ABSTRACT
BACKGROUND: In Korea, tuberculosis is resistant to isoniazid (INH) and/or rifampicin (RIF) in more than 10% of cases. To prevent the spread of resistant Mycobacterium tuberculosis strains, it is crucial to develop more rapid resistance detection methods. METHODS: To determine the feasibility of using direct sequencing for detecting INH- and RIF-resistant strains, the katG gene, the regulatory region of the inhA gene, and the 81-bp hot-spot region of the rpoB gene from 95 culture isolates and 46 respiratory specimens were sequenced. Total 141 culture isolates were classified by conventional drug susceptibility testing (DST) as INH(R)/RIF(R) (N=30), INH(R)/RIF(S) (N=23), INH(S)/RIF(R) (N=15), and INH(S)/RIF(S) (N=73). RESULTS: Compared with phenotypic DST, the overall sensitivity and specificity of sequencing were 83.0% (44/53) and 96.6% (85/88), respectively, for INH resistance, and 93.3% (42/45) and 100% (96/96), respectively, for RIF resistance. The rates were similar between culture isolates and respiratory specimens. Interestingly, three specimens with inhA -15C>T mutation were susceptible to INH by conventional DST. CONCLUSIONS: Detection of mutations in the katG codon 315, the inhA regulatory region, and the hot-spot region of rpoB would be useful for rapid detection of INH and RIF resistance in Korea.
Subject(s)
Humans , Antitubercular Agents/pharmacology , Bacterial Proteins/genetics , Catalase/genetics , Drug Resistance, Multiple, Bacterial , Genotype , Isoniazid/pharmacology , Mutation , Mycobacterium tuberculosis/genetics , Oxidoreductases/genetics , Republic of Korea , Rifampin/pharmacology , Sensitivity and Specificity , Sequence Analysis, DNA/methodsABSTRACT
Barium carbonate is commonly used rodenticidally and industrially, but intoxication has been uncommonly reported. Muscle weakness and hypokalemia are the characteristic features of barium carbonate intoxication. Barium-induced hypokalemia is due to a rapid and large transfer of potassium from the extracellular space into the intracellular space resulting from blocking potassium channels by barium ions. We report 35 cases of barium carbonate intoxication which developed after accidental ingestion of barium poisoned noodle. All patients developed severe hypokalemic paralysis and some degree of vomiting and diarrhea. We managed these patients with aggressive potassium supplementation and all patients were discharged without any sequelae.
Subject(s)
Humans , Barium , Carbon , Diarrhea , Eating , Extracellular Space , Hypokalemia , Intracellular Space , Ions , Muscle Weakness , Paralysis , Potassium , Potassium Channels , VomitingABSTRACT
In Korea, cryptococcal meningitis is a rare opportunistic infection in patients with human immunodeficiency virus (HIV) infection. Cryptococcal meningitis in non-HIV infected patients is usually accompanied by cerebrospinal fluid (CSF) pleocytosis, but sometimes this is not the case in HIV-infected patients. As the number of patients with HIV infection increases in Korea, such atypical cryptococcal meningitis should be considered as a cause of fever of undetermined origin. In addition, if such a diagnosis is made, underlying AIDS should be ruled out. A 61-year old man was admitted to the hospital because of hematemesis. During hospitalization, he experienced fever and a mild continuous headache. Physical examination showed no neck stiffness. For the evaluation of persistent fever, CSF examination was performed, which showed elevated protein, decreased sugar, normal pressure, and no pleocytosis. Meningitis due to Cryptococcus neoformans was diagnosed by positive CSF india ink preparation and fungus culture. HIV infection was later confirmed by Western blot analysis.
Subject(s)
Humans , Middle Aged , Blotting, Western , Cerebrospinal Fluid , Cryptococcus neoformans , Diagnosis , Fever , Fungi , Headache , Hematemesis , HIV Infections , HIV , Hospitalization , India , Ink , Korea , Leukocytosis , Meningitis , Meningitis, Cryptococcal , Neck , Opportunistic Infections , Physical ExaminationABSTRACT
In Korea, cryptococcal meningitis is a rare opportunistic infection in patients with human immunodeficiency virus (HIV) infection. Cryptococcal meningitis in non-HIV infected patients is usually accompanied by cerebrospinal fluid (CSF) pleocytosis, but sometimes this is not the case in HIV-infected patients. As the number of patients with HIV infection increases in Korea, such atypical cryptococcal meningitis should be considered as a cause of fever of undetermined origin. In addition, if such a diagnosis is made, underlying AIDS should be ruled out. A 61-year old man was admitted to the hospital because of hematemesis. During hospitalization, he experienced fever and a mild continuous headache. Physical examination showed no neck stiffness. For the evaluation of persistent fever, CSF examination was performed, which showed elevated protein, decreased sugar, normal pressure, and no pleocytosis. Meningitis due to Cryptococcus neoformans was diagnosed by positive CSF india ink preparation and fungus culture. HIV infection was later confirmed by Western blot analysis.
Subject(s)
Humans , Middle Aged , Blotting, Western , Cerebrospinal Fluid , Cryptococcus neoformans , Diagnosis , Fever , Fungi , Headache , Hematemesis , HIV Infections , HIV , Hospitalization , India , Ink , Korea , Leukocytosis , Meningitis , Meningitis, Cryptococcal , Neck , Opportunistic Infections , Physical ExaminationABSTRACT
Pulmonary mucormycosis is an uncommon, but important opportunistic fungal infection associated with diabetes mellitus, leukemia, lymphoma and other immunocompromised states. Mucor species grow best in acidichigh glucose medium, which explaining the particular susceptibility of diabetic patient who are ketoacidic. Early consideration of this diagnosis, along with aggressive diagnostic evaluation, is critical to effective therapy and patient survival. We have experienced a case of pulmonary murcomycosis mimicking bilateral puimonary edema on chest X-ray that associated with diabetic ketoacidosis. A brief review of the literature was given.
Subject(s)
Humans , Amphotericin B , Diabetes Mellitus , Diabetic Ketoacidosis , Diagnosis , Edema , Glucose , Ketosis , Leukemia , Lymphoma , Mucor , Mucormycosis , Pulmonary Edema , ThoraxABSTRACT
Paraganglioma is an extraadrenal pheochromocytoma originating from chromaffin ceIls distributed in sympathetic nervous systems. This tumor often can produce catecholamines and induce sustained or paroxysmal hypertension, with or without the typical symptams of headache, palpitation and sweating. Paraganglioma without the usual clinical manifestations is not easy to suspect and diagnose. Herein, we report a case of atypical retroperitoneal paraganglioma which was thought to be the pancreas tail mass and result in a paroxysmal adrenergic crisis and fatal dilated cardiomyopathy after the sonographically guided percutaneous biopsy. This rare case warns against the usual practice of percutaneous biopsy for the preoperative diagnosis of intraabdominal or retmperitoneal tumors.