Pediatric Infection and Vaccine

The Korean Society of Pediatric Infectious Diseases (대한소아감염학회)
권호 표지
DOI QR코드

DOI QR Code

Characteristics and Clinical Correlations of Staphylococcus aureus Discovered in Stools from Children Hospitalized at a Secondary Hospital

일개 이차병원에 입원한 소아의 분변에서 발견된 황색포도알균의 특징과 임상적 연관성

  • Shin, Eun Hye (Department of Pediatrics, Eulji University Eulji Hospital) ;
  • Eun, Byung Wook (Department of Pediatrics, Eulji University Eulji Hospital) ;
  • An, Young Min (Department of Pediatrics, Eulji University Eulji Hospital) ;
  • Song, Mi Ok (Infectious Disease Team, Seoul Metropolitan Government Research Institute of Public Health and Environment)
  • 신은혜 (을지대학교 을지병원 소아청소년과) ;
  • 은병욱 (을지대학교 을지병원 소아청소년과) ;
  • 안영민 (을지대학교 을지병원 소아청소년과) ;
  • 송미옥 (서울시 보건환경 연구원 감염병검사팀)
  • Received : 2018.03.08
  • Accepted : 2018.05.31
  • Published : 2018.08.25
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Research on the clinical role of Staphylococcus aureus as a pathogen in acute gastroenteritis (AGE) in children has been scarce. This study aimed to clarify the prevalence and clinical correlation of S. aureus detection in children with AGE. Methods: Fecal samples were collected from children with symptoms of AGE who visited a secondary hospital between January 2012 and December 2015. The samples were sent to the Seoul Metropolitan Government Research Institute of Public Health and Environment to test for pathogenic organisms. Clinical patterns were analyzed through medical record review. Results: Among the 663 participants, the bacteria detection rate was 26.2% (n=174), the virus detection rate was 29.7% (n=197), and the non-detection rate was 43.1% (n=286). S. aureus was tested positive from 102 cases and was confirmed as a single pathogen in 53 cases. It was the third most common pathogen. The prevalence by age was highest (45.3%) in 0-2 year-olds. Most cases occurred in summer. Symptoms included diarrhea (71.7%), vomiting (67.9%), fever (49.1%), and abdominal pain (37.7%). Only vomiting showed a significant difference between the S. aureus group and the non-detection group (67.9% vs. 43.0%; P=0.001). Among enterotoxins, the higher incidence of vomiting was associated with classical staphylococcal enterotoxins (SEA, SEB, SEC, SED, and SEE) and SEH (P=0.027). Conclusions: S. aureus was the bacteria commonly isolated from children with AGE. Our study identified cases of staphylococcal AGE in children based on fecal samples and confirmed the characteristic symptoms, affected age groups, seasonal distribution, and correlation with enterotoxins.

목적: 소아의 급성 위장관염의 세균성 원인 중 살모넬라균, 이질균, 대장균 등은 임상양상과 합병증에 대해 많이 알려져 있는 반면, 황색포도알균의 임상양상에 대한 연구는 드물다. 본 연구는 소아의 분변에서 발견된 황색포도알균의 빈도와 임상적 연관성을 밝히고자 하였다. 방법: 2012년 1월부터 2015년 12월까지 일개 이차병원에서 급성 위장관염 증상으로 입원한 18세 이하 소아 환자의 분변 검체를 서울시보건환경연구원에 보내어 원인 세균 및 바이러스를 검사하였다. 임상양상에 대해 후향적으로 의무기록지를 검토하였다. 결과: 총 663명에서 세균 검출률은 26.2% (174명), 바이러스 검출률은 29.7% (197명), 아무것도 검출되지 않은 미검출군은 43.1% (286명)으로 나타났다. 황색포도알균 양성이면서 장독소가 확인된 사례는 총 102례(15.4%)였고, 그 중 단일 원인체로 황색포도알균이 확인된 경우는 53례(8.0%)로 단일원인체로는 세 번째로 높은 비율을 차지했다. 황색포도알균 단독 검출군의 연령에 따른 검출률은 0-2세에서 45.3% 로 가장 높았고, 주로 여름철에 발생하였다. 증상은 설사(71.7%), 구토(67.9%), 발열(49.1%), 복통(37.7%) 순으로 발생하였고, 미검출군 286명의 증상과 비교하여 유의한 차이를 보인 것은 구토 증상이 유일하였다(P=0.001). 장독소 중 표준형 장독소 (SEA, SEB, SEC, SED, and SEE)와 SEH에 의한 경우 구토 발생률이 더 높았다(P=0.027). 결론: 황색포도알균은 급성 위장관염 소아에게서 흔히 분리되는 균주였다. 본 연구를 통해 소아의 분변에서 발견된 황색포도알균 위장관염의 특징적인 임상 증상 및 호발연령과 계절적 분포, 장독소와의 연관성을 확인할 수 있었다.

