급성 감염 증상 후 발생한 소아기 뇌염 및 뇌증: 단일 기관 연구
Acute Childhood Encephalitis and Encephalopathy following Infectious Symptoms: a Single Center Study
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목적: 급성 뇌염이나 뇌증은 증상 발현 전에 호흡기 감염이나 위장관 감염이 선행하는 경우가 흔하다. 최근에는 원인 병원체를 검사하는 진단법들이 발전함에 따라 보다 쉽게 병원체를 확인할 수 있게 되었으나, 한국에서는 자료가 부족한 실정이다. 본 연구에서는 급성 감염 증상이 보인 후 발생한 뇌염, 뇌증의 원인 병원체의 종류 및 임상경과를 알아보고자 하였다. 방법: 2013년 3월부터 2017년 2월까지 전남대학교 병원 소아청소년과에서, 급성 뇌염 및 뇌증으로 진단받았던 환자들을 대상으로 의무기록을 후향적으로 검토하였다. 결과: 총 51명의 환자들의 평균 나이는 5.8±4.4 세였으며 이 중 뇌염군은 36명(70.6%), 뇌증군은 15명(29.4%)이었다. 선행증상으로 호흡기 증상(62.7%)이 위장관 증상(45.1%)보다 빈번하였다. 뇌 자기공명영상 이상이 54.9%에서, 뇌척수액 백혈구 증다증이 41.2%에서 확인되었다. 계절 중 겨울에 질환의 발병이 가장 빈번하였다(29.4%). 뇌염 환자 중 감염성 뇌염 환자 총 8명(15.7%)에서 enterovirus (4명), EBV (3명, 1명은 HHV6 와 동반감염), 쯔쯔가무시(1명)이 확인되었다. 급성 파종뇌척수염으로 진단된 11명의 환자들 중 adenovirus, influenza A, mycoplasma 감염이 각각 한명씩 확인되었고 비커스태프 뇌간 뇌염 환자 중 1명에서 마이코플라즈마 폐렴이 확인되었다. 원인이 밝혀지지 않은 뇌염 환자 15명 중에서 rhinovi-rus (3명), influenza A (2명), mycoplasma 감염(6명; 2명은 rhinovirus와 중복감염)이 확인되었다. 뇌증군 환자들 중 뇌 영상 이상을 동반한 환자는총 3명이었는데, influenza A 감염과 동반된 acute ne-crotizing encephalopathy, 돌발진을 동반한 acute encephalopathy with biphasic seizures, 대변 no-rovirus가 검출된 mild encephalopathy with a reversible splenial lesion이었다. 나머지 12명의 뇌증 환자들에서는 influenza A (2명), adenovirus (1명), rhinovirus (1명), enterovirus (1명), mycoplasma 감염(4명; 1명은 norovirus와 중복감염) 등이 확인되었다. 결론: 소아기 뇌염 및 뇌증은 겨울에 발병율이 높았고, 호흡기 감염과 연관된 경우가 많았다.
Abstract
Purpose: Acute encephalitis and encephalopathy are preceded by respiratory or enteric infection, whose pathogens can be detected more easily with advanced tools. However, studies for pathogens in Korea remain scarce. We investigated the clinical characteristics and pathogens in childhood encephalitis and encephalopathy. Methods: We retrospectively reviewed the records of children with acute encephalitis and encephalopathy admitted to our hospital between March 2013 and February 2017. Results: The 51 included patients were aged 5.8±4.4 years (mean±standard deviation), comprising 36 with encephalitis (70.6%) and 15 with encephalopathy (29.4%). Respiratory symptoms (62.7%) were more common than enteric symptoms (45.1%). Brain MRI was abnormal in 54.9%, and leu-kocytosis in the cerebrospinal fluid was noted in 41.2%. The prevalence of diseases was highest in winter (29.4%). In encephalitis, eight patients had infective encephalitis (15.7%), comprising enterovirus (N=4), Epstein-Barr virus (N=3; one with HHV6 coinfection), and tsutsugamushi in-fection (N=1). The 11 patients with ADEM included 1each with adenovirus, influenza A, and mycoplasmal infection. One patient with Bickerstaff-brainstem encephalitis had mycoplasmal pneumonia. In the 15 patients with encephalitis of unknown etiology, rhinovirus (N=3), influenza A (N=2), adenovirus (N=1), and mycoplasmal infection (N=6) were found. In the encephalopa-thy group, three patients had abnormal brain MRI: ANE with influenza A, AESD with exanthem subitum, and norovirus-associated MERS. In the remaining 12 patients, influenza A (N=2), ade-novirus, rhinovirus, enterovirus, norovirus (N=1 for each virus), and mycoplasmal infection (N=4) were found. Conclusion: Acute childhood encephalitis and encephalopathy were the most prevalent in winter and were fre-quently associated with respiratory infections.
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