급성 호흡기 감염으로 입원한 소아에서 호흡기 감염의 원인 : 중복검출의 임상적 의미 = Clinical significance of codetection of the causative agents for acute respiratory tract infection in hospitalized children

다국어 초록 (Multilingual Abstract)

Purpose : To determine the prevalence and clinical features of codetected respiratory etiological agents for acute respiratory infection in hospitalized children.
Methods : Nasopharyngeal aspirates were obtained from hospitalized children with acute respiratory infection at Dankook University Hospital from September 2003 through June 2005. Immunofluorescent staining and culture were used for the detection of respiratory viruses (influenza virus [IFV] types A, B; parainfluenza virus [PIV] types 1, 2, 3; respiratory syncytial virus [RSV]; adenovirus [AdV]). Polymerase chain reaction (PCR) assays were used for Mycoplasma pneumoniae (MP) and Chlamydia trachomatis (CT) detection, and PCR and culture were performed for enterovirus detection. Acid-fast staining and culture were performed for tuberculosis detection. The demographic and clinical characteristics were reviewed retrospectively from the patients medical records.
Results : Evidence of two or more microbes was found in 28 children: RSV was detected in 14, PIV 3 in 10, AdV in 10, MP in 8, PIV 2 in 8, CT in 4, and PIV 1 in 3. Codetected agents were found as follows: RSV＋PIV 2, 6 patients; AdV＋MP, 4 patients; AdV＋PIV, 3 patients; RSV＋MP, 3 patients; PIV 1＋PIV 3, 3 patients. Distinct peaks of codetected agents were found in epidemics of MP and each respiratory virus.
Conclusion : The codetected infectious agents were RSV, PIV, AdV, and MP, with distinct peaks found in epidemics of MP and each respiratory virus. Although advances in diagnostic methods have increased the prevalence of codetection, its clinical significance should be interpreted cautiously.

국문 초록 (Abstract)

목 적 : 최근 호흡기 감염의 원인에 대한 검사 방법의 발달로 중복검출에 대한 높은 비율이 보고되고 있다. 이에 소아에서의 급성 호흡기 감염의 원인으로 중복검출에 대한 임상 양상과 그 특징에 대해 알아보고자 하였다.
방 법 : 2003년 9월부터 2005년 6월까지 단국대학교병원 소아과에 급성 호흡기 증상으로 입원한 환아들을 대상으로 의무기록지를 후향적으로 조사하였다. 비인두 흡인물의 호흡기 바이러스(AdV, RSV, PIV 1, 2, 3, IFA, IFB)의 항원과 배양 검사, 혈청의 MP 항체 측정(1:640 이상 혹은 4배 이상의 항체 상승시 양성으로 함), 비인두 흡인물의 MP PCR, CT 항원의 PCR 검사, enterovirus PCR 및 배양검사, 객담의 항산균 도말 염색 및 배양 검사를 받은 환아들 중 2가지 이상에서 양성으로 나온 환아들의 임상 양상에 대해서 조사하였다.
결 과 : 1) 호흡기 감염의 원인에 대한 검사에서 2가지 이상의 양성을 보인 환아는 총 28명이었으며 남아가 17명이었고, 평균 나이는 2년 3개월(19일-13세), 6개월 미만이 11명이었다. 2) 중복검출의 원인 중 RSV가 14례, PIV 3 10례, AdV 10례, MP 8례, PIV 2가 7례, CT, PIV 3가 각각 3례였다. 중복검출되는 원인으로 RSV＋PIV 2 6례, AdV＋MP 4례, AdV＋PIV 3, RSV＋MP, PIV 1＋PIV 3가 각각 3례였다. 3) 임상 진단으로 폐렴 19례, 세기관지염 16례, 후두염이 3례였으며, 4) MP, 호흡기 바이러스의 각각의 유행 시기에 이들에 의한 중복검출이 있었다.
결 론 : 소아의 급성 호흡기 감염의 원인에 대한 중복검출은 영아에서 흔하며, 원인으로 RSV, PIV, AdV, MP가 많았다. MP, 호흡기 바이러스의 각각의 유행 시기에 이들에 의한 중복 검출률의 빈도가 증가함을 볼 수 있었다. 호흡기 감염의 원인에 대한 검사 방법의 발달로 중복 검출률이 높아지고 있어 이의 임상적 의미에 대한 연구가 더 필요하다고 사료된다.

