Nasal Colonization and Molecular Characterization of Methicillin-Resistant Staphylococcus aureus among Hemodialysis Patients in 7 Korean Hospitals / 병원감염관리

BACKGROUND: Staphylococcus aureus is a major bacteremia-causing pathogen in hemodialysis patients, frequently colonizing patient skin and mucosa. Active infection control is necessary to prevent methicillin-resistant S. aureus (MRSA) infection in hospitals; however, the spread of community-associated MRSA has recently become a concern for MRSA infection control. We evaluated the nasal colonization of MRSA among hemodialysis patients and the molecular characterization of the MRSA isolates. METHODS: Nasal swabs were obtained from 482 hemodialysis patients in 7 nationwide hospitals in November 2009, and cultured for MRSA colonization. Swabs were inoculated and cultured in 6.5% NaCl tryptic soy broth, then subcultured on MRSASelect medium (Bio-Rad, Hercules, CA) for 20-24 h. Multiplex PCR was performed to analyze staphylococcal cassette chromosome mec (SCCmec) types of MRSA isolates. RESULTS: Of 482 hemodialysis patients, 57 (11.8%) carried MRSA, ranging from 6.7% to 19.0%. Among the 57 MRSA isolates, we identified 3 (5.3%) SCCmec II, 1 (1.8%) SCCmec IIA, 30 (52.6%) SCCmec IIB, 1 (1.8%) SCCmec III, 6 (10.5%) SCCmec IV, and 16 (28.1%) SCCmec IVA subtypes. CONCLUSION: The MRSA carriage rate (11.8%) of hemodialysis patients in this study was high. The SCCmec IIB subtype, a healthcare-associated strain, was the predominant strain, although SCCmec IV isolates, typically found in community-associated MRSA infections, were also frequently observed. To prevent healthcare-associated MRSA infections in hemodialysis patients, standardized infection control measures should be performed, and efforts to reduce MRSA carriage rates should be considered.

Endothelial cells in peripheral blood smear: an artifact? / 대한혈액학회지

No abstract available.

Detection of Vancomycin-resistant Enterococci using Multiplex Real-time PCR Assay and Melting Curve Analysis / 대한진단검사의학회지

BACKGROUND: We developed and evaluated the utility of a multiplex real-time PCR assay that uses melting curve analysis and allows simultaneous identification of vancomycin-resistant genotypes and clinically relevant enterococci. METHODS: The specificity of the assay was tested using 4 reference strains of vancomycin-resistant enterococci (VRE) and 2 reference strains of vancomycin-susceptible enterococci. Ninety-three clinical isolates of enterococci with different glycopeptide-resistant phenotypes were genotyped and identified using a multiplex real-time PCR assay and melting curve analysis. RESULTS: Representative melting curves were obtained for Enterococcus faecium, Enterococcus faecalis, vanA-containing E. faecium, vanB-containing E. faecalis, Enterococcus gallinarum, and Enterococcus casseliflavus. Phenotypic and genotypic analysis of the isolates revealed same results for 82 enterococcal isolates, while in 4 isolates, the glycopeptide-resistant phenotypes were inconsistent with the glycopeptide-resistant genotypes and in the 4 other isolates, species could not be accurately identified. Three isolates with mixed strains, which were detected by the PCR assay, could not be correctly identified using phenotypic methods. CONCLUSIONS: VRE genotyping and identification of clinically relevant enterococci were rapidly and correctly performed using multiplex real-time PCR assay and melting curve analysis.

