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Of many species of heterophyid flukes known to occur i n Korea, Metagoni mus yokogawai is the most important one with respect to general public health (Chai and Lee, 1990). In heavily infected patients the infection can cause severe gastrointestinal troubles and easy fatiguability. Metagonimus yokogawai is widely distributed along the riverside areas of the southern and eastern coasts where sweetfish are available (Seo et al., 1982; Chai and Lee, 1990). In
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  Of many species of heterophyid flukesknown to occur in Korea, Metagonimus yokogawai  is the most important one withrespect to general public health (Chai and Lee,1990). In heavily infected patients the infectioncan cause severe gastrointestinal troubles andeasy fatiguability. Metagonimus yokogawai  is widely distributed along the riverside areas of the southern and eastern coasts wheresweetfish are available (Seo et al., 1982; Chaiand Lee, 1990). In areas near Samchok-shi,Kangwon-do, a few epidemiological studieshave been performed (Seo et al., 1981; Ahn,1984; Song et al., 1985). However, wormcollection studies that determine the intensity of infection have never been carried out alongthe eastern coasts including Samchok-shi. Thepresent study was, therefore, aimed toinvestigate the prevalence and the intensity of  M. yokogawai infection among the residentsalong the Osib-chon (Stream), Samchok-shi(City), Kangwon-do (Province).Fecal specimens were collected from 165people, including both sexes and all agegroups, residing in two small villages(Sanggoro-ri and Hagoro-ri) in Miro-myon,Samchok-shi, during the period fromNovember 1997 through January 1998. They  were examined by both cellophane thick smear and formalin-ether sedimentation techniques. After the fecal examination, some of the casesshowing a high number of eggs were treated with 10 mg/kg single dose of praziquantel,followed by purgation with 30-40 g of MgSO 4 . Among the treated cases, 11 were cooperativein collection of diarrheic stools more than fiveconsecutive times during 3-4 hr directly after  ─ 33 ─  The Korean Journal of Parasitology  Vol. 38, No. 1, 33-36, March 2000 � Brief Communication � High endemicity of Metagonimus yokogawai  infectionamong residents of Samchok-shi, Kangwon-do  Jong-Yil CHAI 1) *, Eun-Taek HAN 1) , Yun-Kyu PARK  2) , Sang-Mee GUK  1) , Jae-Lip KIM 1) and Soon-Hyung LEE 1) Department of Parasitology  1)  , Seoul National University College of Medicine, and Institute of Endemic Diseases, Seoul National University Medical Research Center, Seoul 110-799, and Department of Parasitology  2)  , Inha University College of Medicine, Inchon 402-751, Korea  Abstract:  A small-scale epidemiological survey was undertaken during 1997-1998 onthe residents along the Osib-chon (Stream), Samchok-shi (City), Kangwon-do (Province), toevaluate the status of Metagonimus yokogawai  infection. A total of 165 fecal samples wascollected and examined by cellophane thick smear and formalin-ether sedimentationtechniques. The egg positive rate of M. yokogawai   was 29.7%, showing a remarkabledifference between males (46.6%) and females (16.3%). To obtain the adult flukes of M.yokogawai  , 11 egg positive persons were treated with praziquantel and purged withmagnesium sulfate. A total of 242,119 adult flukes (average 22,010 per person, 367-119,650 in range) was collected from diarrheic stools, all of which were identified as M.yokogawai  . The results show that M. yokogawai  is still highly endemic in this area. Key words: Metagonimus yokogawai  , human infection, Samchok-shi, epidemiology  � Received 24 December 1999, accepted after revision 15 February 2000.