신생아 및 3개월 이하의 영아의 세균수막염의 임상적 양상과 치료결과
Clinical Manifestations and Treatment Outcome of Bacterial Meningitis in Neonates and Infants Under the Age of Three Months
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목 적:신생아 및 조기 영아기의 세균수막염은 중증도가 가장 심한 감염의 하나로 적절한 치료에도 불구하고 사망을 포함하여 신경학적 합병증 및 후유증이 흔히 동반된다. 본 연구는 경북대학교병원 소아청소년과에 이 연령대에 세균수막염을 진단 받고 치료 받은 환자들을 대상으로 그 임상 양상과 치료 결과를 분석하기 위해 시행되었다. 방 법:1997년 1월부터 2010년 6월까지 경북대학교병원 소아청소년과에서 뇌수막염으로 진단 받은 3개월 미만 환자 135명 중 뇌척수액에서 단일 세균이 배양된 12명을 대상으로 의무기록지를 근거로 임상 양상 및 추적 관찰 결과를 후향적으로 조사 및 비교하였다. 결 과:12명의 환자 중 남자가 6명, 여자가 6명이었으며 평균 연령은 44.2±30.0일 이었다. 입원 당시의 증상으로는 발열이 12례(100%)에서 나타났고 숫구멍 팽창이나 경부강직 없이 진찰에서 정상 소견을 보인 경우가 9례(75%)였다. 뇌척수액에서 배양된 세균으로는 streptococcus agalactiae가 7례(58.3%)로 가장 높은 빈도를 보였다. 12례 중 6례(50%)에서는 혈액 배양 검사에서도 뇌척수액에서 배양되었던 균과 동일한 균의 배양이 확인되었다. 초기 치료 방법으로는 cefotaxime과 ampicilin /sulbactam의 병합 요법 혹은 cefotaxime과 ampicilin 의 병합 요법이 각각 3례(25%) 였으며, 전체 환자의 치료 소요 기간은 평균 15.1±6.0일 이었다. 합병증 및 후유증으로는 경막하삼출 및 청력장애가 각각 2례(16.7 %)가 있었고, 12례의 환자의 평균 추적조사기간은 9.0±8.4개월이었다. 추적조사기간 중 신경학적 후유증이 없었던 경우가 9례(75%)가 있었고, 심각한 운동장애나 인지장애등을 포함하는 중등도 이상의 후유증을 가진 환자는 없었다. 결 론:본 연구에서 신생아나 3개월 미만의 어린 영아에서 세균수막염이 있는 경우 특이한 진찰 소견은 없었으나 발열이 항상 동반되었으며 GBS가 가장 흔한 원인균이었다. 또한 적절한 치료를 조기에 할 경우 합병증 및 후유증을 많이 줄일 수 있었음을 알 수 있었다.
Abstract
Purpose:Bacterial meningitis in neonates and young infants is one of the most serious conditions that can lead to severe neurological sequelae despite the appropriate treatment. This study aimed at evaluating the clinical manifestations and treatment outcomes in patients under the age of three months, who had been diagnosed with bacterial meningitis. Methods:A total of twelve patients with bacterial meningitis under the age of three months from January 1997 to June 2010 were retrospectively evaluated through a review of their medical records. Patients who showed positive culture results were included in the study. Results:A total of 12 patients (6 males and 6 females, mean age 44.2±30.0 days) were enrolled in the study. All patients had fever upon admission. But most of them were unremarkable upon physical examination (75%). Streptococcus agalactiae was the most common organism cultured from CSF (7cases; 58.3%). Six cases showed positive results on CSF culture as well as on blood culture. Cefotaxime and ampicilin/ sulbactam or cefotaxime and ampicilin were given as initial treatment with a mean treatment duration of 15.1±6.0 days. Neurological complications and sequelae included subdural effusion and hearing disturbance in two cases (16.7%). Nine cases (75 %) showed excellent outcomes without neurological deficits, and none were left with a severe degree of sequelae. Conclusion:The study showed that neonates or young infants with bacterial meningitis almost always present with fever and that S.agalactiae was the most common causative organism. In addition, the final outcome for these patients may be improved with early and appropriate treatment.
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