Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지
DOI QR코드

DOI QR Code

Nationwide surveillance of acute interstitial pneumonia in Korea

급성 간질성 폐렴의 전국적 현황 조사

  • Kim, Byoung-Ju (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Han-A (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Song, Young-Hwa (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yu, Jinho (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Seonguk (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, Seong Jong (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Kyung Won (Department of Pediatrics, Yonsei University College of Medicine) ;
  • Kim, Kyu-Earn (Department of Pediatrics, Yonsei University College of Medicine) ;
  • Kim, Dong Soo (Department of Pediatrics, Yonsei University College of Medicine) ;
  • Park, June Dong (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Ahn, Kang Mo (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Hyo-Bin (Department of Pediatrics, Inje University Sanggye Paik Hospital) ;
  • Jung, Hyang-Min (Korea Centers for Disease Control and Prevention) ;
  • Kang, Chun (Korea Centers for Disease Control and Prevention) ;
  • Hong, Soo-Jong (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine)
  • 김병주 (울산대학교 의과대학 소아과학교실) ;
  • 김한아 (울산대학교 의과대학 소아과학교실) ;
  • 송영화 (울산대학교 의과대학 소아과학교실) ;
  • 유진호 (울산대학교 의과대학 소아과학교실) ;
  • 김성국 (울산대학교 의과대학 소아과학교실) ;
  • 박성종 (울산대학교 의과대학 소아과학교실) ;
  • 김경원 (연세대학교 의과대학 소아과학교실) ;
  • 김규언 (연세대학교 의과대학 소아과학교실) ;
  • 김동수 (연세대학교 의과대학 소아과학교실) ;
  • 박준동 (서울대학교 의과대학 소아과학교실) ;
  • 안강모 (성균관대학교 의과대학 소아과학교실) ;
  • 김효빈 (인제대학교 의과대학 소아과학교실) ;
  • 정향민 (질병관리본부 국립보건연구원) ;
  • 강춘 (질병관리본부 국립보건연구원) ;
  • 홍수종 (울산대학교 의과대학 소아과학교실)
  • Received : 2009.01.02
  • Accepted : 2009.02.13
  • Published : 2009.03.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose : Acute interstitial pneumonia (AIP) is a rare disease, but its prognosis is fatal because of lack of efficient treatment modality. Recently, it has been reported that there was epidemic AIP in Korea. This study aims to investigate the past and current status of AIP in Korea. Methods : We performed a nationwide survey and a prospective study. From August 6 to 15, 2008, a questionnaire survey was conducted to identify the prevalence, local distribution, and response to current treatments. The questionnaire was answered by pediatrician working in 23 referral centers in Korea. In addition, 5 referral centers in Seoul performed a preliminary prospective observational study by obtaining clinical data and specimens from appropriate patients. The Korea Centers for Disease Control and Prevention analyzed the samples for possible pathogens. Results : The survey showed 78 AIP cases had occurred and 36 patients had died. Lung biopsy was performed only on 20 patients. In 2008, 9 AIP cases developed. In a prospective study, 9 (M:F=5:4) patients developed AIP in spring and 7 (78%) died, with the mean rate of death occurring 46 days after diagnosis. Human corona virus 229E, cytomegalovirus, influenza A virus, influenza B virus, and parainfluenza virus were isolated from the respiratory specimens. Conclusion : This study showed nationwide prevalence of AIP in Korea. In addition, because of the high mortality rate and rapid progress, pediatricians need to be aware of the disease. Further studies and a nationwide network are required for reducing the morbidity and mortality rates related to AIP.

목 적 : 급성 간질성 폐렴은 매우 드문 질환으로 알려져 있으나 아직 효과적인 치료법이 없어 매우 불량한 예후를 보이고 있다. 최근 보고에 의하면 국내에서의 발생이 적지 않으며 사망률이 높았다. 본 연구는 급성 간질성 폐렴의 과거 및 현재의 전국적인 현황을 알아보기 위해 전국적으로 설문조사를 시행하고, 일부 3차 병원들을 중심으로 급성 간질성 폐렴에 대한 전향적 연구를 시행하였다. 방 법 : 2008년 8월 6일부터 8월 15일까지 10일간 전자우편을 이용하여 전국의 2차 병원급 이상의 소아청소년과를 대상으로2008년 7월까지 발생한 급성 간질성 폐렴의 전국적 발생빈도를 후향적으로 조사하였다. 또한 수도권 5개 3차 병원들이 참여하는 전향적 관찰연구를 시행하여 2008년 2월부터 8월까지 공통 프로토콜에 따라 적절한 환자를 등록하고 임상자료와 치료결과를 수집하였으며 얻어진 검체를 질병관리본부로 이송하여 호흡기 바이러스를 동정하였다. 결 과 : 설문조사는 전국 총 23개 병원이 참여하였다. 증례는 총 78명이었으며 이중 36명이 사망하였다. 20명에서 폐생검이 시행되었다. 서울지역에서 가장 많아 45명이 발생하였고 25명이 사망하였다. 2008년 증례만 살펴보면 전국적으로 9명이 발병하였고 6명이 사망하였으며 서울지역에서는 4명이 발생하고 3명이 사망하였다. 전향적 공동연구 결과 총 9예(남:여=5:4)가 봄철에 발생하였으며 그 중 7예(78%)가 진단 후 평균 46일 이내에 사망하였다. 환자의 검체에서 human corona virus 229E 2예, CMV 1예, influenza A virus 1예, influenza B virus 1예, parainfluenza virus 1예가 동정되었다. 결 론 : 본 연구를 통하여 최근 국내 소아에서 발생하고 있는 급성 간질성 폐렴이 전국적인 분포를 보이며 드물지 않음을 확인하였다. 또한, 49.4%의 높은 사망률과 빠른 임상경과를 보였기 때문에 소아과 의사의 적극적인 인지가 필요하다. 이러한 환자들을 조기에 발견하여 질병이 진행되기 전에 적극적인 치료를 제공하기 위해 전국적인 네트워크 구성과 원인규명을 위한 지속적인 전향적 연구가 필요할 것으로 사료된다.

