通院癩患者의 臨床疫學的 硏究

Abstract

Although the leprosy has a long history among human beings, today the leprosy is still one of important sociomedical diseases in many countries throughout the world. In this study the data of clinical records of the registered leprosy cases at the World Vision Leprosy Center were computerized and analyzed in order to expose various facetss of recent trends in leprosy and to revaluate the previous reports on the epidemiological status of leprosy in Korea. A total of 3164 leprosy cases are included who were diagnosed, registered and treated continuously on ambulatory basis at the Leprosy Center through May 1955 to December 1971. The results are summarized and concluded as follows: 1). The yearly registered number of new cases of leprosy at this Center was peaked to 331 in 1961 and then gradually decreased to 138 in l970. It appeared that overwhole decrease in the number of new cases throughout the country and the increased leprosy services through other out-patIent clinics and mobile teams have brought the gradual decrease in the number of yearly new cases of leprosy after 1961. 2). Examination of birth place and present residence of the registered leprosy cases revealed that birth place of the most of the cages were Honam and Yungnam which are well-known heavily endemic area of leprosy in Korea, but more than a half of the cases have their residence in Seoul and Kyungi Province which are locally close to the Leprosy Center,This indicated a tendency of concentrated residence of leprosy cases in these areas and it appeared to be due, in part, to the social prejudice against leprosy in this country. 3). Generally, the degree of education of the patients was higher than that of other reports, but their economic status was poor. 4). A study of the patients' motives of having diagnosis and treatment on the voluntary basis at this Center showed that the practical training of general practitioner doctors and medical personnel in leprosy, as well as public education on the modern concept of leprosy is of great importance. 5). A famIly history of leprosy was recognized in 17.1% of the total patients and a history of contact with leprosy cases in 17.0%. 6). The distributions of the major disease types in the total patients were 54.0 % ot lepromatous and 34.5% of tuberculold type. In the yearly distribution of leprosy types, the number of lepromatous leprosy patients has gradually increased since 1957, and in l971 the rate of lepromatous to tuberculoid was 1.8:1. It is interpreted to indicate that the epidemicity of leprosy in Korea has been decreasing and the general immunity in the community against leprosy has been lowered. 7). In sex distribution of the registered patients, the ratio of maie to female was about 3 to 1. An analysIs of the distribution of disease types in regard to the birth palce of the patients revealed that in the highly endemic Honam and Yungnam area the lepromatous type was more prevalent than the tuberculold. This finding supported the general assumption that leprosy is quite endemic in Honam and Yungnam areas In Korea. 8). More than a half of the patients had their age of onset between 16 and 20, and the time of the registration at the Center was between 21 and 25. The delay of appromimately 5 years from the onset of the disease to the time of registration ( and treatment ) appeared to impose a serious obstacle in the control of leprosy in Korea. 9). After the onset of the disease, most of the patients wasted more than 2 years until they had exact diagnosis and began treatment. 10). Bacteriological examination of skin smears of the registered patients at the Center showed that 51 % among the total cases and 86,4 % of lepromatous type were positive bacteriologically at the time of diagnosis and registration. Among the bacteriological positive cases, lepromatous cases reguired longer time of treatment to become bacteriological negative i.e., 63.9 % of them took 5 years of regular treatment. The rate of bacteriological positive cases among tuberculoid type was only 6.30 %, and furthermore almost all of them (97.1%) became baoteriologjioally negative within 5 years of treatment.