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1 Focused Issue of This Month Traveling and Imported Parasitic Diseases Myoung-Hee Ahn, MD Department of Parasitology, Hanyang University College of Medicine mhahn@hanyang.ac.kr J Korean Med Assoc 2007; 51(11): Abstract Recently, many peoples travel abroad for sightseeing, business, missionary and other works. At the same time, imported parasitic diseases including malaria has been increased in Korea. The vector borne and food borne diseases were imported from many other countries, Africa, Middle East and South east Asia. Recently many foreigners entered to Korea for studying, working and other purposes. Imported foods, fishes, meats, vegetables are important for parasitic infection, too. The author reviewed imported parasitic diseases in Korea from 1970 to 2006 with literatures. Malaria is most prevalent. And babesiosis of 6 cases, cutaneous leishmaniasis of over 20 cases, visceral leishmaniasis of 5 cases, loiasis of 3 cases, gnathostomiasis of 40 cases, angiostrongylosis of 10 cases, heterophydiasis of 2 cases, schistosomiasis haematobium of 6 cases, schistosomiasis mansoni of 3 cases, hydatidosis of 24 cases, cutaneous larva migrans of 4 cases, and one case of ancylostomiasis, syngamosis, cutaneous myiasis and pentastomiasis are reported, respectively. The protozoa of 5 species and helminthes of 11 species are imported from many other countries. In Korea, re-emerging malaria was appeared at Demilitarized zone (DMZ) on Last year, 2,051 cases of indigenous malaria were reported by Korean Center for Diseases Control (KCDC). However, the most prevalent imported malaria was Plasmodium falciparum and indigenous malaria was only P. vivax. For the prevention of imported parasitic diseases, the education, training for tropical medicine, supply of medication and vaccine are needed. The surveillance system for imported diseases was started by KCDC on Keywords : Imported diseases; Parasite; Malaria; Korea; International travel 993

2 Ahn MH Table 1. The imported and indigenous malaria cases in Korea from 2001 to 2006 Year No. of imported cases* No. of indigenous cases (reemerging) , , , , ,051 total 281 9,810 * Data from Korean CDC 994

3 Traveling and Imported Parasites Table 2. Imported parasitic diseases in Korea from 1970 to 2006 Parasitic Diseases Areas of Acquisition No. of Cases Reporters 1. Malaria South East Asia, Middle East, 80 Soh et al.(1985) Africa, Australia, Latin America 281 Korea CDC*(2006) 2. Babesiosis Ivory Coast 1 Kim et al.(1988) Ivory Coast 1 Shim et al.(1991) Ethiopia & Uganda 1 Lee et al.(1997) Gabon 1 Kweon et al.(1998) Tanzania 1 Kweon et al.(1998) USA 1 Kweon et al.(1998) 3. Cyclosporiasis Indonesia 1 Yu & Sohn (2003) 4. Cutaneous Leishmaniasis Saudi Arabia, Jordan, Afghanistan >20 Yoo et al.(1978) ~ Kim et al.(2006) 5. Visceral Leishmaniasis Manchuria 3 Heu (1952) Saudi Arabia 1 Chi et al.(1983) Argentina 1 Kim et al.(2004) 6. Loiasis Nigeria 1 Min et al.(1987) Cameroon 1 Chun et al.(1998) Cameroon 1 Cho et al.(2007) 7. Gnathostomiasis Thai 1 Lee et al.(1988) Myanmar 1 Lee et al.(2001) Myanmar 38 Chai et al.(2003) 8. Angiostrongylosis Samoa 10 Lee et al.(1981) 9. Heterophyiasis Saudi Arabia 2 Chai et al.(1986) 10. Schistosomiasis N. Yemen 5 Min et al.(1982) N. Yemen 1 Lee et al.(1987) Middle east 1 Kim et al.(194) Yemen 1 Lee et al.(1995) Middle East 1 Lim et al.(1995) 11. Hydatid Disease Kuwait, Sau Arabia, Libya, 24 Chung et al.(1983) Pakistan, Uzbekistan ~ Jeon et al.(2007) 12. Cutaneous larva migrans Brazil, Thailand 2 Park et al.(2001) Cambodia 1 Kwon et al.(2003) Thailand 1 Kim et al.(2006) 13. Ancylostomiasis Philippine 1 Yong et al.(1992) 14. Syngamosis China 1 Kim et al (1998) 15. Cutaneous Myiasis Cameroon 1 Kim et al.(1990) 16. Pentastomiasis Saudi Arabia or Indonesia 1 Park et al.(1985) * Korean Center of Disease Control (2001~2006) Summary on hydatid disease in Table 3 995