참고문헌 (Reference)

1 이승현, "마이코플라즈마 폐렴의 임상 역학적 연구(1993-2003년)" 대한소아과학회 48 (48): 154-157, 2005

2 Jennings LC, "Viral etiology of acute respiratory tract infections in children presenting to hospital; role of polymerase chain reaction and demonstration of multiple infections" 23 : 1003-1007, 2004

3 Nohynek H, "The cause of hospital treated acute lower respiratory tract infection in children" 145 : 618-622, 1991

4 Toikka P, "Streptococcus pneumoniae and mycoplasma pneumoniae coinfection in community acquired pneumonia" 83 : 413-414, 2000

5 Aberle JH, "Single versus dual respiratory virus infections in hospitalized infants" 24 : 605-610, 2005

6 Portnoy B, H.L., "Salvatore. Multiple respiratory virus infections in hospitalized children" 82 : 262-272, 1965

7 Korppi M, "Pneumococcal finding in a sample from upper airways does not indicate pneumococcal infection of lower airways" 24 : 445-451, 1992

8 Jartti T, "Persistence of rhinovirus and enterovirus RNA after acute respiratory illness in children" 72 : 695-699, 2004

9 Esposito S, "Mycoplasma pneumoniae and Chlamydia pneumoniae infections in children with pneumonia" 17 : 241-245, 2001

10 Block S, "Mycoplasma pneumoniae and Chlamydia pneumoniae in community acquired pneumonia: comparative efficacy and safety of clarithromycin vs erythromycin ethylsuccinated" 14 : 471-477, 1995

11 Calvo C, "Multiple simultaneous viral infections in infants with acute respiratory tract infections in Spain" 42 : 268-272, 2008

12 Korppi, "Mixed microbial aetiology of community-acquired pneumonia in children" 110 : 515-522, 2002

13 Drews AL, "Greenberg SB. Dual respiratory virus infections" 25 : 1421-1429, 1997

14 Korppi M, "Etiology of community acquired pneumonia in children treated in hospital" 152 : 24-30, 1993

15 Juven T, "Etiology of community acquired pneumonia in 254 hospitalized children" 19 : 293-298, 2000

16 Heiskanen-Kosma T, "Etiology of childhood pneumonia: serological results of a prospective, population-based study" 17 : 986-991, 1998

17 Wubbel L, "Etiology and treatment of community acquired pneumonia in ambulatory children" 18 : 98-104, 1999

18 Maletzky AJ, "Epidemiology of viral and mycoplasmal agents associated with childhood lower respiratory illness in a civilian population" 78 : 407-414, 1971

19 Michelow IC, "Epidemiology and clinical characteristics of community-acquired pneumonia in hospitalized children" 113 : 701-707, 2004

20 Semple MG, "Dual infection of infants by human metapneumovirus and human respiratory syncytial virus is strongly associated with severe bronchiolitis" 191 : 382-386, 2005

21 Petitjean J, "Detection of respiratory syncytial virus, parainfluenza virus 3, adenovirus and rhinovirus sequences in respiratory tract of infants by PCR and hybridization" 8 : 31-40, 1997

22 von Linsow ML, "Clinical and epidemiologic characteristics of human bocavirus in Danish infants: results from a prospective birth cohort study" 37 : 897-902, 2008

23 Nichol KP, "Bacterial viral interrelations in respiratory infections of children" 277 : 667-672, 1967

24 Palomino MA, "Adenovirus and respiratory syncytial virus-adenovirus mixed acute lower respiratory infections in children and infants" 23 : 337-341, 2004