Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
권호 표지

Mycoplasma pneumoniae 유행 시기(2003년 하반기)의 항체 양전율에 대한 조사

A Study of Antibody Conversion Rate During a Mycoplasma pneumoniae Epidemic Period(the Second Half of 2003)

  • 김도균 (서울대학교 의과대학 소아과학교실) ;
  • 유진호 (서울대학교 의과대학 소아과학교실) ;
  • 유영 (서울대학교 의과대학 소아과학교실) ;
  • 고영률 (서울대학교 의과대학 소아과학교실)
  • Kim, Do Kyun (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Yu, Jinho (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Yoo, Young (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Koh, Young Yull (Department of Pediatrics, Seoul National University College of Medicine)
  • 투고 : 2004.11.19
  • 심사 : 2005.01.06
  • 발행 : 2005.05.15
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

목 적 : 소아 호흡기 감염의 주된 병원체인 M. pneumoniae는 일반적으로 4 내지 7년의 유행 주기를 가지는 것으로 알려져 있으나 M. pneumoniae 유행 기간 중 항체 양전율에 대한 정확한 국내 보고는 아직까지 없는 실정이다. 이에 저자들은 2003년 하반기 M. pneumoniae 유행 기간 전후로 항체 추적 검사를 시행하여 항체 양전율을 조사하고 나이, 초기 항체가, 아토피 유무가 항체 양전율에 미치는 영향을 알아보고자 본 연구를 시행하였다. 방 법 : 2003년 상반기 본원 외래를 방문하여 Mycoplasma 항체를 측정한 환아 중 혈청 항체가가 음성, 1 : 40, 1 : 80이었던 환아 191명을 대상으로 2004년 상반기에 추적 검사를 실시하였다. 추적 검사상 항체 역가가 4배 이상 증가한 경우를 항체 양전으로 정의하였고 항체 양전 여부에 따라 항체 양전군과 항체 비양전군으로 구분하였다. 혈청 항체 검사는 Serodia-Myco II 입자 응집법을 사용하여 시행하였다. 결 과 : 대상 환아들의 평균 나이는 $6.6{\pm}2.7$세였다. 남여 수는 각각 137명과 54명이었고 4세 이상 환아 중 아토피로 분류된 환아는 75명(44.6%)이었다. 대상 환아 중 항체 양전을 보인 환아는 83명(43.5%)이었다. 항체 양전군과 비양전군의 나이, 성별, 아토피 유무를 각각 비교하였을 때 두 군간의 유의한 차이는 보이지 않았다. 대상 환아들을 나이에 따라 네 군으로 나누어 비교하였을 때 각 군 사이 유의한 항체 양전율의 차이는 없었다. 초기 항체가가 음성, 1 : 40, 1 : 80이었던 환아들에서 항체 양전율은 각각 45.5%, 46.3%, 26.1%로 각 군 간 항체 양전율의 유의한 차이는 보이지 않았다. 아토피군과 비아토피군으로 나누어 비교하였을 때 항체 양전율은 각각 40.0%, 48.4%로 통계적으로 유의한 차이는 관찰되지 않았다. 결 론 : 2003년 하반기의 M. pneumoniae 유행 시기에 항체 양전율은 43.5%로 관찰되었으며 나이, 초기 항체가, 아토피 유무에 따른 항체 양전율의 차이는 없었다. 위 결과로 미루어 보아 M. pneumoniae 유행 시기에 소아 연령의 상당수에서 M. pneumoniae 감염에 이환되는 것으로 생각되며 M. pneumoniae의 혈청학적 역학 연구에 항체 양전율 조사가 유용하게 쓰일 수 있을 것으로 사료된다.

Purpose : This study was designed to estimate the prevalence of Mycoplasma pneumoniae infection during an epidemic period by means of examining the antibody conversion rate and to investigate the association of the antibody conversion with age, initial antibody titer, and atopy. Methods : We chose 191 children whose antibody titer to M. pneumoniae was negative, 1 : 40, or 1 : 80 during the first half of 2003. After the second half of 2003 when the M. pneumoniae epidemic occurred, follow-up collection of sera was performed during the first half of 2004. M. pneumoniae antibody titer was measured by Serodia-Myco II particle agglutination test. Results : Of 191 children, antibody conversion was detected in 83 children(43.5 percent). No significant difference was found between the conversion and non-conversion group with respect to age, sex and atopy. Dividing the subjects into four groups by age, results on the antibody conversion rate revealed no significant differences between the groups. Assessed by initial antibody titer, a diminished trend of conversion rate was observed in children with 1 : 80 titer but the difference was not significant. There was no significant difference in the antibody conversion rate between atopic and non-atopic children. Conclusion : Based on the antibody conversion rate in this study, the prevalence of M. pneumoniae infection during an epidemic period was estimated to be 43.5 percent. This high infection rate suggests that during an epidemic, we should bear in mind M. pneumoniae as an important etiologic agent for respiratory infection in children.

