Pediatric Infection and Vaccine

The Korean Society of Pediatric Infectious Diseases (대한소아감염학회)
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Clinical Manifestations of Norovirus Infection in Korean Pediatric Cancer Patients

한국 소아 암환자에서 노로바이러스 감염증의 임상 양상

  • Choi, Hyunshin (Department of Pediatrics, Sungkyunkwan University School of Medicine, Samsung Medical Center) ;
  • Choi, Young Bae (Department of Pediatrics, Sungkyunkwan University School of Medicine, Samsung Medical Center) ;
  • Hwang, Ji-Young (Department of Pediatrics, Sungkyunkwan University School of Medicine, Samsung Medical Center) ;
  • Cheon, Doo-Sung (Division of Enteric Viruses, Center for Infectious Diseases, Korea National Institute of Health Korea Centers for Disease Control and Prevention) ;
  • Jeong, Hye Sook (Division of Enteric Viruses, Center for Infectious Diseases, Korea National Institute of Health Korea Centers for Disease Control and Prevention) ;
  • Choe, Yon Ho (Department of Pediatrics, Sungkyunkwan University School of Medicine, Samsung Medical Center) ;
  • Yoo, Keon Hee (Department of Pediatrics, Sungkyunkwan University School of Medicine, Samsung Medical Center) ;
  • Sung, Ki Woong (Department of Pediatrics, Sungkyunkwan University School of Medicine, Samsung Medical Center) ;
  • Koo, Hong Hoe (Department of Pediatrics, Sungkyunkwan University School of Medicine, Samsung Medical Center) ;
  • Kim, Yae-Jean (Department of Pediatrics, Sungkyunkwan University School of Medicine, Samsung Medical Center)
  • 최현신 (성균관대학교 의과대학 삼성서울병원 소아청소년과) ;
  • 최영배 (성균관대학교 의과대학 삼성서울병원 소아청소년과) ;
  • 황지영 (성균관대학교 의과대학 삼성서울병원 소아청소년과) ;
  • 천두성 (질병관리본부 간염폴리오바이러스과) ;
  • 정혜숙 (질병관리본부 간염폴리오바이러스과) ;
  • 최연호 (성균관대학교 의과대학 삼성서울병원 소아청소년과) ;
  • 유건희 (성균관대학교 의과대학 삼성서울병원 소아청소년과) ;
  • 성기웅 (성균관대학교 의과대학 삼성서울병원 소아청소년과) ;
  • 구홍회 (성균관대학교 의과대학 삼성서울병원 소아청소년과) ;
  • 김예진 (성균관대학교 의과대학 삼성서울병원 소아청소년과)
  • Received : 2010.10.19
  • Accepted : 2010.10.24
  • Published : 2011.06.25
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Abstract

Purpose : Norovirus infection, a common cause of community-acquired gastroenteritis, can also lead to severe illness in immunocompromised patients. We investigated clinical manifestations of norovirus infection in pediatric cancer patients. Methods : Stool specimens were collected from pediatric patients with gastrointestinal symptoms between November 2008 and September 2009 at Samsung Medical Center, Seoul, Korea. Norovirus infection was identified by reverse-transcription polymerase chain reaction (RT-PCR). A retrospective chart review was performed in pediatric cancer patients who were diagnosed with norovirus infection. Results : Ten patients were diagnosed with norovirus infection by RT-PCR in stool samples. The median age was 0.83 years (range 0.25-5.5 years) and the male to female ratio was 1.5:1 (6 males and 4 females). Underlying diseases were hematologic malignancies (4/10, 40%), neuroblastoma (4/10, 40%), and brain tumors (2/10, 20%). Three patients were infected before hematopoietic cell transplantation (HCT) and four patients after HCT. All patients had diarrhea (10/10, 100%), with a median frequency of diarrhea of 8.5 times/day (range 4-22 times/day). Median virus shedding duration was 72.5 days (range 19-299 days). Four patients with pneumatosis intestinalis were conservatively treated with bowel rest and total parenteral nutrition. One patient with severe diarrhea and bloody stool had concomitant chronic gut graft-versus-host disease (GVHD). Norovirus infection-related mortality was not observed. Conclusion : Norovirus infection can cause significant clinical manifestations with prolonged viral shedding in immunocompromised patients. Norovirus should be considered in pediatric cancer patients with severe gastrointestinal symptoms.

목 적 : 노로바이러스는 바이러스성 설사의 흔한 원인이며, 면역 저하 환자에서도 심각한 감염증을 유발하는 것으로 알려져 있어, 소아 암환자에서 노로바이러스 감염의 임상 양상을 알아보고자 하였다. 방 법: 2008년 11월부터 2009년 9월까지 삼성 서울병원에 입원한 환아 중 대변에서 노로바이러스 PCR 양성을 보였던 소아 암환자를 대상으로 하였고, 이들의 의무기록을 후향적으로 분석하였다. 결 과:연구에 포함된 환자는 총 10명이었으며, 이들 연령의 중앙값은 0.83세, 남녀의 비율은 1.5대 1이었다. 기저질환은 혈액암 4명, 신경모세포종 4명, 뇌종양 2명이었고, 감염 진단 당시 조혈모세포이식 수여자는 4명이었다. 모든 환자에서 설사 증상을 보였으며, 설사 횟수의 중앙값은 8.5회/일, 바이러스 배출 기간의 중앙값은 72.5일이었다. 장기종 소견을 보인 4명의 환자는 금식 및 총정맥 영양을 투여 받았으며, 노로바이러스 관련 사망은 관찰되지 않았다. 결 론 : 노로바이러스 감염은 소아 암환자에서 다양한 임상 증상을 유발 할 수 있으며, 이들 면역저하 환자에서 바이러스 배출 기간이 매우 길어, 설사가 있는 암환자에서 고려해야 할 바이러스 감염이다.

Keywords

References

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