2006-2007년 소아 급성 하기도 감염증에서 유행한 메타뉴모바이러스의 유행 및 임상 양상 = Epidemiologic and clinical features in children with acute lower respiratory tract infection caused by human metapneumovirus in 2006-2007

다국어 초록 (Multilingual Abstract)

Purpose : The causes of acute lower respiratory tract infection (ALRTI) are mostly attributable to viral infection, including respiratory syncytial virus (RSV), parainfluenza virus (PIV), influenza virus A/B (IFV A/B), or adenovirus (ADV). Several Korean studies reported human metapneumovirus (hMPV) as a common pathogen of ALRTI. However, studies on seasonal distribution and clinical differences relative to other viruses are insufficient, prompting us to perform this study.
Methods : From November 2006 to October 2007, we tested nasopharyngeal aspiration specimens in children hospitalized with ALRTI with the multiplex reverse transcriptase-polymerase chain reaction to identify 6 kinds of common pathogen (hMPV, RSV, PIV, IFV A/B, and ADV). We analyzed positive rates and clinical features by respiratory chart review.
Results : We detected 38 (8.4%) hMPV-positive cases out of 193 (41.8%) virus-positive specimens among 462 patients. HMPV infection prevailed from March to June with incidence peaking in April. HMPV-positive patients were aged 15 years (76.3%), and the ratio of boys to girls was 1.2:1. The median age was 27 months. HMPV primarily caused pneumonia (76.3 %) (P=0.018). Average hospitalization of HMPV-associated ALRTI patients was 5.8 days. In addition, they showed parahilar peribronchial infiltration (100%) on chest X-ray, normal white blood cell count (73.7%), and negative C-reactive protein (86.8 %) (P>0.05). All hMPV-positive patients recovered without complication.
Conclusion : HMPV is a common pathogen of ALRTI in Korean children, especially in 1-5 year olds, from March to May. Immunocompetent children diagnosed with hMPV-associated ALRTI may have a good prognosis.

국문 초록 (Abstract)

목 적 : 급성 하기도 감염은 소아 환자들에 있어 가장 흔한 질환 중에 하나로, RSV, PIV, IFV A/B, ADV 등이 흔한 원인으로 알려져 있으며, 2001년 이후로 hMPV 또한 주요 원인 바이러스 중의 하나로 밝혀졌다. 하지만 hMPV의 검출율, 유행 양상이 다른 호흡기 바이러스와 어떤 차이가 있는지에 대해서는 국내 연구가 충분하지 않아 본 연구를 시행하였다.
방 법 : 2006년 11월부터 2007년 10월까지 중앙대학교병원 소아청소년과에 급성 호흡기 감염증으로 입원한 환아들을 대상으로 입원 첫 날에 비인두 흡입물을 채취하여 다중 역전사 연쇄중합반응을 시행하여 흔한 호흡기 바이러스 6종(hMPV, RSV, PIV, IFV A/B, ADV)을 분리하였고, 각 바이러스의 검출율과 임상증세를 분석하여 hMPV 양성 환아가 다른 바이러스 감염과 어떠한 차이를 보이는지 연구하였다.
결 과 : 462명 중 193명(41.8%)에서 바이러스가 검출되었으며, 그 중 38명(19.7%)이 hMPV로 나타났다. hMPV가 검출된 환아들의 연령은 1-5세가 대부분이었고(76.3%), 나이의 중앙값은 27개월, 남녀비는 1.2:1이었다. 월별로는 3월부터 5월까지 집중되었고, 4월에 21명(55.3%)으로 절정을 이루었다. 진단명은 폐렴이 가장 흔하였고 이는 29명(76.3%)을 차지하였고(P=0.018), 다음으로는 세기관지염 5명(13.2%), 기관지염 2명(2.6%), 크룹 1명(2.6%), 천식의 급성 악화 1명(2.6%) 순으로 나타났다. 평균 재원 일수는 5.8일 정도였고, 흉부 방사선 소견은 폐문 주위의 기관지침윤 양상(100%)을 보였으며, 대부분에서 백혈구수는 정상(73.7%), C-반응 단백은 음성(86.8 %)으로 나타났으며(P>0.05), hMPV 관련 급성 하기도 감염증으로 확인된 모든 환아들의 예후는 양호했다.
결 론 : 우리 나라에서 면역력이 양호한 1-5세 환아가 3월에서 5월 사이에 급성 하기도 감염으로 내원하는 경우, hMPV에 의한 감염의 가능성을 염두에 두어야 한다. HMPV 관련 급성 하기도 감염증으로 진단시 일반적으로 양호한 경과를 예측할 수 있겠다.

