Diagnosis and Species Identification of Mycobacterial Infections by Polymerase Chain Reaction-Restriction Fragment Length Polymorphism Analysis of Sterile Body Fluids

BACKGROUND/AIMS: The development of effective, accurate, and rapid diagnostic methods for Mycobacterium infection and mycobacterial species identification is required. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) is an easy, rapid and inexpensive technique for identifying Mycobacterium spp. METHODS: We performed PCR-RFLP to detect and identify Mycobacterium spp. from 10 sterile body fluids, including ascites, cerebrospinal fluid, pleural fluid, synovial fluid, and peritoneal dialysis fluid. Clinical samples were collected from patients with diagnoses of definite, probable or suspected mycobacterial infection. The conserved RNA polymerase genes of Mycobacterium spp. were amplified by PCR. RESULTS: The amplified 360-bp region of rpoB was digested with the restriction enzyme MspI or HaeIII. The PCRRFLP results for the clinical samples were identical to those for M. tuberculosis, M. fortuitum, M. intracellulare, and M. avium. In addition, the results of the PCR-RFLP were identical to those obtained by DNA sequencing. CONCLUSIONS: PCR-RFLP analysis of sterile body fluids may be a useful method for the diagnosis of mycobacterial infections and for the differentiation of mycobacterial species.

Efficacy of the Arbekacin and Teicoplanin Combination on Glycopeptide Intermediate Staphylococcus aureus in a Rabbit Model of Endocarditis / 감염과화학요법

BACKGROUND: There have been no reports to evaluate the usefulness of combination therapy with glycopeptide and arbekacin in endocarditis by in vivo model. MATERIALS AND METHODS: We investigated the efficacy of the arbekacin and teicoplanin combination on glycopeptide intermediate Staphylococcus aureus (GISA) in rabbit model of endocardits. GISA Mu50 strain was used for the experiment. The rabbit model of aortic valve endocarditis as described previously was used. Treatment was started 20h later inoculation with teicoplanin alone (at 20 mg/kg of body weight intramuscularly every 12 hours for 4 days after loading dose of 40 mg/kg of body weight intramuscularly), arbekacin alone (5 mg/kg of body weight intramuscularly every 12h for 4 days), or teicoplanin plus arbekacin. The results of therapy for experimental endocarditis due to Mu50 showed that teicoplanin and arbekacin combination was more effective than the administration of both drugs alone in reducing the log10CFU/g of aortic vegetation (P<0.05). CONCLUSION: The combination of teicoplanin and arbekacin was more effective against GISA (Mu50) than both drugs alone in vivo endocarditis model.

Efficacy of the Arbekacin and Teicoplanin Combination on Glycopeptide Intermediate Staphylococcus aureus in a Rabbit Model of Endocarditis / 감염과화학요법

BACKGROUND: There have been no reports to evaluate the usefulness of combination therapy with glycopeptide and arbekacin in endocarditis by in vivo model. MATERIALS AND METHODS: We investigated the efficacy of the arbekacin and teicoplanin combination on glycopeptide intermediate Staphylococcus aureus (GISA) in rabbit model of endocardits. GISA Mu50 strain was used for the experiment. The rabbit model of aortic valve endocarditis as described previously was used. Treatment was started 20h later inoculation with teicoplanin alone (at 20 mg/kg of body weight intramuscularly every 12 hours for 4 days after loading dose of 40 mg/kg of body weight intramuscularly), arbekacin alone (5 mg/kg of body weight intramuscularly every 12h for 4 days), or teicoplanin plus arbekacin. The results of therapy for experimental endocarditis due to Mu50 showed that teicoplanin and arbekacin combination was more effective than the administration of both drugs alone in reducing the log10CFU/g of aortic vegetation (P<0.05). CONCLUSION: The combination of teicoplanin and arbekacin was more effective against GISA (Mu50) than both drugs alone in vivo endocarditis model.

Changing trends of infective endocarditis according to the change in health care system in Korea / 대한내과학회지

BACKGROUND: In July 2000, there was a dramatic change in Korean health care system with the medical reform, the separation system of pharmacies and prescriptions. Before then, patients could easily get antibiotics without doctors' prescriptions. Since the symptoms and signs of infective endocarditis are very nonspecific, prior self treatment with antibiotics before admission was common. This study was performed to determine the changing trends of infective endocarditis according to the change in health care system. METHODS: One hundred eighty eight patients from 8 different medical institutions were included. Medical records were reviewed retrospectively for each patient who was diagnosed as infective endocarditis by Modified Duke criteria. Patients were separated into two different groups (Group I: patients diagnosed before July 2000, Group II: patients diagnosed after November 2000). Clinical characteristics, blood culture positivity, and in-hospital mortality were compared. RESULTS: There was no difference in clinical manifestation between two groups other than malaise. Blood culture positivity was 57.4% in Group I and 71.1% in group II. Blood culture positivity was significantly higher in Group II (p=0.038). In-hospital mortality tends to be lower in Group II, which was 22.3% in group I and 12.9% in group II (p=0.066). The relationship between higher blood culture positivity and lower in-hospital mortality couldn't be clarified. CONCLUSION: There was an increase in blood culture positivity and a tendency to decrease in in-hospital mortality after July, 2000, possibly due to health care reform. This, to my knowledge, is the first effort to investigate the changing trends of an actual clinical disease according to the change in health care system.

