폐농양과 심막삼출이 동반된 A군 연구균에 의한 폐렴 1례

전윤홍,이수영,최상림,정대철,정승연,강진한,Chun, Yoon Hong,Lee, Soo Yong,Choi, Sang Lim,Jeong, Dae Chul,Chung, Seung Yeon,Kang, Jin Han 대한소아감염학회 2004 Pediatric Infection and Vaccine Vol.11 No.2

A군 연구균 감염으로 인한 폐렴이나 기관지염등 하기도의 감염은 흔하지 않은 것으로 되어 있다. 그러나 일단 발생할 경우에는 심한 경과와 함께 폐농양이나 심장염을 포함해 다양한 염증성 합병증을 동반하며 빠르게 진행한다. 본 저자들은 A군 연구균 감염에 의한 농양성 폐렴을 항생제와 흉강 삽관술로 치료하였고, 연속적으로 발현된 심외막염에 의한 심막삼출을 이뇨제로 치료하여 증상호전을 보인 여자 환아 1례를 경험하였기에 보고하는 바이다. Group A streptococcus, also known as Streptococcus pyogenes, is a common bacterial pathogens of the upper respiratory tract and skin infections in children, but this organism is a less common cause of pneumonia, pericarditis. However, pneumonia that is caused by Streptococcus pyogenes, may be rapidly progressive course with developing severe consequences. It may be focal but often is bilateral and diffuse involvement of lung. Empyema is commonly developed, and pleurocentesis often yields thin, watery fluid that continues to flow out when a chest tube is inserted. Antimicrobial resistance to the ${\beta}$-lactam antibiotics has not been reported against group A streptococci, whereas increasing resistance to the macrolides seems to be directly related to the consumption of specific antimicrobial agent use in the community. Clindamycin resistance is uncommon but does occur. We experienced one case of group A streptoccoccal pneumonia with empyema and pericardial effusion, and treated successfully with amoxicillin-clavulanate, clindamycin and roxithromycin.

소아에서 굴곡성 기관지 내시경술을 이용한 무기폐 치료의 유용성

전윤홍 ( Yoon Hong Chun ),강성실 ( Sung Shil Kang ),방경원 ( Kyung Won Bang ),김환수 ( Hwan Soo Kim ),이의경 ( Eu Kyoung Lee ),윤종서 ( Jong Seo Yoon ),김현희 ( Hyun Hee Kim ),김진택 ( Jin Tack Kim ),이준성 ( Joon Sung Lee ) 대한소아알레르기호흡기학회 2013 Allergy Asthma & Respiratory Disease Vol.1 No.3

Purpose: This study was to evaluate the effect of flexible bronchoscopy for the treatment of secondary atelectasis of children following respiratory infection. Methods: The medical records for a total of 19 cases of flexible bronchoscopy were reviewed retrospectively, which were performed for the treatment of secondary atelectasis at the Department of Pediatrics of the Catholic University of Korea Seoul St. Mary’s Hospital from April 2007 to January 2013. Results: A total of 18 patients (11 males and 7 females) were involved in the study. The range of age was 4 months to 15 years old. The causative underlying diseases were 17 cases of pneumonia, 1 case of bronchiolitis and 1 case of bronchial asthma. The most common location of atelectasis was right middle lobe and right middle lobe with left lower lobe was next. Bronchoscopy revealed inflammatory changes in 12 cases (63.2%) such as mucus plug (n=4), profuse secretion (n=4), mucosal edema (n=3), and bronchial narrowing (n=1), although 7 cases (36.8%) showed normal airway. Other additional findings were bronchomalacia, tracheomalacia, and bronchial tree abnormality. Seven out of 19 cases who received therapeutic intervention had complete or partial reexpansion of their atelectasis. Cases who occurred atelectasis within 6 weeks showed significantly higher improvement than cases occurred after 6 weeks (70% vs. 11.1%, P=0.019). Complications including seizure, fever, hypoxia, mucous bleeding, and hypotension were observed in 6 cases. Conclusion: Flexible bronchoscopy revealed to be effective and safe treatment modality in treatment of secondary atelectasis of children. Timely therapeutic intervention in pediatric patients should be considered. (Allergy Asthma Respir Dis 2013;1:274-279)