Infection Control Guideline for Hemodialysis Room / 병원감염관리

A hemodialysis room is the healthcare facility utmost demanding an infection control because dialysis patients have chronic serious underlying conditions and high risks of bloodborne infection due to a indwelling intravascular catheter, a frequent exposure to bloods or body fluids, and a blood transfusion as well as a hemodialysis room can be a mixing vessel to encounter both hospital-acquired pathogens and community-acquird pathogens. Therefore the Korean Society for Nosocomial Infection Control (KOSNIC) purposed to develop a guideline for the infection control in a hemodialysis room with support of Korean Center for Disease Control (KCDC). This guideline was composed of 11 chapters including vascular access control, dialysis water, microbiological and chemical monitoring of dialysis water and dialysates, components and passage of dialysates, maintenance of dialysis machines, disinfection, waste management, infection surveillance, aseptic techniques and standard precaution, environmental control, prevention of bloodborne infections and 5 appendices composing basic infection control techniques. This is the first official guideline approved by KOSNIC and KCDC of the infection control in a hemodialysis room in Korea. Here the guideline was published except appendices and entire guideline including those can be downloaded on hompages of KOSNIC (http://www.kosnic.org/) and KCDC (http//www.cdc.go.kr/).

Major Determinants of Serum Homocysteine Concentrations in a Korean Population

The objective of this study was to identify the factors that determine serum homocysteine concentrations in Korean population. In a community-based study, 871 participants completed detailed questionnaires and physical examination. We found that increased age, male sex, family history of stroke, deficiencies of serum folate and vitamin B12, and elevated serum creatinine significantly increased the risk of hyperhomocysteinemia. However, hormonal and behavioral factors (smoking, alcohol drinking, coffee consumption, and sedentary time) were not associated with the risk of hyperhomocysteinemia. The risk of hyperhomocysteinemia was steeply increased in subjects with two or more risk factors among four selected risk factors (deficiencies of serum folate and vitamin B12, elevated creatinine, and family history of stroke) compared to subjects who did not have any risk factors, especially subjects over the age of 65 yr (odds ratio [OR], 33.5; 95% confidence interval [CI], 3.71-302.0 in men; OR, 39.2; 95% CI, 7.95-193.2 in women). In conclusion, increased age, male sex, family history of stroke, deficiencies of serum folate and vitamin B12, and elevated serum creatinine are important determinants of serum homocysteine concentrations with interaction effects between these factors.

Normal Value for Serum Homocysteine and the Prevalence of Hyperhomocysteinemia in a Rural Population / 한국역학회지

PURPOSE: Homocysteine is a known independent risk factor for cardiovascular diseases and its blood levels are influenced by several factors such as race, diet, and lifestyle, so on. Considering these factors, the normal value for total homocysteine has not been determined in Korea. The objective of this study is to establish the normal value for serum total homocysteine and elucidate the prevalence rate of hyperhomocysteinemia by gender and age. SUBJECTS AND METHODS: Among the participants of a community-based cohort study conducted in Yangpyeong province, 889 subjects were measured the biochemical analytes including homocysteine. Those who had the medical histories of angina, myocardial infarction and/orstroke, those who had low levels of folate and/or vitamin B12 and those who had high creatinine level were excluded. Finally, 506 subjects were selected as the reference population. A normal value was established with Clinical and Laboratory Standards Institute C28-A2 protocol. RESULTS: Homocysteine concentrations of total 889 population and 506 reference population were 10.3+/-5.7 micromol/L (1.9 ~ 93.9 micromol/L) and 8.8+/-2.5 micromol/L (4.3 ~ 21.4 micromol/L), respectively. Homocysteine level was significantly higher in men compared to women (P<0.001) and was significantly increased with age. Normal values were 6.7~15.3micromol/L for men and 5.2~12.7 micromol/L for women. With the normal values, the prevalence rates of hyperhomocysteinemia were 13.3% for men and 8.5% for women in total 889 population. The prevalence rate was highest for individuals aged 60 years or older. CONCLUSIONS: These data on homocysteine concentrations are similar to from different countries. The established normal value might be used to evaluate quantitatively the risk for hyperhomocysteinemia.

Ten Cases of Fitz-Hugh-Curtis Syndrome / 대한소화기학회지

Fitz-Hugh-Curtis syndrome, a kind of perihepatitis, occurs approximately in 3 to 10 percent of patients with pelvic inflammatory disease. It is not easy to detect in clinical settings due to requirement of invasive methods for diagnosis, for example, like a laparoscopic examination. Now, it has become possible to recognize it easily with the aid of non-invasive methods including an abdominal dynamic CT scan and laboratory tests. Moreover, it can be improved after the oral administration of antibiotics. Therefore, noninvasive diagnosis is desirable. Herein, clinical characteristics of ten cases of Fitz-Hugh-Curtis syndrome are reported, with a review of the literature.