키워드

참고문헌

  1. Brunner H. Mycoplasma pneumoniae infection. Isr J Med Sci 1981;17:516-23
  2. Clyde WA Jr. Clinical overview of typical Mycoplasma pneumoniae infection. Clin Infect Dis 1993;17 suppl 1:32-6 https://doi.org/10.1093/clinids/17.1.32
  3. Ieven M, Ursi D, Van Bever H, Quint W, Neisters HGM, Goossens H. Detection of Mycoplasma pneumoniae by two polymerase chain reactions and role of M. pneumoniae in acute respiratory tract infections in pediatric patients. J Infect Dis 1996;173:1445-52 https://doi.org/10.1093/infdis/173.6.1445
  4. Lind K, Benzon MW, Jensen JS, Clyde WA Jr. A seroepidemiological study of Mycoplasma pneumoniae infections in Denmark over the 50-year period 1946-1995. Eur J Epidemiol 1997;13:581-6 https://doi.org/10.1023/A:1007353121693
  5. Ito I, Ishida T, Osawa M, Arita M, Hashimoto T, Hongo T, et al. Cultural verified Mycoplasma pneumoniae pneumoma m Japan: a long-term observation from 1979-99. Epidemiol Infect 2001;27:365-7
  6. Foy HM, Kenney GE, Cooney MK, Allan ID. Long-term epidemiology of infections with Mycoplasma pneumoniae. J Infect Dis 1979;139:681-7 https://doi.org/10.1093/infdis/139.6.681
  7. Park HY, Woo CW, Choung JT, Son CS, Tockgo YC. Trend of the Mycoplasma pneumoniae : during recent 9 years period. Pediatr Allergy Respir Dis 1995;5:49-59
  8. Hong JY, Nah SY, Nam SG, Choi EH, Park JY, Lee HJ. Occurrence of Mycoplasma pneumoniae pneumonia m Seoul, Korea, from 1986 to 1995. J Korean Pediatr Soc 1997:40:607-13
  9. Kang KS, Woo H. Pattern of occurrence of Mycoplasma pneumoniae pneumonia in admitted children: southern central Korea, from 1989 to 2002. J Korean Pediatr Soc 2003; 46:474-9
  10. Leland DS, Barth KA, Cunningham EB. Comparison of the Seradyn Color Vue passive agglutination test and complement fixation for detection of Mycoplasma pneumoniae antibodies. J Clin Microb 1993;31:1013-5
  11. Daxboeck F, Krause R, Wenisch C. Laboratory diagnosis of Mycoplasma pneumoniae infection. Clin Microbiol Infect 2003;9:263-7 https://doi.org/10.1046/j.1469-0691.2003.00590.x
  12. Rastawicki W, Kaluzewski S, Jagielski M. Occurrence of serologically verified Mycoplasma pneumoniae infections m Poland in 1970-1995. Eur J Epidemiol 1998;14:37-40
  13. Lind K, Bentzon MW. Ten and a half years seroepidemiology of Mycoplasma pneumoniae infection in Denmark. Epidemiol Infect 1991;107:189-99 https://doi.org/10.1017/S0950268800048810
  14. Hosker HS, Tam JS, Chain CH, Lai CK. Mycoplasma pneumoniae infection in Hong Kong - Clinical and Epidemiological Features during and Epidemic. Respiration 1993;60:237 -40 https://doi.org/10.1159/000196206
  15. Taylor-Robinson D. Infections due to species of Mycoplasma and Ureaplasma : an update. Clin Infect Dis 1996;23: 671-82 https://doi.org/10.1093/clinids/23.4.671
  16. Broughton RA. Infections due to Mycoplasma pneumoniae in childhood. Pediatr Infect Dis 1986:5:71-85 https://doi.org/10.1097/00006454-198601000-00014
  17. Layani-rnilon MP, Gras I, Valette M, Luciani J, Stagnara J, Ayrnard M, et al. Incidence of upper respiratory tract Mycoplasma pneumoniae infections among outpatients in Rhone-Alpes, France, During five successive winter periods. J Clin Microbiol 1999;37:1721-6
  18. Evatt BC, Dowdle WR, Johnson M. Epidemic Mycoplasma pneumoniae pneumonia. N Engl J Med 1971;285:374-8 https://doi.org/10.1056/NEJM197108122850704
  19. Kwon HO, Lee JH. Epidemic outbreak of Mycoplasma pneumoniae pneumonia in Korea, 2003. Proceedings of the 54th Annual Fall Meeting of Korean Pediatric Society; 2004 Oct 22-24; Seoul. Seoul: Korean Pediatric Society, 2004:294
  20. Moule JH, Caul EO, Wreghitt TG. The specific IgM response to Mycoplasma pneumoniae infection: interpretation and application to early diagnosis. Epidemiol Infect 1987;99: 685-92 https://doi.org/10.1017/S0950268800066541
