In vitro Synergism between Chloroquine and Antibiotics against Orientia tsutsugamushi

BACKGROUND: To investigate whether chloroquine enhances the effect of antibiotics against Orientia tsutsugamushi, the causative organism of scrub typhus, we compared the effect of antibiotics in combination with chloroquine with the effect of antibiotics alone in vitro. MATERIALS AND METHODS: The Boryong or AFSC-4 strain was inoculated into ECV304 cells, and incubated in medium containing doxycycline (4 microg/mL), rifampin (4 microg/mL), azithromycin (0.5 microg/mL), chloroquine (1 microg/mL), and each of these antibiotics in combination with chloroquine for 7 d. Immunofluorescence (IF) staining for O. tsutsugamushi was performed 4 hr and 7 d after inoculation of the bacteria, and IF-positive foci were enumerated. RESULTS: Chloroquine inhibited the growth of O. tsutsugamushi by 15.5%. In combination with chloroquine, the antimicrobial effects increased by 4.4% for doxycycline (a 92.9% reduction of bacterial numbers for doxycycline versus a 97.3% reduction for doxycycline plus chloroquine), 4.6% for rifampin (90.0% versus 94.6%), and 8.3% for azithromycin (86.9% versus 95.2%). The antimicrobial effect of the antibiotics alone was significantly different compared to the combined effect of antibiotics and chloroquine (Wilcoxon signed-rank test, P = 0.001). CONCLUSIONS: The combined use of chloroquine with an antibiotic for the treatment of O. tsutsugamushi infections may be useful for increasing the efficacy of the antibiotics.

Influenza Vaccine Coverage Rate and Related Factors on Pregnant Women

BACKGROUND: During seasonal influenza epidemics and previous pandemics, pregnant women have been at increased risk for complications related to influenza infection. Although influenza vaccination has been widely recommended to pregnant women and immunocompromised hosts, the vaccination rate is presumed to be low in pregnant women. This study was aimed to evaluate the vaccination rate and factors associated with Influenza vaccination among pregnant women, who are at high risk for developing complications from the influenza. MATERIALS AND METHODS: This study was carried out by telephone survey from April, 2007 to August, 2007. Women who were in their second trimester of pregnancy or above,- during October, 2006 and February, 2007, the recommended vaccination period, and had given birth at Inha University Hospital were selected as the study population. Immunization status, general understanding, and factors associated with vaccination were evaluated. RESULTS: Among a total of 506 eligible pregnant women, 227 (44.8%) responded to the questionnaires. The influenza vaccination rate among the pregnant women was only 4% (9/227). Major reasons for not receiving vaccination were first, not awaring the necessity of immunization during pregnancy (48.5%, 110/227) and second, misunderstanding that it is prohibited during pregnancy (36.1%, 82/227). The major factors that influenced the compliance of vaccination were correct understanding and doctor's recommendation on the influenza immunization during pregnancy. CONCLUSIONS: The influenza vaccine coverage on pregnant women was very low and the awareness of influenza vaccination during pregnancy in general was inaccurate. Shift in perception is required and this can be achieved by educating the pregnant women on the safety and efficacy of vaccination. In addition, doctors' active encouragement to vaccination is highly recommended.

Influenza Vaccine Coverage Rate and Related Factors on Pregnant Women

BACKGROUND: During seasonal influenza epidemics and previous pandemics, pregnant women have been at increased risk for complications related to influenza infection. Although influenza vaccination has been widely recommended to pregnant women and immunocompromised hosts, the vaccination rate is presumed to be low in pregnant women. This study was aimed to evaluate the vaccination rate and factors associated with Influenza vaccination among pregnant women, who are at high risk for developing complications from the influenza. MATERIALS AND METHODS: This study was carried out by telephone survey from April, 2007 to August, 2007. Women who were in their second trimester of pregnancy or above,- during October, 2006 and February, 2007, the recommended vaccination period, and had given birth at Inha University Hospital were selected as the study population. Immunization status, general understanding, and factors associated with vaccination were evaluated. RESULTS: Among a total of 506 eligible pregnant women, 227 (44.8%) responded to the questionnaires. The influenza vaccination rate among the pregnant women was only 4% (9/227). Major reasons for not receiving vaccination were first, not awaring the necessity of immunization during pregnancy (48.5%, 110/227) and second, misunderstanding that it is prohibited during pregnancy (36.1%, 82/227). The major factors that influenced the compliance of vaccination were correct understanding and doctor's recommendation on the influenza immunization during pregnancy. CONCLUSIONS: The influenza vaccine coverage on pregnant women was very low and the awareness of influenza vaccination during pregnancy in general was inaccurate. Shift in perception is required and this can be achieved by educating the pregnant women on the safety and efficacy of vaccination. In addition, doctors' active encouragement to vaccination is highly recommended.

