소아 무기폐에서 굴곡성 기관지내시경 소견 및 치료적 유용성

신미용,황종희,정은희,문정희,이주석,박용민,안강모,이상일,Shin, Mee Yong,Hwang, Jong Hee,Chung, Eun Hee,Moon, Jeong Hee,Lee, Ju Suk,Park, Yong Min,Ahn, Kang Mo,Lee, Sang Il 대한소아청소년과학회 2002 Clinical and Experimental Pediatrics (CEP) Vol.45 No.9

목 적: 저자들은 무기폐로 굴곡성 기관지내시경을 시행받은 소아 환자들의 임상 양상, 기관지내시경 소견과 기관지내시경의 치료적 유용성을 알아보고자 하였다. 방 법 : 단순 흉부 방사선 촬영에서 한달 이상 지속된 만성 무기폐, 급성 광범위 무기폐, 또는 우연히 발견되어 지속기간을 알 수 없는 무기폐를 보여 진단 및 치료 목적으로 굴곡성 기관지내시경을 시행 받은 66명의 소아를 후향적으로 분석하였다. 결 과 : 무기폐가 발생한 기저 질환으로는 폐렴 후에 발생한 경우가 32례(60.4%)로 가장 많았고 그 외에 결핵, 만성폐질환, 수술, 천식, 교통사고와 연관되어 나타났다. 무기폐는 우중엽(24.6%)과 우상엽(24.6%)에 가장 많이 발생하였다. 기관지내시경 소견은 정상 기도를 보인 경우가 26례(39.4%)로 많았고, 염증성 기도 변화를 보인 경우가 29례(경도의 염증성 기관지 협착 15례, 기도 점막의 부종과 과다 분비물을 보인 경우가 14례, 작은 육아종 3례, 점액마개가 3례)로 이상 소견의 대부분을 차지하였으며 그 외 선천성 기도 기형, 기관지내결핵, 기관지의 외인성 압박과 혈전 등이 관찰되었다. 폐렴과 연관되어 발생한 무기폐의 기관지내시경 소견도 정상 기도를 보인 경우가 32례 중 14례(43.7%)였으며 기도 점막의 부종과 과다 분비물, 기관지 협착 등의 염증성 변화가 역시 이상 소견의 대부분을 차지하였다. 치료적 목적으로 분비물의 흡입, 기관지 세척 및 N-acetylcystein($Mucomyst^{(R)}$) 주입을 시행받은 39례 중 18례(46.1%)에서 무기폐가 부분적으로 혹은 완전히 호전되었고, 폐렴과 동반되어 나타난 무기폐의 경우에는 치료적 처치를 시행 받은 23명 중 13명(56.5%)에서 무기폐가 호전을 보였다. 결 론: 굴곡성 기관지내시경술을 시행받은 소아들에서 무기폐는 대부분 폐렴과 만성폐질환, 천식 등의 염증성 호흡기질환과 동반되어 발생하였다. 기관지내시경 소견상 이상 소견으로는 경도의 기관지 협착과 다량의 염증성 분비물 등의 염증성 기도 변화가 대부분이었으나 약 40%에서는 정상소견을 보였다. 굴곡성 기관지내시경은 소아에서도 무기폐의 진단에 유용하였고, 만성 무기폐나 급성 광범위 무기폐의 치료에도 효과적임을 알 수 있었으며 특히 폐렴 후 발생한 지속적 무기폐의 치료에 기관지내시경이 유용할 것으로 판단된다. Purpose : We evaluated the clinical manifestations, bronchoscopic findings and therapeutic effects of flexible fiberoptic bronchoscopy in atelectasis of children. Methods : Sixty six children who received bronchoscopy due to persistent atelectasis, acute severe atelectasis and incidental atelectasis on plain chest radiography were studied retrospectively. Results : The most common causative underlying disease was pneumonia(60.4%). Other underlying conditions were pulmonary tuberculosis, chronic lung disease, postoperative state, bronchial asthma and chest trauma. The most common abnormal findings were inflammatory changes such as bronchial stenosis(n=15), mucosal edema and large amount of secretion(n=14), granulation tissue( n=3) and mucus plug(n=3) although 39.4% showed normal airways. Other findings were congenital airway anomalies, endobronchial tuberculosis, extrinsic compression and obstruction by blood clot. In 32 children with pneumonia-associated atelectasis, 43.7% revealed normal airways, and the most common abnormal findings were also inflammatory changes. Eighteen out of 39 patients who received therapeutic intervention such as suctioning of secretion, bronchial washing and intrabronchial administration of N-acetylcysteine($Mucomyst^{(R)}$) had complete or partial resolution of their atelectasis. In 32 patients with pneumonia-associated atelectasis, 56.5% showed improvement by therapeutic intervention. Conclusion : In this study, atelectasis was mainly associated with inflammatory airway diseases such as pneumonia. The most common abnormal bronchoscopic findings were inflammatory changes such as mucosal edema and large amounts of secretion and bronchial stenosis, although about 40% revealed normal airway. Flexible bronchoscopy is helpful for either diagnosis or treatment, especially in pneumonia-associated atelectasis.

