Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Postnatal cytomegalovirus infection in an extremely premature infant transmitted via breast milk: A case report

산모의 모유를 통하여 감염된 극소 저체중 출생아에서의 거대세포바이러스 감염

  • Kim, Ji Hye (Department of Pediatrics, Hanyang University School of Medicine) ;
  • Chung, Eun-Jin (Department of Pediatrics, Hanyang University School of Medicine) ;
  • Park, Hyun Kyung (Department of Pediatrics, Hanyang University School of Medicine) ;
  • Moon, Soo Ji (Department of Pediatrics, Hanyang University School of Medicine) ;
  • Choi, Su-Mi (Department of Internal Medicine, The Catholic University of Korea) ;
  • Oh, Sung Hee (Department of Pediatrics, Hanyang University School of Medicine)
  • 김지혜 (한양대학교 의과대학 소아과학교실) ;
  • 정은진 (한양대학교 의과대학 소아과학교실) ;
  • 박현경 (한양대학교 의과대학 소아과학교실) ;
  • 문수지 (한양대학교 의과대학 소아과학교실) ;
  • 최수미 (가톨릭대학교 의과대학 내과학교실) ;
  • 오성희 (한양대학교 의과대학 소아과학교실)
  • Received : 2009.06.02
  • Accepted : 2009.08.12
  • Published : 2009.09.15
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Abstract

Cytomegalovirus (CMV) is one of the most commonly encountered viral pathogens in newborn infants and is found in 0.3-2.4% of all live births. It has been demonstrated that 40-96% of seropositive mothers shed the virus via their breast milk. Breast milk containing CMV can cause almost one-third of CMV infections occurring in infants. A case of postnatal CMV infection in an extremely premature infant (gestational age $24^{+5}$ weeks, birth weight 750 g) transmitted via breast milk is presented. For neonatal intensive care unit (NICU) management of severe thrombocytopenia, anemia, and sepsis syndrome, the infant received repeated transfusions of platelets; intravenous (IV) immunoglobulins; and gamma- irradiated, filtrated packed red cells and was fed her mother's breast milk since the second week of life. CMV infection was diagnosed with positive CMV immunoglobulin M (IgM) and positive urine CMV culture at the second month of life. Considering the negative CMV IgM and urine CMV culture at birth, postnatally-acquired CMV infection was suspected and confirmed with completely identical nucleotide sequence alignments of the infantile blood isolate and the maternal breast milk isolate. To our knowledge, this is the first case of proven postnatal CMV infection transmitted via breast milk in an extremely premature infant in Korea.

거대세포바이러스(CMV)는 신생아에서 가장 흔한 선천성 감염의 원인 중 하나이며, 모든 정상 출산아 중 약 0.3-2.4%에서 감염되어 있다. 혈청에서 거대세포바이러스 양성인 모체 중 40-96%에서 모유를 통한 바이러스의 배출이 증명되었으며, 거대세포바이러스에 감염된 모유를 통한 감염은 전체 영아 거대세포바이러스 감염의 약 1/3을 차지한다. 본 증례에서는 극소 저체중 출생아에서 모유를 통하여 발생한 거대세포바이러스 감염을 기술하였다. 환아는 생후 7일 경부터 모유 수유를 하였으며, 심한 혈소판감소증, 빈혈, 그리고 패혈증과 유사한 임상 양상에 대하여 반복되는 혈소판 수혈, 적혈구 수혈, 면역 글로불린 요법을 시행받았다. 거대세포바이러스 감염은 생후 2개월 경 혈청 CMV IgM 양성 및 소변 CMV 배양 검사 양성 소견을 통하여 진단하였다. 출생 당시 혈청 CMV IgM 및 소변 CMV 배양 검사가 음성이었으므로 선천성 감염은 배제할 수 있었다. 환아의 혈청과 모유의 핵산 배열 순서 분석을 통하여 동일한 바이러스에 의한 감염임을 증명하였다. 저자들은 국내에서 최초로 nucleotide sequencing 방법을 이용, 모유 수유를 통한 거대세포바이러스 감염이 발생한 극소 저체중 출생아의 예를 보고하는 바이다.

Keywords

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