4 Ahn MH 996

5 Traveling and Imported Parasites 997

6 Ahn MH Table 3. Summary of human hydatid diseases reported in Korea No. Age Sex Involved organ History of abroad travel Chief complaint & sign Reporter F Lung absent Chest pain Chung et al.(1983), Yim et al. (1985) M Lung Kuwait Chest pain Chung et al.(1983), Yim et al.(1985) M Lung Middle East Weight loss Park et al.(1985), Suh et al.(1989) M Lung Middle East Chest pain Lee et al. (1986) M Liver Saudi Arabia Epigastric discomfort Kim et al.(1986) M Liver Saudi Arabia General malaise, epigastic pain Kim and Chang (1987) M Lung Saudi Arabia Pneumonia Im et al. (1987) M Liver Pakistan Epigastric pain Suh et al.(1987), Kim et al.(1993) M Liver Saudi Arabia Fatigability, epigastric pain Jeon et al.(1988) M Retro-peritoneum Saudi Arabia Low abdominal discomfort Lee et al.(1988) M Lung Libya Asymptomatic Kwon et al.(1988), Park et al.(1988) M Liver Saudi Arabia General malaise Huh et al. (1988) M Lung Saudi Arabia Asymptomatic Suh et al.(1989) M Liver Middle East Epigastric discomfort Kim et al. (1993) M Liver Saudi Arabia Epigastric discomfort Kim et al. (1993) M Liver Middle East Epigastric discomfort (1995) F Liver Yunbyun, China Abdominal pain Choi et al (1996) M Pelvis (recurrence of No. 10) Kang et al. (1999) M Liver Vietnam Kim et al. (2001) M Liver Uzbekistan Anaphylactic shock Jeoung et al. (2003) M Liver Koh et al.(2003) M Bladder Uzbekistan* Kim et al. (2004) F Orbit Uzbekistan* Ryou et al. (2006) F Kidney absent Jeon et al. (2007) unknown * Uzbeg working in Korea 998

7 Traveling and Imported Parasites 999

8 Ahn MH 1000

9 Traveling and Imported Parasites 11. Annual Report of KAHP. Korea Association of Health Promotion 2004; Ahn MH, Shin HJ, Im KI, Soh CT. Imported malaria cases in Korea. Yonsei Rep Trop Med 1982; 13: Soh CT, Lee KT, Im KI, Min DY, Ahn MH, Kim JJ, Yong TS. Current status of malaria in Korea. Yonsei Rep Trop Med 1985; 16: Lee SH. Imported parasitic diseases in Korea. J Korean Med Assoc 1989; 32: Min DY. Current status of imported parasites. J Korean Med Assoc 1992; 35: Cho SY, Kang Y, Park SM, Lee JS, Lim YA, Chae SL, Kho WG, Lee JS, Shim JC, Shin HK. Two vivax malaria cases detected in Korea. Korean J Parasitol 1994; 32: Kim HT, Song YW, Choe KW, Chai JY, Lee SH. An imported case of human babesiosis in Korea. Korean J Intern Med 1988; 35: Sim JG, Park HS, Ahn DH, Kho WG, Chai JY. A case of 1001

