Two Cases of Malignant Glaucoma after Ahmed Valve Implantation

Purpose@#To report two cases of malignant glaucoma after Ahmed valve implantation.Case summary: (Case 1) A 76-year-old female with angle closure glaucoma in the right eye underwent Ahmed valve implantation. To reduce the risk of corneal endothelial failure, the tube tip was located in the sulcus. Eight days after surgery, surgical iridectomy was performed due to intraocular pressure elevation and a shallow anterior chamber. Three weeks later, vitrectomy was performed due to intraocular pressure elevation with a shallow anterior chamber. Recurrent intraocular pressure elevation was resolved after tip reposition into the vitreous cavity. (Case 2) A 93-year-old female with pseudoexfoliation glaucoma underwent Ahmed valve implantation in the left eye. Five days after surgery, the intraocular pressure increased with a shallow anterior chamber; the remnant cortex and prolapsed vitreous body were present in the anterior chamber. She underwent anterior chamber washing and surgical iridectomy; however, the increase in intraocular pressure with a shallow anterior chamber worsened after 1 month; thus, anterior vitrectomy was performed. @*Conclusions@#Malignant glaucoma after Ahmed valve implantation is considered very rare. However, if risk factors such as short axial length, zonular weakness, old age, or female gender are present, as in these cases, there may be an increased risk of malignant glaucoma developing after Ahmed valve implantation.

Characteristics of Klebsiella pneumoniae Isolates from Stool Samples of Patients with Liver Abscess Caused by Hypervirulent K. pneumoniae

Characteristics of Klebsiella pneumoniae Isolates from Stool Samples of Patients with Liver Abscess Caused by Hypervirulent K. pneumoniae

BACKGROUND@#Hypervirulent Klebsiella pneumoniae (hvKP) has been the most significant pathogen for liver abscesses in East Asia including the Republic of Korea (ROK). Although gastrointestinal colonization of K. pneumoniae may cross the intestinal barrier to invade the liver, characteristics of gastrointestinal carriage K. pneumoniae of hvKP liver abscess patients in the ROK are not well known.@*METHODS@#Characteristics of K. pneumoniae isolated from stool samples and liver aspirate samples of patients with hvKP liver abscess at a tertiary care hospital in the ROK between 2017 and 2018 were evaluated.@*RESULTS@#Out of 37 patients with hvKP liver abscess, 11 patients were noted to have K. pneumoniae isolated from stool samples and were enrolled for analysis. The median age was 71 years. For hvKP isolates from the liver aspirate samples, the most common serotype was K1 (72.7%) followed by K2 (27.3%). For K. pneumoniae isolates from the stool sample, the majority was non-K1/K2 serotype (72.7%). Among non-K1/K2 serotype isolates, high variability of sequence type (ST; ST15, ST307, ST37, ST273, ST2622, and ST42) with high rate of presence of extended-spectrum beta-lactamase (100.0%) was noted. The concordance rate of the K. pneumoniae isolates between the liver aspirate samples and the stool samples from the primary hvKP liver abscess was low (27.3%).@*CONCLUSION@#This study suggests that significant heterogeneity of K. pneumoniae colonizing intestinal tract of the hvKP liver abscess patients. Further studies involving a larger number of hvKP liver abscess patients with continuing surveillance are needed to define the changing epidemiology and the role of gastrointestinal K. pneumoniae in the hvKP liver abscess patients in the ROK.

Characteristics of Klebsiella pneumoniae Isolates from Stool Samples of Patients with Liver Abscess Caused by Hypervirulent K. pneumoniae