참고문헌 (Reference)

1 박준영, "영아 세기관지염에서 3% 고장성 식염액과Fenoterol 병용흡입 치료의 효과" 대한소아과학회 48 (48): 518-522, 2005

2 염희연, "소아에서 human metapneumovirus 감염" 대한소아과학회 49 (49): 401-409, 2006

3 Boivin G, "Virological features and clinical manifestations associated with human metapneumovirus : a new paramyxovirus responsible for acute respiratory tract infections in all age groups" 186 : 1330-1334, 2002

4 Lee HJ, "Viral etiology and epidemiology of acute lower respiratory tract infections in children" 27 : 319-332, 1995

5 Han YC, "Statistical observation for pediatric inpatients" 28 : 1-15, 1987

6 Chai H, "Standardization of bronchial inhalaion challenge procedures" 56 : 323-327, 1975

7 Ebihara T, "Seroprevalence of human metapneumovirus in Japan" 70 : 281-283, 2003

8 Robinson JL, "Seasonality and clinical features of human metapneumovirus infection in children in Northern Alberta" 76 : 98-105, 2005

9 Kaida A, "Seasonal distribution and phylogenetic analysis of human metapneumovirus among children in Osaka city, Japan" 35 : 394-399, 2006

10 Pelletier G, "Respiratory tract reinfections by the new human metapneumovirus in an immunocompromised child" 8 : 976-978, 2002

11 Treanor J, "Respiratory infections. In: Clinical virology. 1st ed" Churchill Livingstone 533-, 1997

12 Ahn HS, "Respiratory disease. In: Textbook of Pediatrics. 9th ed" Daehan Printing & Publishing Co 20-53, 2007

13 Khetsuriani N, "Prevalence of viral respiratory tract infections in children with asthma" 119 : 314-321, 2007

14 Freymouth F, "Presence of the new human metapneumovirus in French children with bronchiolitis" 22 : 92-94, 2003

15 Mackay IM, "Molecular assays for detection of human metapneumovirus" 41 : 100-105, 2003

16 Tuomas J, "Metapneumovirus and acure wheezing in children" 360 : 1393-1394, 2007

17 Peret TC, "Humpherey C, Osterhau ADME, et al. Characterization of human metapneumoviruses isolated from patients in North America" 185 (185): 2002

18 Maggi F, "Human metapneumovirus tract infections in a 3-year study of nasal swabs from infants in Italy" 41 : 2987-2991, 2008

19 Falsey AR, "Human metapneumovirus infections in young and elderly adults" 187 : 785-790, 2003

20 Banerjee S, "Human metapneumovirus infections among children with acute respiratory infections seen in a large referral hospital in India" 38 : 70-72, 2007

21 Samransamruajkit R, "Human metapneumovirus in infants and young children in Thailand with lower respiratory tract infections; molecular characteristics and clinical presentations" 52 : 254-263, 2006

22 Williams JV, "Human metapneumovirus and lower respiratory tract disease in otherwise healthy infants and children" 29 : 443-450, 2004

23 Takashi E, "Human metapneumovirus Infection in Japanese children" 42 : 126-132, 2004

24 Ju Young Chung, "Human Metapneumovirus Infection in Hospitalized Children with Acute Respiratory Disease in Korea" 대한의학회 21 (21): 838-842, 2006

25 The global initiative for asthma, "Global strategy for asthma management and prevention"

26 Nissen MD, "Evidence of human metapneumovirus in Australian children" 176-188, 2002

27 Berman S, "Epidemiology of acute respiratory infections in children of developing countries" 13 : 454-462, 1991

28 Antonella S, "Detection and pathogenicity of human metapneumovirus respiratory infection in pediatric Italian patients during a winterspring season" 35 : 59-68, 2006

29 Takao S, "Clinical study of pediatric cases of acute respiratory disease associated human matapneumovirus in Japan" 56 : 127-129, 2003

30 Peiris JS, "Children with respiratory disease associated with metapneumovirus in Hong Kong" 9 : 628-633, 2003

31 Van den Hoogen BG, "A newly discovered human metapneumovirus isolated from young children with respiratory tract disease" 7 : 719-724, 2001