소아에서 파라인플루엔자 바이러스 4형의 역학 및 임상 양상에 대한 단일기관 연구: 2015–2017
Epidemiology and Clinical Characteristics of Parainfluenza Virus Type 4 in Korean Children: a Single Center Study, 2015–2017
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목적: 본 연구는 국내 소아에서 parainfluenza virus (PIV) 4형 감염의 역학과 임상양상을 PIV 1–3형과 비교하여 분석하고자 하였다. 방법: 2015년부터 2017년까지 서울대학교 어린이병원에 내원한 소아들 중 실시간 중합효소연쇄반응법을 통해 PIV 1–4형이 검출된 환자들을 대상으로 의무기록을 후향적으로 분석하였다. 임상 진단은 열성 질환, 상기도 감염, 크룹, 모세기관지염과 폐렴으로 분류하였고, PIV 유형별 역학적 특징을 비교하였다. 인구학적 특징 및 임상적 특징은 건강한 환자만을 대상으로 분석하였다. 결과: 전체 PIV 감염은 472건이 확인되었고, 기저질환이 있거나 다른 바이러스가 중복 검출된 경우를 제외하여 최종 108 건(22.9%)을 분석하였다. PIV 3형은 39건(36.1%), PIV 4형은 26건(24.1%), 1형은 24건(22.2%), PIV 2형은 19건(17.6%)이 검출되었다. PIV 4형 환자의 중간 연령은 11개월(0–195개월)이었으며, 2세 미만은 17명(65.4%), 2세 이상 5세 미만은 5명 (19.2%)였다. PIV 4형 환자군의 임상 진단은 세기관지염(38.5%), 폐렴(30.8%), 상부 호흡기 감염(30.8%)의 순이었다. 크룹은 PIV 2형 환자군에서 가장 우세하게 관찰되었고, PIV 4형 환자군에서는 한 명도 관찰되지 않았다(0% vs. 21.1%, P =0.026). 각 형 별 입원율의 유의한 차이는 없었다( P >0.05). 결론: PIV 4형은 우리나라에서 2015년과 2017년에 유행하였다. 입원 환자 중 5세 미만의 연령에서 주로 검출되었고, 입원을 필요로 하는 하기도 감염의 원인으로 고려되어야 할 것이다.
Abstract
Purpose: We aimed to identify the epidemiology and the clinical characteristics of human parainfluenza virus type 4 (HPIV-4) infection compared to HPIVs 1–3 infections in Korean children. Methods: We reviewed medical records of children with HPIV infection who visited Seoul National University Children's Hospital from 2015 to 2017. Detection of respiratory viruses was performed using real time-polymerase chain reaction (rt-PCR), which could differentiate HPIVs 1–4. Diagnosis was classified as a febrile illness, upper respiratory tract infection (URI), croup, bronchiolitis, or pneumonia. The epidemiology, demographic features, and clinical characteristics among HPIV types were compared. The clinical data were analyzed only for the previously healthy children. Results: Of the 472 children diagnosed with HPIV infection, 108 (22.9%) were previously healthy: 24 (22.2%), 19 (17.6%), 39 (36.1%), and 26 (24.1%) in HPIV types 1, 2, 3, and 4, respectively. The median age of children with HPIV-4 infection was 11 (0–195) months: the proportion of children aged < 2 years and 2 to < 5 years were 65.4% and 19.2%, respectively. Clinical diagnoses of HPIV-4 infection were bronchiolitis (38.5%), pneumonia (30.8%), and URI (30.8%). Croup was the most prevalent in HPIV-2 (21.1%) and none in HPIV-4 infection ( P =0.026). Hospital admission rates among HPIV types were not significantly different ( P >0.05). Conclusions: We observed seasonal peak of HPIV-4 infection in 2015 and 2017. HPIV-4 was a common respiratory pathogen causing lower respiratory tract infection in hospitalized children.
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