소아에서 굴곡성 기관지 내시경술을 이용한 무기폐 치료의 유용성

전윤홍 ( Yoon Hong Chun ),강성실 ( Sung Shil Kang ),방경원 ( Kyung Won Bang ),김환수 ( Hwan Soo Kim ),이의경 ( Eu Kyoung Lee ),윤종서 ( Jong Seo Yoon ),김현희 ( Hyun Hee Kim ),김진택 ( Jin Tack Kim ),이준성 ( Joon Sung Lee ) 대한소아알레르기호흡기학회 1991 소아알레르기 및 호흡기학회지 Vol.1 No.3

Purpose: This study was to evaluate the effect of flexible bronchoscopy for the treatment of secondary atelectasis of children following respiratory infection. Methods: The medical records for a total of 19 cases of flexible bronchoscopy were reviewed retrospectively, which were performed for the treatment of secondary atelectasis at the Department of Pediatrics of the Catholic University of Korea Seoul St. Mary’s Hospital from April 2007 to January 2013. Results: A total of 18 patients (11 males and 7 females) were involved in the study. The range of age was 4 months to 15 years old. The causative underlying diseases were 17 cases of pneumonia, 1 case of bronchiolitis and 1 case of bronchial asthma. The most common location of atelectasis was right middle lobe and right middle lobe with left lower lobe was next. Bronchoscopy revealed inflammatory changes in 12 cases (63.2%) such as mucus plug (n=4), profuse secretion (n=4), mucosal edema (n=3), and bronchial narrowing (n=1), although 7 cases (36.8%) showed normal airway. Other additional findings were bronchomalacia, tracheomalacia, and bronchial tree abnormality. Seven out of 19 cases who received therapeutic intervention had complete or partial reexpansion of their atelectasis. Cases who occurred atelectasis within 6 weeks showed significantly higher improvement than cases occurred after 6 weeks (70% vs. 11.1%, P=0.019). Complications including seizure, fever, hypoxia, mucous bleeding, and hypotension were observed in 6 cases. Conclusion: Flexible bronchoscopy revealed to be effective and safe treatment modality in treatment of secondary atelectasis of children. Timely therapeutic intervention in pediatric patients should be considered. (Allergy Asthma Respir Dis 2013;1:274-279)

소아 알레르기비염의 위험 인자와 보호 인자

전윤홍 ( Yoon Hong Chun ),김민지 ( Minji Kim ),김효빈 ( Hyo-bin Kim ),나영호 ( Yeong-ho Rha ),박양 ( Yang Park ),박용민 ( Yong Mean Park ),성명순 ( Myongsoon Sung ),신윤호 ( Youn Ho Shin ),염혜영 ( Hye Yung Yum ),이경석 ( Kyung S 대한천식알레르기학회 2022 Allergy Asthma & Respiratory Disease Vol.10 No.2

Among allergic diseases of the Korean pediatric population, allergic rhinitis shows the most rapidly increasing prevalence. Its economic burden is substantial in many Asian countries including South Korea. This investigation of its risk factors aims to reduce the socioeconomic burden by blocking exposure of susceptible individuals to identified causes. However, the risk factors of allergic rhinitis varied considerably depending on the seasons, geographical locations, and populations involved. This review article primarily deals with studies on the risk factors for allergic rhinitis in Korean children that were published during the last 10 years and additionally investigates associated large scale international studies. Our investigation identified several single-nucleotide polymorphisms, inhalant allergens, pollution, tobacco smoke, chemicals, and family affluence as risk factors for allergic rhinitis. In contrast, breastfeeding, older sibling, and microbial diversity were protective factors against allergic rhinitis. This suggests that various genetic and environmental factors might affect the manifestation and presentation of allergic rhinitis complexly. These findings are beneficial as they can provide insights into modifiable risk factors that may hinder the development of allergic rhinitis. (Allergy Asthma Respir Dis 2022;10:73-79)

