Clinical Characteristics of Streptococcus agalactiae Bacteremia in Adults Living in Jeju Island / 대한임상미생물학회지

BACKGROUND: Streptococcus agalactiae (Group B streptococcus, GBS) is known to be the leading cause of neonatal sepsis and meningitis in the United States and Europe. In addition, GBS infection has been increasingly noted in adults, particularly in those with underlying diseases, such as diabetes mellitus, malignancy and liver disease. A few studies reported that resistances to antibiotics, such as erythromycin, clindamycin, tetracycline are increasing. We report clinical and microbiological characteristics of GBS bacteremic patients in Jeju Island. METHODS: We retrospectively analyzed medical records, such as age, sex, underlying disease, mortality, skin defects, laboratory results and antibiotic resistances of GBS in hospitalized adult patients who were diagnosed with GBS bacteremia from 2008 to 2013 in Jeju Island. RESULTS: Twenty two adult patients were diagnosed as GBS bacteremia from 2008 to 2013. The mean age of GBS bacteremic patients was 66.2 years old. Of 22 bacteremic patients, fifteen patients (68%) were older than 60. Twenty patients (91%) of bacteremic patients had underlying diseases such as diabetes mellitus, malignancy and liver disease. Ten (45%) patients had skin defects which were on the lower extremities and buttock, fifteen (68%) patients had fever at the time of admission, twenty one (95%) patients were admitted via the emergency department. Two (9%) patients died. The mean white blood cell (WBC) count, percentile of neutrophil count, and C-reactive protein (CRP) levels were 11,488/microL, 84.3 %, 13.5 mg/dL respectively. All GBS isolates from bacteremia showed sensitivities to penicillin, ampicillin, and vancomycin, and showed resistances to erythromycin (25%), clindamycin (30%), and tetracycline (55%). CONCLUSION: Bacteremia caused by GBS was prevalent in adult patients with underlying diseases. Most of the GBS bacteremic patients were emergency cases, with a high body temperature, WBC, CRP level, and neutrophil count. Half of them had skin defects, which are considered a source of GBS bacteremia.

Seroprevalences of Mycoplasma pneumoniae IgM Antibodies among Children Living in Jeju Island, Korea

BACKGROUND: Mycoplasma pneumoniae (MP) is a major cause of community-acquired pneumonia in children. The particle agglutination (PA) assay is a clinical test routinely used to detect MP infection and to determine total MP antibody titers. Using this assay, however, it is difficult to differentiate between IgM and IgG antibodies. The aim of this study was to investigate the seroprevalence of MP IgM antibodies in children living in Jeju Island. METHODS: We investigated the seroprevalence of mycoplasma IgM antibodies in 1,693 patients in the age of 0-10 yr who were ordered for mycoplasma IgM antibody testing in Cheju Halla Hospital between April 2011 and March 2013. Results were classified according to age, sex and the month and year during which the samples were obtained. RESULTS: The overall positive rate for mycoplasma IgM antibody was 24.7% and was higher in females than in males (P=0.012). The positive rate was lowest in infants under 6 months of age, and gradually rose with increasing age until the age of 4 yr. A major increase in positive rates was observed between January-April of 2012 and minor cyclical increases were also observed at 2-4 month intervals during the study period. CONCLUSIONS: The seroprevalence of mycoplasma IgM antibodies rises gradually with age until the age of 4 yr. A major peak in MP IgM antibody-positive cases was observed in early 2012, with minor cyclical increases at every 2-4 months. These results will be helpful in the interpretation and diagnosis of MP in children living in Jeju Island.

PCR-based Investigation of Infection Patterns in Patients with Pelvic Inflammatory Diseases in Jeju

BACKGROUND: Pelvic inflammatory disease (PID) is a microbial infection caused by the upward spread of infectious organisms through the cervical os. Early diagnosis and treatment of PID are essential for the prevention of sequelae such as ectopic pregnancies, infertility, and chronic pelvic pain. Although Chlamydia trachomatis and Neisseria gonorrhoeae are well-known causal agents of PID, there have been reports on some changes in PID-associated infection. The aim of this study was to investigate the infection patterns in patients with PID in Jeju. METHODS: Endocervical samples obtained from 65 patients with PID were tested for C. trachomatis, Mycoplasma genitalium, Mycoplasma hominis, N. gonorrhoeae, Trichomonas vaginalis, and Ureaplasma urealyticum using multiplex PCR. RESULTS: The samples were positive for C. trachomatis (63%), M. hominis (34%), U. urealyticum (20%), M. genitalium (17%), N. gonorrhoeae (9%), and T. vaginalis (6%). CONCLUSIONS: This study showed that C. trachomatis infection was prevalent and the incidence of M. hominis was higher than that of U. urealyticum.

