소아에서의 호흡기바이러스 감염과 비인두 폐렴구균 보균의 연관성
Association between Respiratory Virus Infection and Pneumococcal Colonization in Children
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목적: 본 연구는 소아에서 호흡기바이러스 감염과 폐렴구균의 상기도 보균율 간의 연관성을 분석하고자 하였다. 방법: 2009년 5월부터 2010년 6월까지 서울대학교 어린이병원에 호흡기 증상을 주소로 내원한 18세 미만 소아로부터 채취한 비인두 흡인물을 대상으로 폐렴구균을 배양하고 RT-PCR을 통해 호흡기 바이러스(influenza virus A와 B, parainfluenza virus 1, 2와 3, respiratory syncytial virus A와 B, adenovirus, rhinovirus A/B, human metapneumovirus, human coronavirus 229E/NL63, OC43/HKU1)를 검출하여 호흡기바이러스 검출과 폐렴구균 보균 사이의 연관성을 분석하였다. 결과: 대상 환자의 중앙 연령은 27개월이었다. 총 1,367건의 비인두 흡인물 중 폐렴구균이 배양된 검체는 228개(16.7%)이었고, 호흡기바이러스가 검출된 검체는 731개(53.5%)이었다. 흔히 분리된 바이러스는, rhinovirus (18.4%), respiratory syncytial virus (RSV) A (10.6 %), adenovirus (6.9%), influenza virus A (6.8%) 순으로 나타났다. 폐렴구균 보균율은 호흡기바이러스 양성인 경우가 21.3% (156/731)로 음성인 경우 11.3% (72/ 636)보다 높았다(P<0.001). 검출된 호흡기바이러스의 종류에 따라서는 influenza virus A [24.7% (23/93) vs 16.1% (205/1274), P=0.001], RSV A [28.3% (41/ 145) vs 15.3% (187/1222), P=0.001], RSV B [31.3 % (10/32) vs 16.3% (218/1335), P=0.042], rhinovirus A/B [22.6% (57/252) vs 15.3% (171/ 1115), P=0.010]가 양성인 소아는 음성인 소아에 비하여 폐렴구균 보균율이 높게 나타났다. 결론: 본 연구 결과, 호흡기 증상이 있는 소아에서 호흡기바이러스가 검출된 경우 폐렴구균 보균율이 높았다. 향후 호흡기바이러스와 폐렴구균의 보균에 의한 호흡기 감염병의 임상발현 기전을 밝히는 데 도움이 될 것으로 생각된다.
Abstract
Purpose: This study aimed to investigate the association between respiratory virus infection and pneumococcal colonization in children. Methods: From May 2009 to June 2010, nasopharyngeal (NP) aspirates were obtained from patients under 18 years old who visited Seoul National University Children’s Hospital for respiratory symptoms. NP samples were used to detect respiratory viruses (influenza virus A and B, parainfluenza virus 1, 2 and 3, respiratory syncytial virus A and B, adenovirus, rhinovirus A/B, human metapneumovirus, human coronavirus 229E/NL63 and OC43/HKU1) by RT-PCR and pneumococcus by culture. Results: Median age of the patients was 27 months old. A total of 1,367 NP aspirates were tested for respiratory viruses and pneumococcus. Pneumococcus was isolated from 228 (16.7%) of samples and respiratory viruses were detected from 731 (53.5%). Common viruses were rhinovirus (18.4%), respiratory syncytial virus (RSV) A (10.6%), adenovirus (6.9%), influenza virus A (6.8%). Pneumococcal isolation rate was significantly higher in the cases of positive virus detection than negative detection [21.3% (156/731) vs. 11.3% (72/636), P<0.001]. For individual viruses, pneumococcal isolation rate was positively associated with detection of influenza virus A [24.7% (23/93) vs 16.1% (205/1274), P=0.001], RSV A [28.3% (41/145) vs 15.3% (187/1222), P=0.001], RSV B [31.3% (10/32) vs 16.3% (218/1335), P=0.042], rhinovirus A/B [22.6% (57/252) vs 15.3% (171/1115), P=0.010]. Conclusion: The study revealed that pneumococcal isolation from NP aspirates is related with respiratory virus detection. The result of this study could be used to investigate how respiratory viruses and pneumococcus cause clinical diseases.
