Pediatric Infection and Vaccine

The Korean Society of Pediatric Infectious Diseases (대한소아감염학회)
권호 표지

Clinical Manifestation of Human Metapneumovirus Infection in Korean Children

소아에서 human metapneumovirus 감염의 임상 특징

  • Ahn, Jung Min (Department of Pediatrics, Yonsei University College of Medicine, Severance Children's Hospital) ;
  • Choi, Seong Yeol (Department of Pediatrics, Yonsei University College of Medicine, Severance Children's Hospital) ;
  • Kim, Dong Soo (Department of Pediatrics, Yonsei University College of Medicine, Severance Children's Hospital) ;
  • Kim, Ki Hwan (Department of Pediatrics, Yonsei University College of Medicine, Severance Children's Hospital)
  • 안정민 (연세대학교 의과대학 소아과학교실, 세브란스 어린이병원 소아청소년과) ;
  • 최성열 (연세대학교 의과대학 소아과학교실, 세브란스 어린이병원 소아청소년과) ;
  • 김동수 (연세대학교 의과대학 소아과학교실, 세브란스 어린이병원 소아청소년과) ;
  • 김기환 (연세대학교 의과대학 소아과학교실, 세브란스 어린이병원 소아청소년과)
  • Received : 2012.09.15
  • Accepted : 2012.10.22
  • Published : 2013.04.25
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose : The aim of this study was to determine the frequency, epidemiology and the clinical manifestation of human metapneumovirus (hMPV) infection in Korean children. Methods : From February 2010 to January 2012, we collected nasopharyngeal aspiration from 1,554 children who were hospitalized for acute lower respiratory tract infections at the Department of Pediatrics, Severance Children's Hospital. hMPV was detected by performing reverse transcriptase-polymerase chain reaction (RT-PCR). The medical records of the patients with positive results were retrospectively reviewed. Results : We detected hMPV in 99 of the 1,554 hospitalized children. The mean age of the hMPV infected children was 25 months, and 87% of the illnesses occurred between April and June. The most common diagnoses were pneumonia (73%) and bronchiolitis (16%). The clinical manifestations included cough, fever, respiratory distress, hoarseness, tachypnea, and wheezing. Coinfection with other respiratory viruses was found in 43 children (43%). Conclusion : hMPV is one of the major virus causing acute respiratory tract infection in the age between 13 months and 48 months old with peaks during April to June. Reports of hMPV in Korea has been increasing but additional studies are required to define the epidemiology and the extent of disease caused by hMPV to determine future development of this illness in Korean children.

목 적 : 2000년이후human metapneumovirus (hMPV)는 하기도 호흡기 감염을 일으키는 주요 바이러스로 인식되고 있다. 급성 호흡기 감염으로 입원한 소아 환자들에서의 hMPV의 역학 및 임상적 특징, 그리고 혈액학적 특징 및 hMPV에 감염되지 않은 환자와의 비교, 중복 감염등을 통해 hMPV의 특징을 파악하고자 하였다. 방 법 : 2010년 2월부터 2012년 1월까지 급성 호흡기 증상으로 입원한 환아 1,554명의 비인두 흡인을 통해 객담 검체를 채취하여 RT-PCR을 시행 후 hMPV가 검출된 99명의 환아들의 임상 기록지를 후향적으로 검토하여 이들의 임상 증상 및 검사 소견을 분석 비교 하였다. 결 과 : 1,554명 중 1,004명(64.6%)에서 호흡기 바이러스가 검출되었다. 그 중 hMPV가 양성인 환자는 99명으로 양성 검체의 9.8%였다. hMPV에 감염된 환자의 평균 연령은 25.0개월이었으며 해마다 유행 정도는 다르나 4월부터 6월에 주로 발현하였으며 발열기간이 다른 바이러스 보다 길고 호흡기 증중을 보였으며, 천명(wheezing)이 특징적 임상 증상이었다. 진단으로 폐렴이 가장 많았지만, 12개월 이하의 연령군에서는 모세기관지염이 가장 흔하였다. 혈액학적 검사소견은 ESR (erythrocyte sedimentation rate), CRP (C-reactive protein) 모두 hMPV에 감염된 환자군에서 정상 범위 보다 상승된 소견을 보였다. hMPV의 단독 감염과 중복 감염을 비교해 보았을 때 임상증상 및 혈액 검사 소견에서 통계학적 차이를 보이지 않았다. 결론 : hMPV는 폐렴을 일으키는 주요 원인 바이러스이며 13개월 이상부터 48개월 이하의 연령에서 호발하며 평균 연령은 25개월이며 4월에서 6월까지 유행하는 양상을 보였다. 천명이 임상적 특징이며, hMPV에 대하여 우리나라에서의 보고는 점차 증가되고 있으나 아직은 생물학적, 유전학적 특징과 관련된 임상 분석이 더 필요하다.

