Observation of the Free-living Adults of Strongyloides stercoralis from a Human Stool in Korea / 감염과화학요법

A 76-year-old Korean man living in Cheonan, Chungcheongnam-do, visited one University Hospital with dyspnea and abdominal pain. He has been undergoing transcatheter arterial chemoembolization (TACE) for the past three years for the treatment of hepatocellular carcinoma. Abdominal pain developed 10 days ago, and became worse several days prior to coming to the emergency room. Physical examination revealed tenderness over the umbilicus. Eosinophil count was 22% without increase in the number of white blood cells. Stool examination showed adult and larval nematodes, which were subsequently identified as free-living adult worms and rhabditiform larvae of Strongyloides stercoralis. Follow-up stool examination performed six days later demonstrated only rhabditiform larvae of S. stercoralis. This is the first report on the recovery of free- living adult worms from human stool in the world.

Observation of the Free-living Adults of Strongyloides stercoralis from a Human Stool in Korea / 감염과화학요법

A 76-year-old Korean man living in Cheonan, Chungcheongnam-do, visited one University Hospital with dyspnea and abdominal pain. He has been undergoing transcatheter arterial chemoembolization (TACE) for the past three years for the treatment of hepatocellular carcinoma. Abdominal pain developed 10 days ago, and became worse several days prior to coming to the emergency room. Physical examination revealed tenderness over the umbilicus. Eosinophil count was 22% without increase in the number of white blood cells. Stool examination showed adult and larval nematodes, which were subsequently identified as free-living adult worms and rhabditiform larvae of Strongyloides stercoralis. Follow-up stool examination performed six days later demonstrated only rhabditiform larvae of S. stercoralis. This is the first report on the recovery of free- living adult worms from human stool in the world.

Clinical significance of codetection of the causative agents for acute respiratory tract infection in hospitalized children / 소아과

PURPOSE: To determine the prevalence and clinical features of codetected respiratory etiological agents for acute respiratory infection in hospitalized children. METHODS: Nasopharyngeal aspirates were obtained from hospitalized children with acute respiratory infection at Dankook University Hospital from September 2003 through June 2005. Immunofluorescent staining and culture were used for the detection of respiratory viruses (influenza virus [IFV] types A, B; parainfluenza virus [PIV] types 1, 2, 3; respiratory syncytial virus [RSV]; adenovirus [AdV]). Polymerase chain reaction (PCR) assays were used for Mycoplasma pneumoniae (MP) and Chlamydia trachomatis (CT) detection, and PCR and culture were performed for enterovirus detection. Acid-fast staining and culture were performed for tuberculosis detection. The demographic and clinical characteristics were reviewed retrospectively from the patients medical records. RESULTS: Evidence of two or more microbes was found in 28 children: RSV was detected in 14, PIV 3 in 10, AdV in 10, MP in 8, PIV 2 in 8, CT in 4, and PIV 1 in 3. Codetected agents were found as follows: RSV+PIV 2, 6 patients; AdV+MP, 4 patients; AdV+PIV, 3 patients; RSV+MP, 3 patients; PIV 1+PIV 3, 3 patients. Distinct peaks of codetected agents were found in epidemics of MP and each respiratory virus. CONCLUSION: The codetected infectious agents were RSV, PIV, AdV, and MP, with distinct peaks found in epidemics of MP and each respiratory virus. Although advances in diagnostic methods have increased the prevalence of codetection, its clinical significance should be interpreted cautiously.

Long Term Maintenance Immunosuppressive Therapy with Mycophenolate Mofetil and Steroid after Kidney Transplantation

