인플루엔자 A 및 폐렴미코플라스마 감염과 병발한 가와사끼병 1례 Kawasaki Disease with Influenza A Virus and Mycoplasma pneumoniae Infections: A Case Report and Review of Literature원문보기
그 동안 다양한 병원체와 가와사끼병의 관련성이 제기되어 왔으나 아직 확실한 원인으로 증명된 것은 없다. 본 증례는 가와사끼병과 폐렴미코플라스마, 인플루엔자 감염이 동시에 병발한 환자를 소개한다. 27개월 남아가 발열과 기침, 콧물 등의 증상으로 내원하였다. 외래에서 인플루엔자 A 감염을 확인하고 oseltamivir를 복용하였으나 발열이 지속되고 경부 림프절 비대, 양측성 결막 충혈, 입술의 발적과 갈라짐, 딸기혀, BCG 접종 부위의 발진을 보였다. 이에 가와사끼병으로 진단하고 면역글로불린을 정맥주사 하였다. 환아는 혈청 항미코플라스마 IgM 항체가 양성이었고 비인두 도말 중합효소 연쇄반응 검사에서 폐렴미코플라스마 양성으로 나타났다. 본 증례와 더불어 가와사끼병과의 연관성이 거론되었던 병원체들을 살펴보고 가와사끼병의 병인에 대한 가설들을 고찰하여 가와사끼병의 증상이나 관상동맥 병변이 폐렴미코플라스마와 인플루엔자 뿐 아니라 다양한 감염에서 발생할 수 있을 것으로 예상하였다.
그 동안 다양한 병원체와 가와사끼병의 관련성이 제기되어 왔으나 아직 확실한 원인으로 증명된 것은 없다. 본 증례는 가와사끼병과 폐렴미코플라스마, 인플루엔자 감염이 동시에 병발한 환자를 소개한다. 27개월 남아가 발열과 기침, 콧물 등의 증상으로 내원하였다. 외래에서 인플루엔자 A 감염을 확인하고 oseltamivir를 복용하였으나 발열이 지속되고 경부 림프절 비대, 양측성 결막 충혈, 입술의 발적과 갈라짐, 딸기혀, BCG 접종 부위의 발진을 보였다. 이에 가와사끼병으로 진단하고 면역글로불린을 정맥주사 하였다. 환아는 혈청 항미코플라스마 IgM 항체가 양성이었고 비인두 도말 중합효소 연쇄반응 검사에서 폐렴미코플라스마 양성으로 나타났다. 본 증례와 더불어 가와사끼병과의 연관성이 거론되었던 병원체들을 살펴보고 가와사끼병의 병인에 대한 가설들을 고찰하여 가와사끼병의 증상이나 관상동맥 병변이 폐렴미코플라스마와 인플루엔자 뿐 아니라 다양한 감염에서 발생할 수 있을 것으로 예상하였다.
Although an association of Kawasaki disease (KD) with infectious agents has been suggested, none have been proven to cause KD. In this case study, we present a case of KD with concurrent onset of influenza and Mycoplasma pneumoniae (MP) infections. A 27-month-old boy presented with prolonged fever, ...
Although an association of Kawasaki disease (KD) with infectious agents has been suggested, none have been proven to cause KD. In this case study, we present a case of KD with concurrent onset of influenza and Mycoplasma pneumoniae (MP) infections. A 27-month-old boy presented with prolonged fever, cough, and rhinorrhea. During the initial testing, influenza A infection was identified, and he was treated with oseltamivir. Despite the antiviral therapy, the fever persisted, and he had cervical lymph node enlargement, bilateral conjunctival injection, fissured red lips, strawberry tongue, and erythematous skin lesions on the Bacillus Calmette-$Gu{\acute{e}}rin$ vaccination site. Thus, the patient was diagnosed with KD and was treated with intravenous immunoglobulin (IVIG). The result of the initial antimycoplasma immunoglobulin M (IgM) antibody testing and was positive, and an increased IgM titer from baseline was found in a repeat test. We reviewed the hypotheses on pathogens known to be associated with KD and the etiology of KD. Based on our findings, we suspect that symptoms of KD and coronary artery lesions can occur from various infections besides those caused by Mycoplasma species and influenza viruses.
Although an association of Kawasaki disease (KD) with infectious agents has been suggested, none have been proven to cause KD. In this case study, we present a case of KD with concurrent onset of influenza and Mycoplasma pneumoniae (MP) infections. A 27-month-old boy presented with prolonged fever, cough, and rhinorrhea. During the initial testing, influenza A infection was identified, and he was treated with oseltamivir. Despite the antiviral therapy, the fever persisted, and he had cervical lymph node enlargement, bilateral conjunctival injection, fissured red lips, strawberry tongue, and erythematous skin lesions on the Bacillus Calmette-$Gu{\acute{e}}rin$ vaccination site. Thus, the patient was diagnosed with KD and was treated with intravenous immunoglobulin (IVIG). The result of the initial antimycoplasma immunoglobulin M (IgM) antibody testing and was positive, and an increased IgM titer from baseline was found in a repeat test. We reviewed the hypotheses on pathogens known to be associated with KD and the etiology of KD. Based on our findings, we suspect that symptoms of KD and coronary artery lesions can occur from various infections besides those caused by Mycoplasma species and influenza viruses.
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문제 정의
suggested the etiologic agent(s) of KD may be RNA viruses, based on pathological findings from autopsy tissue samples26). The authors were the first to confirm infiltration of oligoclonal IgA plasma cells in inflamed tissues and coronary arteries. Moreover, they confirmed that the synthetic version of such oligoclonal antibodies can detect intracytoplasmic inclusion bodies (ICIs) in the ciliated bronchial epithelium of patients with acute KD.
가설 설정
that was based on the synchronicity between Asian and trans-Pacific wind patterns, and seasonal peaks of the incidence of KD in Japan, Hawaii, and San Diego27). They hypothesized that aerosolized microorganisms are propagated by wind from Central Asia to Southern California. According to the authors, physicians can diagnose KD by predicting the KD activity in specific regions even if the specific KD agent is unknown.
제안 방법
He was brought to the outpatient clinic, and a nasopharyngeal swab was collected for testing as part of a clinical study. For initial testing, a fluorescent immunoassay (Sofia influenza A+B FIA kit, Quidel Inc., San Diego, USA) was performed at the clinic and it revealed an influenza A virus infection, and he was treated with oseltamivir therapy. Despite administration of the antiviral therapy for 2 days, his fever persisted, accompanied by cervical lymph node enlargement.
The laboratory studies consisted of a complete blood cell count, which yielded the following values: white cell count, 8,200/μL; hemoglobin level, 11.6 g/dL; and platelet count, 211,000/μL.
7 mm left main coronary artery and that the previous perivascular echogenicity had disappeared. The patient was continued on clopidogrel therapy and follow-up care.
대상 데이터
The patient was born in a hospital through normal spontaneous vaginal delivery with a birth weight of 2,980 g at the gestational age of 40 weeks. His medical history was unremarkable, and he was in good health before the admission.
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