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스테로이드 치료중 심한 A형 독감 (H1N1)에 걸린 신증후군 환아 1례

A Case of Severe Influenza Infection in a Child with Nephrotic Syndrome on Steroid Therapy

  • 정수진 (CHA의과대학교 분당차병원 소아청소년과) ;
  • 박성은 (CHA의과대학교 분당차병원 소아청소년과) ;
  • 이준호 (CHA의과대학교 분당차병원 소아청소년과)
  • Jung, Su Jin (Department of Pediatrics, CHA Bundang Medical Center, CHA University) ;
  • Park, Sung Eun (Department of Pediatrics, CHA Bundang Medical Center, CHA University) ;
  • Lee, Jun Ho (Department of Pediatrics, CHA Bundang Medical Center, CHA University)
  • 투고 : 2014.02.27
  • 심사 : 2014.03.21
  • 발행 : 2014.04.30

초록

신증후군 환아에서 감염은 매우 중요한 사망원인이 된다. 독감 바이러스는 매번 겨울철마다 유행하며, 독감 바이러스의 치명률은 건강한 소아에서 호흡기세포융합바이러스의 사망률과 비슷하므로 독감에 의한 감염도 신증후군 환아들에게는 매우 치명적일 수 있다. 독감에 의한 사망률에는 폐렴으로 인한 사망이 많은 부분을 차지한다. 하지만, 독감은 예방접종과 항바이러스 치료제가 존재하므로 치료 및 예방이 가능하다. 그러므로, 적극적인 독감 예방접종과 항바이러스 치료는 신증후군 환자들에게서 치명률을 낮출 수 있을 것으로 생각된다. 저자들은 신증후군 치료중에 A형 독감(H1N1)에 의한 폐렴에 걸린 7세 남아를 경험하였기에 보고하는 바이다.

Infection is the most important cause of death in children with nephrotic syndrome. Influenza viral infections can be fatal for these children, given the annual outbreak of this virus, with the mortality rate being similar to that of respiratory syncytial virus in healthy children. Pneumonia is recognized as the most important complication of influenza infections, as it is associated with high death rates. However, the influenza vaccine, as well as antiviral agents, can be used for prevention and treatment. Therefore, aggressive management with influenza vaccination and antiviral agents will lower the overall mortality rate in children with nephrotic syndrome. Here we report the case of a 7-year-old boy with nephrotic syndrome and influenza A virus (H1N1) pneumonia.

키워드

참고문헌

  1. Giangiacomo J, Cleary TG, Cole BR, Hoffsten P, Robson AM. Serum immunoglobulins in the nephrotic syndrome. A possible cause of minimal-change nephrotic syndrome. N Engl J Med 1975;293:8. https://doi.org/10.1056/NEJM197507032930103
  2. Spika JS, Halsey NA, Fish AJ, Lum GM, Lauer BA, Schiffman G, Giebink GS. Serum antibody response to pneumococcal vaccine in children with nephrotic syndrome. Pediatrics 1982; 69:219.
  3. Anderson DC, York TL, Rose G, Smith CW. Assessment of serum factor B, serum opsonins, granulocyte chemotaxis, and infection in nephrotic syndrome of children. J Infect Dis 1979;140:1. https://doi.org/10.1093/infdis/140.1.1
  4. Park SJ, Shin JI. Complication of nephrotic syndrome. Korean J Pediatr 2011;54:322-8. https://doi.org/10.3345/kjp.2011.54.8.322
  5. Eddy AA, Symons JM. Nephrotic syndrome in childhood. Lancet 2003;362:629-39. https://doi.org/10.1016/S0140-6736(03)14184-0
  6. Fleming DM, Pannell RS, Cross KW. Mortality in children from influenza and respiratory syncytial virus. J Epidemiol Community Health 2005;59:586-90. https://doi.org/10.1136/jech.2004.026450
  7. Update: novel influenza A (H1N1) virus infections - worldwide, May 6, 2009. Morbidity and Mortality Weekly Report, 2009, 58:453-8. (Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5817a1.htm; accessed May 2009).
  8. Dawood FS, Iuliano AD, Reed C, Meltzer MI, Shay DK, Cheng PY, et al. Estimated global mortality associated with the first 12 months of 2009 pandemic influenza A H1N1 virus circulation: a modeling study. Lancet Infect Dis 2012;12:687-95. https://doi.org/10.1016/S1473-3099(12)70121-4
  9. "Pandemic (H1N1) 2009 - update 100". Disease outbreak news. World Health Organization (WHO). 14 May 2010. http://www.who.int/csr/don/2010_05_14/en/?utm_source= twitterfeed&utm_medium=twitter.
  10. Gomez-Gomez A, Magana-Aquino M, Garcia-Sepulveda D, Ochoa-Perez UR, Falcon-Escobedo R, Comas-Garcia A, et al. Severe pneumonia associated with pandemic (H1N1) 2009 outbreak. San Luis Potosí, Mexico. Emerg Infect Dis 2010;16: 27-34. https://doi.org/10.3201/eid1601.090941
  11. Marion, DW. Glucocorticoid effects on the immune system. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (Accessed on March 18,2014).