대한영상의학회지 (Journal of the Korean Society of Radiology)

  • 제64권6호
  • /
  • Pages.615-621
  • /
  • 2011
  • /
  • 1738-2637(pISSN)
  • /
  • 2288-2928(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지

신종인플루엔자 (H1N1) 바이러스에 감염된 소아환자의 흉부방사선소견

Chest Radiographic Findings of Novel Swine-Origin Influenza A (H1N1) Virus Infection in Children

  • 배소영 (순천향대학교 의과대학 부천병원 영상의학과) ;
  • 홍현숙 (순천향대학교 의과대학 부천병원 영상의학과) ;
  • 장윤우 (순천향대학교 의과대학 병원 영상의학과) ;
  • 백상현 (순천향대학교 의과대학 부천병원 영상의학과) ;
  • 박성진 (순천향대학교 의과대학 부천병원 영상의학과) ;
  • 차장규 (순천향대학교 의과대학 부천병원 영상의학과) ;
  • 이혜경 (순천향대학교 의과대학 부천병원 영상의학과)
  • Bae, So-Young (Department of Radiology, Soonchunhyang University Bucheon Hospital) ;
  • Hong, Hyun-Sook (Department of Radiology, Soonchunhyang University Bucheon Hospital) ;
  • Chang, Yun-Woo (Department of Radiology, Soonchunhyang University Hospital) ;
  • Paik, Sang-Hyun (Department of Radiology, Soonchunhyang University Bucheon Hospital) ;
  • Park, Seong-Jin (Department of Radiology, Soonchunhyang University Bucheon Hospital) ;
  • Cha, Jang-Gyu (Department of Radiology, Soonchunhyang University Bucheon Hospital) ;
  • Lee, Hae-Kyung (Department of Radiology, Soonchunhyang University Bucheon Hospital)
  • 발행 : 2011.06.01
⟨ 이전 논문 다음 논문 ⟩

초록

목적: 신종인플루엔자(H1N1) 바이러스에 감염된 소아환자의 흉부방사선소견을 알아보고자 한다. 대상과 방법: 2009년 9월부터 11월까지 H1N1 바이러스로 감염된 환자 2,014명 중, 흉부방사선 촬영을 시행한 372명의 환자를 대상으로 하였다. 환자를 3가지 그룹으로 나누었는데 입원환자, 외래환자, H1N1 바이러스 이외의 다른 균과 동시 감염된 환자로 나누었고, 또한 기저질환의 유무와 나이에 따라 환자를 나누었다. 처음 시행한 흉부방사선촬영상의 영상소견, 양상, 이상 소견의 폐영역분포를 분석하였고, 기저질환이나 나이에 따른 흉부방사선소견의 차이도 분석하였다. 결과: 초기 흉부방사선촬영상에서 이상 소견은 154명(41.39%)의 환자에서 나타났다. 주된 영상소견은 기관지주위음영(85; 22.84%)과 과팽창(69; 18.54%)이었고, 대부분이 폐의 중심부를 침범하였으며(75; 71.42%) 오른쪽 아래폐영역을 침범하였다. H1N1 바이러스만 감염된 입원환자와 외래환자 사이에서 이러한 영상소견은 통계적으로 유의한 차이를 보였다. 그러나 H1N1 바이러스만 감염된 입원환자와 H1N1 바이러스 이외의 다른 균과 동시 감염된 환자 사이의 영상소견과 기저질환의 유무, 혹은 나이에 따른 영상소견에 유의한 차이는 없었다. 결론: H1N1 바이러스에 감염된 소아환자에서 초기 흉부방사선촬영상 이상소견은 41.39%에서 보였고, 기관지주위음영, 과팽창의 소견이 많았으며 대부분이 폐의 중심부, 아래 폐영역을 침범하였다.

Purpose: To analyze chest radiographic findings in children infected with laboratory-confirmed novel swine-origin influenza A (H1N1) virus. Materials and Methods: Three hundred seventy-two out of 2,014 children with laboratory confirmed H1N1 infection and who also underwent a chest radiograph from September to November 2009 were enrolled in this study. Patients were divided into in-patients, out-patients, and patients with co-infections and further subdivided into with underlying disease and without underlying disease as well as age (<2 years old, 2-5 years, 5-10 years, 10-18 years old). The initial radiographs were evaluated for radiographic findings and the anatomic distribution of abnormalities. Results: The initial radiographs were abnormal in 154 (41.39%) patients. The predominant radiographic findings were peribronchial wall opacity found in 85 (22.84%) patients and hyperinflation observed in 69 (18.54%) patients. Further, 75 (71.42%) patients exhibited central predominance and the right lower lung zone was also commonly involved. There were statistically significant differences in the radiological findings between in-patient and out-patient groups. However, there were no significant differences in the radiographic findings between in-patients and the co-infection group with respect the presence of underlying disease and age. Conclusion: Initial radiographs of children with laboratory confirmed H1N1 virus were abnormal in 41.39% of cases. The common radiographic findings included peribronchial opacities, hyperinflation, lower lung zonal distribution, and central predominance.