The Nationwide Surveillance Results of Nosocomial Infections along with Antimicrobial Resistance in Intensive Care Units of Sixteen University Hospitals in Korea, 2004 / 병원감염관리

BACKGROUND: This study was to evaluate a nationwide nosocomial infection rate and antimicrobial resistance in intensive care units(ICUs) in Korea. METHODS: The study was carried out at 16 university-affiliated teaching hospitals from July through October 2004. We performed a prospective multicenter study to investigate nosocomial infection rates, device-associated infection rated, and causative pathogens and their antimicrobial resistance. RESULTS: The urinary tract was the most commonly involved site. Nosocomial infection rate was 12.48 in medical. ICU (MICU), 9.59 in medical surgical ICU (MSICU), 14.76 in surgical ICU (MSICU), and 11.60 in other lCU. Device-associated infection rates were as follow: 1) rates of urinary catheter-associated urinary tract infection were 4.26 in MICU, 3.17 in SICU, 4.88 in MSICU, and 5.87 in other ICU; 2) rates of central line-associated bloodstream infection were 3.24 in MICU, 1.56 in SlCU, 2.36 in MSICU, and 1.78 in other ICU; 3) rates of ventilator-associated pneumonia were 3.61 in MlCU, 13.05 in SICU, 1.68 in MSICU, and 4.84 in other lCU. Staphylococcus aureus was the most frequently identified microorganism in this study; 93% of S. aurues were resistant to methicillin; 17% of Pseudomonas aeruginosa isolated were resistant to imipenem; 11% of Enterococcus faecium and 18% of Enterococcus faecalis showed resistance to vancomycin. Over a half of Acinetobacter spp, Stenotrophomonas maltophilia, Klebsiella pneumoniae, and Escherichia coli showed resistant to fluoroquinolone. Conclusion: This study shows the seriousness of antimicrobial resistance and the importance of infection control in the lCU in Korea. This study should provide a theoretical strategy to enforce the infection control.

Two Cases of FitziHugh-Curtis Syndrome in Acute Phase / 대한소화기학회지

Fitz-Hugh-Curtis syndrome has been defined as perihepatitis accompanying pelvic inflammatory disease caused by Neisseria gonorrhoeae and Chlamydia trachomatis. In the acute phase, patients usually complain of severe right upper quadrant pain of sudden onset. The pain is sharp, pleuritic and most intense at the level of the right lower rib margin and thus it is frequently confused with acute cholecystitis or pleurisy. Definitive diagnosis of Fitz-Hugh-Curtis syndrome needs invasive procedures such as laparoscopy or laparotomy, but considering that Fitz-Hugh-Curtis syndrome is a benign condition that can be cured by oral administration of appropriate antibiotics, noninvasive diagnosis is desirable. Recently, we have experienced two cases of Fitz-Hugh-Curtis syndrome in acute phase accompanied with sharp and pleuritic right upper quadrant pain. In one case, pelvic inflammatory disease was not definite, so at first we mistook it for acute cholecystitis and reactivation of chronic hepatitis B. In the other case, Fitz-Hugh-Curtis syndrome followed the preceding, typical pelvic inflammatory disease. Both cases were diagnosed noninvasively and treated successfully by oral administration of antibiotics.

A case of spontaneous bacterial peritonitis and sepsis due to Pasteurella multocida in a patient with liver cirrhosis / 대한내과학회지

Pasteurella multocida is a gram-negative coccobacillus that commonly inhabits the oropharynx of healthy domestic and wild animals, including cats and dogs. Although Pasteurella multocida infection is rare in human beings, in recent years an increasing number of infections have been reported in men, which have included a variety of illness from local infections to systemic illness. Among them, spontaneous bacterial peritonitis due to Pasteurella multocida is particularly rare all through the world. Recently, we have experienced a case of spontaneous bacterial peritonitis and sepsis due to Pasteurella multocida in a liver cirrhosis patient, successfully controlled by antibiotics. To our knowledge, this is the first case report of spontaneous bacterial peritonitis caused by Pasteurella multocida in Korea and provides another causative organism of spontaneous bacterial peritonitis.

