Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
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선천성심장병 환아에서의 Respiratory syncytial virus 감염례 관찰

Respiratory syncytial virus infection cases in congenital heart disease patients

  • 심우섭 (부천세종병원 소아청소년과) ;
  • 이재영 (가톨릭대학교 서울성모병원 소아청소년과) ;
  • 송진영 (부천세종병원 소아청소년과) ;
  • 김수진 (부천세종병원 소아청소년과) ;
  • 김성혜 (부천세종병원 소아청소년과) ;
  • 장소익 (부천세종병원 소아청소년과) ;
  • 최은영 (부천세종병원 소아청소년과)
  • 투고 : 2009.10.28
  • 심사 : 2010.03.02
  • 발행 : 2010.03.15
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초록

목 적 : RSV는 영아기에 세기관지염이나 폐렴을 일으키는 중요한 요인으로 알려져 있다. 건강한 영아에서는 RSV 감염으로 위중한 병을 일으키는 경우는 드물지만 선천성심장병과 관련된 심부전이나 청색증, 폐동맥고혈압의 상태에 있거나 조산 미숙 등과 관련된 만성폐질환 상태에 있는 영아의 경우 위중한 병을 일으킬 수 있다. 본 연구에서는 선천성심장병 소아와 비선천성심장병 소아에서 RSV 감염례를 조사하여 RSV 감염이 선천성심장병 환아에 미치는 영향에 대하여 조사하고자 하였다. 방 법 : 2003년 7월부터 2006년 6월까지 세종병원에 세기관지염이나 폐렴으로 입원한 343례의 환아의 비강 분비물에서 RSV 항원검사를 시행하여 RSV 감염에 의한 하기도염의 연령별 계절별 발생 양상을 조사하였다. RSV 감염된 하기도염 환아들에서 선천성심장병 환아의 여러 경우와 비심장병 환아의 입원 기간, 중환자 치료, 인공환기 치료 등 임상 경과를 비교하였다. 결 과 : RSV에 의한 하기도염은 어린 영아기에 많이 발생하고 있으며 온대지방에서는 겨울철에 유행하는 양상을 보이고 있다. RSV에 의한 하기도염 환아 중 선천성심장병 환아에서 비심장병 환아에 비하여 중증 감염이 많았고 장기입원을 보였다(P <0.01). 비교적 간단한 단순단락 병변인 ASD, PDA, VSD 등의 선천성심장병에서 심장수술로 교정되고 충분히 회복된 환자에서는 RSV에 의한 하기도염에서 비교적 짧은 입원기간과 가벼운 경과를 보여 비심장병 환아와 큰 차이가 없었다. 선천성심장병에 대한 완전교정 수술이나 단계적 고식수술 후에도 감염, 폐동맥고혈압, 판막역류, 혈관협착 등의 원인으로 심폐계에 상당한 문제가 남아있는 경우 RSV 감염시 비심장병 환아에 비하여 장기 입원을 보이고(P <0.01) 중증 경과를 보였다. 교정수술 받지 않은 상태의 선천성심장병을 가진 환아에서는 대부분 6개월 이내의 어린 나이에 RSV에 의한 하기도염이 발생하고 있으며 비심장병 환아에 비하여 장기 입원을 보이고(P <0.01) 중증 경과를 보였다. 선천성심장병 심장수술 후 1개월 이내의 회복기에 병원 감염을 포함하여 상당수의 RSV 감염이 발생하고 있음을 확인하였으며 이들은 심장수술 직후의 면역기능 저하와 관련하여 중증 감염으로 발전할 가능성이 있을 것으로 생각된다. 결 론 : 미교정 상태의 선천성심장병 환아와 교정 후에도 계속 심폐계에 문제가 남아있는 선천성심장병 환아에서 RSV 감염에 의해 중증 경과와 장기 입원이 초래될 수 있다. 선천성심장병 환아에서 이러한 RSV 감염의 피해를 줄이기 위해서는 RSV 감염으로 심각한 위험이 초래 될 수 있는 고위험 세부군의 파악과 이들에 대한 예방 항체 치료 등 적절한 예방 노력이 필요하다.

