Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지

Lower respiratory tract infection of positive antigen test for respiratory syncytial virus on children under 2 years of age

2세 이하의 소아에서 respiratory syncytial virus의 항원검사에 양성인 하기도 감염

  • Jeong, Jea Heon (Department of Pediatrics, College of Medicine, Wonkwang University) ;
  • Moon, Kyoung Hee (Department of Pediatrics, College of Medicine, Wonkwang University) ;
  • Lee, Chang Woo (Department of Pediatrics, College of Medicine, Wonkwang University) ;
  • Choi, Du Young (Department of Pediatrics, College of Medicine, Wonkwang University) ;
  • Oh, Yeun Geun (Department of Pediatrics, College of Medicine, Wonkwang University) ;
  • Yoon, Hyang Suk (Department of Pediatrics, College of Medicine, Wonkwang University) ;
  • Cho, Ji Hyun (Department of Laboratory Medicine, College of Medicine, Wonkwang University) ;
  • Kim, Jong Duck (Department of Pediatrics, College of Medicine, Wonkwang University)
  • 정재헌 (원광대학교 의과대학 소아과학교실) ;
  • 문경희 (원광대학교 의과대학 소아과학교실) ;
  • 이창우 (원광대학교 의과대학 소아과학교실) ;
  • 최두영 (원광대학교 의과대학 소아과학교실) ;
  • 오연균 (원광대학교 의과대학 소아과학교실) ;
  • 윤향석 (원광대학교 의과대학 소아과학교실) ;
  • 조지현 (원광대학교 의과대학 임상진단의학교실) ;
  • 김종덕 (원광대학교 의과대학 소아과학교실)
  • Received : 2005.09.05
  • Accepted : 2005.11.18
  • Published : 2006.04.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose : This study was design and performed for evaluations of resent clinical pattern of bronchiolitis caused by RSV infection with children under 2 year of age for 5 years, who were admitted to pediatric ward. Methods : The inclusion criteria of the patients were children under 24 month-of-age, clinical manifestations of lower respiratory tract infection, and RSV antigen that was detected by a direct immunofluorescence test from the nasal secretions. The additional laboratory and simple chest X-ray findings were reviewed from the medical records of children who were admitted Wonkwang university hospital from Jan. 1999 to Dec. 2003. Results : In the 5 year study duration, 127 patients were enrolled and outbreak of RSV bronchiolitis took place in 2001. The 80 cases(63 percent) of RSV infection were concentrated in later autumn and winter. Number of the cases show coughing were 120(94.5 percent), but rale was audible in 78 cases(61.4 percent). Dyspnea, wheezing, and intercostal retraction were noticed in 27(21.3 percent), 21(16.5 percent), and 4(3 percent) cases respectively. The most common chest X-ray finding was hyperinflation of the lung that was noticed in 110 cases(86.6 percent). Care with mechanical ventilator for more than 2 days required in 5 cases. Conclusion : Lower respiratory tract infection by RSV was common in late autumn and winter season but year-round infection was noticed. The severity of RSV respiratory tract infectiontakes in some degree a grave course. So we suggest that population-based surveillance of acute respiratory infection due to RSV is necessary for assessment of prevalence and epidemiology of this disease.

