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Cholestatic Hepatitis Caused by Tongyeong Strain of Orientia tsutsugamushi

감염과화학요법 2009년 41권 2호 p.99 ~ 104
주고운, 김미경, 길세희, 정문현, 김준미, 강재승,
소속 상세정보
주고운 ( Joo Ko-Woon ) - Inha University College of Medicine Department of Internal Medicine
김미경 ( Kim Mee-Kyung ) - Clinical Research Center, Inha University College of Medicine, Incheon, Korea
길세희 ( Kil Se-Hee ) - Clinical Research Center, Inha University College of Medicine, Incheon, Korea
정문현 ( Chung Moon-Hyun ) - Inha University College of Medicine Department of Internal Medicine
김준미 ( Kim Joon-Mee ) - Inha University College of Medicine Department of Pathology
강재승 ( Kang Jae-Seung ) - Inha University College of Medicine Department of Microbiology

Abstract


In Korea, the clinical manifestation of scrub typhus in humans appears to be severe in the northern regions of the country and mild in the southern areas. Studies on the geographic distribution of the serotype of Orientia tsutsugamushi revealed that the Boryong serotype is predominant in the southern Korean peninsula, whereas the Gilliam, Karp, and Gilliam-Karp serotypes prevail in the northern or central peninsula. We report a case of severe scrub typhus caused by the Japanese Gilliam type of Orientia tsutsugamushi in a 66-year-old woman from Tongyeong, a city located in the southern part of Korean peninsula. The patient was admitted to the hospital with fever on August 29th, 2001. Scrub typhus complicated by shock, pneumonitis, and encephalitis was diagnosed. Additionally, markedly elevated alkaline phosphatase levels was observed, which necessitated an ultrasonographic examination, which showed an ill-defined hyperechogenic mass on the right hepatic lobe. Liver biopsy showed cholestatic hepatitis and blood culture showed growth of O. tsutsugamushi. Gene sequencing of the amplicons of a polymerase chain reaction using primers for the amplification of the gene encoding the 56-kDa protein of O. tsutsugamushi revealed a nucleotide sequence that matched Yonchon strain of O. tsutsugamushi.

키워드

Orientia tsutsugamushi;Scrub typhus;Cholestatic hepatitis;Genotype

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