Purpose : Respiratory syncytial virus (RSV) is one of the main pathogens causing lower respiratory infections (LRI) in young children, usually of limited severity. However, in congenital heart disease (CHD) patients, one of the high-risk groups for RSV infection, RSV can cause serious illnesses and fatal results. To elucidate the effects of RSV infection in CHD patients, we observed RSV infection cases among CHD patients and non-CHD patients. Methods : On admission of 343 LRI patients over 3 years, 77 cases of RSV infection were detected by the RSV antigen rapid test of nasopharyngeal secretion. We compared RSV infection cases among groups of CHD and non-CHD patients. Results : During the winter season, RSV caused 20-0% of LRI admissions in children. In patients with completely repaired simple left to right (L-R) shunt diseases such as ventricular septal defect, atrial septal defect, and patent ductus arteriosus, RSV infections required short admission days similar to non-CHD patients. In patients with repaired CHD other than simple L-R shunt CHD, for whom some significant hemodynamic problems remained, RSV infection required long admission days with severe clinical course. In children with unrepaired CHD, RSV infection mostly occurred in early infant age, with long admission days. RSV infections within a month after cardiac surgery also required long admission days and severe clinical course. Conclusion : To avoid the tragedic outcome of severe RSV infection in the CHD patients, efforts to find the subgroups of CHD patients at high risk to RSV infection are needed, and effective preventive treatment should be applied.