  21. Ghosh K, Clements GB. Surveillance of Mycoplasma pneumoniae infections in Scotland 1986-1991. J Infect 1992;25: 221-7 https://doi.org/10.1016/0163-4453(92)94196-5
  22. Fernald GW, Collier AM, Clyde WA. Respiratory infections due to Mycoplasma pneumoniae in infants and children. Pediatrics 1975;55:327-35
  23. Sakurai N, Nagayama Y, Honda A, Makuta M, Yamamoto K, Kojima S. Mycoplasma pneumoniae and other pathogens in the aetiology of lower respiratory tract infections among Japanese children. J Infect 1988;16:253-61 https://doi.org/10.1016/S0163-4453(88)97604-9
  24. Srifuengfung S, Techachaiwiwat W, Dhiraputra C. Serological study of Mycoplasma pneumoniae infections. J Med Assoc Thai 2004;87:935-8
  25. Barker CE, Sillis M, Wreghitt TG. Evaluation of Serodia Myco II particle agglutination test for detection Mycoplasma pneumonae antibody: comparison with \mu -capture ELISA and indirect immunofluorescence. J Clin Pathol 1990;43:163-5 https://doi.org/10.1136/jcp.43.2.163
  26. Foy HM, Kenny GE, Cooney MK, Allan ID, van Belle G. Naturally acquired immunity to pneumonia due to Mycoplasma pneumoniae. J Infect Dis 1983;147:967-73 https://doi.org/10.1093/infdis/147.6.967
  27. Hahn DL, McDonald R. Can acute Chlamydia pneumoniae respiratory tract infection initiate chronic asthma? Ann Allergy Asthma Immunol 1998;81:339-44 https://doi.org/10.1016/S1081-1206(10)63126-2
  28. Cunningham AF, Johnston SL, julious SA, Lampe FC, Ward ME. Chronic Chlamydia pneumoniae infection and asthma exacerbation in children. Eur Respir J 1998;11:345-9 https://doi.org/10.1183/09031936.98.11020345
  29. Cook PJ, Davies P, Tunnicliffe W, Ayres JG, Honeybourne D, Wise R. Chlamydia pneumoniae and asthma. Thorax 1998;53:254-9 https://doi.org/10.1136/thx.53.4.254
  30. Gencay M, Rudiger JJ, Tamm M, Soler M, Perruchoud AP, Roth M. Increased frequency of Chlamydia pneumoniae antibodies in patients with asthma. Am J Respir Crit Care Med 2001;163:1097-100 https://doi.org/10.1164/ajrccm.163.5.2003162
  31. Yano T, Ichikawa Y, Komatu S, Arai S, Oizumi K. Association of Mycoplasma pneumoniae antigen with initial onset of bronchial asthma. Yano T, Ichikawa Y, Komatu S, Arai S, Oizumi K. Association of Mycoplasma pneumoniae antigen with initial onset of bronchial asthma. Am J Respir Crit Care Med 1994; 149:1348-53 https://doi.org/10.1164/ajrccm.149.5.8173777
  32. Biscardi S, Lorrot M, Marc E, Moulin F, BoutonnatFaucher B, Helibronner C, et 31. Mycoplasma pneumoniae and asthma in children. Clin Infect Dis 2004;38:1341-6 https://doi.org/10.1086/392498
  33. Kraft M, Cassell GH, Henson JE, Watson H, Williamson J. Marmion BP, et al. Detection of Mycoplasma pneumoniae in the airways of adults with chronic asthma. Am J Respir Crit Care Med 1998;158:998-1001 https://doi.org/10.1164/ajrccm.158.3.9711092
  34. Lieberman D, Printz S, Ben-Yaakov M, Lazarovich Z, Ohana B, Friedman MG, et al. Atypical pathogen infection in adults with acute exacerbation of bronchial asthma. Am J Respir Crit Care Med 2003;167:406-10 https://doi.org/10.1164/rccm.200209-996OC
  35. Esposito S, Blasi F, Arosio C, Fioravanti L, Fagetti L, Droghetti R, et al. Importance of acute Mycoplasma pneumoniae and Chlamydia pneumoniae infections in children with wheezing. Eur Respir J 2000;16:1142-6 https://doi.org/10.1034/j.1399-3003.2000.16f21.x
  36. Ferrari M, Poli A, Olivieri M, Verlato G, Tardivo S, Nicolis M, et al. Respiratory symptoms, asthma, atopy and Chlamydia pneumoniae IgG antibodies in a general population sample of young adults. Infection 2002;30:203-7 https://doi.org/10.1007/s15010-002-2143-9