소아에서 발생한 A군 연쇄구균에 의한 침습성 질환의 임상적 특성 분석
Clinical Manifestations of Invasive Infections due to Streptococcus pyogenes in Children
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목적: A군 연쇄구균은 소아에서 인두염, 연조직염을 일으키며 드물게 침습성 질환을 일으키는 중요한 원인균이다. 그리하여 본 연구에서는 한국 소아에서 A군 연쇄구균침습성 감염증의 임상 양상 및 예후에 대해 조사하고자하였다. 방법: 1992년 3월부터 2012년 12월까지 서울대학교어린이병원 및 2003년 3월부터 2012년 12월까지 분당서울대학교병원에 입원한 환자 중 A군 연쇄구균 침습성감염증으로 치료받은 18세 이하의 소아를 대상으로 하였다. 의무기록을 후향적으로 분석하여 대상환자들의 임상양상, 검사결과, 치료방법 및 예후와 합병증에 대해 조사하였다. 결과: A군 연쇄구균 침습성 감염증으로 진단 받은 총36명의 환자 중 30명에 대해 의무기록을 확인할 수 있었다. 남자가 많았으며(남:여=2.75:1) 환자들의 중앙연령은 4년 2개월(생후 12일부터 15세까지)로 그 중 53.3%가 5세 미만이었다. 질환은 피부 및 연조직감염증(9/30,30.0%), 국소 감염부위가 없는 균혈증(4/30, 13.3%) 그리고 관절염 및 골수염(6/30, 20.0%)가 가장 많은 것으로 확인되었다. 연쇄구균 독소쇼크증후군(3/30, 10.0%),호흡기, 복부 및 중추신경계 감염증도 확인되었다. 전체기간 중 2012년에 환자발생이 가장 많았으며(9/30, 30.0%), 사망한 사례는 없었다. Erythromycin 및 clindamycin에대한 항생제 내성률은 각각 3.8% 및 7.5%로 확인되었다. 결론: 본 연구를 통해 소아에서 A군 연쇄구균 침습성감염증으로 입원치료 받은 환자들의 임상양상을 확인할수 있었으며 주로 5세 미만의 어린 연령층에서 발생하는것을 알 수 있었다. 지난 20년 동안 한국 소아에서 발생한 A군 연쇄구균 침습성 감염증의 임상적 특성 및 예후를조사함으로써 향후 임상에서 환자를 빠르게 인지하고 적절하게 치료하는데 본 연구결과가 도움이 될 수 있을 것으로 생각된다.
Abstract
Purpose: Streptococcus pyogenes is an important cause of invasive diseases in children. We aimed to describe the clinicalcharacteristics of invasive infections due to S. pyogenes in children in Korea. Methods: A retrospective study of children under 18 years of age with invasive infections due to S. pyogenes at SeoulNational University Children’s Hospital between March 1992 and December 2012, and Seoul National University BundangHospital between March 2003 and December 2012 was conducted. Demographic factors, clinical characteristics, laboratoryfindings, treatment, mortality and morbidity of all patients were reviewed. Results: A total of 30 among 36 cases identified as invasive disease due to S. pyogenes were available for review. Therewas a predominance for male subjects (male:female=2.75:1). The median age was 50 months (range 12 days to 15 years)and 53.3% were under 5 years of age. Skin and soft tissue infections (9/30, 30.0%), bacteremia without identified focus(4/30, 13.3%) and bone and joint infections (6/30, 20.0%) were the most frequent clinical presentations. Streptococcal toxicshock syndrome (3/30, 10.0%) pulmonary, abdomen and central nervous system infections (2/30, 6.7%) were also seen. There was a peak in number of patients in year 2012 (9/30, 30.0%). There were no cases of mortality. Erythromycin andclindamycin resistance rates were low by 3.8% and 7.5%, respectively. Conclusion: We studied the clinical presentations of invasive infections due to S. pyogenes during the past 20 years inKorean children. The findings of this study help us understand the characteristics of the disease, enhancing early recognitionand prompting adequate antibiotic therapy which is important in reducing morbidity and mortality.
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