BACKGROUND@#Hypervirulent Klebsiella pneumoniae (hvKP) has been the most significant pathogen for liver abscesses in East Asia including the Republic of Korea (ROK). Although gastrointestinal colonization of K. pneumoniae may cross the intestinal barrier to invade the liver, characteristics of gastrointestinal carriage K. pneumoniae of hvKP liver abscess patients in the ROK are not well known.@*METHODS@#Characteristics of K. pneumoniae isolated from stool samples and liver aspirate samples of patients with hvKP liver abscess at a tertiary care hospital in the ROK between 2017 and 2018 were evaluated.@*RESULTS@#Out of 37 patients with hvKP liver abscess, 11 patients were noted to have K. pneumoniae isolated from stool samples and were enrolled for analysis. The median age was 71 years. For hvKP isolates from the liver aspirate samples, the most common serotype was K1 (72.7%) followed by K2 (27.3%). For K. pneumoniae isolates from the stool sample, the majority was non-K1/K2 serotype (72.7%). Among non-K1/K2 serotype isolates, high variability of sequence type (ST; ST15, ST307, ST37, ST273, ST2622, and ST42) with high rate of presence of extended-spectrum beta-lactamase (100.0%) was noted. The concordance rate of the K. pneumoniae isolates between the liver aspirate samples and the stool samples from the primary hvKP liver abscess was low (27.3%).@*CONCLUSION@#This study suggests that significant heterogeneity of K. pneumoniae colonizing intestinal tract of the hvKP liver abscess patients. Further studies involving a larger number of hvKP liver abscess patients with continuing surveillance are needed to define the changing epidemiology and the role of gastrointestinal K. pneumoniae in the hvKP liver abscess patients in the ROK.

Optic Neuropathy after Taking Linezolid

PURPOSE@#We report a case of optic neuropathy in a patient who was treated with pre-extensively drug-resistant tuberculosis(pre-XDR TB) treatment with linezolid.CASE SUMMARY: A 61-year-old male patient with no other underlying disease was diagnosed with pre-XDR Tb 6 months before and took the TB drug at another hospital. Ethambolol was not prescribed because it was resistant from the beginning of TB treatment. Threrefore, linezolid was included for treatment of pre-XDR TB. The patient's best corrected visual acuity was 20/400 in both eyes at the time of outpatient visit. In Ishihara color vision test, both eyes showed complete color blindness. There was no detectable relative afferent pupillary defect, and fundus examination showed hyperemic optic discs and visual field examination showed both central visual field defects. Linezolid induced optic neuropathy was suspected, the drug was discontinued. After one month, the patient's best corrected visual acuity recovered to 20/20 in both eyes, and visual field and color vision returned to normal at 3 months.@*CONCLUSIONS@#Linezolid is a broad spectrum antibiotic and is a useful drug for the treatment of broad-spectrum tuberculosis. However, since long-term use may cause optic neuropathy, the possibility of optic neuropathy should always be considered. If optic neuropathy is suspected, prompt drug withdrawal is required and reversible clinical changes can be expected.

Cellulitis Caused by a Novel Cupriavidus Species Strain J1218 Identified by Whole Genome Sequencing / 대한임상미생물학회지

We report a case of cellulitis caused by a novel Cupriavidus species identified using whole-genome sequence analysis. Subcutaneous tissue biopsies from the left lower leg of a 67-year-old man who suffered from cellulitis were cultured. Round, convex, gray and non-hemolytic colonies were recovered after 72-h incubation. 16S rRNA sequence analysis showed 98.6% similarity with Cupriavidus basilensis DSM 11853(T) in the NCBI database and 99.9% similarity with C. basilensis KF708 in the EzBioCloud database. Genomic analysis using the MiSeq platform (Illumina, USA) and the TrueBac ID database (ChunLab, Korea) revealed that the average nucleotide identity (ANI) of this strain with C. basilensis DSM 11853(T) was 87.6%. The patient was treated with oral cefditoren pivoxil for 9 weeks. This study is the first to report cellulitis caused by Cupriavidus species strain J1218.

A Case of Spontaneous Recovery of an Iris Cyst in a Patient with Peritoneal Tuberculosis

PURPOSE: We report a case of spontaneous recovery of an iris cyst with only tuberculosis medication and conservative eye drops when uveitis and angle closure occurred because of a cyst in a patient with peritoneal tuberculosis. CASE SUMMARY: A 49-year-old female who was diagnosed with iritis and treated with steroid eye drops visited our clinic because of decreased visual acuity 1 month prior. There were anterior chamber inflammation cells and an iris cyst completely obstructing the anterior chamber at 12 o'clock. At the time, the patient had been diagnosed with peritoneal tuberculosis in the Department of Internal Medicine and Gynecology and had been treated with surgery and medication. The patient had no past history of glaucoma, but when the iris cyst developed, the intraocular pressure increased to 29 mmHg and anterior inflammatory cells were seen in the range of +1 to +2. The primary lesion of tuberculosis improved and the iris cyst disappeared with treatments involving medication for tuberculosis, steroid eye drops, and glaucoma eye drops, without invasive treatments such as alcohol curettage, laser treatment, or cyst resection. CONCLUSIONS: If an iris cyst is a new lesion of the eye, it is necessary to identify the pattern and cause of the iris cyst first, and if a secondary benign iris cyst is suspected, the primary treatment of the causative disease is necessary rather than prompt invasive treatment.

