Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Human metapneumovirus infection in Korean children

소아에서 human metapneumovirus 감염

  • Yeom, Hee-Hyun (Department of Pediatrics, College of Medicine, Soonchunhyang University) ;
  • Park, Joon-Soo (Department of Pediatrics, College of Medicine, Soonchunhyang University) ;
  • Jeong, Dong-Jun (Department of Pathology, College of Medicine, Soonchunhyang University) ;
  • Kim, Chang-Jin (Department of Pathology, College of Medicine, Soonchunhyang University) ;
  • Kim, Yong-Bae (Department of Preventive Medicine, College of Medicine, Soonchunhyang University) ;
  • Lee, Dea-Hoon (Seegene Inc.) ;
  • Kim, Kyung-Joong (Seegene Inc.) ;
  • Chun, Jong-Yoon (Seegene Inc.) ;
  • Kang, Chun (Division of Respiratory Viruses§, Department of Virology, NIH, KCDC) ;
  • Chung, Yoon-Seok (Division of Respiratory Viruses§, Department of Virology, NIH, KCDC) ;
  • Cheong, Hyang-Min (Division of Respiratory Viruses§, Department of Virology, NIH, KCDC)
  • 염희현 (순천향대학교 의과대학 소아과학교실) ;
  • 박준수 (순천향대학교 의과대학 소아과학교실) ;
  • 정동준 (순천향대학교 의과대학 병리학교실) ;
  • 김창진 (순천향대학교 의과대학 병리학교실) ;
  • 김용배 (순천향대학교 의과대학 예방의학교실) ;
  • 이대훈 (씨젠 주식회사) ;
  • 김경중 (씨젠 주식회사) ;
  • 천종윤 (씨젠 주식회사) ;
  • 강천 (질병관리본부 국립보건연구원 호흡기바이러스과) ;
  • 정윤석 (질병관리본부 국립보건연구원 호흡기바이러스과) ;
  • 정향민 (질병관리본부 국립보건연구원 호흡기바이러스과)
  • Received : 2005.10.27
  • Accepted : 2005.12.05
  • Published : 2006.04.15
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Abstract

Purpose : Human metapneumovirus(hMPV) is a respiratory viral pathogen that causes a wide spectrum of illnesses, ranging from asymptomatic infection to severe bronchiolitis. The virus has been identified world widely, but so far it has not been published in Korea. Methods : We obtained clinical samples by nasopharyngeal aspiration from 218 children hospitalized due to acute lower respiratory tract infections at Soonchunhyang University Hospital in Cheonan from October, 2004 to April, 2005. We designed specific primers from conserved region of fusion glycoprotein of hMPV. Total RNA was extracted and RT-PCR was performed, and single specific 423 bp product was obtained. The PCR product was confirmed to be fusion glycoprotein RNA by sequencing. Results : We detected hMPV in 15(6.9 percent) of the 218 hospitalized children. The infected children comprised nine boys and six girls; their mean age was 2.8 years(5 mo-12 yrs) and they were diagnosed with pneumonia(60 percent), bronchiolitis(33.3 percent), croup(6.6 percent). The number of cases of detected hMPV in Korea increased dramatically during the period from March to May 2005. Conclusion : hMPV is circulating in Korean children and is associated with respiratory tract infection. Additional studies are required to define the epidemiology and the extent of diseases in the general population caused by hMPV.

목 적 : 호흡기 감염증의 주된 원인 중 하나인 hMPV가 2001년 van den Hoogen 등에 의해 네덜란드에서 처음으로 발견된 후 여러 나라에서 보고되었지만, 국내에서 hMPV의 검출에 대한 보고는 대단히 드물다. 따라서 저자들은 우리나라에서 hMPV의 역학을 연구하고자 하였다. 방 법 : 2004년 10월부터 2005년 5월까지 순천향대학교 천안 병원 소아과에 급성 하기도염으로 입원한 218명의 비인두 흡인액을 추출한 뒤 RT-PCR을 시행하고, hMPV가 검출된 환아들의 비인두 흡인물에서 nucleotide의 sequencing을 하여 네덜란드에서 보고된 예와 비교하고, phylogenetic analysis를 하여 검출된 hMPV들간에 유사성을 검토하며, 배양검사로 hMPV의 검출됨을 재확인한 뒤, hPMV가 검출된 15명의 의무기록지를 토대로 이들의 임상 양상을 조사하였다. 결 과 : 218명 중 15명의 비인두 흡인물에서 RT-PCR로 hMPV를 검출할 수 있었다(검출률 6.9%). hMPV가 검출된 15명의 비인두 흡인물 중 11명의 것으로 hMPV의 Fushion protein의 F gene에 대한 nucleotide sequencing을 하여 네덜란드의 것과 유사한 sequence임을 확인할 수 있었다. Phylogenetic analysis를 하여 본 연구에서 검출된 11개의 F gene이 두 개의 군으로 나뉘는 것을 알 수 있었다. hMPV 감염 환아의 평균연령은 2세 8개월(5개월-12세 2개월)이었고, 남녀비는 1.5 : 1이었고, 이들의 진단명은 폐렴(60.0%)이었고 모세기관지염(33.3%), 후두염(6.6%) 순으로 나타났다. 3월과 4월에만 집중적으로 검출되었고, 동시감염은 단 한 례에서 있었다. hMPV 감염 환아에서 기침이 100.0%, 콧물이 86.6%, 발열 80.0%, 호흡곤란 26.6%, 구토가 13.3%, 인후통와 설사와 두통이 각각 6.6%에서 나타났고, 발열 지속기간은 평균 4.9일(1-8일)이었으며, 입원기간은 평균 6.2일(3-14일)이었다. 신체 진찰상 나음이 80.0%에서, 호기성 천명음이 33.3%에서 청진되었고, 흉부 방사선 검사에서 33.3%에서 폐침윤이 관찰되었다. 검사실 소견상 말초혈액에서 중성구 감소증과 림프구 감소증이 각각 6.6%, 13.3%에서 나타났고, C 반응단백은 평균 19.3 mg/L(3.1-103)이었다. 결 론 : 두 개의 군에 해당되는 hMPV가 우리나라 소아에서도 동시에 유행함을 확인하였다. 연구가 기간이 짧았고, 천안 지역에 국한되었던 제한점이 있으나, hMPV 감염에 의한 급성 하기도염 환아들의 임상양상을 알아 볼 수 있었다. 우리나라에서 hMPV 감염의 정확한 역학 조사와 치료 및 예방대책을 수립하기 위해 많은 연구가 요구된다.

Keywords

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