청소년 연령에서의 볼거리 뇌수막염 유행
An Outbreak of Mumps Meningitis Among Adolescents
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목적: 최근 대전지역에서 집단 발생한 청소년 연령에서의 볼거리뇌수막염에 대한 임상적 특징을 분석하고자 한다. 방법: 2012년 7월부터 2014년 6월까지 을지대학교병원에서 볼거리뇌수막염으로 진단받은 34명을 대상으로 의무기록을 후향적으로 조사하였다. 볼거리 감염환자와의 접촉, 뚜렷한 이하선 부종 및 혈청 또는 뇌척수액에서 볼거리 바이러스 특이 IgM 항체 유무, 그리고 뇌척수액내 백혈구 증가증 여부에 따라 진단하였다. 결과: 31명이 남자였고 3명이 여자로 남성 우세를 분명히 나타내었다. 환자의 중간 연령은 15.8세였고 모든 환자는 중학교 및 고등학교연령 그룹에 속하였다. 16명(47.1%)에서 일측성 유행성 이하선염이 있었고, 29명(85.3%)은 이하선 부종이후 뇌수막염으로 진단하였다. 모든 환자는 발열, 두통, 구역 또는 구토의 수막 자극 징후가 확인되었다. 6명(17.6%)은 고환염이 동반되었으며, 1명(2.9%)은 청력 소실이 발생하였다. 볼거리 바이러스 특이 IgM의 양성율은 혈청에서 총 34명중 17명(50.0%)이었으며, 뇌척수액에서는 34명 중 4명(11.8%)이었다. 입원기간을 포함한 질병의 총 지속 기간은 5일에서 21일이며 중앙값은 11일이었다. 중대한 신경학적 손상은 없었으나 퇴원 후 34명 중 5 명(14.7%)이 현기증을 호소하였고, 이로 인해 일상생활의 복귀가 지연되었다. 결론: 청소년 연령에서 발생한 최근의 볼거리 대유행은 좀 더 합병증이 동반되었다는 사실은 주목할 만하다. 상당한 사회경제적 손실을유발하는 볼거리 대유행에 대한 적극적인 예방이 필요할 것으로 사료된다.
Abstract
Purpose: We report sharp rise of incidence of mumps meningitis at our institute and describe the clinical manifestations, laboratory findings, and complications. Methods: This is a retrospective study involving 34 patients with mumps meningitis at Eulji University Hospital from July 2012 to June 2014. They were diagnosed by definite parotid gland swelling and leukocytosis in cerebrospinal fluid (CSF) study. Results: Nineteen (55.9%) of the 34 patients with mumps meningitis were confirmed as positive by the mumps virus-specific immunoglobulin M (IgM) antibody in serum or CSF and the remaining 15 patients (44.1%) were classified as probable cases. We identified 31 boys and 3 girls clearly showing male predominance. The median age of the patients was 15.8 years and all patients were in the middle school and high school age group. Sixteen patients (47.1%) had unilateral mumps and 29 patients (85.3%) were diagnosed with meningitis after parotid swelling. Six patients (17.6%) were accompanied by testicular involvement and one (2.9%) showed hearing loss. The positivity of mumps virus specific IgM was 17 of 34 (50.0%) in serum and 4 of 34 (11.8%) in CSF. The total duration of illness including hospitalization was 5 to 21 days, median being 11 days. There was no serious neurologic deficit but 5 of 34 (14.7%) complained dizziness after discharge. It caused delay in back-to-work. Conclusion: It is worthy to notice that recent outbreak of mumps among adolescents are more complicated. We need to be more aggressive about prevention of mumps outbreak which bring on substantial socioeconomic loss.
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