Genotype Analysis of Pyrogenic Exotoxin and emm Genes of Streptococcus pyogenes Clinical Isolates

A variety of proteins produced by Streptococcus pyogenes contribute to the virulence of the pathogen. Among the proteins, the M protein and streptococcal pyrogenic exotoxins (Spe) are considered the major S. pyogenes virulence factors. To better characterize the correlation of M protein type and pyrogenic exotoxins with clinical diseases, we tested 269 S. pyogenes clinical isolates from patients with scarlet fever, pharyngitis, skin infection, otitis media, or other invasive streptococcal infections that provided appropriate clinical data. The strains were genotyped (M type) and assayed for speA, speB, and speC genes. The speB gene was detected in all isolates. Also, speA and speC genes were detected in 54 strains (18.2%) and 140 strains (47.3%), respectively. The strains isolated from invasive disease patients showed the highest frequency of speA gene (40.5%). The correlation among emm genotype, speA gene, and clinical patterns was analyzed. Genotypes emm1 (55.6%) and emm3 (22.2%) were predominant in stains with speA gene. The distribution of emm genotypes did not significantly associate with clinical patterns. These data suggest that SpeA is significantly associated with specific emm genotypes, and the exotoxin serve a dominant virulence factor.

Biochemical Characteristics and Antimicrobial Susceptibility Patterns of Vibrio vulnificus Isolated from the Environment of Korea in 2001

Vibrio vulnificus is a pathogen causing two types of severe illness, septicemia and wound infections, and is continually detected in marine environments. To investigate the biochemical characteristics and the antimicrobial susceptibility of V. vulnificus isolated from environment of Korea in 2001, the API 20E kit test, PCR, and antibiotic disk diffusion method were performed. A total of 210 V. vulnificus strains was isolated from seawater, shell-fish, sediments, coastal water, aquarium water, sewage, and others. All of the isolates could be divided into 15 groups on the basis of their API 20E profiles, and were positive in Indole test. Only 173 isolates (82.4%) were positive by the PCR amplifying the cytolysinhemolysin gene. Almost all isolates were susceptible to chloramphenicol (99.5%), tetracycline (90.0%), ciprofloxacin (92.4%), trimethoprim/sulfamethoxazole (89.0%), nalidixic acid (87.6%). Some isolates were resistant to cephalothin (57.6%), amikacin (33.3%), cefoxitin (31.9%). One hundred and forty three isolates (68.1%) were resistant to one or more antimicrobial agents. These results show that V. vulnificus environmental isolates possessed various biochemical characteristics, and some isolates were not detected of the cytolysin-hemolysin gene by PCR, and a part of isolates were resistant to multiple antibiotics.

Serological Analysis and Epidemiologic Characteristics of Group A Streptococci in Seoul(1998-2000)

PURPOSE: Group A streptococci have a cell wall which consists of M protein and T protein. T protein is known to be helpful in the understanding of the epidemiology of group A streptococci. To study the epidemiologic characteristics, we serotyped T protein of group A streptococci obtained from patients admitted to hospitals, or who visited OPD in five districts of Seoul the during last three years. METHODS: Group A streptococci were obtained in five districts in north, northeast, central, northwest and south Seoul from 1998 through 2000. All isolated group A streptococci were serotyped with T protein antisera(Institute of Sera and Vaccine, Prague, Czech Republic). RESULTS: In 1998, analysis of obtained total number of 92 strains revealed that T12, T4, and NT acounted for 72.2%. Among seven cases of scarlet fever, T12 was isolated in four cases and T4 was found in three cases. Two cases of tonsilar abscess produced T8 and NT. One case of cervical lymphadenitis showed T12. In 1999, 41 cases were studied showing that T12, T4, and T1 contributed 68%. Among five cases of scarlet fever, T12 and T4 make up three case. There were two cases of pneumonia(T4 and T1) and one case of cervical lymphadenitis(T8/25). In 2000, the study was performed in four districts except the central area. Among 83 isolates, T12, T4 and T1 accounted for 63.9%. There were three cases of scarlet fever(T12, T4, T5), one case of tonsillar abscess(T12), one case of pneumonia(NT) and one case of sepsis(T1). CONCLUSION: Serological analysis of T protein of group A streptococci shows no endemic specificity. The yearly pattern reveals that T12 had been decreasing but T1 had shown the opposite trend.

Antigenic Analysis of Haemophilus influenzae Based on Biotypes and Patterns of OMP P2

No abstract available.

