Eggerthella Lenta Bacteremia after Appendectomy in a Healthy Patient / 대한내과학회지

Eggerthella lenta (E. lenta) has been reported to cause bacteremia in patients with gastrointestinal tract disorders or malignancies and in immunocompromised patients. Cases of E. lenta have been increasing with the recent development of testing equipment. The mortality rate due to E. lenta bacteremia is high. The authors report a case of E. lenta bacteremia in an immunocompetent patient.

Eggerthella Lenta Bacteremia after Appendectomy in a Healthy Patient / 대한내과학회지

Eggerthella lenta (E. lenta) has been reported to cause bacteremia in patients with gastrointestinal tract disorders or malignancies and in immunocompromised patients. Cases of E. lenta have been increasing with the recent development of testing equipment. The mortality rate due to E. lenta bacteremia is high. The authors report a case of E. lenta bacteremia in an immunocompetent patient.

Septicemia Caused by Neisseria meningitidis With Decreased Ciprofloxacin Susceptibility: The First Case Report in Korea

No abstract available.

A Case of Colon Cancer Associated with Streptococcus gallolyticus Subspecies pasteurianus Bacteremia / 대한내과학회지

Streptococcus Gallolyticus subspecies pasteurianus is a biotype II/2 of Streptococcus bovis. Although there is a clear correlation between Streptococcus bovis bacteremia and the risk of developing colon cancer, the relationship between Streptococcus gallolyticus subspecies pasteurianus bacteremia and colon cancer is not clear. We report a 53-year-old female who initially presented with fever and low back pain. Streptococcus gallolyticus subspecies pasteurianus was isolated in blood cultures, so we performed a colonoscopy and discovered colon cancer.

Liver Abscess Caused by Listeria monocytogenes : A Case Report

Listeria monocytogenes has been recognized as a pathogen in elderly and immunecompromised hosts with malignancies, alcohol abuse, diabetes mellitus, transplanted organs, liver cirrhosis, renal failure, or acquired immunodeficiency syndrome (AIDS). In adults, it usually presents as neuromeningeal infection, such as meningitis, meningoencephalitis, or encephalitis, or as primary bacteremia. Involvement of the liver with L. monocytogenes is uncommon. We report on a case of multiple liver abscesses and bacteremia associated with L. monocytogenes in a 67-year-old diabetic female with concomitant active multidrug-resistant pulmonary tuberculosis. Blood cultures were positive for L. monocytogenes. In patients with liver abscess with advanced age or who are immune-compromised, including those with diabetes, clinicians should consider Listeria infection as a differential diagnosis.

Unusual Primary Peritonitis due to Streptococcus pyogenes in a Young Healthy Woman

We describe the first case of primary peritonitis in Korea of a healthy person due to Streptococcus pyogenes. In the absence of comorbid conditions, such as liver cirrhosis, immunosuppression, or nephrotic syndrome, primary peritonitis is uncommon in a young healthy woman. Abdomen computed tomography revealed ascites in the lower abdomen and peritoneal enhancement suggesting peritonitis. In diagnostic laparoscopy, purulent ascites was found in the pelvic cavity but both ovaries and fallopian tubes were intact. There were no intra-abdominal abnormalities such as bowel perforation, appendicitis, or necrosis. The reports of blood culture, ascites culture, and cervical swab culture confirmed S. pyogenes. After use of antibiotics, the patient was cured and discharged without sequelae.

Fatal Necrotizing Fasciitis Due to Streptococcus pneumoniae: A Case Report

Necrotizing fasciitis is known to be a highly lethal infection of deep-seated subcutaneous tissue and superficial fascia. Reports of necrotizing fasciitis due to Streptococcus pneumoniae are exceedingly rare. We report a case of necrotizing fasciitis in a 62-yr-old man with liver cirrhosis and diabetes mellitus. He presented with painful swelling of left leg and right hand. On the day of admission, compartment syndrome was aggravated and the patient underwent surgical exploration. Intra-operative findings revealed necrotizing fasciitis and cultures of two blood samples and wound aspirates showed S. pneumoniae. The patient died despite debridement and proper antimicrobial treatment. To the best of our knowledge, this is the first case of fatal necrotizing fasciitis with meningitis reported in Korea. We also review and discuss the literature on pneumococcal necrotizing fasciitis.