*Corresponding author (e-mail: cjy@plaza.snu.ac.kr)  the treatment. Diarrheic stools were washedseveral times with tap water, and the sediment  was fixed with 1% formalin and transported toour laboratory. The flukes were collectedunder a stereomicroscope and the number wascounted. Some of the specimens were flattenedgently under a cover slip pressure, which werefixed with 10% neutral buffered formalin andstained with Semichon’s acetocarmine. Through the fecal examination, variouskinds of helminth eggs and protozoan cysts were detected (Table 1). Overall egg and/or cyst positive rate was 32.7% (54 out of 165examined). The egg positive rate of helminths was the highest for M. yokogawai  (29.7%)followed by Trichuris trichiura  (0.6%), Enterobius vermicularis  (0.6%), and Clonorchis sinensis  (0.6%). The cyst positive rate wasrelatively low; Entamoeba coli  (1.6%) and Giardia lamblia  (1.2%).In the case of M. yokogawai  infection, thehighest egg positive rate was observed in theage group of 61-70 years (40.7%), followed by the forties (38.9%) and the fifties (33.3%) (Fig.1). Among the younger age groups, less than20 years, no infected cases were detected. Thepositive rate was significantly higher (p<0.05)for the males (46.6%) than the females(16.3%). From 11 cooperative cases incollection of adult flukes, a total of 242,119adult specimens (average 22,010 per person,367-119,650 in range) were collected (Table 2). All the flukes was identified as M. yokogawai  .Most of the infected people, especially those with more than 10,000 worms, recalled that they had experienced mild to severe degrees of gastrointestinal troubles including episodes of diarrhea and colicky pain. Many of the infectedpeople admitted that they had eaten raw fresh- water fish ( Plecoglossus altivelis  ) caught around this area.In Korea, three species of Metagonimus  areknown to occur; M. yokogawai  (Chai and Lee,1990), M. miyatai  (Chai et al., 1993; Saito et al., 1997), and M. takahashii  (Ahn and Ryang,1988; Chai et al., 1993). However, the majority of epidemiological studies have beenconducted on M. yokogawai  (Seo et al., 1981;Song et al., 1985; Chai and Lee, 1990). Largeand small rivers in the eastern and southerncoastal areas, where sweetfish are available,have turned out to be endemic foci of M.yokogawai  infection (Chai and Lee, 1990; Chaiet al., 1998). According to a survey along thefive major rivers, the average egg positive rateof riverside people was 4.8% (Seo et al., 1981).Other studies have revealed that theSomjingang (River), Tamjingang (River), ─ 34 ─ Table 1. Results of fecal examination of theresidents in Samchok-shi, Kangwon-do (1997-1998) a) No. of egg/Parasitecyst positivecases (%)No. examined165No. overall egg and/or cyst54(32.7)positive cases Metagonimus yokogawai  49(29.7) Trichuris trichiura  1(0.6) Enterobius vermicularis  1(0.6) Clonorchis sinensis  1(0.6) Entamoeba coli  3(1.6) Giardia lamblia  2(1.2) a) Fecal examination was done by both cellophanethick smear and formalin-ether sedimentationtechniques.   Fig. 1. Metagonimus yokogawai  egg positive rates by age and sex of residents in Samchok-shi,Kangwon-do.  Bosonggang (River), and Kojedo (Island) werefound to be highly endemic with 10-40% eggpositive rates among the residents (Yeo andSeo, 1971; Soh et al., 1976; Chai et al., 1977;Seo et al., 1981). In general population,however, quinquennial national surveysshowed 1.2% egg positive rate in 1981, 1.0%in 1986, and 0.3% in 1992 and 1997 (Ministry of Health and Welfare and Korea Association of Health, 1997). Around this area, two epidemiologicalsurveys were performed on M. yokogawai  infection previously (Seo et al., 1981; Ahn,1984). According to the former report (Seo et al., 1981), the egg positive rate was 28.5%, a figure very similar to the present study.Compared to the latter (Ahn, 1984) in whichthe rate was reported as 35.4%, only a littledecrease was recognized in the present study. This persistent endemicity of M. yokogawai  inthis area is undoubtedly related to a continuedraw eating habbit of sweetfish by the localresidents, especially among the adult agegroup. It is noteworthy, however, to mentionthat no school children were found to beinfected, which could be a result from a successful health education among this agegroup. In other areas of the eastern coasts, variable infection rates of residents werereported previously; 9.4% in Ulchu-gun (Jooand Park, 1982), 23.1% in Ulchin-shi, and6.7% in Miryang-gun (Seo et al., 1981), all of  which showed lower prevalences than in thepresent study. As far as the intensity of infection in termsof the number of worms in each person isconcerned, there have been a few reports inKorea. A report of two cases who expelled17,560 and 154 worms after a treatment wasthe first which documented the intensity of infection (Seo