Breast abscess caused by Staphylococcus aureus in 2 adolescent girls with atopic dermatitis / 소아과

Atopic dermatitis (AD) is a chronic inflammatory skin disease in children. Patients with AD experience a high rate of colonization of the skin surface by Staphylococcus aureus. Because of a skin barrier defect, there is a potential risk of staphylococcal invasive infection in patients with AD. Here, we present 2 cases of breast abscess caused by S. aureus in 2 adolescent girls with severe AD. Methicillin-sensitive S. aureus was identified from the breast abscess material. They were treated with appropriate antibiotics, however surgical drainage of the abscess was needed in case 1. Identical strains were found from the breast abscess material as well as the lesional and the nonlesional skin of the patients through matrixassisted laser desorption/ionization time-of-flight analysis. We characterized the differential abundance of Firmicutes phylum in patients' skin in microbiota analysis. In particular, S. aureus, a member of Firmicutes, differed significantly between the lesional and the normal-appearing skin. Our cases demonstrate the potential severity of bacterial deep tissue infection in AD and the dysbiosis of skin microbiota may be involved in inflammation in AD.

Clinical Features of Influenza and Acute Respiratory Illness in Older Adults at Least 50 Years of Age in an Outpatient Setting in the Republic of Korea: a Prospective, Observational, Cohort Study

Two prospective, multi-centre, observational studies (GlaxoSmithKline [GSK] identifier No. 110938 and 112519) were performed over 2 influenza seasons (2007–2008 and 2008–2009) in the Republic of Korea (ROK) with the aim to evaluate the burden of laboratory-confirmed influenza (LCI) in patients ≥ 50 years of age seeking medical attention for acute respiratory illness (ARI). The median participant age was 58 years in the 2007–2008 season and 60 years in the 2008–2009 season. LCI was observed in 101/346 (29.2%) of ARI patients in the 2007–2008 season and in 166/443 (37.5%) of ARI patients in the 2008–2009 season. Compared to patients with non-influenza ARI, those with LCI had higher rates of decreased daily activities (60.4% vs. 32.9% in 2007–2008 and 46.4% vs. 25.8% in 2008–2009), work absenteeism (51.1% vs. 25.6% and 14.4% vs. 7.7%), and longer duration of illness. These results indicated that influenza is an important cause of ARI in adults aged 50 and older causing more severe illness than non-influenza related ARI.

Diffuse Lamellar Keratitis after Trabeculectomy in a Patient with Laser in situ Keratomileusis

PURPOSE: In the present study, a case of diffuse lamellar keratitis after trabeculectomy in a patient who had received laser in situ keratomileusis many years prior is reported. CASE SUMMARY: A 54-year-old male diagnosed with binocular primary open-angle glaucoma underwent trabeculectomy in the left eye because of poor intraocular pressure control and visual field defect progression even with maximal medical treatments. Faint, non-progressing subepithelial opacities pre-existed in the left cornea but no treatment was administered. The patient had a history of laser in situ keratomileusis in both eyes 12 years prior. On the first postoperative day, conjunctival buttonhole was found and because leaking from the hole continued, topical steroid was discontinued on the fourth postoperative day. On the seventh postoperative day, diffuse lamellar keratitis developed on the central cornea without intraocular pressure elevation, and diffuse infiltration under the corneal flap was observed in the anterior segment on optical coherence tomography. The patient was treated with topical steroid eye drops every 3 hours for the first 2 days and the frequency was increased to every hour because the keratitis did not improve. On the ninth postoperative day, keratitis began to improve and 2 months postoperatively, subepithelial lamellar infiltration improved significantly but did not show complete remission. CONCLUSIONS: Diffuse lamellar keratitis can develop in an eye with laser in situ keratomileusis after trabeculectomy if appropriate treatment with topical steroid eye drops is not administered.