Three Cases of Central Nervous System Infection Caused by Multi-Drug-Resistant Acinetobacter baumannii / 대한내과학회지

In recent years, Acinetobacter baumannii has become an increasingly common nosocomial pathogen. It causes rare, but severe, central nervous system (CNS) infection, especially in patients undergoing neurosurgical procedures or with head trauma. Multi-drug-resistant A. baumannii (MDR-AB) has emerged as a pathogen causing CNS infection. We describe A. baumannii CNS infections seen during the last 5 years and focus on MDR-AB CNS infection. Seven patients were admitted to the neurosurgical intensive care unit with serious head injuries. Imipenem-susceptible A. baumannii was identified in all four cases seen from 2003 to 2006, whereas the three cases seen from 2007 to 2008 were MDR-AB CNS infections. Two cases of MDR-AB CNS infection were cured with intraventricular or intrathecal colistin without any side effects. Therefore, intraventricular or intrathecal colistin should be considered for MDR-AB CNS infection. Studies of the dose and duration of intraventricular and intrathecal administration are needed.

Pandemic Influenza A/H1N1 Viral Pneumonia without Co-Infection in Korea: Chest CT Findings / 결핵및호흡기질환

BACKGROUND: To evaluate chest CT findings of pandemic influenza A/H1N1 pneumonia without co-infection. METHODS: Among 56 patients diagnosed with pandemic influenza A/H1N1 pneumonia, chest CT was obtained in 22 between October 2009 and Februrary 2010. Since two patients were co-infected with bacteria, the other twenty were evaluated. Predominant parenchymal patterns were categorized into consolidation, ground glass opacity (GGO), and mixed patterns. Distribution of parenchymal abnormalities was assessed. RESULTS: Median age was 46.5 years. The CURB-65 score, which is the scoring system for severity of community acquired pneumonia, had a median of 1. Median duration of symptoms was 3 days. All had abnormal chest x-ray findings. The median number of days after the hospital visit that Chest CT was performed was 1. The reasons for chest CT performance were radiographic findings unusual for pneumonia (n=13) and unexplained dyspnea (n=7). GGO was the most predominant pattern on CT (n=13, 65.0%). Parenchymal abnormalities were observed in both lungs in 13 cases and were more extensive in the lower lung zone than the upper. Central and peripheral distributions were identified in ten and nine cases, respectively. One showed diffuse distribution. Peribronchial wall thickening was found in 16 cases. Centrilobular branching nodules (n=7), interlobular septal thickening (n=4), atelectasis (n=1), pleural effusion (n=5), enlarged hilar and mediastinal lymph nodes (n=6 and n=7) were also noted. CONCLUSION: Patchy and bilateral GGO along bronchi with predominant involvement of lower lungs are the most common chest CT findings of pandemic influenza A/H1N1 pneumonia.

A Case of Primary Adrenal Insufficiency in a Patient with Acquired Immunodeficiency Syndrome

The adrenal gland is the most commonly involved endocrine organ in patients infected with the human immunodeficiency virus (HIV). Adrenal function abnormality is more common in HIV patients than in the general population. It is important to recognize the condition of adrenal insufficiency, as this adrenal disorder may prove fatal if left untreated. Herein, we report a case of primary adrenal insufficiency in a 37-year-old male patient with acquired immunodeficiency syndrome. The patient complained of fever, general weakness, and fatigue. Impaired adrenal function was noted in the rapid ACTH stimulation test. After steroid supplementation, the patient's symptoms were improved. Therefore, HIV care physicians should ascertain adrenal dysfunction in HIV patients when they complain of fever and general weakness.

Catheter-related Candidemia Caused by Candida haemulonii in a Patient in Long-term Hospital Care

Candida haemulonii, one of the non-albicans Candida species, is an emerging yeast pathogen that is known to be resistant to amphotericin B and other antifungal agents such as azoles. These anti-fungal agents have often been associated with clinical treatment failure, so no treatment regimen has been clearly established for invasive C. haemulonii infections. We investigated a catheter-related infection of C. haemulonii candidemia in an adult patient in long-term hospital care. In the early stages, the candidemia remained persistent despite treatment with fluconazole. However, after changing the antifungal agent to caspofungin, the candidemia was resolved. Fluconazole and amphotericin B are not reliable empirical antifungal agents for invasive C. haemulonii infections, as shown in previous case reports. An echinocandin such as caspofungin may be an appropriate empirical choice of antifungal agent for an invasive C. haemulonii infection.

A case of idiopathic granulomatous hepatitis in an HIV-infected patient / 대한내과학회지

Patients infected with human immunodeficiency virus (HIV) may develop various liver diseases, including viral hepatitis, granulomatous inflammation, malignancies, vascular disease, drug-induced hepatitis and, sometimes, diseases of unknown origin. In this case, a 35-year-old HIV-infected man presented with fatigue, myalgia, elevated liver enzymes, and multiple skin lesions for 3 months. Since the abdominal computed tomography (CT) and viral marker tests failed to explain the cause of his symptoms and signs, a liver biopsy was performed. This revealed a granuloma consisting of epithelioid cells without necrosis. His symptoms, skin lesions, and abnormal liver enzymes improved without changing his management, including the anti-retroviral agents. He was diagnosed with idiopathic granulomatous hepatitis based on the pathologic findings of the liver and clinical course. Aggressive diagnostic methods, such as a liver biopsy, should be considered for HIV-infected patients with liver disease.

