소아 요로감염의 원인균주별 임상양상과 항생제 내성률 : 대장균과 비대장균의 비교

배이영,강진한,이수영,정대철 대한소아감염학회 2010 Pediatric Infection and Vaccine Vol.17 No.2

Purpose : We aimed to compare the clinical features and antibiotic resistance of urinary tract infection (UTI) caused by pathogens other than E. coli (non-E. coli) with UTI caused by E. coli in children. Methods : We enrolled patients with culture-proven UTI, who were admitted to the study hospital from September 2008to August 2009. We investigated clinical data of patients with UTI and antibiotic resistance of isolated strains. For comparison,patients were divided according by results of the urine culture into E. coli and non-E. coli UTI groups. Results : A total of 84 patients participated in this study. Twenty one cases (25.0%) were caused by non-E. coli pathogens. Frequency of non-E. coli UTI differed according to age and sex: ‘male <6 months’, 10.5%; ‘male ≥6 months’, 50.0%; ‘female <6 months’, 43.7%; and ‘female ≥6 months’, 25.0% (P =0.014). More patients who received previous antibiotic treatment (P =0.017), but fewer patients who showed hematuria (P =0.014) were included in the non-E. coli UTI group than in the E. coli UTI group. Comparison of antibiotic resistance showed that the non-E. coli UTI group possessed more strains that were resistant to cefazolin, cefotaxime, imipenem, trimethoprim/sulfamethoxazole (TMP/SMZ) and tetracycline than the E. coli UTI group (P <0.05). Conclusion : Increased incidence, different distribution by age and sex, and high antibiotic resistance of non-E. coli UTI should be considered in selection of empirical antibiotics for treatment of UTI in children. 목 적:소아 UTI에서 non-E. coli UTI 의 빈도를 확인하고 원인균주별(E. coli vs. non-E. coli) 임상양상과 항생제 내성률을 비교하고자 하였다. 방 법: 2008년 9월부터 2009년 8월까지 UTI 입원환아 중에서 원인균주가 배양 증명된 환아들을 대상으로하였다. 인구학적 특징, 임상양상, 검사소견, 원인균주와항생제 내성률을 전향적으로 조사하였다. 결 과:전체 84명 중 E. coli UTI 은 63명(75.0%)이었고 non-E. coli UTI은 21명(25.0%)이었다. 성별ㆍ연령군에 따라서 non-E. coli의 분포는 차이를 보였다 :6개월 미만 남아군, 10.5%; 6개월 이상 남아군, 50.0%;6개월 미만 여아군, 43.7%; 6개월 이상 여아군, 25.0%(P =0.014). E. coli UTI군에 비해, non-E. coli UTI 군에는 입원 전 항생제를 치료받은 환아의 비율이 높았고(P =0.017), 혈뇨가 동반된 환아의 비율은 낮았다(P =0.014). E. coli 보다 non-E. coli는 cefazolin과cefotaxime, imipenem, TMP/SMX, tetracycline에 대해 높은 내성률을 보였다(P <0.05). 결 론:소아 UTI 치료과정에서, 증가 추세의 non-E. coli UTI 빈도와 성별ㆍ연령군별 원인균주의 차이, E. coli 보다 높은 non-E. coli의 항생제 내성률은 고려되어야 할 사항이다.

Neonatal Meningoencephalitis caused by Herpes Simplex Virus Type 2

김대은,배라미,배이영,한지윤,한승범,정대철,이인구,강진한 대한소아감염학회 2014 Pediatric Infection and Vaccine Vol.21 No.2

Despite its rare occurrence, early diagnosis and appropriate treatment for neonatal herpes simplex virus infection aremandatory due to its high morbidity and mortality. In Korea, there has been no epidemiologic data on neonatal herpessimplex virus infection, and even case reports are rare. We observed a 16-day-old neonate who presented with feverand seizures. We diagnosed her with meningoencephalitis caused by herpes simplex virus type 2 based on the polymerasechain reaction test, and treated her with intravenous acyclovir and anticonvulsants. The seroprevalence of herpes simplexvirus type 2 sharply increases in women in their 30s, and the average age for childbirth has increased to older than 30years of age in Korea; we therefore expect that the incidence of neonatal herpes simplex virus type 2 infection will risein Korea, and more attention should be directed to neonatal herpes simplex virus type 2 infection. We report this newbornpatient’s case along with a literature review.