계란 알레르기의 최신 지견

신미용 ( Mee Yong Shin ) 대한천식알레르기학회 2015 Allergy Asthma & Respiratory Disease Vol.3 No.1

Egg allergy is one of the most common food allergies in children and has a wide spectrum of clinical presentation including anaphylaxis. Many studies suggested egg-specific IgE cutoff values (diagnostic decision point) and skin prick test size that predict a clinical allergic reaction without oral food challenges. Some patients may react to all forms of egg including raw egg, but many egg-allergic patients tolerate baked egg products. A few studies reported that a high concentration of ovomucoid-specific IgE antibody indicates a high risk of reacting to heated egg white. Recently it has been suggested that regular ingestion of baked egg products may hasten tolerance development. Egg allergy may be more persistent than previously thought. The treatment of egg allergy still relies on dietary avoidance of egg-containing foods until tolerance has developed. In recent years there has been increasing success in clinical trials of egg oral immunotherapy, and oral immunotherapy can be a promising treatment modality for providing protection from reactions caused by accidental egg exposure. However, concerns regarding the safety and long-term efficacy still preclude the general use of oral immunotherapy in clinical practice. In this article, the recent literature regarding egg allergens, clinical presentation, diagnosis, management and natural history of egg allergy will be reviewed.

소아 간이식후 림프세포증식성질환에 의한 상기도 폐쇄 1례

신미용 ( Mee Yong Shin ),( Jin A Jung ),( Kang Mo Ahn ),( Yon Ho Choe ),( Sang Il Lee ),( Yeon Lim Suh ),( Young Hyeh Ko ),( Young Ik Son ),( Suk Ku Lee ) 대한소아알레르기호흡기학회 2004 소아알레르기 및 호흡기학회지 Vol.14 No.3

나이에 따른 우유 알레르기 환아의 우유단백 특이 IgE 항체 비교

신미용 ( Mee Yong Shin ),한영신 ( Young Shin Han ),박화영 ( Hwa Young Park ),안연화 ( Yeon Hwa Ahn ),정은희 ( Eun Hee Chung ),안강모 ( Kang Mo Ahn ),이상일 ( Sang Il Lee ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2004 소아알레르기 및 호흡기학회지 Vol.14 No.3

2개 지역에서 소아의 급성 바이러스성 하기도염의 유행성에 관한 역학조사

문정희,소경진,정은희,신미용,이주석,박용민,이광신,안강모,이남용,마상혁,이상일,Moon, Jeong Hee,Suh, Kyoung Jin,Chung, Eun Hee,Shin, Mee Yong,Lee, Ju Suk,Park, Yong Mean,Lee, Kwang Sin,Ahn, Kang Mo,Lee, Nam Yong,Ma, Sang Hyuk,Lee, Sang 대한소아감염학회 2002 Pediatric Infection and Vaccine Vol.9 No.2