Keywords

References

  1. Bhutta ZA. Acute gastroenteritis in children. In: Kliegman RM, Stanton BF, St Geme JW III, Schor NF, editors. Nelson textbook of pediatrics. 20th ed. Philadelphia (PA): Elsevier, 2016:1854-7.
  2. Le Loir Y, Baron F, Gautier M. Staphylococcus aureus and food poisoning. Genet Mol Res 2003;2:63-76.
  3. Ochoa TJ, Chea-Woo E. Approach to patients with gastrointestinal tract infections and food poisoning. In: Cherry JD, Harrison GJ, Kaplan SL, Steinbach WJ, Hotez PJ, editors. Feigin and Cherry's textbook of pediatric infectious diseases. 8th ed. Philadelphia (PA): Elsevier, 2018:450-1.
  4. Lee JI, Park SH, Kim MS, Oh YH, Yu IS, Choi BH, et al. Surveillance of acute gastroenteritis in Seoul, Korea, during May 2004 and June 2007. J Bacteriol Virol 2009;39:363-71. https://doi.org/10.4167/jbv.2009.39.4.363
  5. Kwun JW, Lee CH. Trends of recent food-borne disease outbreaks in Korea. J Korean Med Assoc 2007;50:573-81. https://doi.org/10.5124/jkma.2007.50.7.573
  6. National Institute of Food and Drug Safety Evaluation (KR). Risk assessment of Staphylococcus aureus and Clostridium perfringens in processed egg products [Internet]. Cheongju: National Institute of Food and Drug Safety Evaluation; 2017 [cited 2018 Jan 15]. Available from: http://www.nifds.go.kr/nifds/02_research/sub_09_10.jsp?mode=view&boar d_no=197&article_no=11533.
  7. Kang Y, Yoon S, Jwa S, Lee D, Woo GJ, Park Y, et al. Prevalence of Staphylococcus aureus in Kimbab. J Food Hyg Saf 2002;17:31-5.
  8. Hennekinne JA, De Buyser ML, Dragacci S. Staphylococcus aureus and its food poisoning toxins: characterization and outbreak investigation. FEMS Microbiol Rev 2012;36:815-36. https://doi.org/10.1111/j.1574-6976.2011.00311.x
  9. Pinchuk IV, Beswick EJ, Reyes VE. Staphylococcal enterotoxins. Toxins (Basel) 2010;2:2177-97. https://doi.org/10.3390/toxins2082177
  10. Song JH, Sun DS, Park JS, Choi YJ, Nam HS, Kim YB, et al. Comparison of clinical features of norovirus and rotavirus gastroenteritis in hospitalized children and norovirus genotype analysis. Infect Chemother 2010;42:143-8. https://doi.org/10.3947/ic.2010.42.3.143
  11. Kim SY, Kim HJ, Shin EH, Eun BW, Ahn YM, Song MO. Etiology and clinical features of acute bacterial gastroenteritis in children managed at a secondary hospital. Pediatr Infect Vaccine 2017;24:95-101. https://doi.org/10.14776/piv.2017.24.2.95
  12. Chiang YC, Liao WW, Fan CM, Pai WY, Chiou CS, Tsen HY. PCR detection of staphylococcal enterotoxins (SEs) N, O, P, Q, R, U, and survey of SE types in Staphylococcus aureus isolates from food-poisoning cases in Taiwan. Int J Food Microbiol 2008;121:66-73. https://doi.org/10.1016/j.ijfoodmicro.2007.10.005
  13. Omoe K, Imanishi K, Hu DL, Kato H, Fugane Y, Abe Y, et al. Characterization of novel staphylococcal enterotoxin-like toxin type P. Infect Immun 2005;73:5540-6. https://doi.org/10.1128/IAI.73.9.5540-5546.2005
  14. Dinges MM, Orwin PM, Schlievert PM. Exotoxins of Staphylococcus aureus. Clin Microbiol Rev 2000;13:16-34. https://doi.org/10.1128/CMR.13.1.16
  15. Lin Z, Kotler DP, Schlievert PM, Sordillo EM. Staphylococcal enterocolitis: forgotten but not gone? Dig Dis Sci 2010;55:1200-7. https://doi.org/10.1007/s10620-009-0886-1
  16. Park HS, Han DS. Management of antibiotics-associated diarrhea. Korean J Gastroenterol 2009;54:5-12. https://doi.org/10.4166/kjg.2009.54.1.5
  17. Asha NJ, Tompkins D, Wilcox MH. Comparative analysis of prevalence, risk factors, and molecular epidemiology of antibiotic-associated diarrhea due to Clostridium difficile, Clostridium perfringens, and Staphylococcus aureus. J Clin Microbiol 2006;44:2785-91. https://doi.org/10.1128/JCM.00165-06

Cited by

  1. Causes of acute gastroenteritis in Korean children between 2004 and 2019 vol.64, pp.6, 2021, https://doi.org/10.3345/cep.2020.01256