2011-2012절기 B형 인플루엔자 감염의 임상 양상

김민선,성현우,배이영,한승범,정대철,강진한,Kim, Min Sun,Sung, Hyun Woo,Bae, E Young,Han, Seung Beom,Jeong, Dae Chul,Kang, Jin Han 대한소아감염학회 2013 Pediatric Infection and Vaccine Vol.20 No.2

목 적 : 국내 B형 인플루엔자의 임상 양상 및 A형 인플루엔자와 비교를 위해 후향적 연구를 시행하였다. 방 법 : 2011-2012 인플루엔자절기에 multiplex PCR로 인플루엔자가 진단된 소아청소년 입원 환자들의 의무 기록 분석으로 B형 인플루엔자의 임상 양상과 함께 같은 기간 A형 인플루엔자와의 차이점을 조사하였다. 결 과 : 연구 기간 동안 진단 된 145명 인플루엔자 환자 중, A형 인플루엔자 66명, B형 인플루엔자 78명이 있었고, 1명은 A, B형 인플루엔자가 동시에 진단되었다. 이들은 기침(88.2%), 콧물(77.1%), 가래(60.4%) 등 호흡기 증상을 호소하며, 하기도 감염(49.3%) 및 상기도 감염(31.9%)으로 진단된 경우가 많았다. B형과 A형 인플루엔자 환자의 주요 증상 및 검사실 소견은 차이가 없었고, A형에 비해 B형 인플루엔자 환자의 입원 전 발열기간이 길었다(3.0일 vs. 2.5일, P=0.043). 결 론 : 임상 양상만으로 B형과 A형 인플루엔자 감별은 제한성이 있고, B형 인플루엔자 환자의 입원 전 발열 기간 3일을 고려한다면 진단 후 치료보다 감염 전 예방이 중요하다. Purpose: This retrospective study was performed to identify the clinical characteristics of influenza B infection and compare to influenza A infection. Methods: Medical records of patients diagnosed with influenza using a multiplex PCR test, admitted to Seoul St. Mary's Hospital, during the 2011-2012 influenza season were analyzed. Clinical and laboratory characteristics of influenza B patients were investigated and compared with those of influenza A patients. Results: A total of 145 influenza patients were enrolled during this study period. Among these, 66 and 78 patients were diagnosed with influenza A and B, respectively, and 1 patient was diagnosed with co-existing influenza A and B. Cough (88.2%), rhinorrhea (77.1%) and sputum (60.4%) were the most common symptoms among these influenza patients, and most were diagnosed with upper respiratory infection (31.9%) or lower respiratory infection (49.3%). In comparison to influenza A patients, influenza B patients were older ($4.7{\pm}4.1$ years vs. $3.3{\pm}2.5$ years, P=0.016), and the number of fever days before hospitalization were longer (3.0 days vs. 2.5 days, P=0.043). While sore throat (10.3% vs. 1.5%, P=0.039) and vomiting (20.5% vs. 6.1%, P=0.012) were more common in influenza B patients than in influenza A patients, other clinical and laboratory characteristics were not significantly different between the two groups. Conclusions: No significant differences in clinical and laboratory perspectives were manifested in influenza A and B infections. Preventive measures should be emphasized over treatment in influenza B due to prolonged fever duration before admission.

Pulmonary hemorrhage in pediatric lupus anticoagulant hypoprothrombinemia syndrome

김지수,김민재,배이영,정대철 대한소아청소년과학회 2014 Clinical and Experimental Pediatrics (CEP) Vol.57 No.4

Lupus anticoagulant-hypoprothrombinemia syndrome (LAHPS), a very rare disease that is causedby the presence of antifactor II antibodies, is usually counterbalanced by the prothrombotic effectof lupus anticoagulant (LAC). Patients with LAHPS are treated using fresh frozen plasma, steroids,immunosuppressive agents, and immunoglobulins for managing the disease and controllinghemorrhages. Notably, steroids are the important treatment for treating hypoprothrombinemia andcontrolling the bleeding. However, some patients suffer from severe, life-threatening hemorrhages,when factor II levels remain very low in spite of treatment with steroids. Here, we report a case ofLAHPS in a 15-year-old girl who experienced pulmonary hemorrhage with rapid progression. She wasreferred to our hospital owing to easy bruising and prolonged bleeding. She was diagnosed with LAHPSthat presented with pancytopenia, positive antinuclear antibody, proloned prothrombin time, activatedpartial thromboplastin time, positive LAC antibody, and factor II deficiency. Her treatment includedmassive blood transfusion, high-dose methylprednisolone, vitamin K, and immunoglobulin. However,she died due to uncontrolled pulmonary hemorrhage.

