, infection with P. malariae as well as P. falciparum and P. vivax should be considered. For the accurate diagnosis and treatment of imported malaria cases, we should confirm infection with Plasmodium species by PCR as well as peripheral blood smear and rapid malaria antigen test. 최근 말라리아 풍토병 지역으로 한국인 여행자나 해외 근무자의 수가 증가하였고 그에 따라 해외유입형 말라리아 감염자의 수도 증가하고 있다. 국내에서 해외유입형 말라리아는 열대열말라리아와 삼일열말라리아에 의해 대부분 발생하고 있으며 지금까지 사일열말라리아 감염에 대한 보고는 한 증례가 유일하다. 저자들은 말초혈액 도말검사와 small subunit ribosomal RNA (SSU rRNA) 유전자를 표적으로 하는 이중중합효소연쇄반응을 이용하여 확진된 유입형 사일열말라리아 1예를 보고하는 바이다. 환자는 53세 남자 환자로 서아프리카 기니에서 약 40일간 체류하였고, 입원 3일 전부터 발열과 두통을 호소하였다. SD Malaria Antigen/Antibody Kit (Standard Diagnostics, Korea)를 이용한 말라리아 신속항원검사에서 음성의 결과가 나왔으나 Wright-Giemsa로 염색한 말초혈액도말검사에서 말라리아원충이 관찰되었다. 종 확진 및 혼합감염 여부를 확인하기 위해 SSU rRNA 유전자를 표적으로 한 이중중합효소연쇄반응을 시행하여 사일열말라리아 단독 감염을 확인하였다. 사일열말라리아의 SSU rRNA 유전자를 염기서열 분석한 결과, 분리된 사일열말라리아는 사일열말라리아 type 2로 확인되었다. 그러므로 해외유입형 말라리아로 의심 시 열대열말라리아나 삼일열말라리아뿐만 아니라 사일열말라리아도 염두에 두고 진단을 하여야 하며, 정확한 진단과 치료를 위해 말초혈액도말검사 및 신속항원검사 외에 중합효소연쇄반응검사로 말라리아의 종을 확진하는 것이 필요할 것으로 사료된다.

Phenoloxidase Activity in Hemolymph of Plasmodium-Melanizing and Nonmelanizing Strains of Anopheles gambiae

Chun, Jae-Sun 한국곤충학회 2003 Entomological Research Vol.33 No.3

Phenoloxidase (PO) activity was compared in two strains of the mosquito, Anopheles gambiae, one of which melanotically encapsulates and kills malaria parasites (Plasmodium spp.) and a second which permits normal development of these parasites. The enzyme assay, based on the formation of dopachrome from L-dopa, was linear with respect to enzyme concentration and time and was as inhibitable by phenylthiourea. There were no significant differences in the Km or Vmax of hemolymph samples taken from 3 days old naive mosquitoes of each strain. An age course demonstrated that PO activity was slightly higher in the refractory strain on Days 1 and 2 after emergence but decreased to similar stable levels in both strains by Day 3. PO activity differed in the two strains following an uninfected blood meal. While PO activity significantly increased by 48 h post blood feeding in Plasmodium-susceptible strain, activity remained level or slightly decreased in the Plasmodium-refractory strain. Finally, protease inhibitors and proteases were tested for effects on PO activity. Leupeptin, TLCK, and TPCK all inhibited PO activity in both strains. PO in both strains was activated by bovine trypsin but not by bovine chymotrypsin.