목 적 : 세기관지염은 영유아에서 흔한 하기도 감염이며 RSV 바이러스가 가장 흔한 원인 바이러스다. 그러나 RSV 감염에 대한 능동면역을 이용한 예방은 아직 이용할 수 없는 실정이다. 본 임상고찰은 최근 5년 동안 2세 이하의 어린이에서 RSV 감염에 의한 세기관지염의 임상양상을 평가하고자 하였다. 방 법 : 1999년 1월부터 2003년 12월까지 원광대학교병원 소아과에 입원한 환아 가운데 생후 24개월 미만이며 하부호흡기 감염의 증거가 있는 환아 513명 중 비강 분비물에서 RSV 항원 양성인 소아 127명을 대상으로 하여 흉부 X-선, 임상양상과 기본 혈액검사 소견을 조사하였다. 결 과 : 1999년부터 2003년까지 5년간 각 연도별 발생은 2001년에 43례(34%)로 가장 많은 발생을 보였다. 5년 통산 월별 발병은 11월에 37례(29%)로 가장 많았고 매년 늦가을부터 겨울철에 발병이 집중되는 양상을 보였다. 주요 임상소견은 기침이 120례(94%)에서 나타났고 수포음은 78례(61%)에서 청진되었고 호흡곤란과 천명은 각각 27례(21%), 21례(17%)에서 관찰되어 수포음의 청진이 하기도 감염의 주요 소견이었다. 가장 흔한 흉부 X-선 소견은 폐의 과도한 공기음영이었고 110례(87%)에서 관찰되었다. 122례에서 합병증없이 회복되었으나 5례에서 2일간 기계적인 인공호흡 치료가 필요하여 고위험군에 속하는 환아의 집중관리가 요구된다. 결 론 : 5년간 입원환자로 본 RSV에 의한 하부호흡기 감염은 늦가을과 겨울철에 발병이 많았지만 일년내내 하기도 감염 환아가 발생하였으며, RSV 감염으로 주로 고위험군 소아에서 중한 경과를 취하는 경우가 있어서 RSV 호흡기 감염에 대한 인구를 기초로 한 감시체계와 범국가적인 체계적 조사로 유병률 및 유행에 대한 평가가 필요할 것으로 사료된다.