Use of intravenous immunoglobulin in a disseminated varicella infection in an immunocompromised child

김재홍,권대현,배이영,한승범,이재욱,정낙균,정대철,조빈,강진한,김학기 대한소아청소년과학회 2014 Clinical and Experimental Pediatrics (CEP) Vol.57 No.8

Varicella-zoster virus infection can lead to severe illness in immunocompromised patients. Further themortality rate of disseminated varicella infection is extremely high particularly in immunocompromisedchildren. We report a case of disseminated varicella infection in a child with acute lymphoblasticleukemia who was receiving chemotherapy, but was initially admitted with only for acute abdominalpain. The patient rapidly developed severe complications, including acute respiratory distresssyndrome, acute hepatitis, disseminated intravascular coagulation, and encephalopathy. Acyclovir is ahighly potent inhibitor of varicella-zoster virus infection. However, owing to rapid disease progression, itmight not be sufficient to control a disseminated varicella infection, especially in immunocompromisedpatients. Immunoglobulin neutralize virus invasion and suppress viremia, acting synergistically withacyclovir. In this case, early administration of acyclovir and a high-dose of immunoglobulin, combinedwith mechanical respiratory support, proved adequate for treatment of this severe illness.

Pertussis Seroprevalence in Korean Adolescents and Adults Using Anti-Pertussis Toxin Immunoglobulin G

이수영,한승범,배이영,김종현,강진한,박연준 대한의학회 2014 Journal of Korean medical science Vol.29 No.5

This study was conducted to evaluate age-specific seroprevalence of pertussis in Korea andto formulate a strategy to prevent and reduce the incidence of pertussis. Residual serumsamples of healthy adolescents and adults 11 yr of age or older were collected between July2012 and December 2012, and anti-pertussis toxin (PT) IgG titers were measured using acommercial ELISA kit. We compared the mean anti-PT IgG titers and seroprevalence ofpertussis of the six age groups: 11-20, 21-30, 31-40, 41-50, 51-60, and ≥ 61 yr. A totalof 1,192 subjects were enrolled. The mean anti-PT IgG titer and pertussis seroprevalencewere 35.53 ± 62.91 EU/mL and 41.4%, respectively. The mean anti-PT IgG titers andseroprevalence were not significantly different between the age groups. However, theseroprevalence in individuals 51 yr of age or older was significantly higher than inindividuals younger than 51 yr (46.5% vs 39.1%, P = 0.017). Based on these results, anew pertussis prevention strategy is necessary for older adults.

치료불응 가와사끼병의 임상양상을 보인 대식세포활성 증후군

박현진,조윤정,배이영,최의윤,정대철,이경일,강진한,이수영 대한소아감염학회 2010 Pediatric Infection and Vaccine Vol.17 No.2

Few cases of macrophage activation syndrome (MAS) or reactive hemophagocytic lymphohistiocytosis (HLH) during the acute febrile phase of Kawasaki disease (KD) have been reported. We report on a case of a 19 month-old girl with MAS or reactive HLH during the course of KD. Despite immunoglobulin and steroid therapy, she showed persistent fever with hepatosplenomegaly and evidence of hemophagocytosis in the bone marrow. A high index of suspicion for clinical features associated with MAS is necessary for KD patients in order to provide appropriate treatment. KD의 급성 열성기에 드물지만 MAS가 발생할 수 있다. 저자들은 19개월 여아의 KD 치료 중에 발생된 MAS 를 경험하였다. 환아는 IVIG과 steroid 치료를 받았지만,발열과 간비종대는 지속되었고 골수생검에서 혈구탐식구증이 관찰되었다. KD에 동반된 MAS를 인지하여 적기에 치료하기 위해서는 임상양상과 치료반응을 토대로,MAS의 가능성을 고려하는 것이 필요하다.