Frequency of Mycoplasma pneumoniae Antibodies in Children Living on Jeju Island / 대한임상미생물학회지

BACKGROUND: Mycoplasma pneumoniae (MP) is a major cause of community-acquired pneumonia in children. Currently, no study exists regarding the frequency of the mycoplasmal antibody on Jeju Island. The aim of the present study was to investigate the frequency of mycoplasmal antibody among children living on Jeju Island. METHODS: From March 2009 to February 2011, the frequency of mycoplasmal antibody among 1580 pediatric (1:40, 20.8% in an antibody titer >1:320, and 10.7% in an antibody titer >1:640. The positive rates of each antibody titer were lowest in children under the age of 6 months, and the positive rates increased gradually with age until 4 years, where the frequency showed a "plateau." There were minor cyclic increases of positive rate (>1:320, >1:640) every three months from August 2009 to June 2010, and there was a major increase of positive rate (>1:320, >1:640) from July 2010 to January 2011. However, there was no positive rate cyclic pattern of mycoplasmal antibody in the lower titer (>1:40) patients. CONCLUSION: The frequency of mycoplasmal antibody titer is lowest under the age of 6 months. The positive rates rise gradually with age until the age of 4 years. The present study showed minor peaks of mycoplasmal antibody titer every three months and a major peak of mycoplasmal antibody titer. The results can be helpful for the interpretation and diagnosis of MP among pediatric patients on Jeju Island.

Contamination rate of white blood cells in fresh frozen plasma and evaluation of a commercial WBC-reduction filter / 대한임상병리학회지

BACKGROUND: Recently, sufficient numbers of lymphocytes that may cause alloimmunization have been detected in fresh frozen plasma (FFP) and the need for filtration and/or irradiation of FFP for certain patients has been proposed. We examined the numbers of white blood cells (WBCs) in FFP and evaluated a new WBC-reduction filter designed for FFP. METHODS: A total of 118 units of FFP were analyzed. We counted WBCs by using the crystal violet-staining method. Forty-four units of FFP were tested for WBC numbers before and after filtration by using the Nageotte chamber. The viable WBC count was performed using the 0.4% trypan blue-staining method. The biologic activity of the coagulation factor viii was measured in 34 units of FFP before and after filtration with the ACL 3000 (Instrumentation Laboratory, Milano, Italy). RESULTS: In the 118 units of FFP, 39 units (33.1%) and 1 unit (0.9%) had counts greater than 1X10(6)/unit and 5X10(6)/unit, respectively. The filter reduced the WBC numbers to less than 1X106/unit in all units. The average percentage of viable WBCs before and after filtration was 34.9% and 4.7%, respectively. The average leukocyte removal rate of the WBC-reduction filter was 81.0%. The average factor viii activity before and after filtration was 72.2 U/dL and 75.1 U/dL, respectively. CONCLUSIONS: Some FFP prepared by the Korean Red Cross blood center may contain enough to require WBC-reduction filtration. Therefore, WBC-reduction filtration of FFP should be considered in order to prevent adverse effects, particularly in those patients expected to receive repeated transfusions.

A Novel Discriminant Function in the Diagnosis of IgA Nephropathy / 대한임상병리학회지

BACKGROUND: IgA nephropathy is characterized by showing a prominent mesangial deposition of IgA in biopsy specimens. More than 20% of these patients progress to an end-stage renal disease over a period of 20 years. However, it is difficult to perform renal biopsies in all patients who present with hematuria or proteinuria. The present study was undertaken to determine whether discriminant analysis before renal biopsy is useful in the diagnosis of IgA nephropathy. METHODS: A total of 144 patients who were diagnosed by renal biopsy were analyzed. This group of 144 patients included 76 patients who had an IgA nephropathy, and did not include those patients that had systemic lupus erythematosus, Henoch-Schonlein purpura or other systemic diseases, and 68 patients with a different kind of primary chronic glomerulonephritis. Discriminant analysis was used to clearly demarcate these two groups by using 20 clinical variables. RESULTS: Among the 20 clinical variables, the levels of serum albumin, serum IgG, serum IgA, the degree and quantitation of proteinuria, the degree of microhematuria, and the RBC counts of the urinary sediments in the IgA nephropathy group were significantly higher than those in the non-IgA nephropathy group. Also, the presence of subjective symptoms was significantly different between the two groups. Using the stepwise method, serum albumin (ALB), serum IgA (IGA), and the degree of microhematuria (MICRO) were chosen to be the discriminant markers and resulted in a correct classification rate of 81.3%. The discriminant function (D) was 'D=0.842XALB+0.523XIGA+0.414XMICRO'. CONCLUSIONS: It was considered that discriminant analysis using clinical markers such as serum albumin, serum IgA, and degree of microhematuria before renal biopsy is useful in the clinical diagnosis of IgA nephropathy.