et al., 1971). Near the basin of  Tamjin River, where the egg positive rate of M.yokogawai   was 40.3%, the intensity of infection in average EPG (eggs per gram of feces) was 1,707 (Chai et al., 1977). It seems worthwhile to note that 2,886-63,587 adult flukes were collected individually from 14infected people in Tamjin River basin (Seo et al., 1985), which became the most recent record on the worm burden of M. yokogawai  . Therefore, the worm burdens of 119,650(patient No. 1) and 68,170 (patient No. 2) inthis study are the heaviest record among theliterature. The infected people experiencedmild to severe degrees of gastrointestinaltroubles including diarrhea, and the twoheaviest cases recalled that they had repeatedepisodes of profuse diarrhea and colicky pain. Taken together, the results of the present study suggest that M. yokogawai  is still highly endemic along the Osib-chon (Stream),Samchok-shi. Proper control measures areurgently needed in this area. REFERENCES  Ahn YK (1984) Epidemiological studies on Metagonimus yokogawai  infection inSamcheok-gun, Kangwon-do, Korea. Korean J Parasitol  22: 161-170 (in Korean). Ahn YK, Ryang YS (1988) Epidemiological studieson Metagonimus  infection along the Hong-cheon River, Kangwon Province, Korea. Korean J Parasitol  26: 207-213 (in Korean).Chai JY, Cho SY, Seo BS (1977) Study on Metagonimus yokogawai  (Katsurada, 1912) inKorea IV. An epidemiological investigationalong Tamjin River basin, South Cholla Do,Korea. Korean J Parasitol  15: 115-120.Chai JY, Huh S, Yu JR, Kook J, Jung KC, Park EC, Sohn WM, et al. (1993) An epidemiol- ─ 35 ─ Table 2. Number of M. yokogawai  specimenscollected from egg positive cases after prazi-quantel treatment and purgationSerial caseAge/No. of worms recoveredNo.sex 144/M119,650238/M68,170369/M26,000461/M10,300557/M6,195662/M4,665770/M2,529845/F2,220976/M1,1811062/F8421130/M367 Total242,119 (av. 22,010) a)a)  Average number of worms recovered per person  ogical study of metagonimiasis along theupper reaches of the Namhan River. Korean J Parasitol  31: 99-108.Chai JY, Lee SH (1990) Intestinal trematodes of humans in Korea: Metagonimus  , heterophyidsand echinostomes. Korean J Parasitol  28 (suppl.) : 103-122.Chai JY, Song TE, Han ET, Guk SM, Park YK,Choi MH, Lee SH (1998) Two endemic foci of heterophyids and other intestinal flukeinfections in southern and western coastalareas in Korea. Korean J Parasitol  36: 155-161. Joo CY, Park SG (1982) Epidemiological survey of  Metagonimus yokogawai  in Ulju county,Kyungnam Province, Korea. Kyungpook Univ Med J  23: 1-9.Ministry of Health and Welfare, Korean Association of Health (1997) Prevalence of intestinal parasitic infections in Korea — Thesixth report —. Seoul, Korea (Monographseries in Korean).Saito S, Chai JY, Kim KH, Lee SH, Rim HJ (1997) Metagonimus miyatai  sp. nov. (Digenea:Heterophyidae), a new intestinal trematodetransmitted by freshwater fishes in Japanand Korea. Korean J Parasitol  35: 223-232.Seo BS, Hong ST, Chai JY, Lee SH (1982) Study on Metagonimus yokogawai  (Kasturada,1912) in Korea VI. The geographicaldistribution of metacercarial infection insweetfish along the east and south coast. Korean J Parasitol  20: 28-32 (in Korean).Seo BS, Lee HS, Chai JY, Lee SH (1985) Intensity of Metagonimus yokogawai  infection amonginhabitants in Tamjin River basin withreference to its egg laying capacity in thehuman host. Seoul J Med  26: 207-212.Seo BS, Lee SH, Cho SY, Chai JY, Hong ST, HanIS (1981) An epidemiologic study onclonorchiasis and metagonimiasis in riversideareas in Korea. Korean J Parasitol  19: 137-150 (in Korean).Seo BS, Rim HJ, Lee HS, Cho SY, Kwack CW, Lee WJ, Yeo TO (1971) Two cases of metagoni-miasis with special reference on the egglaying capacity in the human host. Seoul J Med  12: 234-241.Soh CT, Lee KT, Cho KM (1976) Prevalences of clonorchiasis and metagonimiasis alongrivers in Jeonra-Nam-Do, Korea. Yonsei Rep Trop Med  7: 3-16.Song CY, Lee SH, Jeon SR (1985) Studies on theintestinal fluke, Metagonimus yokogawai  Katsurada, 1912 in Korea. IV. Geographicaldistribution of sweetfish and infection status with Metagonimus  metacercaria in south-eastern areas of Korea. Korean J Parasitol  23: 123-138 (in Korean). ─ 36 ─
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