Keywords

References

  1. Olson J, Colby TV, Elliott CG. Hamman-Rich syndrome revisited. Mayo Clin Proc 1990;65:1538-48
  2. Katzenstein AL, Myers JL, Mazur MT. Acute interstitial pneumonia. A clinicopathologic, ultrastructural, and cell kinetic study. Am J Surg Pathol 1986;10:256-67 https://doi.org/10.1097/00000478-198604000-00004
  3. Travis WD, Matsui K, Moss J, Ferrans VJ. Idiopathic nonspecific interstitial pneumonia: prognostic significance of cellular and fibrosing patterns: survival comparison with usual interstitial pneumonia and desquamative interstitial pneumonia. Am J Surg Pathol 2000;24:19-33 https://doi.org/10.1097/00000478-200001000-00003
  4. Hilman BC, Amaro-Galvez R. Diagnosis of interstitial lung disease in children. Paediatr Respir Rev 2004;5:101-7 https://doi.org/10.1016/j.prrv.2004.01.001
  5. Vourlekis JS. Acute interstitial pneumonia. Clin Chest Med 2004;25:739-47 https://doi.org/10.1016/j.ccm.2004.07.001
  6. Dinwiddie R, Sharief N, Crawford O. Idiopathic interstitial pneumonitis in children: a national survey in the United Kingdom and Ireland. Pediatr Pulmonol 2002;34:23-9 https://doi.org/10.1002/ppul.10125
  7. Cheon CK, Jin HS, Kan EK, Kim HB, Kim BJ, Yu J, et al. Epidemic acute interstitial pneumonia in children occurred during the early 2006s. Korean J Pediatr 2008;51:383-90 https://doi.org/10.3345/kjp.2008.51.4.383
  8. American Thoracic Society; European Respiratory Society. American Thoracic Society/European Respiratory Society international multidisciplinary consensus classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med 2002;165:277-304
  9. Park SH, Ahn YH, Han JH, Kim JK, Ahn KM. Clinical features of the 15 patients with idiopathic interstitial pneumonia. Pediatr Allergy Respir Dis(Korea) 2007;17:271-81
  10. Chung JH, Ha SJ, Kim BS, Hong SJ. Clinical spectrum and lung pathology in children with interstitial lung disease. J Korean Pediatr Soc 2002;45:79-87
  11. Pene F, Merlat A, Vabret A, Rozenberg F, Buzyn A, Dreyfus F. Coronavirus 229E-related pneumonia in immunocompromised patients. Clin Infect Dis 2003;37:929-32
  12. Dijkman R, Jebbink MF, El Idrissi NB, Pyrc K, Müller MA, Kuijpers TW. Human coronavirus NL63 and 229E seroconversion in children. J Clin Microbiol 2008;46:2368-73 https://doi.org/10.1128/JCM.00533-08
  13. van der Hoek L. Human coronaviruses: what do they cause? Antivir Ther 2007;12:651-8
  14. Fulmer JD, Katzenstein ALA. The interstitial lung diseases. In : Bone, RC editor. Pulmonary and critical care medicine. St. Louis : Mosby Year Book, 1993:part M 1-15
  15. Vourlekis JS, Brown KK, Cool CD, Young DA, Cheniack RM, King TE, et al. Acute interstitial pneumonitis. Case series and review of the literature. Medicine (Baltimore) 2000;79:369-78 https://doi.org/10.1097/00005792-200011000-00003
  16. Kerem E, Bentur L, England S, Reisman J, O'Brodovich H, Bryan AC. Sequential pulmonary function measurements during treatment of infantile chronic interstitial pneumonitis. J Pediatr 1990;116:61-7 https://doi.org/10.1016/S0022-3476(05)81646-4
  17. Primack SL, Hartman TE, Ikezoe J. Acute interstitial pneumonia: Radiographic and CT findings in nine patients. Radiology 1993;188:817-20
  18. Dinwiddie R. Treatment of interstitial lung disease in children. Paediatr Respir Rev 2004;5:108-15 https://doi.org/10.1016/j.prrv.2004.01.004

Cited by

  1. Humidifier disinfectant-associated children’s interstitial lung disease: Computed tomographic features, histopathologic correlation and comparison between survivors and non-survivors vol.26, pp.1, 2009, https://doi.org/10.1007/s00330-015-3813-1
  2. Interstitial Lung Disease in Children Younger Than 2 Years vol.137, pp.6, 2016, https://doi.org/10.1542/peds.2015-2725
  3. Humidifier disinfectant-associated lung injury in adults: Prognostic factors in predicting short-term outcome vol.27, pp.1, 2009, https://doi.org/10.1007/s00330-016-4367-6
  4. Association of high-level humidifier disinfectant exposure with lung injury in preschool children vol.616, pp.None, 2009, https://doi.org/10.1016/j.scitotenv.2017.10.237
  5. Cognitive Emotion Regulation Strategies and Insomnia or Other Psychiatric Symptoms among Humidifier Disinfectant Victims vol.9, pp.1, 2009, https://doi.org/10.17241/smr.2018.00136
  6. Humidifier disinfectant and use characteristics associated with lung injury in Korea vol.29, pp.5, 2009, https://doi.org/10.1111/ina.12585
  7. How Business Interests and Government Inaction Led to the Humidifier Disinfectant Disaster in South Korea: Implications for Better Risk Governance vol.40, pp.2, 2009, https://doi.org/10.1111/risa.13400