The Comparison Between Behcet's Disease and Spondyloarthritides: Does Behcet's Disease Belong to the Spondyloarthropathy Complex?

This study was to clarify whether Behcet's disease (BD) could be classified into the spondyloarthropathy (SpA) complex. It was undertaken on 58 patients with BD (BD group), 56 patients with SpA (SpA group), and 3 patients who concurrently satisfied the criteria for BD and SpA (BDSpA group). The clinical parameters and known susceptible HLA antigens were compared between BD group and SpA group. In addition, 3 patients in BDSpA group were reviewed. The prevalence of definitive sacroiliitis (SI) in BD group and SpA group was 46.4% and 5.2%, respectively. However, none had a definitive SI in healthy controls. Enthesitis was observed in 3.4% of BD group and in 50% of SpA group. The patterns of eye involvement were different between these two groups. HLA-B27 was negative in all 49 patients of BD group, whereas it was positive in 67.9% of SpA group. The prevalence of HLA-B51 was 51.7% in BD group, and that in SpA group was 21.4%. One patient in BDSpA group was considered to have concurrent BD and ankylosing spondylitis (AS). Another patient was closer to AS, and the third to BD. Conclusively, it seems that BD could not be classified into the SpA complex.

Kaposi's sarcoma occurring during short-term dialysis: report of two cases

Kaposi's sarcoma (KS) appears to develop in association with kidney transplantation, but unlikely with dialysis. We report two cases of classic KS that occurred in patients receiving short-term (less than 3 yr) dialysis. They have been suffering from chronic renal failure due to tuberculosis and diabetes mellitus, respectively. Several to multiple, reddened-violaceous patches, plaques and nodules were found on the hand and the lower extremities. Laboratory studies showed no evidence suggesting immunosuppressed state and there was no history of taking immunosuppressive agents. The biopsies of the two cases revealed proliferation of spindle-shaped cells focally arranged in bundles and multiple dilated vascular spaces outlined by an attenuated endothelium with intravascular and extravasated erythrocytes. The specimens expressed positivity with CD34 antigen. Human herpesvirus 8 (Kaposi's sarcoma-associated herpesvirus) was detected in one case by polymerase chain reaction method.

Rud's Syndrome

Rud's syndrome (RS), basically composed of ichthyosis, mental deficiency and hypogonadism, is a rare hereditary disease. Some varying dermatologic, neurologic, endocrinologic, ophthalmologic and musculoskeletal abnormalities have coincided with RS. No case of RS has been documented from Asian countries except one from Japan. We describe a 16-year-old girl who presented with lamellar ichthyosis, mental retardation, hypogonadism, short stature, alopecia, sparse eyebrows, strabismus, cataracts, and congenital dislocation of the hip. To our knowledge, RS coexisting congenital dislocation of the hip herein is the first case in English literature.

Gender Verification Test Based on PCR Determination of Y Chromosomal DNA: Experience in Genetic Sex Typing during the '99 Kangwon Asian Winter Games / 대한임상병리학회지

BACKGROUND: The aim of gender verification test is to maintain impartiality among female competitors by excluding males in women's sports competitions. Some microscopic methods such as X-chromatin test and Y-chromatin test had been used for this purpose. Because of their known shortcomings, the methods were replaced with the polymerase chain reaction(PCR)-based test. In this report we describe the assay used in the gender verification during the '99 Kangwon Asian Winter Games. METHODS: Buccal smear samples of 126 female competitors were obtained. These samples underwent digestion with proteinase K, and were followed by boiling treatment with Chelex resin. PCR was performed to detect the sex determining region of Y chromosome(SRY) in order to confirm the femininity, and beta globin region was coamplified for confirming that the DNA was extracted from buccal cells. An X-Y homologous region encoded amelogenin was also amplified so that the femininity could be reconfirmed. RESULTS: No SRY and Y-amelogenin like sequences were amplified in any of samples of 126 female competitors analysed. CONCLUSIONS: Established gender verification method based on PCR amplification of Y chromosomal DNA seems to be superior to others. Sampling is simple. The procedure of extracting DNA is simple, rapid, and does not require multiple tube transfers. False positivity and/or false negativity appear to be less. It appear that this method is useful and reliable for gender verification in international sports events.