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참고문헌

  1. Welliver RC. Review of epidemiology and clinical risk factors for severe RSV infection. J Pediatr 2003;143:112-7 https://doi.org/10.1067/S0022-3476(03)00508-0
  2. Noyola DE, Rodriguez-Moreno G, Sanchez-Alvarado J, Martinez-Wagner R, Ochoa-Zavala JR. Viral etiology of lower respiratory tract infections in hospitalized children in Mexico. Pediatr Infect Dis J 2004:23:118-23 https://doi.org/10.1097/01.inf.0000110269.46528.a5
  3. Noyola DE, Zuviri-Gonzlez A, Castro-Garca JA, Ochoa-Zavala JR. Impact of respiratory syncytial virus on hospital admissions in children younger than 3 years of age. J Infect 2007;54:180-4 https://doi.org/10.1016/j.jinf.2006.02.004
  4. Smyth RI, Openshaw PJ. Bronciolitis. Lancet 2006;368:312-22 https://doi.org/10.1016/S0140-6736(06)69077-6
  5. American Academy of Pediatrics, Committee of Infectious Diseases. Respiratory Syncytial Virus. In: Pickering LK, Baker CJ, Long SS, Mcmillan JA, eds. Red Book: 2006 Report of the committee on infectious diseases. 27th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2006:560-6
  6. Henrickson KJ, Hall CB. Diagnositic assays for respiratory syncytial virus disease. Pediatr Infect Dis J 2007:26:36-40 https://doi.org/10.1097/01.inf.0000247105.45185.13
  7. Navarro-Mar JM, Sanbonmatsu-Gmez S, Prez-Ruiz M, De La Rosa-Fraile M. Rapid detection of respiratory viruses by shell vial assay using simultaneous culture of HEp-2, LLCMK2, and MDCK cells in a single vial. J Clin Microbiol 1999;37:2346-7
  8. Meberg A, Bruu AL. Respiratory syncytial virus infections in congenital heart defects - hospitalizations and costs. Acta Pediatrica 2006;95:404-6 https://doi.org/10.1080/08035250500447944
  9. MacDonald NE, Hall CB, Suffin SC, Alexson C, Harris TJ, Manning JA. Respiratory syncytial virus infection in infants with congenital heart disease. N Engl J Med 1982;307:397-400 https://doi.org/10.1056/NEJM198208123070702
  10. Fixler DE. Respirator syncytial virus infection in children with congenital heart disease: a review. Pediatr Cardiol 1996;17:163-8 https://doi.org/10.1007/BF02505206
  11. Bowles NE, Ni J, Kearney DL, Pauschinger M, Schultheiss HP, McCarthy R, et al. Detection of viruses in myocardial tissues by polymerase chain reaction. evidence of adenovirus as a common cause of myocarditis in children and adults. J Am Coll Cardiol 2003;42:466-72 https://doi.org/10.1016/S0735-1097(03)00648-X
  12. DePalma L, Yu M, McIntosh CL, Swain JA, Davey RJ. Changes in lymphocyte subpopulations as a result of cardiopulmonary bypass. J Thorac Cardiovasc Surg 1991;101:240-4
  13. Nguyen DM, Mulder DS, Shennib H. Effect of cadiopulmonary bypass on circulationg lymphocyte function. Ann Thorac Surg 1992; 53: 611-6 https://doi.org/10.1016/0003-4975(92)90319-Y
  14. Tajima K, Yamamoto F, Kawazoe K, Nakatani I, Sakai H, Abe T, Kawashima Y. Cardiopulmonary bypass and cellular immunity: changes in lymphocyte subsets and natural killer cell activity. Ann Thorac Surg 1993; 55: 625-30 https://doi.org/10.1016/0003-4975(93)90265-J
  15. Chin J, Magoffin RL, Shearer LA, Schieble JH, Lennette EH. Field evaluation of a respiratory syncytial virs vaccine and a trivalent parainfluenza virus vaccine in a pediatric population. Am J Epidemiol 1969; 89: 449-63
  16. Kapikian AZ, Mitchell RH, Chanock RM, Shvedoff RA, Steward CE. An epidemiologic study of altered clinical reactivity to respiratory syncytial (RS) virus infection in children previously vaccinated with an inactivated RS virus vaccine. Am J Epidemiol 1969; 89: 405-21
  17. Jafri HS. Role of chemokines in RSV disease. Pediatr Infect Dis J 2002; 21: 454-6 https://doi.org/10.1097/00006454-200205000-00032
  18. Varga SM, Braciale TJ. RSV-induced immunopathology: dynamic interplay between the virus and host immune response. Virology 2002; 295: 203-7 https://doi.org/10.1006/viro.2002.1382
  19. Openshaw PJ, Culley FJ, Olszewska W. Immunopathogenesis of vaccine-enhanced RSV disease. Vaccine 2002;20:27-31 https://doi.org/10.1016/S0264-410X(01)00301-2
  20. Piedra PA. Clinical experience with respiratory syncytial virus vaccines. Pediatr Infect Dis J 2003; 22:94-9 https://doi.org/10.1097/00006454-200301000-00025
  21. Committee on Infectious Diseases and Committee on Fetus and Newborn. Respiratory syncytial virus immune globulin intravenous: indication for use. Pediatrics 1997;99:645-50 https://doi.org/10.1542/peds.99.4.645
  22. Committee on Infectious Diseases and Committee on Fetus and Newborn. Prevention of respiratory syncytial virus infections infections: Indications for the use of Palivizumab and update on the use of RSV-IGIV. Pediatrics 1998;102:1211-6 https://doi.org/10.1542/peds.102.5.1211
  23. The IMpact-RSV Study Group. Palivizumab, a humanized respiratory syncytial virus monoclonal antibody, reduces hospitalization from respiratory syncytial virus infection in highrisk infants. Pediatrics 1998; 102: 531-7 https://doi.org/10.1542/peds.102.3.531
  24. Vujovic O, Mills J. Preventive and therapeutic strategies for respiratory syncytial virus infection. Curr Opin Pharmacol 2001;1:497-503 https://doi.org/10.1016/S1471-4892(01)00087-X
  25. Simoes EA, Sondheimer HM, Top FH, Meissner HC, Welliver RC, Kramer AA, et al. Respiratory syncytial virus immune globulin for prophylaxis against respiratory syncytial virus disease in infants and children with congenital heart disease. J Pediatr 1998; 133: 492-9 https://doi.org/10.1016/S0022-3476(98)70056-3
  26. Committee on Infectious Diseases and Committee on Fetus and Newborn. Revised indications for the use of palivizumab and respiratory syncytial virus immune globulin intravenous for the prevention of respiratory syncytial virus infections. Policy statement. Pediatrics 2003;112:1442-6 https://doi.org/10.1542/peds.112.6.1442
  27. Meissner HC, Long SS. Revised indications for the use of palivizumab and respiratory syncytial virus immune globulin intravenous for the prevention of respiratory syncytial virus infections. Technical report. Pediatrics 2003; 112: 1447-52 https://doi.org/10.1542/peds.112.6.1447
  28. Paes BA. Current strategies in the prevention of respiratory syncytial virus disease. Paediatr Respir Rev 2003;4:21-7 https://doi.org/10.1016/S1526-0542(02)00306-8
  29. Feltes TF, Cabalka AK, Messner HC, Piazza FM, Carlin DA, Top FH, et al. Palivizumab prophylaxis reduces hospitalization due to rispiratory syncytial virus in young children with hemodynamically significant congenital heart disease. J Pediatr 2003;143:532-40 https://doi.org/10.1067/S0022-3476(03)00454-2
  30. Yount LE, Mahle WT. Economic analysis of Palivizumab in infants with congenital heart disease. Pediatrics 2004;114:1606-11 https://doi.org/10.1542/peds.2004-0224
  31. Meissner HC. Selected population at increased risk from respiratory syncytial virus infection. Pediatr Infect Dis J 2003;22:40-5 https://doi.org/10.1097/00006454-200302001-00006

피인용 문헌

  1. Assessment of the prevalence of congenital heart disease in children with pneumonia in tertiary care hospital: A cross-sectional study vol.73, pp.None, 2022, https://doi.org/10.1016/j.amsu.2021.103111