반복적인 모세기관지염, 과반응 기관지염을 보인 영유아의 임상양상, 치료와 자연경과

박현진,김주현,전윤홍,이수영,김상용,강진한,Park, Hyoun Jin,Kim, Joo Hyun,Chun, Yoon Hong,Lee, Soo Young,Kim, Sang Yong,Kang, Jin Han 대한소아감염학회 2014 Pediatric Infection and Vaccine Vol.21 No.1

목적: 영유아기 두 번 이상 반복된 모세기관지염, 즉 과반응 기관지염(RAD)을 보인 환아의 임상양상, 치료와 5년 후 자연경과를 조사하고자 연구를 계획하였다. 방법: 2007년 1월부터 12월까지 연구병원 소아청소년과에 모세기관지염으로 2회 이상 입원한 영유아를 대상으로 하였다. 의무기록을 후향적으로 조사하였고, 추가로 5년 후 2013년 현재의 의학적 상태를 보호자와 전화면담을 시행하여 문의하였다. 결과: 2007년 1년간 총 63명의 영유아들이 2회 이상 모세기관지염으로 입원하였다. 연구대상의 평균연령은 8.1개월이었고, 이들 중 남아는 44명(69.8%)이었다. 입원 중 흡입 스테로이드 치료를 받은 환아는 62명(98.4%), 기관지확장제 치료 53명(84.1%) 항생제 치료 40명(63.5%)이었다. 대상 환아 63명 중 45명과 전화면담이 가능하였고, 이들 중, 2013년 현재 38명(84.4%)은 더 이상 호흡장애가 없었고, 5명(11.1%)은 알레르기 비염, 2명(4.4%)은 천식으로 치료 중이었다. 결론: 영유아기 반복적인 쌕쌕거림을 보였던 RAD 환아들의 대부분은, 호흡기가 성숙된 5년 후에는 더 이상 호흡장애를 보이지 않았다. 모세기관지염에 대한 국내 치료지침이 제안되어야 할 것이고 RAD의 자연경과에 대한 좀더 체계적인 연구가 필요하다. Purpose: The purpose of this study was to investigate the clinical manifestations and 5-year natural course of recurrent bronchiolitis or reactive airways disease (RAD) in infants. Methods: We reviewed the medical records of infants with recurrent bronchiolitis from January 2007 to December 2007 at The Catholic University of Korea St. Mary's Hospital in Incheon, South Korea. Additionally, we telephoned their parents to confirm their present medical statuses. Results: Sixty-three subjects with recurrent bronchiolitis were identified. The mean age at admission was 8.1 months and the number of males was 44 (69.8%). Of the 63 infants with recurrent bronchiolitis, inhaled corticosteroids, bronchodilators, and antibiotics were given to 62 (98.4%), 53 (84.1%), and 40 (63.5%), respectively. Among the total 63 subjects, we were able to contact the parents of 45 children by telephone. None of these children had been hospitalized during the previous one year period due to respiratory infections or for other medical reasons. Of the 45 subjects we were able to contact, 38 (84.4%) had not experienced any further respiratory difficulties at all. Five (11.1%) had been diagnosed with allergic rhinitis while two (4.4%) were being managed for asthma. Conclusion: Most children who presented with recurrent episodes of bronchiolitis in infancy did not show any further respiratory difficulties after five years of age.

소아의 굴염에서 생리 식염수 비 세척과 충혈 제거제의 사용에 대한 전향적 무작위 개방 시험

윤종서 ( Jong Seo Yoon ),조연수 ( Yeon Soo Cho ),김민성 ( Min Sung Kim ),전윤홍 ( Yoon Hong Chun ),김현희 ( Yeon Soo Cho ),김진택 ( Jin Tack Kim ),이준성 ( Joon Sung Lee ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2010 소아알레르기 및 호흡기학회지 Vol.20 No.4

