2003년 겨울철 소아의 바이러스성 하기도 감염증에 대한 원인 및 바이러스별 임상양상

Purpose : This study was performed to characterize the etiology and clinical features of acute viral lower-respiratory tract infections(LRI). Methods : Etiologic agents and clinical features of acute viral LRI were studied from October. 2003 through March. 2004 in hospitalized children with LRI(253 cases) at Samsung Cheil Hospital. The viruses were identified by indirect immunofluorescent method. Medical records of patients with proven viral LRI were reviewed retrospectively. Results : Ninety two cases(36.4%) were confirmed as viral infections. The identified pathogens were respiratory syncytial virus(RSV, 76.0%), adenovirus(ADV, 12.0%), influenza virus type A(INFA, 9.8 %), influenza virus type B(INFB, 1.1%) and parainfluenza virus(PIV, 1.1%). Eight four point eight% of patients were younger than 2 years of age. Clinical diagnosis of LRI were pneumonia(56.5%), bronchiolitis(35.9%), tracheobronchitis(4.3%) and croup(3.3%). The clinical symptoms and signs were cough(98.8%), rhinorrhea(82.6%), fever(70.7%), rale(67.4%), wheezing(29.3%), chest retraction(28.3%) and cyanosis(4.3%). The severe respiratory symptoms and signs were more common in RSV-infected patients, even cyanosis could be observed. Seventeen point four percent of patient had fever of $38.5^{\circ}C$ or higher and their most common etiologic agent was INFA(66.7%). Twenty three point nine percent had fever more than 5 days and common etiologic agent was INFA(77.8%). The elevated WBC count($>14{\times}10^3/{\mu}L$) was in 14.1%, and common etiologic agents were INFA(22.2%) and ADV(18.2%). C-reactive protein(CRP >4.0 mg/dL) was increased in 13.0%, and common in ADV(63.6 %). Increased aspartate aminotransferase(AST)/alanine aminotransferase(ALT) was detected in 10.9%, and the most common etiologic agent was RSV(12.9%). Conclusion : The common agents of acute viral LRI were RSV, ADV and INF, respectively. Because the etiologic agents present variable clinical features, it may be helpful to treat and to evaluate acute viral LRI that we should understand their etiologic variability. 목 적 : 바이러스성 호흡기 감염이 유행하는 2003년 겨울철 소아의 하기도 감염증의 원인 바이러스를 규명하고, 그 임상 양상을 분석하여 환아의 진단, 경과 예측 및 치료에 도움이 되고자 본 연구를 시행하였다. 방 법 : 2003년 10월부터 2004년 3월까지 크룹, 기관기관지염, 세기관지염, 폐렴 등의 급성 하기도 감염증으로 삼성제일병원 소아과에 입원한 253례를 대상으로 비인두 흡입물을 채취하여 간접 면역 형광검사에 의해 바이러스가 확진된 92례를 대상으로 임상증상, 진찰소견, 방사선 소견, 혈액검사 소견을 의무기록을 중심으로 후향적으로 분석하였다. 결 과 : 1) 호흡기 바이러스 검사를 실시한 253례 중 92례에서 호흡기 바이러스를 검출하여 검출률 36.4%이었고, 이중 RSV가 76.0%로 가장 많았고, ADV가 12.0%, INFA가 9.8%,