Keratitis Caused by Paecilomyces lilacinus after Cataract Surgery in a Patient with Systemic and Autoimmune Disease

PURPOSE: To report a case of Paecilomyces lilacinus fungal keratitis after cataract surgery in a patient with chronic systemic and autoimmune disease who was treated with medical therapy and penetrating keratoplasty. CASE SUMMARY: A 72-year-old female was referred for decreased visual acuity and ocular pain in the left eye. She underwent cataract surgery in the left eye 1 month earlier and was treated for 2 weeks for corneal edema and stromal infiltration around the corneal suture. She had a chronic systemic disease with hypertension, hyperlipidemia, hepatitis C and rheumatoid arthritis. Suspecting infectious keratitis, the patient was instructed to stop applying topical and systemic steroids and use topical amphotericin B (0.15%) and moxifloxacin (0.5%). However, without improvement, amphotericin B (0.15%) and moxifloxacin (0.5%) were changed to natamycin (5%) and topical voriconazole (2%) and systemic voriconazole was added. However, her systemic status deteriorated and corneal melting developed, scleral graft implantation and amniotic membrane implantation were performed to prevent corneal perforation 6 weeks after the initial visit. Paecilomyces lilacinus was identified in culture at 7 weeks and penetrating keratoplasty was performed 12 weeks after the initial visit. After penetrating keratoplasty, corneal status was stable for 6 months and no signs of recurrence were observed. CONCLUSIONS: In a patient with Paecilomyces lilacinus fungal keratitis and chronic systemic and autoimmune disease, penetrating keratoplasty showed good prognosis when the disease was refractory to topical and systemic antifungal agents.

A Case of Bilateral Branch Retinal Vein Occlusion after Taking Tamoxifen

PURPOSE: To report a case of bilateral branch retinal vein occlusion development after taking long-term tamoxifen adjuvant therapy. CASE SUMMARY: A 72-year-old female breast cancer patient with a 10-year history of tamoxifen intake presented with decreased visual acuity that began 5 years prior. The patient had no other past history. The best corrected visual acuity (BCVA) was 0.3 in the right eye and 0.04 in the left eye. There was no specific finding of anterior segment on slit lamp examination. On fundus examination, sheathed branch retinal veins were observed in the inferotemporal area of the right eye and superotemporal and inferotemporal areas of the left eye. Microangiopathies were observed around the occluded branch retinal veins in both eyes and macular edema was present in the left eye. Laser photocoagulation was performed at the non-perfusion area in both eyes and an intravitreal injection of bevacizumab and 3 intravitreal injections of triamcinolone were administered into the left eye. The BCVA did not change after 3 years and remained relatively stable. CONCLUSIONS: If a patient presents with decreased visual acuity after taking tamoxifen, fundus examination and fluorescein angiogram should be performed due to the possibility of branch retinal vein occlusion.

A Comparison of Implants Used in Double Door Laminoplasty : Allogeneic Bone Spacer versus Hydroxyapatite Spacer

OBJECTIVE: The aim of this study was to compare the clinical and radiological outcomes associated with the use of hydroxyapatite (HA) spacer and allogeneic bone (AB) spacer in laminoplasty. METHODS: From January 2006 to July 2014, 79 patients with cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament underwent cervical laminoplasty. The radiologic parameters were obtained from plain radiography and three-dimensional computed tomography. All images were taken before and after surgery. Cervical lordosis, spinal canal dimension, fusion between lamina and spacer, and resorption of spacer were checked. Clinical outcomes were assessed using visual analog scale and Japanese Orthopedic Association. RESULTS: Double-door laminoplasty was performed on 280 levels : 182 in the HA group and 98 in the AB group. The mean follow-up was 23.1 months (range : 4–69 months). Similar fusion rates were found in these groups (p=0.3). The resorption rate between lamina and spacer was lower in the HA group (p<0.001). During the immediate postoperative period, the canal dimension of both groups increased compared with the results in the preoperative period. However, the canal dimension of the AB group decreased over time compared with that of the HA group (p<0.001). CONCLUSION: Double-door laminoplasty improved the clinical outcomes of both groups. However, the spinal canal dimension in the AB group showed a greater degree of reduction than in the HA group at the final postoperative follow-up. Therefore, we suggest that surgeons consider the use of larger-sized AB spacers in double-door laminoplasties.