PURPOSE: Cyclosporine associated hemolytic uremic syndrome (HUS) is a serious complications following kidney transplantation. In this study, 2 renal transplant patients, treated by the dual drugs -Mycophenolate Mofetil (MMF) and steroid (Deflazacort), without cyclosporine- due to development of HUS, were followed-up. Additionally, IFN-gamma and IL-10 as Th1 and Th2 cytokines, respectively, and their serum levels investigated. METHODS: Following their recovery from HUS, the 2 patients have been followed for 37 and 45 months, respectively, with MMF and steroid as maintenance immunosuppressants. The serum IFN-gamma and IL-10 levels were measured simultaneously in the 2 patients on dual drug, 10 on triple drug (cyclosporine, MMF, steroid) therapies and 18 normal volunteers. The 10 patients on the triple drug therapy were selected from 14 patients, that had undergone renal transplantations in the same year as the 2 dual drug therapy patients. RESULTS: At 37 and 45 months post-transplantation, the 2 pdual drug therapy patients showed serum creatinine levels less than 1.8 and 1.7 mg/dl, respectively. The serum IFN-gamma and IL-10 levels of the 12 (2 dual and 10 triple drug therapy) renal transplant patients (11.83+/-5.01 and 5.96+/-6.02 pg/ml, respectively) were significantly higher than those of the 18 normal volunteers (7.25+/-0.84 and 1.40+/-0.81 pg/ml, respectively), (IFN-gamma: P=0.000, IL-10: P=0.000). However a comparison of IFN-gamma and IL-10 levels between the 2 dual(11.56+/-3.35 and 4.91+/-1.66 pg/ml, respectively) and 10 triple drug therapy patients (11.89+/-5.43 and 6.17+/-6.61 pg/ml, respectively) showed no significant difference (IFN-gamma: P=0.606, IL-10: P=0.485). CONCLUSION: Long-term maintenance treatment with MMF and steroid is an effective alternative therapy in case of cyclosporine induced HUS.

Combination Effects of Various Beta-Lactam Antibiotics with Vancomycin or Teicoplanin against Staphylococcus aureus with Reduced Susceptibility to Vancomycin / 대한진단검사의학회지

BACKGROUND: Combination effects of various beta-lactam antibiotics with vancomycin or teicoplanin against methicillin-resistant Staphylococcus aureus (MRSA) that were detected as pos-sible hetero-vancomycin resistant Staphylococcus aureus (hetero-VRSA) by the Mu-3 agar method, were evaluated. METHODS: Twenty-four strains of MRSA (possible hetero-VRSA) from 22 inpatients of Dankook University Hospital from July through November 1998, were subjected to the study. Minimum inhibitory concentrations (MICs) of antibiotics, alone or in combination, were tested with the agar dilution method and the fractional inhibitory concentration (FIC) indices were calculated to estimate the combination effects. RESULTS: Six strains of 24 MRSA were estimated as hetero-VRSA by population analysis. The aver-age FIC index of imipenem (I), flomoxef (F), cephalothin (C), cefpirome (E) in combination with van-comycin (V) and teicoplanin (T) were 0.584 for I-V, 0.200 for I-T, 0.747 for F-V, 0.230 for F-T, 0.633 for C-V, 0.374 for C-T, 0.773 for E-V, and 0.386 for E-T, respectively. The presence of synergy and addi-tivity in beta-Lactams were observed as 5.3% (16/304) and 90.1% (274/304) for the combination of van-comycin with I, F, C, or E, respectively, and 29.3% (164/560) and 69.8% (391/560) for the combina-tion of teicoplanin with I, F, C, or E, respectively. CONCLUSIONS: We concluded that the selected beta-lactam antibiotics with vancomycin or teicoplanin showed effective against possible hetero-VRSA, as the combination effects were syner-gistic or additive with the average of the FIC index and the frequency of synergy and additivity in this study.

Quantitative Determination of Plasma and Urine Paraquat Concentrations using Spectroscopic Method / 대한진단검사의학회지

BACKGROUND: It is well known that plasma paraquat concentration is one of the most important prognostic indicators for paraquat poisoning. Quantitative analyses of paraquat, however, are not generally used in clinical laboratories. In this work, we evaluated the second-derivative spectroscop-ic method for quantitation of paraquat in plasma and urine, and investigated the clinical significance in patients with paraquat poisoning. METHODS: Linearity, precision, interferences, and comparison with high-performance liquid chro-matography (HPLC) were evaluated in 20 paraquat-poisoning cases using the UV-160 A recording spectrophotometer. The relationship of plasma and urine paraquat concentrations with the clinical outcomes was also studied. RESULTS: The within-run and between-day coefficients of variation (CV) for groups of low and high levels were less than 5%. The derivative amplitude was linearly related to paraquat concentra-tion through the range from 0.5 to 10 ng/mL. The correlation coefficient (r) between spectrophotom-etry and HPLC was 0.992. The accuracy for predicting the outcome for patients based on plasma paraquat concentration was 84.6%. The urine paraquat levels on admission were more than 10 ng/ mL in all of the 9 non-survivors group and in 5 out of 11 of the survivors group. The eliminating rates for plasma and urine paraquat concentrations by extracorporeal procedures were not statistically different between the two groups. CONCLUSIONS: Second-derivative spectroscopic methods for quantitation of paraquat showed an acceptable performance and suitable procedure for clinical laboratory use and it was thought to be seful in assessing the severity and in predicting the prognosis for paraquat poisoning.