10 Ahn MH babesiosis in an eight year old Korean boy. J Korean Pediatr 1991; 34: Lee SS, Yang SY. Cho YK, Kim E, Kim YS, Woo JH, Ryu J, Chai JY. An imported case of babesiosis. Korean J Infect Dis 1997; 29: Kweon SH, Kim YS, Pai H, Park J, Park H, Choi HH, Chai JY. A case of mixed infection with malaria and Babesia. Korean J Infect Dis 1998; 30: Jang HJ, Kim JH, Park WJ, Kim CH, Kim DG, Hyun IG, Huh S, Kho WG, Chai JY. A case of intraerythrocytic parasitism treated with Quinine and Clindamycin. Korean J Infect Dis 1998; 30: Yon KT, Kim YA, Ku NS, Kim JH, Jung SJ, Kim HJ, Song KH, Choi YK, Shin SY, Kim YK, Kim MS, Park YS, Choi JY, Sung YG, Kim JM. A case of human babesiosis confirmed by polymerase chain reaction and treated with Atovaquone and Azithromycin. Infect Chemother 2006; 38: Kim JY, Cho Sh, Joo HN, Tsuji M, Cho SR, Park IJ, Chung GT, JU JW, Cheun HI, Lee HW, Lee YH, Kim TS. First case of human babesiosis in Korea: Detection and characterization of a novel type of Babesia sp. (Ko1) similar to ovine Babesia. J Clin Microbiol 2007; 45: Yu JR, Sohn WM. A case of human cyclosporiasis causing traveler's diarrhea after visiting Indonesia. J Korean Med Sci 2003; 18: Yoo TY, Chang BK, Lee SH. Two cases of cutaneous leishmaniasis. Korean J Dermatol 1978; 16: Kim HJ, Shin DH, Kim YW. Five cases of cutaneous leishmaniasis. Korean J Dermatol 1984; 22: Yun TY. Eun HC, Lee YS, Chi JG, Ham EK, Hong ST, Lee SH. Two cases of imported cutaneous leishmaniasis in Korea. Korean J Parasitol 1985; 23: Park JS, Lee DK, Hong SJ, Son SJ, Cho MK. A case of cutaneous leishmaniasis. Korean J Dermatol 2001; 39: Kim DY, Cho SB, Chung KY. A case of cutaneous leishmaniasis treated with intralesional injection of meglumine antimoniate. Korean J Dermatol 2006; 44: Heu IM. Three cases of Kalaazar, especially on the various serologic reaction. Korean J Intern Med 1952; 1: Chi JG, Shong YK, Hong ST, Lee SH, Seo BS, Choe KW. An imported case of Kala-azar in Korea. Korean J Parasitol 1983; 21: Kim HY, Jung SE, Park KW, Kim WK. Visceral leishmaniasis in a child. J Korean Assoc Pediatr Surg 2004; 10: Min DY, Soh CT, Woon JW. A case of Calabar swelling suspected a loiasis. Korean J Parasitol 1987; 25: Chun YS, Chun SI, Im KI, Moon TK, Lee MG. A case of loiasis. Yonsei Med J 1998; 39: Cho HY, Lee YJ, Shin SY, Song HO, Ahn MH, Ryu JS. Subconjunctival Loa loa with Calabar swelling. J Korean Med Sci 2007; (accepted article). 26. Lee SH, Hong ST, Chai JY. Description of male Gnathostoma spinigerum recovered from a Thai woman with meningoencephalitis. Korean J Parasitol 1988; 26: Lee SD, Lee HJ, Kim JW. A case of gnathostomiasis. Korean J Dermatol 2001; 39: Chai JY, Han ET, Shin EH, Park JH, Chu JP, Hirota M. NakamuraUchiyama F, Nawa Y. An outbreak of gnathostomiasis among Korean emigrants in Myanmar. Am J Trop Med Hyg 2003; 69: Lee NH, Sim YE, Kim CB, Yang YM, Lee SH, Lee CI, Kim DH, Hwang JW, Kliks M. Ten cases of eosinophilic meningitis. Eulji Med J 1981; 4: Chai JY, Seo BS, Lee SH, Hong SJ, Sohn WM, Human infection by Heterophyes heterophyes and H. dispar imported from Saudi Arabia. Korean J Parasitol 1986; 24: Min DY, Soh CT, Lee MS, Choi HK, Park CI. Urinary schistosomiasis among Korean returnees from the MiddleEast. Yonsei Rep Trop Med 1982; 13: Lee SY, Lee HC, Park YY, Kwon SW, Kim OK. Urinary schistosomiasis: A case report. Korean J Urol 1989; 30: Kim YD, Choi SK, KIm BT, Shin WH, Byun BJ. Cerebellar schistosomiasis. Case report. J Korean Neurosurg Soc 1994; 23: Lee YK, Choi TY, Jin SY, Lee DW. Imported CNS schistosomiasis. A case report. J Korean Med Sci 1995; 10: Lim SD, Suh YL, Chi JG, Hong ST, Lee SH. Mansonian schistosomiasis in rectum. Korean J Parasitol 1995; 33: Chung KY, Lee DY, Hong PW. Surgical treatment of pulmonary hydatid cyst-two case reports. Korean J Thoracic Surg 1983; 16: Jeon SH, Kim TH, Lee HL. Laparoscopic treatment of isolated renal hydatid cyst. Korean J Urol 2007; 48: Chai JY, Seo M, Suh KS, Lee SH. An imported case of hepatic unilocular hydatid disease. Korean J Parasitol 1995; 33: Choi KH, Kim MH, Choi JW, Suh JT. A case of echinococcal infection. Korean J Clin Pathol 1996; 16: Kim IK, Kim DY, Moon I, Kim TS, Ock MS, Oh KS, Rhew HY. A case of echinococcal hydatid cyst as misdiagnosed to the bladder cancer. Korean J Urol 2004; 45: Ryou JY, Kim KH, Kim SY. Hydatid cyst of the orbit. J Korean Opthalmol Soc 2006; 47: Kang J, Jung BC, Lee SB, Hong SK, Jeong H, Kim SH, Lee SE. A case of recurred hydatid cyst in pelvic cavity. Korean J 1002

