Pediatric Infection and Vaccine

  • 제26권3호
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  • Pages.199-205
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  • 2019
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  • 2384-1079(pISSN)
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  • 2384-1087(eISSN)
대한소아감염학회 (The Korean Society of Pediatric Infectious Diseases)
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Early Detection and Successful Treatment of Vertically Transmitted Fulminant Enteroviral Infection Associated with Various Forms of Arrhythmia and Severe Hepatitis with Coagulopathy

  • Lee, So Ra (Department of Pediatrics, Cheil General Hospital & Women's Health Care Center, Dankook University College of Medicine) ;
  • Ko, Sun Young (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Yoon, So Young (Department of Pediatrics, Cheil General Hospital & Women's Health Care Center, Dankook University College of Medicine) ;
  • Lee, Yeon Kyung (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Shin, Son Moon (Department of Pediatrics, Cheil General Hospital & Women's Health Care Center, Dankook University College of Medicine)
  • 투고 : 2018.12.26
  • 심사 : 2019.05.20
  • 발행 : 2019.12.25
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초록

엔테로바이러스 감염은 신생아에게 흔히 일어나며, 경한 감염에서부터 다기관 부전이나 사망에까지 이를 수 있다. 특히, 출생 시 모체로부터 수직 감염된 신생아들의 경우 심각한 질환에 이르게 될 수 있다. 본 증례의 환아는 모체에게서 엔테로바이러스의 수직 감염이 일어났으며, 파종 혈관내 응고장애, 간염, 그리고 심근염으로 빠르게 진행하였다. 환아가 태어난 시기가 엔테로바이러스의 유병률이 높은 6월인 점, 환아의 어머니와 형제에게서 고열이 있었던 점, 임상 증상 등을 고려하여 저자들은 환아가 엔테로바이러스의 수직 감염 가능성이 있다고 보고 검사와 치료를 진행하였다. 이 환아는 빈맥을 동반한 다양한 형태의 부정맥을 보였으며, 일반적인 치료에 반응을 잘 하지 않았으나, 엔테로바이러스 감염을 조기에 의심하고 치료하여 완전히 회복할 수 있었다. 신생아의 엔테로바이러스 감염에서, 응고장애를 동반한 간염과 심근염이 동시에 오는 경우는 드물다. 본 증례에서, 저자들은 응고장애를 동반한 간염과 다양한 형태의 부정맥을 동반한 엔테로바이러스 수직 감염을 조기에 진단하고 성공적으로 치료하였기에 보고하는 바이다.

Enteroviral infections are common in neonates. One important infection pathway is vertical transmission from an infected mother to her neonate. Here, we report the early detection and successful treatment of a vertically transmitted fulminant enteroviral infection associated with myocarditis and hepatitis. The patient had a sudden onset of high fever on the fourth day of life and developed severe, rapidly progressing symptoms of disseminated intravascular coagulopathy (DIC), hepatitis, and myocarditis accompanied by tachyarrhythmia. As it was the peak season for enteroviral infections and both the mother and the patient's 36-month-old sibling had a high fever around the time of delivery, we suspected an enteroviral infection. Thus, we initiated prompt evaluation of enteroviral infection, as well as close observation and intensive care of the neonate. We strongly recommend evaluation for the possibility of vertical enterovirus infection in neonates when the mother is suspected of having a viral infection (e.g., high fever and negative results from bacterial infectious studies) around the time of delivery and when the neonate shows some early symptoms of infectious diseases such as thrombocytopenia, DIC, hepatitis, and myocarditis. Early detection of enteroviral infections and prompt implementation of proper treatment are key to reduce the risk of complications and mortality associated with enteroviral infections in neonates.

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참고문헌

  1. Tebruegge M, Curtis N. Enterovirus infections in neonates. Semin Fetal Neonatal Med 2009;14:222-7. https://doi.org/10.1016/j.siny.2009.02.002
  2. Zaoutis T, Klein JD. Enterovirus infections. Pediatr Rev 1998;19:183-91. https://doi.org/10.1542/pir.19-6-183
  3. Schlapbach LJ, Ersch J, Balmer C, Pretre R, Tomaske M, Caduff R, et al. Enteroviral myocarditis in neonates. J Paediatr Child Health 2013;49:E451-4. https://doi.org/10.1111/jpc.12248
  4. Yen MH, Huang YC, Chen MC, Liu CC, Chiu NC, Lien R, et al. Effect of intravenous immunoglobulin for neonates with severe enteroviral infections with emphasis on the timing of administration. J Clin Virol 2015;64:92-6. https://doi.org/10.1016/j.jcv.2015.01.013
  5. Banjac L, Nikcevic D, Vujosevic D, Raonic J, Banjac G. Tachycardia in a newborn with enterovirus infection. Acta Clin Croat 2014;53:102-6.
  6. Bryant PA, Tingay D, Dargaville PA, Starr M, Curtis N. Neonatal coxsackie B virus infection-a treatable disease? Eur J Pediatr 2004;163:223-8. https://doi.org/10.1007/s00431-004-1408-y
  7. Kaga A, Katata Y, Suzuki A, Otani K, Watanabe H, Kitaoka S, et al. Perinatal coxsackievirus B3 infection with transient thrombocytopenia. Tohoku J Exp Med 2016;239:135-8. https://doi.org/10.1620/tjem.239.135
  8. Haston JC, Dixon TC. Nonpolio enterovirus infections in neonates. Pediatr Ann 2015;44:e103-7. https://doi.org/10.3928/00904481-20150512-09
  9. Takahashi H, Tsukamoto K, Takahashi S, Nakamura T, Ito Y, Kaneko M, et al. Reversible atrioventricular block and junctional ectopic tachycardia in coxsackievirus B3-induced fetal-neonatal myocarditis without left ventricular dysfunction. AJP Rep 2011;1:37-42. https://doi.org/10.1055/s-0031-1277102
  10. Batra AS, Chun DS, Johnson TR, Maldonado EM, Kashyap BA, Maiers J, et al. A prospective analysis of the incidence and risk factors associated with junctional ectopic tachycardia following surgery for congenital heart disease. Pediatr Cardiol 2006;27:51-5. https://doi.org/10.1007/s00246-005-0992-6
  11. Anderson BR, Silver ES, Richmond ME, Liberman L. Usefulness of arrhythmias as predictors of death and resource utilization in children with myocarditis. Am J Cardiol 2014;114:1400-5. https://doi.org/10.1016/j.amjcard.2014.07.074
  12. Abzug MJ, Michaels MG, Wald E, Jacobs RF, Romero JR, Sanchez PJ, et al. A randomized, double-blind, placebo-controlled trial of pleconaril for the treatment of neonates with enterovirus sepsis. J Pediatric Infect Dis Soc 2016;5:53-62. https://doi.org/10.1093/jpids/piv015

피인용 문헌

  1. Clinical characteristics of severe neonatal enterovirus infection: a systematic review vol.21, pp.1, 2019, https://doi.org/10.1186/s12887-021-02599-y