다중 PCR법으로 진단한 Verotoxin 생성 Escherichia coli O157:H7 출혈성 장염인 영아 1예
A Case of Verotoxin-producing Escherichia coli O157:H7 with Hemorrhagic Colitis in an Infant, Diagnosed by Multiplex PCR
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초록
장출형성 대장균(EHEC)는 소아연령에서 혈성설사를 일으키는 중요한 원인균이지만, 1세 미만 영아에서는 드물다. 저자들은 지역사회 획득성 장염의 원인균을 진단하는 다중 PCR로 verotoxin 양성 E. coli O157:H7에 의한 출혈성 장염을 진단하여 보고하고자 한다. 환자는 9개월 된 남아로 이틀간의 혈변을 주소로 내원하였다. 설사변에 다중 PCR을 실시하여verotoxin, O157, H7 등에 특이적인 증폭산물을 얻어서 verotoxin 생성 E. coli O157:H7 감염이 추정되었다. Sorbitol-MacConkey 한천배지에 무색의 E. coli가 배양되었고, O157 항체와 반응시켰을 때 양성이었다. 대변검체를 mitomycin C가첨가된 배지에 증균하여 실시한 verotoxin 효소면역법에서 양성이었으며 분리된 균주 또한 verotoxin 양성으로 verotoxin 생성 E. coli O157:H7에 의한 EHEC로 최종진단하였다. 환아의 이유식 재료인 흰 쌀죽, 당근, 양배추, 소고기 간 것 등모두 배양 음성이었고, 환아의 가족인 부모와 3살된 누나는 장염 증상이 없었다. 환아는 입원 당일 E. coli O157:H7 장염으로 진단하여 cefdinir 투여를 하루 만에 중단하였으며, 입원 2일째부터 배양과 독소 검사는 음성으로 전환되었다. 향후직접검체에서 다양한 설사 원인균을 신속하게 검출할 수 있는 다중 PCR 검사가 EHEC의 조기 진단과 적절한 치료에유용할 것이다. [대한임상미생물학회지 2010;13:85-89]
Abstract
Enterohemorrhagic Escherichia coli (EHEC) is an important cause of bloody diarrhea in children, but is considered to be rare in infants. Herein, a case of infant hemorrhagic colitis of verotoxin-producing E. coli O157:H7 diagnosed by multiplex PCR is reported. A nine-month-old boy was admitted to our hospital with bloody diarrhea for the previous two days. Multiplex PCR using SeeplexⓇ Diarrhea ACE Detection Kit (Seegene, Seoul, Korea) was directly applied to the stool specimens. Amplified bands specific for verotoxin,O157, and H7 indicated the presence of O157:H7 EHEC. The stool specimens were inoculated on sorbitol-MacConkey agar (SMA) and tryptic soy broth containing mitomycin C (TSB-M). Colorless colonies on sorbitol-MacConkey agar were O157-positive. TSB-M enrichment cultures of the stool specimen and the isolates were positive for verotoxin according to an enzyme immunoassay (EIA). The prepared ingredients of baby foods for the patient including ground meat, chopped carrot, chopped cabbage, and white rice porridge showed no EHEC on TSB-M and SMA. The patient’s parents and three-year-old sister did not recently have any gastrointestinal symptoms. Cefdinir was administered for one day and was ceased after diagnosis of EHEC colitis. The stool culture and verotoxin assay were negative on the second day of hospitalization. Application of multiplex PCR and verotoxin EIA directly to diarrheal stool warrants the rapid diagnosis and appropriate treatment of EHEC colitis. (Korean J Clin Microbiol 2010;13:85-89)
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