Eradication of <i>Plasmodium falciparum</i> from Erythrocytes by Controlled Reactive Oxygen Species via Photodynamic Inactivation Coupled with Photofunctional Nanoparticles

Wang, Kang-Kyun,Jang, Jin Woo,Shin, Eon Pil,Song, Hyung Wan,Hwang, Jeong Wook,Kim, Young Keun,Lim, Chae Seung,Kim, Yong-Rok American Chemical Society 2017 ACS APPLIED MATERIALS & INTERFACES Vol.9 No.15

<P>We investigated the antimalarial effect of photodynamic inactivation (PDI) coupled with magnetic nanoparticles (MNPs) as a potential strategy to combat the emergence of drug-resistant malaria and resurgence of malaria after treatment. Because the malarial parasite proliferates within erythrocytes, PDI agents need to be taken up by erythrocytes to eradicate the parasite. We used photofunctional MNPs as the PDI agent because nanosized particles were selectively taken up by Plasmodium-infected erythrocytes and remained within the intracellular space due to the enhanced permeability and retention effect. Also, the magnetism of Fe3O4 nanoparticles can easily be utilized for the collection of photofunctional nanoparticles (PFNs), and the uptaken PFNs infected the erythrocytes after photodynamic treatment with external magnetics. Photofunctionality was provided by a photosensitizer, namely, pheophorbide A, which generates reactive oxygen species (ROS) under irradiation. PAs were covalently bonded to the surface of the MNPs. The morphology and structural characteristics of the MNPs were investigated by scanning electron microscopy and X-ray diffraction (XRD), whereas the photophysical properties of the PFNs were studied with Fourier transform infrared, absorption, and emission spectroscopies. Generation of singlet oxygen, a major ROS, was directly confirmed with time -resolved phosphorescence spectroscopy. To evaluate the ability of PFNs to kill malarial parasites, the PDI effect of PFNs was evaluated within the infected erythrocytes. Furthermore, malarial parasites were completely eradicated from the erythrocytes after PDI treatment using PFNs on the basis of an 8 day erythrocyte culture test.</P>

Cloning and Subcellular Localization of a Serpin containing Nuclear Export Signal from the Korean malaria vector, Anopheles sinensis

Mi Young Noh,Yong Hun Jo,Seung Han Oh,Dong Hyun Kim,Hee Jung Park,Ik Soo Kim,Carolina Barillas Mury,Heung Chul Kim,Won Ja Lee,In Hee Lee,Sook Jae Seo,Se Won Kang,Yong Seok Lee 한국유전학회 2006 Genes & Genomics Vol.28 No.4

Anopheles sinensis is known to play a critical role in malaria transmission and re-emergence in the areas near the Demilitarized Zone (DMZ) of Korea. However, no study on Plasmodium-midgut interactions using A. sinensis has been reported. Here, we describe the cloning and dynamic subcellular localization of the orthologue of Anopheles gambiae (AgSRPN10), isoform RCM, from Anopheles sinensis (AnsiSRPN10). AnsiSRPN10 mRNA is expressed in embryoes, and is almost undetectable in 4(th) instar larvae. It increases transiently in pupae and is most abundant in adult females. Expression is higher in the abdomen and the midgut compared to the thorax and ovary. It is induced in response to laminarin and Actinomycin-D. AnsiSRPN10 protein does not contain a consensus nuclear localization signal (NLS), but has a putative nuclear export signal (NES) and small ubiquitin-like modifier (SUMO) modification site. It is present mainly in the nucleus of healthy midgut cells, but translocates from the nucleus to the cytosol in Plasmodium-invaded cells. AnsiSRPN10 expression increases as midgut cells undergo apoptosis, indicating that the epithelial responses to P. berghei invasion are conserved across different anopheline species. AnsiSRPN10 is a useful marker of Plasmodium-induced apoptosis in midgut. To our knowledge, this is the first report on A. sinensis innate immunity in the context of Time Bomb model.

한국 군장병에서 OptiMAL 검사를 이용한 삼일열 말라리아 진단 및 치료 후 추적

조덕,임채승,김덕래,양동욱 대한임상병리학회 2001 대한임상병리학회지 Vol.21 No.4

급성 신부전이 합병된 Plasmodium vivax 말라리아

정병하 ( Byung Ha Chung ),황태준 ( Tae Jun Hwang ),이세원 ( Sei Won Lee ),이상은 ( Sang Eun Lee ),신호식 ( Ho Sik Shin ),이대동 ( Dae Dong Lee ) 대한신장학회 2008 Kidney Research and Clinical Practice Vol.27 No.1