목적: 소아 굴염은 치료방법에 대해 논란이 많다. 일반적으로는 항생제를 사용하는 것이 가장 기본적인 치료로 알려져 있다. 부가적인 치료로서, 식염수로 비강을 세척하는 방법 그리고 충혈 제거제의 사용이 이루어지고 있으나, 이러한 추가적인 치료들의 효과에 대하여는 아직 명확하게 밝혀져 있지 않다. 이에 저자는 굴염의 치료에 있어서, 항생제를 기본적으로 사용하고, 이에 추가로 생리 식염수로 비강을 세척하는 방법 또는 충혈 제거제 복용, 또는 이 두 가지를 함께 추가하는 치료를 시도해서 각 치료 방법의 성과를 비교하고자 하였다. 방법: 소아 호흡기질환 클리닉에 내원한 굴염 환자를 대상으로 분석하였다. 무작위로 다음의 4가지 치료법 중 한 가지의 치료법을 적용하였다. 그룹 1은 고용량 아목시실린만 사용, 그룹 2는 고용량 아목시실린에 추가로 생리 식염수로 비강 세척을 사용, 그룹 3은 고용량 아목시실린에 추가로 충혈 제거제를 사용, 그룹 4는 고용량 아목시실린에 추가로 생리 식염수 비강 세척과 충혈 제거제를 모두 사용한 경우로 하였다. 치료에 대한 반응을 급성 및 아급성 굴염의 경우은 치료 시작 후 최소 4일 후, 만성 굴염의 경우는 치료 시작 후 최소 7일 후에 평가하였다. 결과: 4개의 치료법 간의 치료에 대한 반응을 비교했을 때, 각 그룹간에 차이가 없었다. 환자가 화농성 콧물, 코 막힘, 후비루, 굴 사진에서 특정한 소견, 그리고 아데노이드 비대증을 가지고 있는가에 따라 더 좋은 반응을 보이는 치료 방법은 없었다. 결론: 소아 굴염 환자 치료 시에 고용량 아목시실린에 추가적으로 생리 식염수 비 세척이나 충혈 제거제의 경구 사용은 환자의 증상개선에 있어서 추가적인 이득이 없었다. Purpose: The management of sinusitis in children is controversial. Antibiotic is known as the most essential management. Despite nasal irrigation and nasal decongestant have been used as adjunctive treatments of sinusitis, it is still unclear whether these are effective on sinusitis. Therefore, we used antibiotics with either nasal irrigation and an oral nasal decongestant and tried to estimate the outcome of each case. Methods: This study was conducted with sinusitis patients who visited our pediatric respiratory disease clinic. They were randomized into 4 groups: Group 1 were treated with a high dose of amoxicillin only; Group 2 were treated with nasal irrigation and a high dose of amoxicillin; Group 3 were treated with a nasal decongestant and a high dose of amoxicillin; and Group 4 were treated with nasal irrigation, a oral nasal decongestant, and a high dose of amoxicillin. Responses to treatment were estimated more than 4 days after the beginning of the therapy in acute or subacute sinusitis, and more than 7 days chronic sinusitis. Results: The responses to the treatments the 4 groups were not comparable. A favorable therapy was not found, regardless of whether a patient had suppurative rhinorrhea, nasal stuffness, typical findings of PNS plain radiograph, or adenoid hypertrophy. Conclusion: The use of nasal irrigation or a oral nasal decongestant as an additional therapy to antibiotics for the symptoms of pediatric sinusitis showed no additional effects on sinusitis. [Pediatr Allergy Respir Dis(Korea) 2010;20:232-237]

소아중환자실 호흡기질환 입실 환자의 재입실 위험 요소

정우진 ( Woo Jin Chung ),윤다혜 ( Da Hye Yoon ),이의경 ( Eui Gyung Lee ),방경원 ( Kyong Won Bang ),김환수 ( Hwan Su Kim ),전윤홍 ( Yoon Hong Chun ),윤종서 ( Jong Seo Yoon ),김현희 ( Hyun Hee Kim ),김진택 ( Jin Tack Kim ),이준성 ( 대한소아알레르기호흡기학회 2014 Allergy Asthma & Respiratory Disease Vol.2 No.2

