성인의 만성 기침에 대한 감별진단으로서의 백일해
Pertussis as a Differential Diagnosis of Chronic Cough in Adults
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목 적 : 백일해는 소아기에 발생하는 전염병으로 오랫동안 알려져 왔다. 그러나, 미국과 유럽에서는 1990년대에 들면서 성인에서도 백일해가 유행하며, 만성 기침 환자의 20% 정도가 백일해를 앓는 것으로 보고하고 있다. 저자들은 국내에서 성인 만성기침의 원인으로 백일해의 가능성을 확인하고자 하였다.재료 및 방법 : 2002년 9월부터 2003년 5월까지 서울의 일개 대학보건진료소 또는 일개 시립병원 외래를 방문한 환자 중 기저 폐질환 없이 1주 이상 기침을 하는 성인을 대상으로 Bordetella pertussis에 대한 배양검사와 중합효소 연쇄반응검사(PCR)를 시행하였다. 결 과 : 1주 이상의 기침을 하는 성인 102명 중 배양검사에서 양성인 환자는 없었으나 3명(2.7%)에서 PCR 양성이었으며 이들 모두 3주 이상 기침이 지속되었고 백일해의 특징적인 증상을 호소하였다. 결 론:국내에도 성인에서 백일해가 발생하고 있음을 확인하였고 따라서 성인 만성기침의 원인으로 백일해를 감별 진단해야 한다.
Abstract
Background:Pertussis was long considered a childhood illness. However, in the last two decades, it has been reported as a cause of prolonged cough in adolescents and adults in other countries. Infection of Bordetella pertussis was prospectively searched among adults with a persistent cough. Materials and Methods:Adult patients, who visited either the outpatient clinic of a municipal hospital or a university health service center due to cough of more than six days' duration without underlying pulmonary disease, from September 2002 to May 2003, were enrolled. The culture and polymerase chain reaction (PCR) were used for confirming of B. pertussis infection. Results:102 adult patients with persistent cough were evaluated. 3 (2.9%) patients were PCR positive for B. pertussis. There were no patients with positive culture. All patients with positive PCR had one or more classic symptoms of pertussis and their cough persisted for 3-7 weeks. Conclusion:We confirmed the morbidity of pertussis in Korean adults with persistent cough. Pertussis should be considered as a differential diagnosis of chronic cough in adults.
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