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新生児エンテロウイルス感染症の臨床的特徴について
[Clinical features of neonatal enterovirus infection].
PMID: 32571465
抄録
目的:
新生児エンテロウイルス感染症、特に重症エンテロウイルス感染症の臨床的特徴を検討する。
OBJECTIVE: To study the clinical features of neonatal enterovirus infection, especially severe enterovirus infection.
方法:
エンテロウイルス感染症の新生児244例の臨床データを対象にレトロスペクティブ解析を行った。感染の重症度に応じて，231名の一般感染群と13名の重症感染群に分けた．臨床的特徴を両群間で比較した。
METHODS: A retrospective analysis was performed for the clinical data of 244 neonates with enterovirus infection. According to the severity of infection, they were divided into a common infection group with 231 neonates and a severe infection group with 13 neonates. Clinical features were compared between the two groups.
結果:
新生児244人のうち、207人（84.8％）が5～10月に発症し、6～7月が最も多かった。重症感染群では，一般感染群と比較して，出生時の妊娠年齢が有意に低く，早産児の割合が有意に高かった（P＜0.05）．重症感染群は一般感染群に比べて発症時期が有意に早く（P<0.05），発症率が有意に高かった（P<0.05）．05）、皮膚点状疱疹や掻痒症、呼吸器症状、敗血症様症状（食欲不振、泣き声が小さくなる、動きが少なくなる）、併存疾患（肺炎、心筋炎、壊死性肝炎、凝固障害など）、血小板減少症、プロトロンビン時間延長、クレアチンキナーゼMB上昇、アラニンアミノトランスフェラーゼ上昇の発症率が有意に高かった（P<0.05）。重症感染群は一般感染群に比べて有意に高い死亡率を示した（P＜0.05）．
RESULTS: Of the 244 neonates, 207 (84.8%) developed the disease in May to October, with the highest number of patients in June to July. Compared with the common infection group, the severe infection group had a significantly lower gestational age at birth and a significantly higher proportion of preterm infants (P<0.05). Compared with the common infection group, the severe infection group had a significantly earlier onset time (P<0.05) and significantly higher incidence rates of skin petechiae and ecchymosis, respiratory symptoms, sepsis-like manifestations (poor appetite, crying less, and less movement), concomitant diseases (such as pneumonia, myocarditis, necrotic hepatitis, and coagulation disorder), thrombocytopenia, prolonged prothrombin time, elevated creatine kinase-MB, and elevated alanine aminotransferase (P<0.05). The severe infection group had a significantly higher mortality rate than the common infection group (P<0.05).
結論:
共通感染群と重症エンテロウイルス感染群の新生児間では，発症時期，共通の臨床症状，併存疾患に有意な差が認められた．エンテロウイルス流行期において、新生児に食欲不振や運動機能低下などの発疹および／または敗血症様症状がみられた場合、特に臨床検査で肝障害や凝固機能障害が示唆された場合は、重症エンテロウイルス感染症の可能性があるので、特に注意が必要である。
CONCLUSIONS: There are significant differences in onset time, common clinical manifestations, and concomitant diseases between the neonates with common and severe enterovirus infection. In the enterovirus epidemic season, if the neonates have rashes and/or sepsis-like manifestations such as poor appetite and less movement, especially if the laboratory tests suggest liver damage and coagulation dysfunction, it is necessary to pay particular attention to the possibility of severe enterovirus infection.