Enterovirus 71에 의해 발생된 수막척수뇌염이 합병된 수족구병 5례
Hand Foot Mouth Disease with Meningomyeloencephalitis Caused by Enterovirus 71
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우리나라는 인구밀도가 높고, 영아 시기부터 아이를 보육 시설에 맡기는 경우가 많으며 해외여행의 빈도도 점차 증가하고 있어 수족구병의 급속한 전파 및 유행의 가능성이 크다. 손씻기 등의 개인 위생 관리는 물론, 바이러스의 전파가 쉽게 이루어질 수 있는 가정, 보육시설, 놀이터, 여름 캠프, 병원 내에서의 철저한 위생관리도 필요하다. 2009년 5월에 사망 사례 보고 이후 많은 부모들이 수족구병에 대해 막연한 두려움을 느끼고 있다. 이에 저자들은 엔테로바이러스 71에 의한 신경학적 합병증이 동반되었던 수족구병 환자들에서 면역글로불린 사용이나 대증요법으로 후유증 없이 완전히 회복된 5례를 경험 하였고, 이에 따라 엔테로바이러스 71에 의한 수족구병의 심각성에 대해 인식을 높이고, 특히 신경학적 검사가 어려운 어린 연령에서 자세한 문진이 필요하며, 엔테로바이러스 감염 환자에서 신경학적 합병증의 발생 여부를 면밀히 감시해야 함을 강조하고자 본 증례를 보고하는 바이다.
Abstract
Hand-foot-and-mouth disease (HFMD) is a viral illness with a distinct clinical presentation of oral and characteristic distal extremity lesions. It is caused by members of the enterovirus genus, namely, coxsackievirus A16 or enterovirus 71. HFMD is more severe in infants and children than adults, but generally, the disease has a mild course and is self-limiting. However, in recent epidemiology of HFMD in Asia, severe cases with complications have been reported. Enterovirus 71 may cause myocarditis, pneumonia, and severe neurological complications such as brainstem encephalitis, aseptic meningitis, acute flaccid paralysis, meningoencephalitis, meningomyeloencephalitis, and even death. A large outbreak of HFMD in Taiwan and Singapore caused by enterovirus 71 had a high mortality rate; the deaths resulted from pulmonary hemorrhage, interstitial pneumonitis, or brainstem encephalitis. HFMD was also epidemic in Korea in the spring of 2010. Severe cases with complications including neurological complications and death have been reported in HFMD patients, thus it has become a public health issue. We report five children who had severe HFMD caused by enterovirus 71 with meningomyeloencephalitis which caused a disturbance in consciousness, motor weakness, strabismus, and voiding difficulty. There was no mortality, and no patients exhibited sequelae.
참고문헌 (25)
- Feigin RD, "Textbook of pediatric infectious disease. 2nd ed. Philadelphia", pp.1729~1735 (1987), WB Saunders Co
- Chang LY, "Risk factors of enterovirus 71 infection and associated hand, foot, and mouth disease", herpangina in children during an epidemic in Taiwan, 2002, pp.109, e88~
- Chong CY, "Hand, foot and mouth disease in Singapore: a comparison of fatal and non-fatal cases", Acta Paediatr, 92, pp.1163~1169 (2003)
- Korea centers for Disease Control and Prevention, "Case reports and genetic identification of serious infections by enterovirus 71 in Korea, 2009", Public Health Weekly Report, 2, pp.328~329 (2009)
- Ryu WS, "Clinical and Etiological Characteristics of Enterovirus 71-Related Diseases during a Recent 2-Year Period in Korea", JOURNAL OF CLINICAL MICROBIOLOGY, 48, pp.2490~2494, AMER SOC MICROBIOLOGY
- 조혜경, "Enterovirus 71-associated hand, foot and mouth diseases with neurologic symptoms, a university hospital experience in Korea, 2009", Korean Journal of Pediatrics, 53(5), pp.639~643 (2010), 대한소아과학회
- 김현경, "급성 이완성 마비 증상을 보인 엔테로바이러스 71 감염", 대한소아신경학회지, 19(1), pp.61~66 (2011), 대한소아신경학회
- Gilbert GL, "Outbreak of entero- virus 71 infection in Vistoria, Australia, with a high incidence of neurologic involvement", Pediatr Infect Dis J, 7, pp.484~488 (1988)
- Chomaitree T, "Schwalenstocker E. Enterovirus 71 infection: Report of an outbreak with two cases of paralysis and a review of the literature", Pediatr, 67, pp.489~493 (1981)
- Wang SM, "Enterovirus 71: epidemiology, pathogenesis and management", Expert Rev Anti Infect Ther, 7, pp.735~742 (2009)
- Ooi MH, "Clinical features, diagnosis, and management of enterovirus 71", Lancet Neurol, 9, pp.1097~1105 (2010)
- Gilbert GL, "Outbreak of enterovirus 71 infection in Victoria, Australia, with a high incidence of neurologic involvement", Pediatr Infect Dis J, 7, pp.484~488 (1988)
- Chumakov M, "Enterovirus 71 isolated from cases of epidemic poliomyelitis-like disease in Bulgaria", Arch Virol, 60, pp.329~340 (1979)
- Ishmaru Y, "Outbreak of hand, foot and mouth disease by enterovirus 71", Arch Dis Child, 55, pp.583~588 (1980)
- Samuda GM, "Monoplegia caused by enterovirus 71: an outbreak in Hong Kong", Pediatr Infect Dis, 6, pp.206~208 (1987)
- Melnick JL, "Enterovirus type 71 infections; a varied clinical pattern sometimes mimicking paralytic poliomyelitis", Rev Infect Dis, 6(2), pp.387S~390S (1984)
- Huang CC, "Neurologic complications in children with enterovirus 71 infection", N Engl J Med, 341, pp.936~942 (1999)
- Ooi MH, "Human enterovirus 71 disease in Sarawak, Malaysia: a prospective clinical, virological, and molecular epidemiological study", Clin Infect Dis, 44, pp.646~656 (2007)
- Chen KT, "Epidemiologic features of hand-foot-mouth disease and herpangina caused by enterovirus 71 in Taiwan, 1998-2005", Pediatrics, 120, pp.e244~e252 (2007)
- Kleigman R, "Nelson textbook of pediatrics. 18th ed", pp.1350~1356 (2007), Saunders
- Nolan MA, "Survival after pulmonary edema due to enterovirus 71 encephalitis", Neurology, 60, pp.1651~1656 (2003)
- Wang S, "Pathogenesis of enterovirus 71 brainstem encephalitis in pediatric patients: roles of cytokines and cellular immune activation in patients with pulmonary edema", J Infect Dis, 188, pp.564~570 (2003)
- Wang S, "Modulation of cytokine production by intravenous immunoglobulin in patients with enterovirus 71-associated brainstem encephalitis", J Clin Virol, 37, pp.47~52 (2006)
- Chang LY, "Clinical features and risk factors of pulmonary edema after enterovirus 71-related hand, foot, and mouth disease", Lancet, 354, pp.1682~1686 (1999)
- Choi CS, "Clinical manifestations of CNS infections caused by enterovirus type 71", Korean Journal of Pediatrics, 54(1), pp.11~16 (2011), 대한소아과학회