열성 경련과 바이러스 감염의 연관성에 대한 연구
A Correlation Analysis between Febrile Seizures and Viral Infections
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목 적 : 소아에서의 바이러스 감염은 흔한 질환으로 열성 경련과의 연관성에 대해 조사하여 보고, 이에 대한 예방 및 대처로 불필요한 항생제 사용을 줄이고, 소아의 신경학적 발달에 도움이 되고자 본 연구를 시행하였다. 방 법 : 2009년 9월부터 2010년 8월까지 을지대학병원 소아청소년과에 발열을 동반한 경련을 주소로 내원한 환아를 대상으로 임상 증상과 징후, 병력, 신체 진찰, 혈액 검사, 소변 검사, 대변 검사 및 세균 배양 검사, 흉부 방사선 검사를 시행하였고, 의심되는 경우 바이러스 검사 및 뇌영상 검사, 뇌파검사, 뇌척수액 검사를 시행하였다. 결 과 : 전체 대상 환자는 114명으로 남녀 비는 2.3:1이었고, 평균 연령은 27.1개월로 18-24개월에서 발병률이 가장 높았다. 경련의 유형은 전신 발작이 111명(97.4%), 부분발작이 3명(2.6%)이었다. 경련 지속시간은 1분에서 5분 미만이 81명(71.1%), 1분 미만 19명(16.7%), 15분 미만 11명(9.6%), 15분 이상은 3명(2.6%)이었다. 발열의 원인은 미상 41명(36.0%), 상기도 감염 27명(23.7%), 급성 위장관염 16명(14.0%), 세기관지염 15명(13.2%), 폐렴 10명(8.9%), 급성 후두염 4명(3.5%), 요로감염 1명(0.1%) 순이었다. 바이러스 검사에서 RSV 7명, Rhinovirus 6명, Parainfluenza virus 4명, Adenovirus 3명, Influenza A virus 2명, Influenza B virus 1명, Coronavirus 2명, Metapneumovirus 1명, Rotavirus 6명, Enterovirus가 4명에서 검출되었다. 세균 검사에서 Echerichia coli와 Salmonella group D가 각각 1명에서 나왔고 그 외 98.2%에서 음성이었으나 86명(75.4%)에서 항생제를 처방하였다. 뇌파검사는 51명에서 시행하였고 2명에서 이상소견을 보였다. 결 론 : 열성 경련의 원인으로 바이러스 감염 질환과의 연관성이 높음을 인식하고 신속한 진단과 적절한 치료를 행하며 불필요한 항생제 사용을 줄여야겠다.
Abstract
Purpose : Viral infections are common in children,. This study was aimed to identify the correlation between febrile seizures and virus infections, to reduce the use of antibiotics and to help the normal development. Methods : We studied 114 children with the chief complaint of febrile seizures who visited Eulji Medical University Hospital for from September, 2009 to August, 2010. Data included clinical findings, signs, routine laboratory testing and chest x-ray. Viral and bacterial studies, neuroimagings, electroencephalograms and cerebrospinal fluid studies were performed if clinically indicated. Results : A total of 114 patients were enrolled in the study. The male to female ratio was 2.3:1. The mean age was 27.1 months and incidence was high in patients from 18 to 24 months of age. Generalized seizure was 97.4% and partial seizure was 2.6% in seizure type. Seizures lasted from 1 to less than 5 min in 81 patients (71.1%); within 1 min in 19 (16.7%); from 5 to less than 15 min in 11 (9.6%); and 15 min or more in 3 (2.6%). The etiologies of fever were listed as follows; unknown in 41 patients (36.0%), URI in 27 (23.7%), gastroenteritis in 16(14.0%), bronchiolitis in 15 (13.2%), pneumonia in 10 (8.9%), croup in 4 (3.5%) and UTI in 1 (0.1%). Among 74 patients in which viral studies performed, 36 patients were positive ; RSV(7), Rhinovirus (6), Parainfluenza virus (4), Adenovirus (3), Influenza A virus (2), Influenza B virus (1), Coronavirus (2), Metapneumovirus (1), Rotavirus (6) and Enterovirus (4). Bacterial cultures were negative in 98.2% but antibiotics were prescribed in 74.5%. Abnormal findings in electroencephalograms were 2. Conclusion : The main cause of infection in children with febrile seizure was viral. Therefore a rapid viral testing would lead to an early diagnosis, less invasive investigations and a reduction in empiric antibacterial treatment.
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