11 Traveling and Imported Parasites Urol 1999; 40: Park JW, Kwon SJ, Ryu JS, Hong EK, Lee JU, Yu HJ, Ahn MH, Min DY. Two imported cases of cutaneous larva migrans. Korean J Parasitol 2001; 39: Kwon IH, Kim HS, Lee JH, Choi MH, Chai JY, Nakamura Uchiyama F, Nawa Y, Cho KH. A serologically diagnosed human case of cutaneous larva migrans caused by Ancylostoma caninum. Korean J Parasitol 2003; 41: Kim TH, Lee BS, Sohn WM. Three clinical cases of cutaneous larva migrans. Korean J Parasitol 2006; 44: Yong TS, Shin HJ, Im KI, Kim WH. An imported human case of hookworm infection with worms in the rectum. Korean J Parasitol 1992; 30: Kim HY, Lee SM, Joo JE, Na MJ, Ahn MH, Min DY. Human syngamosis: The first case in Korea. Thorax 1998; 53: Kim YK, Kim HJ, Hwang KJ, Hyeon KJ, Ree HI. Cutaneous myiasis by Cordylobia anthropophaga. J Korean Med Assoc 1990; 33: Park CS, Kim MW, Hong WK, Lee HB, Lee DW, Kang DY, Chai JY, Lee SH. Pentastomiasis which caused eosinophilic pneumonia: Report of a case. J Korean Med Assoc 1985; 28: Skarbinski J, Eliades MJ, Causer LM, Barber AM, Mali S, NguyenDinh P, Roberts JM, Parise ME, Slutsker L, Newman RD. Malaria surveillanceunited States, MMWR Surveill Summ 2006; 55: Askling HH, Nilsson J, Tegnell A, Janzon R, Kkdahl K. Malaria risk in travelers. Emerg Inf Dis 2005; 11: Kim MY, Eom KS, Jang T, Kim YR, Yoo JH, Cho SY, Yoo SY, Kang MW. Clinical analysis of 40 cases of malaria. Korean J Infect Dis 1998; 30: Park SH, Han JS, Rah HR, Chang HW. Clinical diagnostic analysis of 28 cases of malaria diagnosed in Pusan. J Korean Acad Fam Med 2001; 22: Kim JH, Park KS, Lee JM, Choi JH, Lee IS, Kim MY, Kim YR, Kang MW. A case of primaquineresistant tertian malaria. Korean J Infect Dis 1997; 29: Keiser L, Utzinger J. Emerging foodborne trematodiasis. Emerg Inf Dis 2005; 11:

12 Ahn MH Peer Reviewer Commentary 1004

386-390.hwp

386-390.hwp 386 HANYANG MEDICAL REVIEWS Vol. 29 No. 4, 2009 우리나라 미숙아의 통계와 의료비용 Statistics and Medical Cost of Preterm in Korea 윤혜선 을지대학교 노원을지병원 소아청소년과학교실 Hye Sun Yoon, M.D., Ph.D., Department of Pediatrics, Nowon