소아기 엔테로바이러스 수막염의 연령별, 바이러스 혈청형별 임상양상
Clinical Characteristics of Childhood Enteroviral Meningitis according to Age and Viral Serotype
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목적: 무균성 수막염은 소아기에 흔한 질환으로 대부분 엔테로바이러스에 의해 발생한다. 엔테로바이러스는 혈청형별로 다양한 임상증상이 있다고 알려져 있다 . 본 연구는 2008년부터 2014년까지 엔테로로바이러스 수막염 환아의 연령군별, 혈청형군별, 임상양상의 차이를 알아보고자 하였다 . 방법: 2008년 1월부터 2014년 12월까지 전남대학교병원 소아청소년과에서 무균성 수막염으로 진단 후 치료받았던 18세 미만 소아 환아들의의무기록을 후향적으로 검토하였다 . 결과: 무균성 수막염 환아 655명 중,66.6%에서 엔테로바이러스 검사가 시행되었으며, 이 중 69.7%에서 바이러스가 검출되었고 52.6% 에서 혈청형을 확인할 수 있었다 . 검사 시행률은 연령군의 나이가 어릴수록 높았다( P<0.001). 두통 및 보챔은 연령군이 증가할수록 흔하였고, 호흡기 증상과 신경학적 증상은 영아기와 유아기에 빈번하였다(P<0.05). 세균성 수막염을 의심할 만한, 기준치 이상 척수액 백혈구수의 증가는신생아기와 영아기에 자주 관찰되었고,기준치 이상 척수액 단백의 증가는 사춘기에서 빈번하였다( P<0.05). 신생아기에서는 CB1이, 영아기 및 유아기에서는 EV71이 가장 빈번하게 검출되었다.발열은 E군에서, 두통 및 보챔 증상은 CB군과 EV71, 구토는 CB군에서 엔테로바이러스 수막염평균보다 빈도가 낮았고, 신경학적 증상은 EV71에서 빈번하였다( P<0.05). 기준치 이상 척수액 백혈구 수의 증가는CB군과 E군에서 빈번하였다( P<0.05). 결론: 엔테로바이러스 수막염은 연령군별, 혈청형군별로 임상양상과 검사 결과의 차이를 보였으며, 연령군에 따라 호발하는 혈청형의 빈도도유의한 차이를 보였다 .
Abstract
Purpose: Enterovirus is the most common cause of aseptic meningitis, and there are many different serotypes of enteroviruses that cause diverse clinical symptoms. This study compared the clinical characteristics of childhood enteroviral meningitis in different age groups and viral serotypes. Methods: Patients younger than 18 years who were diagnosed with aseptic meningitis in the Pediatric Department of Chonnam National University Hospital from January 2008 to December 2014 were enrolled. We retrospectively reviewed their clinical records. Results: Enterovirus was tested in 66.6% of 655 patients with aseptic meningitis, with the testing being more frequent in younger patients (P<0.001). Enterovirus was present in 69.7% of patients, and able to be serotyped in 52.6%. Headache and irritability were more frequent in older children, whereas respiratory and neurologic symptoms were more common in infants and early childhood (P<0.05). Marked pleocytosis in the cerebrospinal fluid (CSF) was more frequent in neonates and infants, whereas marked increases in CSF proteins were more common in adolescents (P<0.05). The most common enterovirus was coxsackievirus B1 (CB1) in neonates and enterovirus 71 (EV71) in infancy and early childhood. Compared with the mean frequencies of symptoms in enteroviral meningitis, less frequent symptoms were fever in echoviruses (Es), headache or irritability in CBs and EV71, and vomiting in CBs. Neurologic symptoms were frequent in EV71 (P<0.05). Marked CSF pleocytosis was more frequent in CBs and Es (P<0.05). Conclusion: The clinical characteristics and laboratory findings of childhood enteroviral meningitis differ with age and viral serotype. In addition, the prevalent enteroviral serotypes differ with age.
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