The study of HLA antigens in a familial Behcet? disease / 대한류마티스학회지

OBJECTIVE: Behcet? disease (BD) is a chronic inflammatory disorder affecting several organs. The etiology of BD remains unclear, although genetic factors, infectious agents, and immune mechanisms have been studied. The association of BD with certain genetic factors, especially HLA-B51 antigen, is well known in some geographical areas. Nevertheless, the familial occurrence of BD is rare. In this paper, HLA phenotype was evaluated in one family member showing the clustering of BD. METHODS: The serological tissue typing of HLA class I and class II antigens was performed by standard National Institutes of Health microlymphocytotoxicity method in seven family members in which four siblings were affected by BD. The diagnosis of BD was established by the criteria of the International Study Group of BD in these four siblings. RESULTS: In this family study, all members had HLA-A2 and DQ3 antigens. Although HLA-B51 antigen was positive in six out of seven family members, BD was developed in three of the six having HLA-B51 antigen. Three siblings had the exact same HLA phenotype. However, only one person had BD among three siblings with identical HLA phenotype. In addition, all siblings who developed erythema nodosum-like lesion had HLA-B51 antigen. CONCLUSION: This family suggests that the familial clustering of BD may not be explained solely by a susceptible HLA phenotype. The environmental factor or other genetic factors besides HLA-B51 might play a role in the development of BD. Furthermore, more studies and information will be needed to clarify the role of A2 and DQ3 antigens in BD.

Sulindac-induced Cholestatic Hepatitis and Acute Pancreatitis in a Patient having Systemic Sclerosis with Anti-RNP Antibody: report of a case / 대한류마티스학회지

Sulindac is a commonly used nonsteroidal anti-inflammatory drug (NSAID). It is relatively economical and seems to be less nephrotoxic due to its property of minimal renal prostaglandin inhibition. Although hepatic injury has been infrequently reported for nearly all NSAIDs currently on the market, sulindac has more commonly been associated with hepatotoxicity. In addition, it has been known that sulindac is the agent to have a definite association with pancreatitis. We describe a 37-year-old woman who developed cholestatic hepatitis and acute pancreatitis in association with sulindac. This patient met the diagnostic criteria of both mixed connective tissue disease and systemic sclerosis, in which the disease classification needs to be clarified. While being treated with sulindac, close observation and periodic liver function test seem to play an important role.

A case of coexisting Behcet's disease and ankylosing spondylitis

Behcet's disease (BD) is a chronic inflammatory condition involving several organs, such as skin, mucous membrane, eye, joint, intestine, lung and central nervous system. Ankylosing spondylitis (AS) is a prototype of seronegative spondyloarthropathy, and a chronic systemic inflammatory disorder of the axial skeleton, mainly affecting the sacroiliac joint and spine. In the latter, systemic complications may develop in addition to joint involvement. The coexistence of BD and AS has been rarely reported in the literature. The inclusion of BD among seronegative spondyloarthritides and whether sacroiliitis (SI) develops in BD are still being debated. We describe a 28-year-old man who has fulfilled the diagnostic criteria for BD and AS as well.