목 적 : 바이러스에 의한 급성 하기도염은 병원에 입원하게 되는 가장 흔한 질병으로 이를 진단하는데는 역학적 진단이 절대적으로 중요하다. 이에 저자들은 서로 다른 두 지역에서의 바이러스성 급성 하기도염의 역학조사를 시행함으로써 지역간의 차이를 알아보고자 하였다. 방 법 : 2000년 6월부터 2001년 6월까지 마산 파티마병원과 삼성서울병원에 급성 하기도염으로 입원한 환자 796명을 대상으로 하였으며, 바이러스 검출은 비인두 분비물을 통해 시행하였다. 두 병원간 원인 바이러스, 연령분포, 임상증상, 계절 유행양상 등을 비교하였다. 결 과 : 1) 바이러스가 배양된 환아는 208명(26.1%)였다. 바이러스 검출율은 삼성서울병원 21.9%, 마산 파티마병원 30.0%였다. 삼성서울병원에서의 연령분포는 2세 이하의 환아가 60.2%였으며 5세 이상의 환아는 12.8%이었는데 비해 마산 파티마병원에서는 2세 이하의 환아가 90.0%였으며 5세 이상의 환자는 0.8%였다(P<0.05). 2) 마산 파티마병원에서는 RSV의 검출율이 높았고(72.3%), 삼성서울병원에서는 adenovirus, influenza type A와 parainfluenza virus의 검출율이 상대적으로 높았다(P<0.05). 3) 임상양상을 비교해 보면 삼성서울병원에서는 기관기관지염과 폐렴이, 마산 파티마병원에서는 모세기관지염과 크룹이 더 많은 비율을 차지하고 있었다(P<0.05). 두 병원 모두 모세기관지염은 RSV, 크룹은 parainfluenza virus가 가장 많았다. 폐렴의 경우 삼성서울병원에서는 adenovirus, 마산 파티마병원은 RSV가 가장 많았고, 기관기관지염의 경우 삼성서울병원에서는 adenovirus, 마산 파티마병원은 influenza virus-type A가 가장 많았다. 4) 두 병원 모두 RSV는 가을과 겨울, parainfluenza virus는 봄, influenza virus는 겨울과 봄에 나타나는 양상을 보였고 adeonvirus는 연중 발생하는 양상을 보였다. 결 론 : 두 병원의 바이러스의 유행시기, 임상양상에 따른 원인바이러스의 분포결과는 유사하였다. 각 바이러스의 검출률과 임상상의 분포 등에서는 차이를 보였는데 이는 지역적 차이보다는 주로 대상연령군의 차이에 기인하는 것으로 생각된다. 우리나라에서 바이러스성 호흡기감염의 지역적 차이 유무를 확인하기 위해서는 비슷한 연령군을 대상으로 한 전국적이고 지속적인 역학조사가 이루어져야 할 것으로 사료된다. Purpose : This study was performed to investigate the epidemiology of viral acute lower respiratory tract infection(ALRI) in two different areas of Korea. Methods : A total of 796 patients hospitalized for ALRI aged 15 years or less from June 2000 to June 2001 in Samsung Seoul hospital(SSH) and Masan Fatima hospital(MFH) were enrolled. Viral etiologies were confirmed using nasopharyngeal aspirates. We compared etiologic agents, age distribution, clinical manifestations, and seasonal occurrence of viral ALRI between the two hospitals. Results : Virus was isolated in 208 patients(26.1%). The proportion of patients aged under 2 years in SSH was 60.2%, while those in MFH was 90.0%(P<0.05). Respiratory syncytial virus(RSV) was more prevalent in MFH, but adenovirus, influenza virus and parainfluenza virus were more prevalent in SSH(P<0.05). Croup and bronchiolitis occurred more frequently in MFH than in SSH(P<0.05). The most frequent viral pathogens causing bronchiolitis and croup were RSV and parainfluenza virus, respectively, in both hospitals. Adenovirus was the main cause of pneumonia in SSH, in contrast to RSV in MFH. In terms of tracheobronchitis, adenovirus was detected most frequently in SSH, whereas influenza virus-type A was mainly isolated in MFH. Similar pattern of seasonal occurrences of RSV, parainfluenza virus and influenza virus-type A was noted in both hospitals. Adenovirus was isolated sporadically throughout the study periods. Conclusion : Seasonal occurrence and clinical syndromes according to viral pathogens showed similar pattern in two areas. However, distribution of offending viruses was different, although this is mainly related to the different age distribution. An annual nationwide surveillance is necessary to understand the viral epidemiology associated with respiratory illnesses in Korea.

