서울의 2008-2009년 가을, 겨울철에 유행한 소아의 하기도 호흡기 바이러스 병원체의 규명

Identification of Viral Pathogens for Lower Respiratory Tract Infection in Children at Seoul During Autumn and Winter Seasons of the Year of 2008-2009

  • 김기환 (연세대학교 의과대학 소아과학교실, 세브란스 어린이병원 소아청소년과) ;
  • 김지홍 (연세대학교 의과대학 소아과학교실, 강남세브란스 소아청소년과) ;
  • 김경효 (이화여자대학교 의과대학 소아과학교실) ;
  • 강춘 (질병관리본부 인플루엔자팀) ;
  • 김기순 (질병관리본부 호흡기바이러스팀) ;
  • 정향민 (질병관리본부 호흡기바이러스팀) ;
  • 김동수 (연세대학교 의과대학 소아과학교실, 세브란스 어린이병원 소아청소년과)
  • Kim, Ki Hwan (Department of Pediatrics, Yonsei University College of Medicine, Severance Children's Hospital) ;
  • Kim, Ji Hong (Department of Pediatrics, Yonsei University College of Medicine, Severance Children's Hospital) ;
  • Kim, Kyung Hyo (Department of Pediatrics, Ewha Womans University, College of Medicine) ;
  • Kang, Chun (Division of Influenza, Korea Centers for Disease Control and Prevention) ;
  • Kim, Ki Soon (Division of Respiratory Viruses, Korea Centers for Disease Control and Prevention) ;
  • Chung, Hyang Min (Division of Respiratory Viruses, Korea Centers for Disease Control and Prevention) ;
  • Kim, Dong Soo (Department of Pediatrics, Yonsei University College of Medicine, Severance Children's Hospital)
  • 투고 : 2010.03.26
  • 심사 : 2010.05.10
  • 발행 : 2010.06.25

초록

목 적 : 서울 지역의 급성 호흡기 감염의 원인이 되는 바이러스를 분석하고 임상적 특징과 비교, 분석하였다. 방 법: 2008년 9월부터 2009년 3월까지 3개 대학병원에 입원한 5세 미만의 소아의 급성하기도감염환자에서 418개의 비인두흡입검체를 채취하여, 14종 바이러스를 multiplex PCR을 통한 진단하였다. 바이러스 양성환자의 임상정보를 병원별, 시기별로 분석하였다. 결 과: 418명이 분석되었고, 연령은 평균 16.4개월, 성별비는 1.36대 1이었다. 환자들 중 56.2%에서 바이러스 양성을 보였고, RSV (35%)가 가장 많이 검출된 바이러스였으며, 다음은 hRV (22%)였으며, HBoV, ADV, hMPV, PIV1, IFV, hCoV, PIV2, PIV3가 검출되었다. 양성검체 중 21.9%에서 동시감염이 있었다. 결 론:바이러스의 지역별, 시기별 지속적인 감시가 필요하며, 급성호흡기질환을 보이는 소아의 진료에, 유행하는 바이러스의 특징을 고려해야 할 것이다.

Purpose : The Purposes of this study are to identify the circulating etiologic viruses of acute lower respiratory tract infection in children and to understand the relation with clinical diagnosis. Methods : We obtained a total of 418 nasopharyngeal aspirates from children admitted for their acute lower respiratory tract infections at three tertiary hospitals in Seoul from September 2008 to March 2009. We performed multiplex RT-PCR to identify 14 etiologic viruses and analyzed their emerging patterns and clinical features. Results : Average age of patients was 16.4 months old and the ratio of male to female was 1.36. Viruses were detected in 56.2% of a total of 418 samples. Respiratory syncytial virus (35%) was the most frequently detected and followed by human rhinovirus (22%), human bocavirus, adenovirus, human metapneumovirus, parainfluenza virus, influenza virus and human coronavirus. Co-infection reached 21.9 % of positive patients. Conclusion : When we manage the patients with acute lower respiratory infectious diseases, we should remind the role of various viral pathogens, which might be circulating by seasons and by local areas.

