Journal of the Korean Child Neurology Society (대한소아신경학회지)

The Korean Child Neurology Society (대한소아신경학회)
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Reconsideration of Diagnostic Lumbar Puncture in Childhood Enteroviral Meningitis

소아 엔테로바이러스 뇌수막염에서 진단적 요추 천자의 재고

  • Nam, Ji Woo (Department of Pediatrics, Eulji University Hospital) ;
  • Kim, Tae Soon (Department of Pediatrics, Eulji University Hospital) ;
  • Kim, Ju Young (Department of Pediatrics, Eulji University Hospital) ;
  • Kim, Jon Soo (Department of Pediatrics, Chungbuk National University Hospital)
  • 남지우 (을지대학교병원 소아청소년과) ;
  • 김태순 (을지대학교병원 소아청소년과) ;
  • 김주영 (을지대학교병원 소아청소년과) ;
  • 김존수 (충북대학교병원 소아청소년과)
  • Received : 2018.08.05
  • Accepted : 2018.09.02
  • Published : 2018.09.30
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Abstract

Purpose: Despite the fact that enteroviral meningitis is the most common cause of meningitis in children with signs of meningeal irritation and has benign course, most clinicians routinely perform an invasive lumbar puncture (LP) that result in inadequate antibiotic therapy and unnecessary long-term hospitalization. This study was aimed to compare the clinical characteristics of childhood enteroviral meningitis according to LP. Methods: Children over 2 years of age who can clearly express signs of meningeal irritation in the pediatric department of Eulji university hospital from July 2013 and August 2016 were enrolled. The patients were diagnosed by reverse transcriptase polymerase chain reaction in stool and/or cerebrospinal fluid. We retrospectively reviewed their clinical records. Results: A total of 257 patients were diagnosed with enterovirus meningitis and median age was 6.3 (2.1-7.9) years. One hundred fifteen patients (44.7%) with confirmed enterovirus in the stools underwent supportive care without LP. Mostly, there was no statistically significant difference in age, sex, clinical symptoms, except gastrointestinal involvement (abdominal pain, diarrhea), and serologic findings when compared with patients who underwent LP. But patients who underwent LP had longer hospital stay (4 vs 3 days, P<0.001). Four of them (2.8%) were readmitted with back pain and persistent headache, probably related to LP procedure. All patients were discharged without neurologic complications. Conclusion: Rapid detection of enteroviruses in stool specimens that can be easily obtained in children with signs of meningeal irritation may reduce invasive LP.

목적: 엔테로바이러스 뇌수막염은 뇌막염의 징후가 있는 어린이에게서 가장 흔한 원인이며 양성 경과를 보임에도 불구하고 대부분의 임상의는 부적절한 항생제 치료와 불필요한 장기간 입원이 초래되는 침습성 요추 천자를 관습적으로 시행한다. 이 연구는 요추 천자 유무에 따른 소아기 엔테로바이러스 뇌수막염의 임상 양상을 비교하고자 하였다. 방법: 2013년 7월부터 2016년 8월까지 을지대학교병원 소아청소년과에 뇌막 자극 징후가 명확했던 2세 이상 환아를 대상으로 하였다. 뇌척수액 또는 대변검체에서 RT-PCR을 시행하여 엔테로바이러스 감염을 확인하였고 이들의 임상 기록을 후향적으로 분석하였다. 결과: 엔테로바이러스 뇌수막염으로 진단받은 환자는 총 257명으로 중앙값은 6.3 (2.1-17.9)세였다. 요추 천자를 시행하지 않고, 분변검체에서 엔테로바이러스가 확인된 115명의 환자(44.7%)는 요추 천자 없이 대증 치료를 받았다. 요추 천자를 시행 받은 환자와 비교했을 때, 위장관증상(복통, 설사)을 제외하고는 연령, 성별, 다른 임상증상 및 혈청학적 소견에서는 통계적으로 유의한 차이가 없었다. 그러나 요추 천자를 시행 받은 환자들은 입원 기간이 더 길었다. 그들 중 4명(2.8%)은 허리 통증과 지속적인 두통으로 재입원하였으며, 이는 요추 천자 시술과 관련이 있었다. 모든 환자는 신경학적 합병증 없이 퇴원하였다. 결론: 뇌막자극징후를 보이는 소아에서 쉽게 얻을 수 있는 분변검체를 통해 엔테로바이러스를 신속히 진담함으로써 침습적 요추 천자 시술을 줄일 수 있을 것이다.

Keywords

References

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