A Case of Progressive Multifocal Leukoencephalopathy in a Patient with Acquired Immune Deficiency Syndrome / 감염과화학요법

In Korea, as the prevalence of acquired immune deficiency syndrome (AIDS) increases, various opportunistic infections are becoming a problem. Progressive multifocal leukoencephalopathy (PML) is postulated to be associated with impaired cellular immunity and can be more frequently encountered these days primarily due to increasing incidence of AIDS. Neurologic deficits and brain imaging study together strongly suggest PML, but confirmatory diagnosis can be made only by cerebrospinal fluid study or tissue biopsy. In Korea few cases of confirmed PML in AIDS patients have been reported, and herein we offer our experience of a case of PML who underwent brain biopsy for confirmative diagnosis.

A Case of Progressive Multifocal Leukoencephalopathy in a Patient with Acquired Immune Deficiency Syndrome / 감염과화학요법

In Korea, as the prevalence of acquired immune deficiency syndrome (AIDS) increases, various opportunistic infections are becoming a problem. Progressive multifocal leukoencephalopathy (PML) is postulated to be associated with impaired cellular immunity and can be more frequently encountered these days primarily due to increasing incidence of AIDS. Neurologic deficits and brain imaging study together strongly suggest PML, but confirmatory diagnosis can be made only by cerebrospinal fluid study or tissue biopsy. In Korea few cases of confirmed PML in AIDS patients have been reported, and herein we offer our experience of a case of PML who underwent brain biopsy for confirmative diagnosis.

Clinical Outcomes of Tuberculosis in Renal Transplant Recipients

Tuberculosis (TB) is an important cause of morbidity and mortality in renal transplant recipients. Rifampin has a potent sterilizing activity, but it reduces the serum concentrations of the immunosuppressive agents. Moreover, the possible contribution made by mycobacterial infection to the incidence of graft rejection or renal dysfunction remains unclear. In this study, we investigated the recurrence of TB and graft survival duration according to rifampin usage, and we evaluated the factors that could influence the duration time until the recurrence of TB. Seventy-eight TB patients diagnosed after kidney transplantation were studied. Pulmonary TB was diagnosed in 26 of the 78 patients (33.3%), pleural TB in 23 (29.5%), combined pulmonary and pleural TB in 5 (6.4%), miliary TB in 19 (24.4%), and intestinal TB in 2 patients. In the pulmonary (pulmonary TB and pleural TB) TB group, no differences in graft survival and the TB free duration period were observed between the rifampin usage subgroup and the non- rifampin usage subgroup. In the extrapulmonary TB group, no difference was found in mean graft survival time between the rifampin usage subgroup and the non-rifampin usage subgroup, but the rifampin usage subgroup showed that the TB had a tendency to recur later than for the non-rifampin usage subgroup (87 +/-8 vs. 44 +/-7 months, respectively, p=0.30). The factor affecting the duration period until the recurrence of TB was the treatment duration (RR=0.761, p=0.030). This study suggests that rifampin does not affect graft survival in renal transplant recipients in whom immunosuppression is carefully monitored. Also, the study results indicate that rifampin may prevent a recurrence of extrapulmonary tuberculosis. Prolonged treatment appears to be appropriate for renal transplant recipients with TB.

Comparison of Clinical Characteristics of Pneumocystis Carinii Pneumonia Between HIV Infected and Non-infected Persons / 결핵

BACKGROUND: Pneumocystis carinii pneumonia (PCP) is one of the most common cause of infection in patients with HIV infection. Recently, the incidence of PCP have been increasing in immunocompromised hosts without HIV infection. We compared the clinical characteristics of PCP between HIV infected and non-infected persons. PATIENTS AND METHODS: We retrospectively reviewed the charts of 25 patients diagnosed as PCP from 1996 to 2002. Age, sex, underlying conditions, use of immunosuppressants, clinical courses, laboratory findings, treatment and prognosis were compared between HIV infected and non-infected persons. RESULTS: Twenty-five patients with PCP were identified. 16 were HIV infected, and 9 were HIV non-infected. The mean age of overall patients was 43.4+/-13.2 years. Underlying conditions in HIV non-infected persons were hematologic malignancy (7 cases), solid organ transplant (1 case), and autoimmune disease (1 case). Seven cases (77.8%) of HIV non-infected persons had a history of steroid use. Mean duration of symptoms was longer in HIV infected persons than in HIV non-infected persons, but it was not statistically significant. PaO2 was lower in HIV infected persons (61.2+/-16.9 mmHg vs.65.4+/-15.4), but it was not statistically significant. Chest X ray showed typical ground glass opacity in 12 cases (75%) of HIV infected persons and in 4 cases (44.4%) of HIV non-infected persons. Twelve cases (75%) of HIV infected persons were treated with steroid, as were 6 cases (66.7%) of HIV non-infected persons. Ventilator care was needed in 6 cases (37.5%) of HIV infected persons and in 2 cases (22.2%) of HIV non-infected persons. Mortality of HIV infected persons was 50%, and that of HIV non-infected persons was 11.1%. CONCLUSIONS: PCP showed some different clinical characteristics between HIV infected and non-infected persons. Prospective studies regarding the risk factors of PCP, prophylaxis, treatment and prognosis in HIV infected and non-infected persons are warranted.