A Case of Pneumococcal Endocarditis Accompanied by Arthritis and Meningitis

Streptococcus pneumoniae is a common cause of pneumonia. S. pneumoniae also had been a frequent cause of infective endocarditis in the past, but its incidence has markedly decreased after the introduction of effective antibiotics. S. pneumoniae is now a rare cause of this invasive and fatal disease, not to mention S. pneumoniae bacteremia with multiple metastatic infections. We report a 74-year-old woman who presented with arthritis and fever and was diagnosed with infective endocarditis accompanied by meningitis and septic arthritis due to S. pneumoniae without pneumonia. After treatment with antibiotics, the patient recovered without complications. Although S. pneumoniae is a rare cause of infective endocarditis with multiorgan involvement, S. pneumonia should be considered as one of the potential pathogens in such cases.

Bloodstream Infections and Clinical Significance of Healthcare-associated Bacteremia: A Multicenter Surveillance Study in Korean Hospitals

Recent changes in healthcare systems have changed the epidemiologic paradigms in many infectious fields including bloodstream infection (BSI). We compared clinical characteristics of community-acquired (CA), hospital-acquired (HA), and healthcare-associated (HCA) BSI. We performed a prospective nationwide multicenter surveillance study from 9 university hospitals in Korea. Total 1,605 blood isolates were collected from 2006 to 2007, and 1,144 isolates were considered true pathogens. HA-BSI accounted for 48.8%, CA-BSI for 33.2%, and HCA-BSI for 18.0%. HA-BSI and HCA-BSI were more likely to have severe comorbidities. Escherichia coli was the most common isolate in CA-BSI (47.1%) and HCA-BSI (27.2%). In contrast, Staphylococcus aureus (15.2%), coagulase-negative Staphylococcus (15.1%) were the common isolates in HA-BSI. The rate of appropriate empiric antimicrobial therapy was the highest in CA-BSI (89.0%) followed by HCA-BSI (76.4%), and HA-BSI (75.0%). The 30-day mortality rate was the highest in HA-BSI (23.0%) followed by HCA-BSI (18.4%), and CA-BSI (10.2%). High Pitt score and inappropriate empirical antibiotic therapy were the independent risk factors for mortality by multivariate analysis. In conclusion, the present data suggest that clinical features, outcome, and microbiologic features of causative pathogens vary by origin of BSI. Especially, HCA-BSI shows unique clinical characteristics, which should be considered a distinct category for more appropriate antibiotic treatment.

Acute generalized exanthematous pustulosis due to amoxicillin/clavulanate / 대한내과학회지

Acute generalized exanthematous pustulosis (AGEP) was initially named by Beylot to describe a disease entity with sudden- onset amicrobial pustular eruptions accompanied by fever and leukocytosis. Most cases appear to be related to drug reactions, mainly antibiotics, although viral infections and hypersensitivity to mercury also cause AGEP. A 28-year-old woman presented with sudden-onset, multiple, and generally pinhead-sized pustules on an erythematous base scattered on the face and anterior chest wall. The patient had been on amoxicillin/clavulanate for acute pharyngitis. Histopathologically, the skin biopsy specimen revealed subcorneal and subepidermal pustules with neutrophil spongiosis, perivascular neutrophilic infiltration, and karyorrhectic debris. The eruption cleared rapidly after discontinuing the drug and administering systemic corticosteroid therapy.

The Analysis of Risk Factor and Infection Control of Carbapenem-Resistant Acinetobacter baumannii in a Medical Intensive Care Unit / 병원감염관리

BACKGROUND: An epidemiologic study was performed after the outbreak of carbapenem-resistant Acinetobacter baumannii (CRAB) in the medical intensive care unit (MICU) from December 2006 to May 2007. METHODS: A retrospective case-control study was performed using the medical records of the patients. The case and control patients were compared for age, gender, total length of stay in MICU, prior carbapenem use, Acute Physiology and Chronic Health Evaluation II (APACH II) score, presence of central line, effect of mechanical ventilation, and sputum suction. Environmental and hand-washing studies were performed during the outbreak. RESULTS: Ten CRAB-affected patients and 29 controls were enrolled in this study. Univariate analysis showed that the age, total length of stay in MICU, presence of central line, and prior carbapenem use were associated with the CRAB outbreak. However, multivariate analysis showed that only prior carbapenem use was associated with the CRAB outbreak (odd ratio: 8.67, P=0.01). The outbreak disappeared after implementing a combined infection control strategy, including the sequential disinfection of MICU and strict compliance with cross-transmission prevention protocols. CONCLUSION: The use of carbapenem was associated with an increased risk of CRAB infection. This study suggests that the MICU contamination and infection transmission by health-care workers played a major role in the CRAB outbreak. Novel strategies such as restricted use of broad-spectrum antibiotics, strict hand hygiene, strict isolation of the patients, and MICU disinfection may be required to prevent the CRAB outbreak.