키워드

참고문헌

  1. Valero N, Larreal Y, Arocha F, Gotera J, Mavarez A, Bermudez J, et al. Viral etiology of acute respiratory infections. Invest Clin 2009;50:359-68.
  2. Michelow IC, Olsen K, Lozano J, Rollins NK, Duffy LB, Ziegler T, et al. Epidemiology and clinical characteristics of community-acquired pneumonia in hospitalized children. Pediatrics 2004;113:701-7. https://doi.org/10.1542/peds.113.4.701
  3. van den Hoogen BG, de Jong JC, Groen J, Kuiken T, de Groot R, Fouchier RA, et al. A newly discovered human pneumovirus isolated from young children with respiratory tract disease. Nat Med 2001;7:719-24. https://doi.org/10.1038/89098
  4. Allander T, Tammi MT, Eriksson M, Bjerkner A, Tiveljung- Lindell A, Andersson B. Cloning of a human parvovirus by molecular screening of respiratory tract samples. Proc Natl Acad Sci U S A 2005;102:12891-6. https://doi.org/10.1073/pnas.0504666102
  5. Ma X, Endo R, Ishiguro N, Ebihara T, Ishiko H, Ariga T, et al. Detection of human bocavirus in Japanese children with lower respiratory tract infections. J Clin Microbiol 2006;44:1132-4. https://doi.org/10.1128/JCM.44.3.1132-1134.2006
  6. Gerna G, Piralla A, Rovida F, Rognoni V, Marchi A, Locatelli F, et al. Correlation of rhinovirus load in the respiratory tract and clinical symptoms in hospitalized immunocompetent and immunocompromised patients. J Med Virol 2009;81:1498-507. https://doi.org/10.1002/jmv.21548
  7. Louie JK, Roy-Burman A, Guardia-Labar L, Boston EJ, Kiang D, Padilla T, et al. Rhinovirus associated with severe lower respiratory tract infections in children. Pediatr Infect Dis J 2009;28:337-9. https://doi.org/10.1097/INF.0b013e31818ffc1b
  8. Renwick N, Schweiger B, Kapoor V, Liu Z, Villari J, Bullmann R, et al. A recently identified rhinovirus genotype is associated with severe respiratory-tract infection in children in Germany. J Infect Dis 2007;196:1754-60. https://doi.org/10.1086/524312
  9. Wilfret DA, Baker BT, Palavecino E, Moran C, Benjamin DK, Jr. Epidemiology of respiratory syncytial virus in various regions within North Carolina during multiple seasons. N C Med J 2008;69:447-52.
  10. Gerna G, Campanini G, Rovida F, Sarasini A, Lilleri D, Paolucci S, et al. Changing circulation rate of human metapneumovirus strains and types among hospitalized pediatric patients during three consecutive winter-spring seasons. Brief report. Arch Virol 2005;150:2365-75. https://doi.org/10.1007/s00705-005-0581-2
  11. Choi EH, Lee HJ, Kim SJ, Eun BW, Kim NH, Lee JA, et al. The association of newly identified respiratory viruses with lower respiratory tract infections in Korean children, 2000-2005. Clin Infect Dis 2006;43:585-92. https://doi.org/10.1086/506350
  12. Chun JK, Lee JH, Kim HS, Cheong HM, Kim KS, Kang C, et al. Establishing a surveillance network for severe lower respiratory tract infections in Korean infants and young children. Eur J Clin Microbiol Infect Dis 2009; 28:841-4. https://doi.org/10.1007/s10096-009-0701-0
  13. Hall CB, Weinberg GA, Iwane MK, Blumkin AK, Edwards KM, Staat MA, et al. The burden of respiratory syncytial virus infection in young children. N Engl J Med 2009; 360:588-98. https://doi.org/10.1056/NEJMoa0804877
  14. Lee JT, Chang LY, Wang LC, Kao CL, Shao PL, Lu CY, et al. Epidemiology of respiratory syncytial virus infection in northern Taiwan, 2001-2005 -- seasonality, clinical characteristics, and disease burden. J Microbiol Immunol Infect 2007;40:293-301.
  15. Jackson DJ, Gangnon RE, Evans MD, Roberg KA, Anderson EL, Pappas TE, et al. Wheezing rhinovirus illnesses in early life predict asthma development in high-risk children. Am J Respir Crit Care Med 2008;178:667-72. https://doi.org/10.1164/rccm.200802-309OC
  16. Leigh R, Oyelusi W, Wiehler S, Koetzler R, Zaheer RS, Newton R, et al. Human rhinovirus infection enhances airway epithelial cell production of growth factors involved in airway remodeling. J Allergy Clin Immunol 2008;121:1238-45. https://doi.org/10.1016/j.jaci.2008.01.067
  17. Peltola V, Waris M, Osterback R, Susi P, Hyypia T, Ruuskanen O. Clinical effects of rhinovirus infections. J Clin Virol 2008;43:411-4. https://doi.org/10.1016/j.jcv.2008.08.014
  18. Marguet C, Lubrano M, Gueudin M, Le Roux P, Deschildre A, Forget C, et al. In very young infants severity of acute bronchiolitis depends on carried viruses. PLoS One 2009;4:e4596. https://doi.org/10.1371/journal.pone.0004596
  19. Paranhos-Baccala G, Komurian-Pradel F, Richard N, Vernet G, Lina B, Floret D. Mixed respiratory virus infections. J Clin Virol 2008;43:407-10. https://doi.org/10.1016/j.jcv.2008.08.010
  20. Konig B, Konig W, Arnold R, Werchau H, Ihorst G, Forster J. Prospective study of human metapneumovirus infection in children less than 3 years of age. J Clin Microbiol 2004;42:4632-5. https://doi.org/10.1128/JCM.42.10.4632-4635.2004
  21. Kaplan NM, Dove W, Abd-Eldayem SA, Abu-Zeid AF, Shamoon HE, Hart CA. Molecular epidemiology and disease severity of respiratory syncytial virus in relation to other potential pathogens in children hospitalized with acute respiratory infection in Jordan. J Med Virol 2008; 80:168-74. https://doi.org/10.1002/jmv.21067