Purpose: Children admitted to pediatric intensive care unit (PICU) with respiratory tract disease, often have a tendency to be readmitted to PICU with disease progression. We studied the risk factors for readmission to PICU, with respiratory disease progression. Methods: Among 286 children admitted to Seoul St. Mary’s Hospital PICU from April 2009 to March 2012, 129 children admitted with respiratory tract disease were enrolled. We grouped the children readmitted to PICU with respiratory tract disease progression within 2 weeks (readmission group), and the others (control group). We compared basic and respiratory tract disease characteristics at initial PICU admission between them, by retrospective chart review. Results: Among 129 children, 8 were included in the readmission group, and 121 in the control group. Mortality and underlying disease incidence were higher in the readmission group (P=0.003 and P=0.033, respectively). The readmission group showed higher parenchymal lung disease incidence, and lower initial saturation by pulse oxymeter (SpO2)/fraction of inspiratory oxygen (FiO2), despite underlying disease influence (P=0.035 and P=0.041, respectively). Logistic regression on the underlying disease and respiratory variables showed no single factor with a significantly independent influence on readmission, but parenchymal lung disease had more independent influence. Conclusion: For PICU readmission with respiratory tract disease progression, parenchymal lung disease and lower initial SpO2/FiO2 can be a risk factor despite underlying disease influence. Underlying disease and each respiratory characteristic were not significantly independent risk factors, suggesting a correlation of factors. But, parenchymal lung disease can be a more independent risk factor. (Allergy Asthma Respir Dis 2014;2:128-133)

Polymerase chain reaction 양성 소아 마이코플라스마 폐렴에서 혈청 IgM enzyme-linked immunosorbent assays의 진단적 가치

이혜진 ( Hye Jin Lee ),이윤태 ( Yoon Tae Lee ),김경훈 ( Kyung Hoon Kim ),양은애 ( Eun Ae Yang ),김환수 ( Hwan Soo Kim ),전윤홍 ( Yoon Hong Chun ),윤종서 ( Jong-seo Yoon ),김현희 ( Hyun Hee Kim ),김진택 ( Jin Tack Kim ) 대한천식알레르기학회(구 대한알레르기학회) 2018 Allergy Asthma & Respiratory Disease Vol.6 No.5

Purpose: Mycoplasma pneumoniae (MP) is a common cause of community-acquired pneumonia (CAP) in children. MP serum IgM and polymerase chain reaction (PCR) are the methods that enable early diagnosis in patients with MP pneumonia. The objective of this study was to investigate the clinical value of serum MP-specific IgM antibodies in PCR-positive MP pneumonia for the early diagnosis of MP pneumonia in children with CAP. Methods: Out of 129 patients with lower respiratory tract infection aged over 3 years, 90 CAP children were enrolled in the study. Throat swab MP real-time PCR and serum enzyme-linked immunosorbent assays (ELISA) IgM antibodies were performed. A positive rate of MP PCR and serum IgM, the level of IgM index, clinical features, and laboratory findings were analyzed. Results: MP PCR was positive in 57 cases. Longer fever duration before admission (P<0.001), higher rates of lobar or segmental pneumonia (P=0.048), unilateral infiltration (P=0.038), and extrapulmonary symptoms (P=0.049) were associated with MP PCR-positive pneumonia. Serum IgM index was significantly higher in MP PCR-positive pneumonia them in MP PCR-negative pneumonia (3.9±3.0 vs. 0.8±1.3, P<0.001). Using MP PCR as a gold standard, the sensitivity, specificity, positive predictive value and negative predictive value of serum IgM were 85.5%, 82.1%, 91.4%, and 71.9%, respectively. The area under the curves for serum IgM index was 0.892, and the ROC analysis indicated that an optimal cutoff value of 1.05 for serum IgM provided the highest sensitivity and specificity interestingly (83.9% vs. 85.7%, P<0.001). Conclusion: Serum IgM ELISA has useful diagnostic value in PCR-positive MP pneumonia. Applying an IgM index cutoff of 1.05 improves diagnostic accuracy. (Allergy Asthma Respir Dis 2018;6:248-254)