Evaluation of Ceftriaxone Utilization at Multicenter Study

BACKGROUND/AIMS: As bacterial resistance to antimicrobial agents has grown due to the increasing use of antimicrobial agents, we sought to evaluate the suitability of ceftriaxone usage (representative of third generation cephalosporins) at 10 university hospitals in Korea. METHODS: We prospectively evaluated the appropriateness of antibiotic usage in 400 adult patients who received ceftriaxone between February 1, 2006 and June 30, 2006. Drug utilization evaluation (DUE) methods were based on standards set forth by the American Society of Hospital Pharmacists. The DUE criteria used in this study were modified to be more suitable in our hospital setting: justification of drug use, critical and process indications, complications, and outcome measures. RESULTS: The average patient age was 64.4 years. The utilization of ceftriaxone was appropriate in 262 cases (65.5%) for the justification of use, while inappropriate use was observed in 138 cases (34.5%). Common reasons for inappropriate use of ceftriaxone included continued empiric use for presumed infections, prophylactic perioperative injection, and empiric therapy for fever. Most of the critical indications showed a high rate of suitability (66.5-98.5%). Complications occurred in 37 cases (9.3%). With respect to outcome measures, clinical responses were observed in 60.7% of cases, while only 15.7% of cases showed evidence of infection eradication via negative cultures. CONCLUSIONS: Appropriate use (65.5%) of ceftriaxone was higher than inappropriate use (34.5%) at university hospitals in Korea. Inappropriate utilization, however, including continued empiric use for presumed infections and prophylactic perioperative injection remained high. Intensification of educational programs and antibiotic control systems for ceftriaxone is needed to improve the suitability of antimicrobial use.

A case of ventriculitis caused by Vancomycin-Resistant Enterococcus durans / 대한내과학회지

Infections associated with Enterococcus durans have been rare in humans until now. E. durans is a frequent component of the intestinal flora of several domestic animal species and may cause septicemia and encephalomalacia in chicks. We report a case of ventriculoperitoneal shunt infection caused by vancomycin-resistant E. durans in a 17-year-old woman with Dandy-walker syndrome. To the best of our knowledge, this is the first human case of ventriculitis caused by vancomycin-resistant E. durans.

A case of ventriculitis caused by Vancomycin-Resistant Enterococcus durans / 대한내과학회지

Infections associated with Enterococcus durans have been rare in humans until now. E. durans is a frequent component of the intestinal flora of several domestic animal species and may cause septicemia and encephalomalacia in chicks. We report a case of ventriculoperitoneal shunt infection caused by vancomycin-resistant E. durans in a 17-year-old woman with Dandy-walker syndrome. To the best of our knowledge, this is the first human case of ventriculitis caused by vancomycin-resistant E. durans.

Hepatitis A Virus Seropositivity among Healthcare Workers at a University Hospital in Korea / 대한진단검사의학회지

BACKGROUND: Healthcare workers (HCW) are known as a risk group of hepatitis A virus (HAV) infection and vaccination of this group against HAV has been suggested. However, the seroprevalence of HAV antibody among HCW in Korea has not been reported. We investigated the seropositivity of HAV antibody in HCW, to obtain a baseline data. METHODS: We measured serum total HAV antibody using chemiluminescent immunoassay (ADVIA Centaur, Germany) in 174 HCW at one university hospital in Seoul, Korea. RESULTS: Serum HAV antibody was positive in 48 (27.6%) of 174 subjects tested. The seropositivity of HAV antibody was significantly increased with increasing age: 21.1% (26/123), 55% (22/40), and 100% (11/11) in the age groups of 20's, 30's, and 40's, respectively (P<0.001). However it was not significantly different among different occupations (physicians 38%, nurses 24.6%, other workers 31.4%, P=0.376) and work places (medical ward 29.1%, pediatric ward 25.9%, emergency room 34.4%, laboratory 0%, P=0.140). The seroprevalence rate of HAV antibody in the age groups of 20's and 30's in this study was not higher than that of previous studies on non-HCW populations in Korea since 2006. CONCLUSIONS: The seroprevalence of HAV antibody among HCW in the age groups of 20's and 30's in a Korean hospital was not higher than that of non-HCW populations, and the seropositivity increased with increasing age. Further studies are needed for the age-specific strategy for vaccination, considering the increased risk of exposure in HCW to HAV infection in hospital environment with the increase of symptomatic patients with HAV.