Malaria is one of the most important parasitic infection in the world. Four species of the genus Plasmodium cause nearly all malarial infections in humans, but the clinical features vary according to the causative species. Among them, Plasmodium falcifarum malaria is associated with numerous complications such as renal failure, cerebral malaria, and DIC, but Plasmodium vivax malaria usually has benign course. The proposed mechanism is blockage of microcirculation to vital organ by sequestration of parasitized erythrocytes. In Korea, for recent 20 years, there have been increasing numbers of malaria infection especially at North area of Geonggi-do. But serious complications in association with Plasmodium vivax malaria are rarely reported. Recently we experienced a case of Plasmodium vivax infection complicated by acute renal failure and report it with literature review.

Diagnosis and Molecular Analysis on Imported Plasmodium ovale curtisi and P. ovale wallikeri Malaria Cases from West and South Africa during 2013-2016

신현일,구보라,김유정,김태윤,조신형,이상은 대한기생충학ㆍ열대의학회 2020 The Korean Journal of Parasitology Vol.58 No.1

Majority of the imported malaria cases in Korea is attributed to Plasmodium falciparum and P. vivax infections, whereas P. malariae and P. ovale infections are very rare. Falciparum and ovale malaria are mostly imported from Africa, while most of the vivax malaria cases are imported from Southeast Asia. Here, we report 6 Korean imported ovale malaria cases (4 males and 2 females) who had visited in Africa during 2013-2016. These subjects were diagnosed with P. ovale based on microscopic findings, Plasmodium species-specific nested-PCR, and phylogenetic clade using 18S rRNA gene sequences. We identified 2 P. ovale subtypes, 1 P. ovale curtisi (classic type) and 5 P. ovale wallikeri (variant type). All patients were treated with chloroquine and primaquine, and no relapse or recrudescence was reported for 1 year after treatment. With increase of travelers to the countries where existing Plasmodium species, the risk of Plasmodium infection is also increasing. Molecular monitoring for imported malaria parasites should be rigorously and continuously performed to enable diagnosis and certification of Plasmodium spp.

삼일엽 원충(Plasmodium vivax)감염에 의한 부정맥 및 심막 삼출액 발생 1예

유제성,이진희,정성필,구홍두,박인철 대한감염학회 2006 감염과 화학요법 Vol.38 No.6

말라리아에 감염되었을 경우, 고열 외에 뇌형 말라리아, 급성신부전, 급성 폐부종, 저혈당, 세균성 감염 등의 합병증을 유발하는 것으로 알려져 있다. 드물지만, 외국에서는 열대열 원충에 의해 부정맥이나 심막 삼출액 등과 같은 심장 질환이 발생한 보고도 있다. 하지만 본 예와 같이 삼일열 원충에 의해서도 서맥, 2도, 3도 방실결절 차단의 부정맥과 심막 삼출액 발생할 수도 있다. 말라리아가 빈발하는 지역에서 이런 증상의 환자를 발견하는 경우, 반드시 말라리아 감염을 의심하고, 적절한 진단 및 치료가 이루어지도록 해야 할 것이다. 저자들은 삼일열 원충에 의해 부정맥 및 심막 삼출액이 발생한 환자 1예를 경험하였기에 보고하였다. Plasmodium vivax is a typically seen infectious disease in Korea. The incidence of Plasmodium vivax malaria has been increasing in recent year despite of worldwide attempts at control. Fever, anemia, thrombocytopenia, and splenomegaly are the most common manifestations seen in Korean patient with P. vivax. Cardiac involvement is thought to be a very rare complication of malaria infection. Cardiac complication seems to be limited to acute infection with Plasmodium falcifarum. However we have experienced cardiac complication such as pericardial effusion, and complete AV block by Plasmodium vivax. Physicians should consider cardiac involvement in patient who present hypotension, fever and arrhythmia in malaria endemic area.

Plasmodium falciparum에 의한 급성 신부전을 동반한 뇌형 말라리아 1예

강문수,최종원,남정현,배수환 대한임상병리학회 2000 대한임상병리학회지 Vol.20 No.5