Keywords

References

  1. Jung BS, Oh JS, Cho B, Kim HH, Lee JS. A clinical study of respiratory tract infection. Pediatr Allergy Respir Dis 1996;6:60-3.
  2. Valero N, Larreal Y, Arocha F, Gotera J, Mavarez A, Bermudez J, et al. Viral etiology of acute respiratory infections. Invest Clin 2009;50:359-68.
  3. Michelow IC, Olsen K, Lozano J, Rollins NK, Duffy LB, Ziegler T, et al. Epidemiology and clinical characteristics of community-acquired pneumonia in hospitalized children. Pediatrics 2004;113:701-7. https://doi.org/10.1542/peds.113.4.701
  4. van den Hoogen BG, de Jong JC, Groen J, Kuiken T, de Groot R, Fouchier RA, et al. A newly discovered human pneumovirus isolated from young children with respiratory tract disease. Nat Med 2001;7:719-24. https://doi.org/10.1038/89098
  5. Deffrasnes C, Hamelin ME, Boivin G. Human metapneumovirus movirus. Semin Respir Crit Care Med 2007;28:213-21. https://doi.org/10.1055/s-2007-976493
  6. Houben ML, Coenjaerts FE, Rossen JW, Belderbos ME, Hofland RW, Kimpen JL, et al. Disease severity and viral load are correlated in infants with primary respiratory syncytial virus infection in the community. J Med Virol 2010;82:1266-71. https://doi.org/10.1002/jmv.21771
  7. Kim YK, Kim JW, Wee YS, Yoo EG, Han MY. Clinical features of human metapneumovirus and respiratory syncytial virus infection in hospitalized children. Pediatr Allergy Respir Dis 2009;19:12-9.
  8. Gern JE, Martin MS, Anklam KA, Shen K, Roberg KA, Carlson-Dakes KT, et al. Relationships among specific viral pathogens, virus-induced interleukin-8, and respiratory symptoms in infancy. Pediatr Allergy Immunol 2002;13:386-93. https://doi.org/10.1034/j.1399-3038.2002.01093.x
  9. Williams JV, Harris PA, Tollefson SJ, Halburnt-Rush LL, Pingsterhaus JM, Edwards KM, et al. Human metapneumovirus and lower respiratory tract disease in otherwise healthy infants and children. N Engl J Med 2004;350:443-50. https://doi.org/10.1056/NEJMoa025472
  10. Takao S, Shimozono H, Kashiwa H, Shimazu Y, Fukuda S, Kuwayama M, et al. Clinical study of pediatric cases of acute respiratory diseases associated with human metapneumovirus in Japan. Jpn J Infect Dis 2003;56:127-9.
  11. Peiris JS, Tang WH, Chan KH, Khong PL, Guan Y, Lau YL, et al. Children with respiratory disease associated with metapneumovirus in Hong Kong. Emerg Infect Dis 2003;9:628-33. https://doi.org/10.3201/eid0906.030009
  12. Jartti T, van den Hoogen B, Garofalo RP, Osterhaus AD, Ruuskanen O. Metapneumovirus and acute wheezing in children. Lancet 2002;360:1393-4. https://doi.org/10.1016/S0140-6736(02)11391-2
  13. Paek H, Lee YJ, Cho HM, EU EJ, Jung G, Kim EE, et al. Clinical manifestation of human metapneumovirus infections in korean children. Korean J Pediatr Infect Dis 2008;15;129-37.
  14. Dollner H, Risnes K, Radtke A, Nordbo SA. Outbreak of human metapneumovirus infection in norwegian children. Pediatr Infect Dis J 2004;23:436-40. https://doi.org/10.1097/01.inf.0000126401.21779.74
  15. Boivin G, De Serres G, Cote S, Gilca R, Abed Y, Rochette L, et al. Human metapneumovirus infections in hospitalized children. Emerg Infect Dis 2003;9:634-40. https://doi.org/10.3201/eid0906.030017
  16. Mejias A, Chavez-Bueno S, Ramilo O. Human metapneumovirus: a not so new virus. Pediatr Infect Dis J 2004;23:1-7.