日本新生児成育医学会雑誌　第33巻　第1号　111 ～ 117頁（2021年）

日本新生児成育医学会雑誌　33(1)：111 -117；2021　

受付日：2020．10．15

受理日：2020．11．20

NICU 内で面会者から感染したヒトパレコウイルス3 型感染症の双胎

Twins with Human Parechovirus Type 3 Infection in the NICU

＊ 1 富山大学附属病院周産母子センター　新生児部門，＊ 2 厚生連高岡病院周産母子センター

＊ 1 Division of Neonatology, Maternal and Perinatal Center, Toyama University Hospital ＊ 2 Maternal and Perinatal Center, Kouseiren Takaoka Hospital

中里圭貴＊ 1・猪又智実＊ 1・川崎裕香子＊ 1・長岡貢秀＊ 1・田村賢太郎＊ 1・牧本優美＊ 1・今村博明＊ 2・吉田丈俊＊ 1

Yoshitaka NAKASATO ＊ 1，Satomi INOMATA ＊ 1，Yukako KAWASAKI ＊ 1，Mitsuhide NAGAOKA ＊ 1， Kentaro TAMURA ＊ 1，Masami MAKIMOTO ＊ 1，Hiroaki IMAMURA ＊ 2，Taketoshi YOSHIDA ＊ 1

Key Words：human parechovirus type 3，horizontal transmission，family visitation，neonates

　ヒトパレコウイルス3 型（HPeV3）は新生児・早期乳児期に罹患すると，敗血症や脳炎など重篤な合併症を引き起こす。今回NICU 内で発症したHPeV3 感染症の双胎例を経験した。症例は在胎28 週2 日で出生した双胎で，修正36 週3 日に両児ともに無呼吸発作の増悪と体幹の皮疹が出現し人工呼吸器管理を要した。両児の咽頭ぬぐい液や糞便などからHPeV3 が検出された。頭部MRI で広範な白質病変を認め，現在修正1 歳であるがうち一児は発達遅延を認めている。発症2 日前にNICU 内で患者母によるskin to skin ケアが行われ，同日夜に母が発熱しており母からの感染と考えた。追加の問診で1 週間前に両児の同胞の発熱も確認され，同時期に地域でのHPeV3 の流行も認められていた。NICU における感染予防の観点から，同胞による感染リスクの認識，家族の感冒症状の聴取，地域でのHPeV3 流行の把握が重要であると考えられた。

Human parechovirus type 3（ HPeV3） infection is responsible for severe diseases such as sepsis and encephalitis in neonates and infants. On the other hand, children after 3 months of age have mild symptoms such as those of upper respiratory infection, gastroenteritis, and myalgia, or do not have any symptoms due to HPeV3 infection. It is worth noting that asymptomatic patients can transmit HPeV3 to neonates and infants. Here, we report a set of twins with HPeV3 encephalitis who were infected in the neonatal intensive care unit（ NICU）. They were born at 28 weeks and 2 days of gestation. On day 58, their apnea worsened and they required mechanical ventilation. At the same time, they had erythema on their trunks. HPeV3 was detected in pharyngeal swabs and stool samples collected from each of the patients. Extensive white matter lesions were found on brain MRIs, and one of the patients had developmental delays at 1 year of age. Their mother provided kangaroo mother care for them, and had fever 2 days before their apnea worsened. Based on that episode, we presumed the twins were infected by the mother. Their older sibling also had fever one week before that episode, and HPeV3 was prevalent in the area at the time. Despite the fact that visitors were required to wash their hands and use alcohol-based hand disinfectant when they entered the NICU during kangaroo mother care, horizontal transmission of HPeV3 still occurred in the NICU. To prevent HPeV3 infection in the NICU, it is important to recognize epidemics of HPeV3 in each area, to ask the visitors whether their family, including themselves and the patient’s siblings in the household, have cold-like symptoms, and to recognize the fact that families with young siblings are at high risk of infection.