Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
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2006-2007년 소아 급성 하기도 감염증에서 유행한 메타뉴모바이러스의 유행 및 임상 양상

Epidemiologic and clinical features in children with acute lower respiratory tract infection caused by human metapneumovirus in 2006-2007

  • 박귀옥 (중앙대학교 의과대학 소아과학교실) ;
  • 김지현 (중앙대학교 의과대학 소아과학교실) ;
  • 이재희 (중앙대학교 의과대학 소아과학교실) ;
  • 이정주 (중앙대학교 의과대학 소아과학교실) ;
  • 윤신원 (중앙대학교 의과대학 소아과학교실) ;
  • 임인석 (중앙대학교 의과대학 소아과학교실) ;
  • 이동근 (중앙대학교 의과대학 소아과학교실) ;
  • 최응상 (중앙대학교 의과대학 소아과학교실) ;
  • 유병훈 (중앙대학교 의과대학 소아과학교실) ;
  • 이미경 (중앙대학교 의과대학 진단검사의학과교실) ;
  • 채수안 (중앙대학교 의과대학 소아과학교실)
  • Park, Gwi Ok (Department of Pediatrics, College of Medicine, Chung Ang University) ;
  • Kim, Ji Hyun (Department of Pediatrics, College of Medicine, Chung Ang University) ;
  • Lee, Jae Hee (Department of Pediatrics, College of Medicine, Chung Ang University) ;
  • Lee, Jung Ju (Department of Pediatrics, College of Medicine, Chung Ang University) ;
  • Yun, Sin Weon (Department of Pediatrics, College of Medicine, Chung Ang University) ;
  • Lim, In Seok (Department of Pediatrics, College of Medicine, Chung Ang University) ;
  • Lee, Dong Keun (Department of Pediatrics, College of Medicine, Chung Ang University) ;
  • Choi, Eung Sang (Department of Pediatrics, College of Medicine, Chung Ang University) ;
  • Yoo, Byoung Hoon (Department of Pediatrics, College of Medicine, Chung Ang University) ;
  • Lee, Mi Kyung (Department of Laboratory Medicine, College of Medicine, Chung Ang University) ;
  • Chae, Soo Ahn (Department of Pediatrics, College of Medicine, Chung Ang University)
  • 투고 : 2008.08.06
  • 심사 : 2008.11.08
  • 발행 : 2009.03.15
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초록

목 적 : 급성 하기도 감염은 소아 환자들에 있어 가장 흔한 질환 중에 하나로, RSV, PIV, IFV A/B, ADV 등이 흔한 원인으로 알려져 있으며, 2001년 이후로 hMPV 또한 주요 원인 바이러스 중의 하나로 밝혀졌다. 하지만 hMPV의 검출율, 유행 양상이 다른 호흡기 바이러스와 어떤 차이가 있는지에 대해서는 국내 연구가 충분하지 않아 본 연구를 시행하였다. 방 법 : 2006년 11월부터 2007년 10월까지 중앙대학교병원 소아청소년과에 급성 호흡기 감염증으로 입원한 환아들을 대상으로 입원 첫 날에 비인두 흡입물을 채취하여 다중 역전사 연쇄중합반응을 시행하여 흔한 호흡기 바이러스 6종(hMPV, RSV, PIV, IFV A/B, ADV)을 분리하였고, 각 바이러스의 검출율과 임상증세를 분석하여 hMPV 양성 환아가 다른 바이러스 감염과 어떠한 차이를 보이는지 연구하였다. 결 과 : 462명 중 193명(41.8%)에서 바이러스가 검출되었으며, 그 중 38명(19.7%)이 hMPV로 나타났다. hMPV가 검출된 환아들의 연령은 1-5세가 대부분이었고(76.3%), 나이의 중앙값은 27개월, 남녀비는 1.2:1이었다. 월별로는 3월부터 5월까지 집중되었고, 4월에 21명(55.3%)으로 절정을 이루었다. 진단명은 폐렴이 가장 흔하였고 이는 29명(76.3%)을 차지하였고(P=0.018), 다음으로는 세기관지염 5명(13.2%), 기관지염 2명(2.6%), 크룹 1명(2.6%), 천식의 급성 악화 1명(2.6%) 순으로 나타났다. 평균 재원 일수는 5.8일 정도였고, 흉부 방사선 소견은 폐문 주위의 기관지침윤 양상(100%)을 보였으며, 대부분에서 백혈구수는 정상(73.7%), C-반응 단백은 음성(86.8 %)으로 나타났으며(P>0.05), hMPV 관련 급성 하기도 감염증으로 확인된 모든 환아들의 예후는 양호했다. 결 론 : 우리 나라에서 면역력이 양호한 1-5세 환아가 3월에서 5월 사이에 급성 하기도 감염으로 내원하는 경우, hMPV에 의한 감염의 가능성을 염두에 두어야 한다. HMPV 관련 급성 하기도 감염증으로 진단시 일반적으로 양호한 경과를 예측할 수 있겠다.

Purpose : The causes of acute lower respiratory tract infection (ALRTI) are mostly attributable to viral infection, including respiratory syncytial virus (RSV), parainfluenza virus (PIV), influenza virus A/B (IFV A/B), or adenovirus (ADV). Several Korean studies reported human metapneumovirus (hMPV) as a common pathogen of ALRTI. However, studies on seasonal distribution and clinical differences relative to other viruses are insufficient, prompting us to perform this study. Methods : From November 2006 to October 2007, we tested nasopharyngeal aspiration specimens in children hospitalized with ALRTI with the multiplex reverse transcriptase-polymerase chain reaction to identify 6 kinds of common pathogen (hMPV, RSV, PIV, IFV A/B, and ADV). We analyzed positive rates and clinical features by respiratory chart review. Results : We detected 38 (8.4%) hMPV-positive cases out of 193 (41.8%) virus-positive specimens among 462 patients. HMPV infection prevailed from March to June with incidence peaking in April. HMPV-positive patients were aged 15 years (76.3%), and the ratio of boys to girls was 1.2:1. The median age was 27 months. HMPV primarily caused pneumonia (76.3 %) (P=0.018). Average hospitalization of HMPV-associated ALRTI patients was 5.8 days. In addition, they showed parahilar peribronchial infiltration (100%) on chest X-ray, normal white blood cell count (73.7%), and negative C-reactive protein (86.8 %) (P>0.05). All hMPV-positive patients recovered without complication. Conclusion : HMPV is a common pathogen of ALRTI in Korean children, especially in 1-5 year olds, from March to May. Immunocompetent children diagnosed with hMPV-associated ALRTI may have a good prognosis.

키워드

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피인용 문헌

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  2. Clinical Manifestations of Respiratory Viruses in Hospitalized Children with Acute Viral Lower Respiratory Tract Infections from 2010 to 2011 in Busan and Gyeongsangnam-do, Korea vol.22, pp.3, 2009, https://doi.org/10.7581/pard.2012.22.3.265
  3. Clinical and Epidemiological Characteristics of Human Metapneumovirus Infections, in Comparison with Respiratory Syncytial Virus A and B vol.20, pp.3, 2009, https://doi.org/10.14776/kjpid.2013.20.3.168
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