키워드

참고문헌

  1. Smith TF, Burgert EO Jr, Dowdle WR, Noble GR, Campbell RJ, Van Scoy RE. Isolation of swine influenza virus from autopsy lung tissue of man. N Engl J Med 1976;294:708-710 https://doi.org/10.1056/NEJM197603252941308
  2. Ito T, Couceiro JN, Kelm S, Baum LG, Krauss S, Castrucci MR, et al. Molecular basis for the generation in pigs of influenza A viruses with pandemic potential. J Virol 1998;72:7367-7373
  3. De Jong JC, Paccaud MF, de Ronde-Verloop FM, Huffels NH, Verwei C, Weijers FF, et al. Isolation of swine-like influenza A (H1N1) viruses from man in switzerland and the netherlands. Ann Inst Pasteur Virol 1988;139:429-437 https://doi.org/10.1016/S0769-2617(88)80078-9
  4. Goldfield M, Bartley JD, Pizutti W, Black HC, Altman R, Halperin WE. Influenza in New Jersey in 1976: isolations of influenza A/New Jersey/76 virus at Fort Dix. J Infect Dis 1977;136 Suppl: S347-S355 https://doi.org/10.1093/infdis/136.Supplement_3.S347
  5. Rota PA, Rocha EP, Harmon MW, Hinshaw VS, Sheerar MG, Kawaoka Y, et al. Laboratory characterization of a swine influenza virus isolated from a fatal case of human influenza. J Clin Microbiol 1989;27:1413-1416
  6. Wells DL, Hopfensperger DJ, Arden NH. Swine influenza virus infections: transmission from ill pigs to humans at a wisconsin agricultural fair and subsequent probable person-person transmission. JAMA 1991;265:478-481 https://doi.org/10.1001/jama.1991.03460040054028
  7. Wentworth DE, Thompson BL, Xu X, Regnery HL, Cooley AJ, McGregor MW, et al. An influenza A (H1N1) virus, closely related to swine influenza virus, responsible for a fatal case of human influenza. J Virol 1994;68:2051-2058
  8. Gregory V, Bennett1 M, Thomas Y, Kaiser L, Wunderli W, Matter H, et al. Human infection by a swine influenza A (H1N1) virus in Switzerland Brief Report. Arch Virol 2003;148:793-802 https://doi.org/10.1007/s00705-002-0953-9
  9. Top FH, Russell PK. Swine influenza at Fort Dix, New Jersey (January-Febuary 1976). IV. Summary and speculation. J Infect Dis 1977;136 Suppl:S376-S380 https://doi.org/10.1093/infdis/136.Supplement_3.S376
  10. Perez-Padilla R, de la Rosa-Zamboni D, Ponce de Leon S, Hernandez M, Quinones-Falconi F, Bautista E, et al. Pneumonia and respiratory failure from swine-origin influenza A (H1N1) in Mexico. N Engl J Med 2009;361:680-689 https://doi.org/10.1056/NEJMoa0904252
  11. Agarwal PP, Cinti S, Kazerooni EA. Chest radiographic and CT findings in novel swine-origin influenza A (H1N1) virus (S-OIV) infection. AJR Am J Roentgenol 2009;193:1-6
  12. Ajlan AM, Quiney B, Nicolaou S, Muller NL. Swine-Origin Influenza A (H1N1) Viral Infection: radiographic and CT findings. AJR Am J Roentgenol 2009;193:1494-1499 https://doi.org/10.2214/AJR.09.3625
  13. Lee EY, McAdam AJ, Chaudry G, Fishman MP, Zurakowski D, Boiselle PM. Swine-Origin Influenza A (H1N1) viral infection in children: initial chest radiographic findings. Radiology 2010;254:934-941 https://doi.org/10.1148/radiol.09092083
  14. Webster RG, Bean WJ, Gorman OT, Chambers TM, Kawaoka Y. Evolution and ecology of influenza A viruses. Microbiol Rev 1992;56:152-179
  15. Novel Swine-Origin Influenza A (H1N1) Virus Investigation Team, Dawood FS, Jain S, Finelli L, Shaw MW, Lindstrom S, et al. Emergence of a novel swine-origin influenza A (H1N1) virus in humans. N Engl J Med 2009;360:2605-2615 https://doi.org/10.1056/NEJMoa0903810
  16. Condon VR. Pneumonia in children. J Thorac Imaging 1991;6:31-44 https://doi.org/10.1097/00005382-199107000-00006
  17. Wildin SR, Chonmaitree T, Swischuk LE. Roentgenographic features of common pediatric viral respiratory tract infections. Am J Disc Child 1998;142:43-46
  18. Griscom NT. Pneumonia in children and some of its variants. Radiology 1988;167:297-302 https://doi.org/10.1148/radiology.167.2.3357939
  19. Donnelly LF. Imaging in Immunocompetent children who have pneumonia. Radiol Clin N Am 2005;43:253-265 https://doi.org/10.1016/j.rcl.2004.11.001
  20. Bramson RT, Griscom NT, Cleveland RH. Interpretation of chest radiographs in infants with cough and fever. Radiology 2005;236:22-29 https://doi.org/10.1148/radiol.2361041278
  21. Aherne W, Bird T, Court SDM, Gardner PA, McQillin J. Pathological changes in virus infections of the lower respiratory tract in children. J Clin Path 1970;23:7-18 https://doi.org/10.1136/jcp.23.1.7
  22. Broughton RA. Infections due to Mycoplasma pneumonia in childhood. Pediatr lnftct Dis 1986;5:71-85 https://doi.org/10.1097/00006454-198601000-00014
  23. McCullers JA. Insights into the Interaction between influenza virus and pneumococcus. Clin Microbiol Rev 2006;19:571-582 https://doi.org/10.1128/CMR.00058-05