Effect of interleukin-29 on interferon- alpha secretion by peripheral blood mononuclear cells

The effect of interleukin [IL]-29, a new therapeutic agent similar to type I interferons [IFNs], on IFN- alpha secretion of human plasmacytoid dendritic cells [pDCs] has not been studied. Therefore, in this study, we aimed to clarify the effect of IL-29 on IFN- alpha secretion of pDCs using human peripheral blood mononuclear cells [PBMCs] in the presence of cytosine-phosphate-guanosinemotif-containing oligodeoxy nucleotides [CpG]. In this experimental and prospective study, PBMCs were obtained from 11 healthy volunteers and divided into four culture conditions: I. control, II. CpG treatment, III. IL-29 treatment and IV. CpG plus IL-29 treatment. The amount of IFN- alpha secretion was measured from each culture supernatant by flow cytometry using the flowcytomix apparatus [eBioscience, Vienna, Austria]. Fractional IFN- alpha production of the cultured PBMCs was measured by intracellular staining using the cytomics FC 500 system [Beckman Coulter, Brea, CA, USA] with CXP Software. The mean +/- standard deviation [SD] of supernatant IFN- alpha secretion per pDC/ micro L was 5.7 +/- 9.3 pg/mL/count/ micro L for condition I, 1071.5 +/- 1026.6 pg/mL/count/ micro L for condition II, 14.1 +/- 21.1 pg/mL/count/ micro L for condition III, and 1913.9 +/- 1525.9 pg/mL/count/ micro L for condition IV. There were statistically significant differences between conditions I and II as well as betweenconditions II and IV. Intracellular IFN- alpha production was only detectable in the pDC fraction from one culture; the production amount was similar between the cells treated with CpG and those treated with CpG plus IL-29. Natural killer [NK] cell production of IFN- alpha was observed in two out of three cultures and one culture showed IFN- alpha production in the monocyte fraction. IL-29 alone did not show any effect on IFN- alpha secretion of PBMCs. However, the addition of CpG along with IL-29 enhanced IFN- alpha secretion of PBMCs. Given that pDCs are the major secretors of IFN- alpha in peripheral blood, this result has suggested the possibility that IL-29 has an enhancing effect in human pDC IFN- alpha secretion. Although the supernatant IFN- alpha secretion was not directly correlated with pDCs's intracellular IFN- alpha production in this study, prolonged incubation of pDC and other PB subsets with CpG or IL-29 for over 4 hours could be applied in future studies. These studies would help to elucidate the mechanism of action of IL-29 in human pDCs associated with viral infections

Comparison of Nasopharyngeal Aspirates and Nasopharyngeal Flocked Swabs for Respiratory Virus Detection / 대한임상미생물학회지

BACKGROUND: Nasopharyngeal aspirate (NPA) is known as the best specimen for accurate diagnosis of viral respiratory infections in pediatric patients, but the procedure is very annoying. Recently introduced flocked swabs have been reported to be easy to obtain a good quality specimen and comfortable to patients. The purpose of this study was to compare the sensitivities between NPA and nasopharyngeal flocked swabs (NPFS) for detection of respiratory viruses in children. METHODS: For this study, 111 hospitalized children with acute respiratory tract infections were recruited. NPA and NPFS were performed in parallel from each patient. NPFS were always collected after NPA. Specimens were tested for six common respiratory viruses in triplicate using indirect immunofluorescence (IIF), viral cultures, and multiplex reverse transcription PCR (RT-PCR). RESULTS: The proportion of specimens inadequate for IIF was higher in NPA (23.4%) than NPFS (5.4%). According to the consensus positive, the positive rates of NPFS were higher than those of NPA when using IIF (45.7% and 30.6%, P=0.048) and culture (38.7% and 27.9%, P=0.004). However, the false-positive rates of NPFS were higher than those of NPA when using IIF (12.4% and 1.2%, P=0.004). The positive rates of NPFS and those of NPA were not different in multiplex RT-PCR (67.6% and 55.9%, P=0.055). CONCLUSION: The higher sensitivity of IIF for NPFS specimens and of culture for respiratory viruses and the similar sensitivities in multiplex PCR could make them an alternative to NPA samples, especially in physician clinics or emergency rooms.