Quantitative Analysis of Urinary Organic Acids by Gas Chromatography-Mass Spectrometry / 대한임상병리학회지

BACKGROUND: Analysis of urinary organic acids is an important procedure for the diagnosis of inherited disorders of amino acid and organic acid metabolism. Analysis of urinary organic acids by gas chromatography-mass spectrometry (GC-MS) were initially developed for qualitative purposes, and quantitative anlytical procedure have seldom been extensively studied if at all. The purpose of this study is to evaluate a quantitative procedure for profiling organic acids with GC-MS. METHODS: Urine samples (1.5 mL) were extracted with ethylacetate, and derivated to trimethylsilyl derivatives. The compounds were analysed with MD-800 GC-MS (Fisons, Manchester, U.K.). The quantitation was done by establishment of calibration curves with the standard solutions of 74 organic acids. A response factor for internal standard was used to quantify organic acids of which the standards were not available. Extraction efficiencies for 51 organic acids were evaluated. Interassay and intraassay imprecisions were estimated from the analysis of two quality control specimens with the different concentrations of organic acids. RESULTS: Extraction efficiencies varied from 7.9 0.2% to 182.7 4.8% according to organic acids. Interassay imprecisions of specimen I and II were 4.1~60.7% and 10.7~84.9%, respectively. Intraassay imprecisions were 1.7~24.3% and 2.8~38.1%, respectively. But interassay imprecisions for clinically important analytes were below 20%. CONCLUSIONS: The described method for quantification of urinary organic acids with GC-MS is a acceptable routine method for screening of urinary organic acids. The result that imprecisions of clinically significant organic acids were less than 20% suggests that the method would be acceptable not only for diagnosis, but also for follow-up.

Bone Mineral Density in Postmenopausal Women / 대한산부인과학회잡지

To examine the influence of the duration of menopause on bone loss, 60 healthy women, aged 34~74 years in 1995 were studied. After exclusion of past or present hormonal replacement therapy or past history of chronic disease, 60 women formed the final study population. Bone masses were measured at 3 sited of femur(femoral neck, Wards triangle and trochanter) and in the L2~L4 lumbar spine by Dual energy X-ray bone densitometry(DEXA). Correlation analysis and multiple linear regression analysis were used to analyze the relationships of gynecological variables(age, body mass index:BMI), and years since menopause(YSM) with bone mineral density(BMD) of lumbar spin and the three different sites of femur. The coefficients of correlation(r) of the bone mineral density(%) at the lumbar spine and the three different sites of femur with YSM were ranged -0.37~-0.48(p < 0.01). Only YSM was independently related to BMD(%) data at all sites, except Wards triangle by multiple linear regression analysis(p < 0.01). In conclusion, the menopause and the duration of menopause have a great effect on bone mineral loss.

Quantitation of Methylmalonic Acid by Isotope Dilution Gas Chromatography Mass Spectrometry / 대한임상병리학회지

BACKGROUND: Methylmalonic aciduria can be caused by inherited defects in the methylmalonyl-CoA mutase enzyme, Inherited defects in the metabolism of vitamin Bl2 and acquired or inherited vitamin Bl2 deficiency. Quantitation of urinary methylmalonic acid (MMA) is very useful In diagnosis of methylmalonic acidemia and cobalamin deficiency. We evaluated a quantitation method of urinary MMA and determined reference values. METHODS: The method involved stable isotope dilution gas chromatographymass spectrometry (GC-MS) with (methyl 2H3)-MMA as the internal standard. We determined the detection limit, linearity and periodic variations of the assay. Urinary MMA levels were measured in 70 individuals of ages newborn to 58 years with no metabolic disorders. RESULTS: The lower limit of detection calculated from blank runs (mean+/-3SD) was 2.62nmo1/m1. One control urine tramp)e analyzed 23 times within 3 weeks game results of 7.83+/-1.09 (mean+/-SD, CV=13.8%) nmol/mL. The linearity at four different concentrations of MMA was acceptable (R2=0.9992). The concentration of urinary MMA in 70 individuals was 2.33+/-2.19 mmol/mol creatinine (mean+/-SD). Age related reference values which decreased with age were also reported (p=1.23x10-9). CONCLUSIONS: The described method is sensitive, specific and noninvasive, which is considered the gold standard method for measuring MMA. The method could be used as a screening test for cobalamin deficiency and inherited methyl malonic acidemia. On the basis of the narrow range of normal concentration, it is expected that the method would readily detect mild cobalamin deficiency.