첫 번째 respiratory syncytial virus 세기관지염 시기와 추후 천명 및 천식 발생 사이의 연관성

김리라 ( Ri Ra Kim ),신미용 ( Mee Yong Shin ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2012 소아알레르기 및 호흡기학회지 Vol.22 No.1

Purpose: Respiratory syncytial virus (RSV) bronchiolitis is believed to be associated with later development of asthma and wheezing. This study was conducted to determine the relationship between the age of the first RSV bronchiolitis episode, the development of later wheezing and asthma, and the related other factors. Methods: We studied 255 infants admitted with their first episode of RSV bronchiolitis. Epidemiological and clinical data were collected retrospectively from medical records and through telephone interviews. The patients were divided into ≤3 months, 4 to 12 months, and 13 to 24 months. Results: Eighty-one infants were ≤3 months, 115 were 4 to 12 months, and 59 were 13 to 24 months old. The gender ratios (Male: Female) were 1:1, 1.6:1, and 3.2:1. Familial and personal history of allergic diseases and disease severity did not significantly differ according to the age of the first RSV bronchiolitis episode. The occurrence of wheezing was associated with the presence of a familial and personal history of allergic diseases, but not with gender (male) or disease severity. The risk for asthma increased when the infants had their first RSV bronchiolitis episode at an older age. A personal history of allergic diseases was associated with an increased risk for asthma. Conclusion: Asthma was more frequently diagnosed in older infants. The most important risk factors for recurrent wheezing and asthma were a familial and personal history of allergic diseases. Therefore, it was thought that RSV bronchiolitis is not the cause of recurrent wheezing and asthma, but that infants with a genetic predisposition to asthma have an increased risk for RSV bronchiolitis.

소아 대,소엽성 폐렴의 임상 양상 및 원인에 대한 고찰

이윤희 ( Yoon Hee Lee ),신영림 ( Young Lim Shin ),서원석 ( Won Suk Suh ),신미용 ( Mee Yong Shin ),박재옥 ( Jae Ock Park ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2009 소아알레르기 및 호흡기학회지 Vol.19 No.3