천명이 있는 소아에서 인터페론-감마 유도 단백질 10 kDa의 임상적 특성

김범준 ( Beom Joon Kim ),배길성 ( Kil Seong Bae ),김환수 ( Hwan Soo Kim ),전윤홍 ( Yoon Hong Chun ),윤종서 ( Jong-seo Yoon ),김현희 ( Hyun Hee Kim ),김진택 ( Jin Tack Kim ) 대한천식알레르기학회(구 대한알레르기학회) 2016 Allergy Asthma & Respiratory Disease Vol.4 No.3

Purpose: Recent studies have shown that interferon-gamma-inducible protein of 10 kDa (IP-10/CXCL10) levels is increased in acute bronchiolitis and asthma. The aim of this study was to examine the levels of IP-10 in children with wheezing and whether it correlates with other clinical variables. Methods: A total of 62 subjects children were hospitalized for lower respiratory tract infection with wheezing and visited the Emergency Department due to an acute exacerbation of asthma. IP-10 levels were measured using enzyme-linked immunosorbent assay in the serum collected at admission. Serum IP-10 levels were evaluated for the relationships with age, sex, blood eosinophils counts, acute phase reactant, allergic sensitization, history of wheezing, and chest X-ray findings. Results: Age showed a significant negative correlation with serum IP-10 levels (P=0.002). The serum levels of IP-10 were also significantly increased in patients with pneumonic infiltration on X-rays compared to those with normal or hyperinflation (P<0.009). There was no significant difference in the serum IP-10 level according to the other factors, including allergic sensitization. Conclusion: Serum IP-10 is significantly associated with inflammation of the lung and age, but not with allergic inflammation. (Allergy Asthma Respir Dis 2016;4:174-180)

소아에서 human metapneumovirus와 respiratory syncytial virus에 의한 호흡기질환의 비교

정우진 ( Woo Jin Chung ),강성실 ( Sung Shil Kang ),방경원 ( Kyong Won Bang ),전윤홍 ( Yoon Hong Chun ),윤종서 ( Jong Seo Yoon ),김현희 ( Hyun Hee Kim ),김진택 ( Jin Tack Kim ),이준성 ( Joon Sung Lee ) 대한소아알레르기호흡기학회 2013 Allergy Asthma & Respiratory Disease Vol.1 No.2

Purpose: Human metapneumovirus (hMPV) is known to result in clinical manifestation similar to respiratory syncytial virus (RSV) in children. But some recent studies showed different features. This study compared the clinical manifestation of respiratory disease between hMPV and RSV. Methods: A total of 801 children who admitted to Seoul St. Mary’s Hospital for respiratory infection from January to June, 2012 were enrolled. Respiratory viral polymerase chain reaction (PCR) using nasopharyngeal swab was performed in all children. We grouped hMPV positive children and RSV positive children and compared clinical features between them by retrospective chart review. Results: Among 801 children, 365 showed one virus PCR positive with 44 showing hMPV and 41 showing RSV. Respiratory diseases were upper respiratory infection, acute bronchitis, acute bronchiolitis and pneumonia. The peak season was March and April for hMPV and February and March for RSV. Fever incidence, fever duration and neutrophil percent of complete blood cell count were higher in hMPV group than RSV group (P<0.05). The mean age of hMPV group was higher than RSV group (P<0.05). But in acute bronchiolitis children, there was no mean age difference between two group. Acute bronchiolitis incidence declined with increased age for both group (P<0.05). The hMPV group showed relatively lower bronchiolitis and higher pneumonia incidence than RSV group, suggesting relation with age. Conclusion: Respiratory infection by hMPV developed at late winter and spring, slightly later than RSV and at older age. The lower incidence of acute bronchiolitis for hMPV infection than RSV is maybe due to older age than RSV. (Allergy Asthma Respir Dis 2013;1:157-163)