The Effect of Caffeinated Energy Drink Consumption on Intraocular Pressure in Young Adults

PURPOSE: Several energy drinks containing a high content of caffeine are widely consumed among young adults. We examined the effects of caffeinated energy drinks on intraocular pressure (IOP) and blood pressure (BP) in healthy young subjects. METHODS: In this prospective randomized, case-controlled cross over study conducted, from August to September of 2014, 40 healthy young volunteers (80 eyes) in their 20's and 30's drank 2 types of beverage each consumed after a 3-month washout period. The study participants were randomly given the caffeinated energy drink (group I, n = 20) or caffeine-free drink (group II, n = 20), IOP and BP were measured at 0, 30, 60, 90, and 120 minutes and 12 and 24 hours after beverage consumption. RESULTS: In group I, the mean +/- standard deviation (SD) of IOP at baseline was 13.2 +/- 1.56 mm Hg and the IOP increased until 24 hours after drink consumption. IOPs at 30, 60, 90, and 120 minutes and 12 and 24 hours after drinking caffeinated energy drink were 14.45 +/- 2.12, 14.93 +/- 2.02, 14.85 +/- 1.55, 14.2 +/- 1.34, 14.25 +/- 1.74, and 13.35 +/- 1.61, respectively and statistically significant at 30, 60, 90, 120 minutes and 12 hours (p < 0.05). A corresponding increase in BP after drinking the caffeinated energy drink was observed but without statistical significance. Drinking the caffeine-free beverage did not affect IOP or BP significantly. CONCLUSIONS: IOP increases after consuming the caffeinated energy drink were statistically significant at 30, 60, 90, and 120 minutes and 12 hours. Therefore, caffeinated energy drinks may not be recommended for glaucoma patients or glaucoma suspects.

The Effect of Caffeinated Energy Drink Consumption on Intraocular Pressure in Young Adults

PURPOSE: Several energy drinks containing a high content of caffeine are widely consumed among young adults. We examined the effects of caffeinated energy drinks on intraocular pressure (IOP) and blood pressure (BP) in healthy young subjects. METHODS: In this prospective randomized, case-controlled cross over study conducted, from August to September of 2014, 40 healthy young volunteers (80 eyes) in their 20's and 30's drank 2 types of beverage each consumed after a 3-month washout period. The study participants were randomly given the caffeinated energy drink (group I, n = 20) or caffeine-free drink (group II, n = 20), IOP and BP were measured at 0, 30, 60, 90, and 120 minutes and 12 and 24 hours after beverage consumption. RESULTS: In group I, the mean +/- standard deviation (SD) of IOP at baseline was 13.2 +/- 1.56 mm Hg and the IOP increased until 24 hours after drink consumption. IOPs at 30, 60, 90, and 120 minutes and 12 and 24 hours after drinking caffeinated energy drink were 14.45 +/- 2.12, 14.93 +/- 2.02, 14.85 +/- 1.55, 14.2 +/- 1.34, 14.25 +/- 1.74, and 13.35 +/- 1.61, respectively and statistically significant at 30, 60, 90, 120 minutes and 12 hours (p < 0.05). A corresponding increase in BP after drinking the caffeinated energy drink was observed but without statistical significance. Drinking the caffeine-free beverage did not affect IOP or BP significantly. CONCLUSIONS: IOP increases after consuming the caffeinated energy drink were statistically significant at 30, 60, 90, and 120 minutes and 12 hours. Therefore, caffeinated energy drinks may not be recommended for glaucoma patients or glaucoma suspects.

Comparison of Quantitation of Cytomegalovirus DNA by Real-Time PCR in Whole Blood with the Cytomegalovirus Antigenemia Assay