목적: 과거 대·소엽성 폐렴은 주로 세균 감염이 원인으로 생각되었으나 최근에는 마이코플라스마 폐렴도 흔히 대소엽성 폐렴을 일으키는 것으로 알려졌다. 저자들은 우리나라 소아의 대소엽성 폐렴의 임상 양상 및 원인을 조사하여 치료에 도움이 되고자 하였다. 방법: 2006년 6월부터 2008년 5월까지 대·소엽성 폐렴으로 순천향대학교 부천병원에서 입원치료를 받은 소아 288명을 대상으로 하였다. 입원 시에 anti-Mycoplasma pneumoniae IgM/IgG, 혈액배양, 인후도말 또는 가래 배양 및 호흡기바이러스 항원 검사와 소변 폐구균 항원 검사를 시행하였고 입원 5-7일 후 Mycoplasma IgM/IgG 추적검사를 시행하였다. 입원 전과 후의 발열기간과 입원 기간 등의 임상 양상을 조사하였다. 결과: 1) 발생 연령은 평균 5.9세였고 2세 미만 25명(8.7%), 2-6세 175명(60.8%), 7-10세 65명(22.6%), 11-15세 23명(8.0%)으로, 2-6세에 가장 호발하였다. 남녀 비는 147:141 이었다. 2) 187례(64.9%)에서 원인이 확인되었다. 마이코플라스마 폐렴이 146례(50.7%)로 가장 많았으며 세균성 폐렴은 17례(5.9%), 바이러스에 의한 경우는 6례(2.1%), 중복 감염이 확인된 경우는 17례(5.9%)였다. 세균 감염은 대부분 S. pneumoniae가 원인이었다. 3) 마이코플라스마 폐렴이 5-6세에 가장 많이 발생하였던 반면에, 단독 세균성 폐렴은 주로 1-2세에 발생하였다. 4) 대·소엽성 폐렴은 8월부터 증가하기 시작하여 11월과 12월에 가장 많이 발생하였다. 5) 단독 세균성 폐렴과 마이코플라스마 폐렴을 비교하였을 때 발열 기간이나 입원 기간은 차이가 없었지만, 세균성 폐렴에서 백혈구 수와 ESR, CRP가 유의하게 높았다. 6) 흉수는 18.1%에서 동반되었고 흉수가 동반되지 않은 경우에 비해 입원 전과 후의 발열기간과 재원기간이 길었으며, ESR과 CRP가 유의하게 높았다. 결론: 소아에서 대·소엽성 폐렴은 마이코플라스마 폐렴이 절반을 차지하였다. 호발 연령은 마이코플라스마 폐렴이 5-6세, 세균성 폐렴이 1-2세로 차이를 보였다. 대·소엽성 폐렴의 치료에 있어서 연령이 가장 먼저 고려되어야 할 것이다. Purpose: We aimed to evaluate the clinical characteristics and etiological organisms associated with lobar/lobular pneumonia in Korean children. Methods: Children hospitalized due to radiographically confirmed lobar/lobular pneumonia were evaluated prospectively between June 2006 and May 2008. Anti-Mycoplasma pneumoniae IgM/IgG (at admission and follow-up), blood cultures, throat swabs for bacterial detection or sputum culture, respiratory viruses (Respiratory syncytial virus, Adenovirus and Influenza A/B) antigen testing, and urinary antigen testing for S. pneumoniae were performed. Results: Two hundred eighty-eight immunocompetent children (mean age, 5.9 years) were enrolled. The age distribution showed a peak frequency at 2-6 years of age (<2 years, 8.7%; 2-6 years, 60.8%; 7-10 years, 22.6%; 11-15 years, 8.0%). Typical respiratory organisms were identified in 64.9% of cases. Identified organisms were Mycoplasma pneumoniae (50.7%), bacteria in (5.9%), viruses (2.1%) and mixed infection (5.9%). Mycoplasma pneumoniae was the most commonly identified organism in all age groups. The majority (88.9%) of bacterial pneumonias including mixed infection were caused by Streptococcus pneumoniae. Mycoplasma pneumonia was the most frequent at 5-6 years of age, but bacterial pneumonia was most frequent at 1-2 years of age. Lobar/lobular pneumonia began to increase from August and showed peak incidence in November and December. The levels of WBC, ESR, and CRP more significantly elevated in those with bacterial pneumonia than in children with mycoplasma pneumonia. Pleural effusion was present in 18.1% of cases. In these cases, the duration of fever and hospitalization was prolonged, and the ESR and CRP levels were significantly higher, than those without pleural effusion. Conclusion: Mycoplasma pneumoniae was the most common organism causing lobar/lobular pneumonia in children. Mycoplasma pneumoniae was the most frequent causative organism at 5-6 years of age. On the other hand, bacterial pneumonia was more common at 1-2 years of age. Thus, age may be a significant factor for the diagnosis and treatment of lobar/lobular pneumonia in children. [Pediatr Allergy Respir Dis(Korea) 2009;19:271-281]

부천지역 초등학생의 식품알레르기 발생 실태 및 다른 알레르기질환과의 연관성

박재영 ( Jae Young Park ),박가영 ( Ga Young Park ),한영신 ( Young Shin Han ),신미용 ( Mee Yong Shin ) 대한소아알레르기호흡기학회 1991 소아알레르기 및 호흡기학회지 Vol.1 No.3

Purpose: This study was performed to evaluate the current status of food allergy (FA) and to analyze the relationship between allergy to individual foods and other allergic diseases in elementary school children. Methods: We performed a questionnaire survey for FA, asthma, allergic rhinitis, and atopic dermatitis using International Study of Asthma and Allergies in Childhood questionnaires. A total of 1,929 students in 3 elementary schools were enrolled. Results: A total of 324 students (16.8%) had ever suffered from FA symptoms more than once. Only 64 out of 324 students (19.8%) were diagnosed with FA by doctors. The presence of soy allergy was associated with the increased risk of bronchial asthma (adjusted odds ratio [aOR], 5.90; 95% confidence interval [CI], 1.87 to 18.59). The presence of egg (aOR, 1.91; 95% CI, 1.04 to 3.52) and wheat allergy (aOR, 5.45; 95% CI, 1.94 to 15.36) were associated with the increased prevalence of allergic rhinitis. The allergic symptoms to fruits/tomato was associated with the increased risk of allergic rhinoconjunctivitis symptoms (aOR, 2.98; 95% CI, 1.18 to 7.47). The allergic symptoms to egg (aOR, 2.29; 95% CI, 1.22 to 4.29), wheat (aOR, 4.91; 95% CI, 1.86 to 12.95), and shrimp/crab (aOR, 2.48; 95% CI, 1.37 to 4.49) were associated with the presence of atopic dermatitis. Conclusion: The prevalence of FA of elementary school students in Bucheon-city was 16.8%. A significant positive association between the suspected foods and the other allergic diseases was found. Soy allergy was significantly correlated to having bronchial asthma and fruits/tomato allergy correlated with allergic rhinoconjunctivitis. (Allergy Asthma Respir Dis 2013;1:266-273)