참고문헌 (18)
- Rodrigues F, "Relationships between rhinitis symptoms, respiratory viral infections and nasopharyngeal colonization with Streptococcus pneumoniae, Haemophilus influenzae and Staphylococcus aureus in children attending daycare", Pediatr Infect Dis J, 32, pp.227~232 (2013)
- Bogaert D, "Streptococcus pneumoniae colonisation: the key to pneumococcal disease", Lancet Infect Dis, 4, pp.144~154 (2004)
- Holmes SJ, "Child-care practices:effects of social change on the epidemiology of infectious diseases and antibiotic resistance", Epidemiol Rev, 18, pp.10~28 (1996)
- 김선미, "국내 소아의 비강 내 폐구균 보균율과 혈청형에 관한 역학연구", Korean Journal of Pediatrics, 47(6), pp.611~616 (2004), 대한소아과학회
- 김경효, "유아원 소아의 구인강에서 분리된 폐구균의 혈청군과 항균제 내성에 관한 연구", Korean Journal of Pediatrics, 45(3), pp.9~353 (2002), 대한소아과학회
- 이진아, "소아의 임상 검체 및 건강한 소아의 비인두에서 분리된 페구균의 혈청형 및 페니실린 감수성", Korean Journal of Pediatrics, 46(9), pp.846~853 (2003), 대한소아과학회
- Zhou H, "Invasive pneumococcal pneumonia and respiratory virus co-infections", Emerg Infect Dis, 18, pp.294~297 (2012)
- Ampofo K, "Seasonal invasive pneumococcal disease in children: role of preceding respiratory viral infection", Pediatrics, 122, pp.229~237 (2008)
- McCullers JA, "Insights into the interaction between influenza virus and pneumococcus", Clin Microbiol Rev, 19, pp.571~582 (2006)
- Vu HT, "Association between nasopharyngeal load of Streptococcus pneumoniae, viral coinfection, and radiologically confirmed pneumonia in vietnamese children", Pediatr Infect Dis J, 30, pp.11~18 (2011)
- 윤기욱, "Streptococcus pneumoniae Type Determination by Multiplex Polymerase Chain Reaction", Journal of Korean Medical Science, 26(8), pp.971~978 (2011), 대한의학회
- Wolter N, "High nasopharyngeal pneumococcal density, increased by viral co-infection, is associated with invasive pneumococcal pneumonia", J Infect Dis (2014)
- Grijalva CG, "The role of influenza and parainfluenza infections in nasopharyngeal pneumococcal acquisition among young children", Clin Infect Dis, 58, pp.1369~1376 (2014)
- Rawlings BA, "Bacterial pathogens in the nasopharynx, nasal cavity, and osteomeatal complex during wellness and viral infection", Am J Rhinol Allergy, 27, pp.39~42 (2013)
- Moore HC, "The interaction between respiratory viruses and pathogenic bacteria in the upper respiratory tract of asymptomatic Aboriginal and non-Aboriginal children", Pediatr Infect Dis J, 29, pp.540~545 (2010)
- Wadowsky RM, "Effect of experimental influenza A virus infection on isolation of Streptococcus pneumoniae and other aerobic bacteria from the oropharynges of allergic and nonallergic adult subjects", Infect Immun, 63, pp.1153~1157 (1995)
- Wang JH, "Rhinovirus enhances various bacterial adhesions to nasal epithelial cells simultaneously", Laryngoscope, 119, pp.1406~1411 (2009)
- Nakamura S, "Synergistic stimulation of type I interferons during influenza virus coinfection promotes Streptococcus pneumoniae colonization in mice", J Clin Invest, 121, pp.3657~3665 (2011)