A Case of Cerebral Gumma Presenting as Brain Tumor in a Human Immunodeficiency Virus (HIV)-Negative Patient

Syphilis, along with the recent increase of human immunodeficiency virus (HIV) patients, has also been on the rise. It has a broad spectrum of clinical manifestations, among which cerebral gumma is, a kind of neurosyphilis, however, it is rare and can be cured by penicillin. Thus, cerebral gumma needs to be differentially diagnosed from other brain masses that may be present in syphilis patients. We have experienced a case where the patient was first suspected of brain tumor, but confirmed by surgery to be cerebral gumma due to neurosyphilis. This is the first such case encountered in Korea, therefore, we report it here in. A 40-year old woman complaining of headaches was found to have a brain mass on her CT scans and MRI. Suspecting a brain Tumor, a resection was performed on the patient, and histological results revealed that the central portion of the mass contained necrotic material and the peripheral region was infiltrated with plasma cells. Warthin-Starry staining of the region revealed spirochetes, and the patient was thus diagnosed as brain gumma. Venereal Disease Research Laboratory (VDRL) of cerebrospinal fluid (CSF) was reactive. After an operation, penicillin-G at a daily dose of 24x10(6) U was given for 10 days from post-operative day 10, and thereafter, the mass disappeared.

Deep Cutaneous Ulcer Caused by Serratia marcescens after Fresh Water Exposure

Serratia marcescens causes various diseases. Skin ulcer is one of S. marcescens related diseases, but it is rare clinical syndrome. We experienced a case of skin ulcer caused by S. marcescens in a woman with alcohol induced cirrhosis. After exposure to fresh water while trimming the codfish, she developed deep ulcer on her right hand and bacteremia by S. marcescens. S. marcescens should be considered as a specific etiology of skin infection presenting after fresh water exposure.

Deep Cutaneous Ulcer Caused by Serratia marcescens after Fresh Water Exposure

Serratia marcescens causes various diseases. Skin ulcer is one of S. marcescens related diseases, but it is rare clinical syndrome. We experienced a case of skin ulcer caused by S. marcescens in a woman with alcohol induced cirrhosis. After exposure to fresh water while trimming the codfish, she developed deep ulcer on her right hand and bacteremia by S. marcescens. S. marcescens should be considered as a specific etiology of skin infection presenting after fresh water exposure.

Severe Paradoxical Reaction Requiring Tracheostomy in a Human Immunodeficiency Virus (HIV)-negative Patient with Cervical Lymph Node Tuberculosis

During drug treatment of tuberculous lymphadenitis, paradoxical response (PR) may occasionally occur. Continued treatment or lymph node aspiration improves PR without severe sequelae. However, we report a case of severe PR in a patient with cervical lymph node tuberculosis causing airway obstruction due to retropharyngeal lymph node swelling during antituberculous treatment. Tracheostomy and drainage of the node were performed to secure the airway. Possible airway obstruction due to PR must be suspected when cervical lymph node tuberculosis involves the retropharyngeal lymph node.

A Case Study of Meningococcal Vaccination At a University Hospital

Meningococcal infection is a life threatening disease that leaves serious sequelae in spite of appropriate treatment, thus vaccination for high risk groups are important for the prevention of meningococcal diseases. However, the vaccine for Neisseria meningitidis has not been available in Korea until we introduced bivalent (serogroup A and C) polysaccharide vaccine for the first time for relief works in our university hospital. The vaccine was administered from January 2005 to March 2007 to 317 persons. Of the groups administered, the largest group among them were 133 (133/317, 42%) students who planned to study abroad and needed the vaccination for secure entrance to school dormitories. This group was followed by health care workers, travellers to the regions of the world with high risks of meningococcal diseases, and splenectomised patients. To rationalize the domestic use of meningococcal vaccine, the availability of vaccines first needs to be simplified by introducing them to the domestic market; for this to be possible, the approval system for vaccines should be reformed and epidemiogical studies need to be carried out.

A Case Study of Meningococcal Vaccination At a University Hospital

Meningococcal infection is a life threatening disease that leaves serious sequelae in spite of appropriate treatment, thus vaccination for high risk groups are important for the prevention of meningococcal diseases. However, the vaccine for Neisseria meningitidis has not been available in Korea until we introduced bivalent (serogroup A and C) polysaccharide vaccine for the first time for relief works in our university hospital. The vaccine was administered from January 2005 to March 2007 to 317 persons. Of the groups administered, the largest group among them were 133 (133/317, 42%) students who planned to study abroad and needed the vaccination for secure entrance to school dormitories. This group was followed by health care workers, travellers to the regions of the world with high risks of meningococcal diseases, and splenectomised patients. To rationalize the domestic use of meningococcal vaccine, the availability of vaccines first needs to be simplified by introducing them to the domestic market; for this to be possible, the approval system for vaccines should be reformed and epidemiogical studies need to be carried out.

Rectus Muscle Hematoma Due to Severe Cough in CAPD Patient / 대한신장학회지

Rectus muscle hematoma is uncommon condition, caused by a tear in an epigastric vessel. Most cases were caused by direct trauma or anticoagulation therapy. In addition, it has been frequently associated with other conditions such as coughing, sneezing, vomiting, pregnancy, hypertension, prior paracentesis or laparotomy, excessive retraction in surgery. There are several reports of rectus muscle hematoma in renal failure, but no report has come out with CAPD patients in Korea. We herein present a case of rectus muscle hematoma due to severe cough in end-stage renal disease patient on CAPD.