BACKGROUND: Quantitation of cytomegalovirus (CMV) DNA using real-time PCR has been utilized for monitoring CMV infection. However, the CMV antigenemia assay is still the 'gold standard' assay. There are only a few studies in Korea that compared the efficacy of use of real-time PCR for quantitation of CMV DNA in whole blood with the antigenemia assay, and most of these studies have been limited to transplant recipients. METHOD: 479 whole blood samples from 79 patients, falling under different disease groups, were tested by real-time CMV DNA PCR using the Q-CMV real-time complete kit (Nanogen Advanced Diagnostic S.r.L., Italy) and CMV antigenemia assay (CINA Kit, ArgeneBiosoft, France), and the results were compared. Repeatedly tested patients were selected and their charts were reviewed for ganciclovir therapy. RESULTS: The concordance rate of the two assays was 86.4% (Cohen's kappa coefficient value=0.659). Quantitative correlation between the two assays was a moderate (r=0.5504, P<0.0001). Among 20 patients tested repeatedly with the two assays, 13 patients were transplant recipients and treated with ganciclovir. Before treatment, CMV was detected earlier by real-time CMV DNA PCR than the antigenemia assay, with a median difference of 8 days. After treatment, the antigenemia assay achieved negative results earlier than real-time CMV DNA PCR with a median difference of 10.5 days. CONCLUSIONS: Q-CMV real-time complete kit is a useful tool for early detection of CMV infection in whole blood samples in transplant recipients.

The Antimicrobial Activity of (-)-Epigallocatehin-3-Gallate and Green Tea Extracts against Pseudomonas aeruginosa and Escherichia coli Isolated from Skin Wounds

BACKGROUND: Skin infections with Gram-negative bacteria are sometimes challenging to treat, because these bacteria show multidrug resistance against commonly used antibiotics and patients with Gram-negative bacterial infection overall have deteriorated in conditions in many cases. Studies have shown that epigallocatechin gallate (EGCG) and green tea extracts (GTE) inhibit the growth of several Gram-positive bacteria species. OBJECTIVE: The purpose of this study was to investigate the minimum inhibitory concentrations (MICs) of EGCG and GTE in Pseudomonas aeruginosa and Escherichia coli, and assess the use of these chemicals as an alternative or adjunct topical antimicrobial agent against P. aeruginosa and E. coli with multidrug resistance. METHODS: The MICs of EGCG, GTE, and other tested antibiotics were measured and compared to determine the antibacterial efficacy and the differences in pattern of resistance. RESULTS: The P. aeruginosa and E. coli strains used in this study showed multidrug resistance. EGCG inhibited the growth of P. aeruginosa at a MIC level of 200~400 microg/ml. The MIC of GTE was a 1 : 16 dilution for P. aeruginosa. EGCG showed antimicrobial activity against E. coli at a MIC of 400 microg/ml. In the case of GTE, the MIC was a dilution between 1:8 and 1:4 for E. coli. CONCLUSION: EGCG and GTE showed potential as alternative or adjunct topical antimicrobial agents for infections that are resistant to traditional antibiotic therapy.

Performance of the Elecsys HIV combi PT Assay Compared to the ARCHITECT HIV Ag/Ab Combo Assay

BACKGROUND: The aim of this study was to compare the analytical sensitivity and specificity of the recently updated 4th generation Elecsys HIV combi PT assay (Roche Diagnostics GmbH, Germany) to those of the ARCHITECT HIV Ag/Ab Combo assay (Abbott Laboratories, Germany). METHODS: A total of 2,003 fresh random clinical samples, 4 HIV seroconversion panels, a WHO International Standard p24 antigen sensitivity panel, 5 HIV-1 subtype viral lysates, and 5 HIV-1 subtype antibodies were tested in comparative studies with the Elecsys HIV combi PT and ARCHITECT HIV Ag/Ab Combo assays. Samples were assayed with both tests on the same day. The MP Diagnostics HIV Western Blot 2.2 Assay, the Elecsys HIV p24 Ag Test and Confirmatory Test, and the COBAS AmpliPrep/COBAS TaqMan HIV-1 Test were performed as supplementary tests. RESULTS: Both the Elecsys and ARCHITECT assays detected viral antigens in all four seroconversion panels on the same bleed days, and had lower limits of detection of <1 IU/mL with the p24 antigen sensitivity panel. The ARCHITECT assay showed slightly higher sensitivity in detecting viral antigens with some HIV-1 subtype viral lysates, while the Elecsys assay was more sensitive in detecting each of the 5 HIV-1 subtype antibodies. Both assays detected 5/5 HIV+ clinical samples correctly. The analytical specificities of the Elecsys and ARCHITECT assays were 99.90% and 99.80%, respectively. CONCLUSIONS: The Elecsys HIV combi PT assay performed comparably to the ARCHITECT HIV Ag/Ab Combo assay. Thus, the Elecsys HIV combi PT assay is suitable for diagnostic testing in university hospital settings.