Keywords

Acknowledgement

Supported by : 원광대학교

References

  1. Collins PL, McIntosh K, Chanock RM. Respiratory syncytial virus. In : Fields BN, Knipe DM. editors. Viology. 3rd ed. New York : Raven Press, 1996:1313-51
  2. Blount RE Jr., Morris JA, Savage RE. Recovery of cytopathogenic agent from chimpanzees with coryza. Proc Soc Exp Biol Med 1956;92:544-9
  3. Lee HJ, Jang SH. Clinical and epidemiologic patterns of respiratory syncytial virus infection. J Korean Pediatr Soc 1992;35:1389-401.
  4. Stensballe LG, Devasundaram JK, Simoes EA. Respiratory syncytial virus epidemics : the ups and downs of a seasonal virus. Pediatr Infect Dis J 2003;22(2 Suppl):21S-32S https://doi.org/10.1097/00006454-200302001-00004
  5. CDC. Respiratory syncytial virus and parainfluenza virus surveillance-United States, 1989-90 season. MMWR Morb Mortal Wkly Rep 1990;39:832-3
  6. CDC. Respiratory syncytial virus activity--United States, 2000-01 season. Morb Mortal Wkly Rep 2002;51:26-8
  7. Lee JJ, Park HS, Kim ML, Kim DH, Lee HL, Park JY, et al. Epidemiologic and clinical patterns of acute lower respiratory infection of respiratory syncytial and parainfluenza virus. J Korean Pediatr Soc 1997;40:1071-80
  8. Kim MR, Lee HR, Lee GM. Epidemiology of acute viral respiratory tract infections in Korean children. J Infect 2000;41:152-8 https://doi.org/10.1053/jinf.2000.0715
  9. Lee HJ. Respiratory syncytial virus. Korean J Pediatr Infect Dis 1997;4:48-6
  10. Iwane MK, Edwards KM, Szilagyi PG, Walker FJ, Griffin MR, Weinberg GA, et al. Population-based surveillance for hospitalizations associated with respiratory syncytial virus, influenza virus, and parainfluenza viruses among young children. Pediatrics 2004;113:1758-64 https://doi.org/10.1542/peds.113.6.1758
  11. Jeng MJ, Lemen RJ. Respiratory syncytial virus bronchiolitis. Am Fam Physician 1997;55:1139-46, 49-50
  12. Johnson KM, Chanock RM, Rifkind D, Kravetz HM, Knight V. Respiratory syncytial virus IV. Correlation of virus shedding, serologic response, and illness in adult volunteers. JAMA 1961;176:663-7
  13. Johnston SL, Siegel CS. Evaluation of direct immunofluorescence, enzyme immunoassay, centrifugation culture, and conventional culture for the detection of respiratory syncytial virus. J Clin Microbiol 1990;28:2394-7
  14. Kapikian AZ, Bell JA, Mastrota FM, Johnson KM, Huebner RJ, Chanock RM. An outbreak of febrile illness and pneumonia associated with respiratory syncytial virus infection. Am J Hyg 1961;74:234-48
  15. Sterner G, Wolontis S, Bloth B, de Hevesy G. Respiratory syncytial virus. An outbreak of acute respiratory illnesses in a home for infants. Acta Paediatr Scand 1966;55:273-9 https://doi.org/10.1111/j.1651-2227.1966.tb17654.x
  16. Cho JI, Choi HC, Cho JH, Kim JD. The clinical study of the lower respiratory tract infection by respiratory syncytial virus on children under 2 year of age. Korean J Pediatr Infec Dis 2000;7:193-200 https://doi.org/10.14776/kjpid.2000.7.2.193
  17. Putto A, Ruuskanen O, Meurman O. Fever in respiratory virus infections. Am J Dis Child 1986;140:1159-63
  18. Jeon NL, Kim BS, Kim YK, Hong SJ. Etiology and clinical features of severe acute viral lower respiratory tract infections in children. J Korean Pediatr Soc 2000;43:1558-68
  19. Malhotra A, Krilov LR. Influenza and respiratory syncytial virus. Update on infection, management, and prevention. Pediatr Clin North Am 2000;47:353-72, vi-vii https://doi.org/10.1016/S0031-3955(05)70211-X
  20. Hall CB, Douglas RG, Jr. Modes of transmission of respiratory syncytial virus. J Pediatr 1981;99:100-3 https://doi.org/10.1016/S0022-3476(81)80969-9
  21. Korppi M, Kroger L, Laitinen M. White blood cell and differential counts in acute respiratory viral and bacterial infections in children. Scand J Infec Dis 1993;25:435-40 https://doi.org/10.3109/00365549309008524
  22. Korppi M, Kroger L. C-reactive protein in viral and bacterial respiratory infection in children. Scand J Infect Dis 1993;25:207-13 https://doi.org/10.3109/00365549309008486
  23. Ruuskanen O, Putto A, Sarkkinen H, Meurman O, Irjala K. C-reactive protein in respiratory virus infections. J Pediatr 1985;107:97-100 https://doi.org/10.1016/S0022-3476(85)80624-7
  24. Korppi M, Leinonen M, Koskela M, Makela PH, Launiala K. Bacterial coinfection in children hospitalized with respiratory syncytial virus infections. Pediatr Infect Dis J 1989; 8:687-92 https://doi.org/10.1097/00006454-198910000-00005
  25. Johanston SL, Holgate ST. Epidemiology of viral respiratory tract infections. In : Myint S, Talyor-Robinson D, editors. Viral and other infections of the human respiratory tract. 1st ed. London : Chapman & Hall, 1996:1-38
  26. Martinez FD. Viral infections and the development of asthma. Am J Respir Crit Care Med 1995;151:1644-8 https://doi.org/10.1164/ajrccm.151.5.7735627
  27. Welliver RC. Review of epidemiology and clinical risk factors for severe respiratory syncytial virus(RSV) infection. J Pediatr 2003;143(5 Suppl):112S-7S https://doi.org/10.1067/S0022-3476(03)00508-0
  28. Willson DF, Landrigan CP, Horn SD, Smout RJ. Complications in infants hospitalized for bronchiolitis or respiratory syncytial virus pneumonia. J Pediatr 2003;143(5 Suppl): 142S-9S https://doi.org/10.1067/S0022-3476(03)00514-6
  29. Simoes EA. Environmental and demographic risk factors for respiratory syncytial virus lower respiratory tract disease. J Pediatr 2003;143(5 Suppl):118S-26S https://doi.org/10.1067/S0022-3476(03)00511-0
  30. Krilov LR. Respiratory syncytial virus infection. Emedicine [serial online] 2004 Nov.24[cited 2005 Aug 26]. Available from : URL://http://www.emedicine.com/PED/topic2706.htm.