소아 마이코플라스마 폐렴에서 흉부 방사선 소견에 따른 임상 양상의 차이

박가영 ( Ga Young Park ),이영임 ( Young Im Lee ),신미용 ( Mee Yong Shin ),박재옥 ( Jae Ock Park ),김창휘 ( Chang Hwi Kim ) 대한소아알레르기호흡기학회 1991 소아알레르기 및 호흡기학회지 Vol.1 No.4

Purpose: This study was conducted to evaluate the difference of clinical characteristics of pneumonia in children caused by Mycoplasma pneumoniae, according to their chest radiographic patterns. Methods: We analyzed medical records of 921 children who were admitted to Soonchunhyang University Buchon Hospital due to M. pneumoniae pneumonia from January 2008 to December 2011. Enrolled children were divided into 2 groups by radiological patterns: lobar/lobular pneumonia group (group 1) and broncho/interstitial pneumonia group (group 2). Results: The number of patients in group 1 was 295 (32%) and in group 2, 626 (68%). Lobar/lobular pneumonia occurred in older children compared to broncho/interstitial pneumonia (mean age, 6.4 years vs. 4.2 years; P=0.00). Group 1 had significantly longer durations of fever and hospitalization than group 2. The frequency of pleural effusion was significantly higher in group 1. Erythrocyte sedimentation rate and C-reactive protein values were higher in group 1. Coinfections with respiratory viruses were more frequent in group 2. The history of allergic diseases were more common in group 2 (P=0.006). In 2011, lobar/lobular pneumonia was more frequent and the duration of fever was longer compared with 2008.2010. Conclusion: In M. pneumoniae pneumonia, patients with lobar/lobular pneumonia were more older and had more severe clinical features and laboratory findings. Because there was an outbreak with severe clinical course in 2011, we wonder that the outbreak was related to the macrolide resistant M. pneumoniae. Careful attention about clinical course and consequences of patients with lobar/ lobular pneumonia is required. (Allergy Asthma Respir Dis 2013;1:362-369)

소아 마이코플라스마 폐렴에서 흉부 방사선 소견에 따른 임상 양상의 차이

박가영 ( Ga Young Park ),이영임 ( Young Im Lee ),신미용 ( Mee Yong Shin ),박재옥 ( Jae Ock Park ),김창휘 ( Chang Hwi Kim ) 대한천식알레르기학회 2013 Allergy Asthma & Respiratory Disease Vol.1 No.4

Purpose: This study was conducted to evaluate the difference of clinical characteristics of pneumonia in children caused by Mycoplasma pneumoniae, according to their chest radiographic patterns. Methods: We analyzed medical records of 921 children who were admitted to Soonchunhyang University Buchon Hospital due to M. pneumoniae pneumonia from January 2008 to December 2011. Enrolled children were divided into 2 groups by radiological patterns: lobar/lobular pneumonia group (group 1) and broncho/interstitial pneumonia group (group 2). Results: The number of patients in group 1 was 295 (32%) and in group 2, 626 (68%). Lobar/lobular pneumonia occurred in older children compared to broncho/interstitial pneumonia (mean age, 6.4 years vs. 4.2 years; P=0.00). Group 1 had significantly longer durations of fever and hospitalization than group 2. The frequency of pleural effusion was significantly higher in group 1. Erythrocyte sedimentation rate and C-reactive protein values were higher in group 1. Coinfections with respiratory viruses were more frequent in group 2. The history of allergic diseases were more common in group 2 (P=0.006). In 2011, lobar/lobular pneumonia was more frequent and the duration of fever was longer compared with 2008.2010. Conclusion: In M. pneumoniae pneumonia, patients with lobar/lobular pneumonia were more older and had more severe clinical features and laboratory findings. Because there was an outbreak with severe clinical course in 2011, we wonder that the outbreak was related to the macrolide resistant M. pneumoniae. Careful attention about clinical course and consequences of patients with lobar/lobular pneumonia is required.