Liver abscess due to Klebsiella pneumoniae in a healthy 12-year-old boy

윤다혜,전연진,배이영,정대철,강진한 대한소아청소년과학회 2013 Clinical and Experimental Pediatrics (CEP) Vol.56 No.11

Pyogenic liver abscess (PLA) is rare in healthy children. We report a case of PLA in an immunocompetent 12-year-old boy. Percutaneous catheter drainage was performed for the abscess. In addition,parenteral antibiotics were administered for 3 weeks. Klebsiella pneumoniae was detected in the culture of blood and drained fluid. Here, we present this case and a brief review of the literature on this subject.

Deferoxamine과 Deferasirox에 의한 면역반응 비교

정대철,정영숙,배이영,정낙균,조빈,김학기,민창기,한치화,김호식 대한혈액학회 2008 Blood Research Vol.43 No.3

Background: The iron chelating agents (ICA) have various biological effects besides iron chelation. We investigated the immunomodulatory effects of Deferasirox (DFS) compared to Deferoxamine (DFO). Methods: Spleen cells (SP) were obtained from 5 week-old C57/BL6 (H-2b). The cytotoxicity of ICAs was examined using the CCK8 method. For the cell proliferation assay, SP were cultured with irradiated in addition to 10, 50, 100μM of DFS or DFO and 200ng/mL of cyclosporin A (CSA). Cytokines and nitrite levels were evaluated from supernatants by ELISA. Results: The viability of ICA was reported to be over 100%. Both DFS and DFO inhibited cell proliferation in a manner comparable to CSA. Cell proliferation without iron was reduced at the concentration of 100μM of DFO. With iron treatment, the reduction of the stimulation index was dependent on DFO concentrations. DFS decreased the proliferation without reference to the concentrations. After stimulation of phytohemagglutinin, the nitrite concentrations increased with iron. With lipopolysaccharides, the nitrite levels were higher in DFO with iron than control, but similar in DFS regardless of iron treatment. The levels of interleukin-2 were not different. Interleukin-10 was more abundantly produced in 50μM of DFO compared to DFS. Transforming growth factor-β was higher in DFS than DFO at the low concentration, but opposite at the high concentration. Conclusion: These data suggested that both iron chelating agents possessed immune suppressive effects comparable to CSA. The immunosuppressive effect of DFS may be distinct from DFO. More experiments are required to determine the exact mechanism of the immunosuppressive effect of DFS. (Korean J Hematol 2008;43:150-158.)

Clinical Features and Prognosis of Invasive Pulmonary Aspergillosis in Korean Children with Hematologic/Oncologic Diseases

한승범,Seong Koo Kim,배이영,이재욱,윤종서,정낙균,조빈,정대철,강진한,김학기,이동건,이현실,임수아 대한의학회 2015 Journal of Korean medical science Vol.30 No.8

Invasive pulmonary aspergillosis (IPA) is the most frequent form of invasive fungal diseases in immunocompromised patients. However, there are only a few studies on IPA in immunocompromised children in Korea. This study was designed to characterize IPA in Korean children with hematologic/oncologic diseases. Medical records of children with hematologic/oncologic diseases receiving antifungal therapy were reviewed. The enrolled children were divided into the IPA group (proven and probable IPA) and non-IPA group, and the clinical characteristics and prognosis were compared between the two groups. During the study period, 265 courses of antifungal therapy were administered to 166 children. Among them, two (0.8%) episodes of proven IPA, 35 (13.2%) of probable IPA, and 52 (19.6%) of possible IPA were diagnosed. More children in the IPA group suffered from neutropenia lasting for more than two weeks (51.4% vs. 21.9%, P < 0.001) and showed halo signs on the chest computed tomography (78.4% vs. 40.7%, P < 0.001) than in the non-IPA group. No other clinical factors showed significant differences between the two groups. Amphotericin B deoxycholate was administered as a first line antifungal agent in 33 (89.2%) IPA group episodes, and eventually voriconazole was administered in 27 (73.0%) episodes. Ten (27.0%) children in the IPA group died within 12 weeks of antifungal therapy. In conclusion, early use of chest computed tomography to identify halo signs in immunocompromised children who are expected to have prolonged neutropenia can be helpful for early diagnosis of IPA and improving prognosis of children with IPA.