Genotypic and Phenotypic Analysis Among Clinical Isolate of Streptococcus pyogenes in Seoul , Korea

A total of 152 strains of Streptococcus pyogenes were isolated from patients with pharyngitis, scarlet fever, skin infection, or invasive streptococcal infections in Seoul, Korea from January 1988 to December 1999. All isolates were epidemiologically characterized to decide phenotypes by T protein serotype and serum opacity factor (OF) detection. Genetic diversity of the isolates were analyzed by emm genotyping and pulsed-field gel electrophoresis (PFGE). T protein serotype showed 17 kinds in distribution and T12 (40.1% of study strains), T4 (19.1%), and T1 (7.9%) were the prevalent ones. When sources of S. pyogenes isolates were analyzed by T serotype distribution, T12 type was predominant in pharyngitis and skin infection isolates which contributed to 30 strains (49.2%) and 11 strains (18.0%), respectively. When T serotype of S. pyogenes isolates were analyzed by emm genotype distribution, of the 61 isolates of T12 type, 48 strains (78.7%) belonged to the emm type 12 (M12) and of the 29 isolates of T4 type, 27 strains (93.1%) belonged to the emm genotype 4 (M4). PFGE of genomic DNA of different emm genotype (emm12, emm4 and emm1) showed distinctive patterns. When the DNA of same emm gene type isolates were analyzed genetic relatedness by PFGE pattern, emm4, emm1, and emm12 types showed over 90%, 75%, and 70% of genetic similarity, respectively. Therefore, it was suggested that these emm genotype isolates were closely related genetically whereas among the isolates of other emm genotypes showed less than 30% of genetic similarity. Show genotypes are more diverse in comparison with phenotypes. In even epidemiologically unrealated isolates, genetic subtypes appeared correlated. The phenotypic and genotypic analysis used in the study were discriminative and appropriate for epidemiological study of S. pyogenes.

Surgical Management of Cecal Diverticulitis Detected during Appendectomy

PURPOSE: Acute diverticulitis of the right colon is not rare in Korea and the clinical presentation is indistin guishable from acute appendicitis. Cecal diverticulitis has led to a controversy in the management of disease. METHODS: Thirty-one cases of acute cecal diverticulitis who underwent operation for suspected acute appendicitis were reviewed retrospectively from January 1995 to December 1998. RESULTS: There were 17 men & 14 women. Ages ranged from 9 to 69 (mean: 37.5) years. All patients presented with signs and symptoms as acute appendicitis. All patients were explored through a transverse incision in the right lower quadrant under the impression of acute appendicitis. An appendectomy and drainage was performed in 13 patients, and resection of the lesion was performed in 18 patients (12 ileocecal resection, one partial cecectomy including appendix, one partial cecectomy and an appendectomy, 4 diverticulectomy and appendectomy), depending on the location of diverticulitis, severity of inflammation, and surgeon. Staples (TA(R), GIA(R)) were used in all cecal resection cases except for diverticulectomy. Five complications were observed, 3 in cecal resection cases (one wound seroma, one wound infection and one bleeding), and 2 in appendectomy and drainage cases (two wound infections). There was no postoperative mortality. The average length of the postoperative stay was 10.2 days in the drainage group and 8.8 days in the cecal resection group. Two recurrences were observed. One was the patient who had diverticulectomy performed. The other was a patient who had had appendectomy and drainage. CONCLUSION: We concluded that the preferred surgical management of an acute cecal diverticulitis operated for a presumed acute appendicitis is cecectomy using staples depending on its location and severity of inflammation. It was safe, relatively easy to do through the same incision, and could be a definitive treatment.

Pulsed field gel electrophoresis profile of erythromycin-clindamycin resistant Streptococcus pyogenes isolated in Korea

Ninety two strains of Streptococcus pyogenes were isolated from patients with pharyngitis, scarlet fever, skin infection, and invasive streptococcal infections in Seoul, Korea from January to December, 1998. All isolates were epidemiologically characterized by T protein serotype, and serum opacity factor (OF) detection to phenotypes. To analyze the genetic relationship, fifty two isolates including 32 erythromycin-clindamycin (Em-Cm) resistant strains, 20 antimicrobial susceptible strains were attempted to the pulsed-field gel electrophoresis (PFGE). T protein serotype showed 16 kinds in distribution including T12 and T4. Among the total isolates, 40 strains (43.5%) belonged to the T12 serotype and twenty strains (21.7%) to T4 serotype. On the other hand, when infection aspect of S. pyogenes isolates were analysed by T serotype distribution, T12 type was predominant for pharyngitidis which contributed to 21 strains (53%) and for skin infection isolates which contributed to 11 strains (28%), respectively. In case of T4 type, it was the most predominant pharyngitidis isolates which contributed to 8 strains (40%). In T serotype distribution of Em-Cm resistant strains, 27 strains (84%) of the thirty two showed T12 serotype. In minimum inhibitory concentration (MIC) values of Em-Cm resistance isolates, thirty two isolates showed resistant to erythromycin 27 strains (84%), had high MIC of >128 mug/ml. And also to clindamycin, twenty two strains (69%) had high MIC of >128 mug/ml. When OF detection of Em-Cm resistance of S. pyogenes isolates were analyzed by T serotype distribution, T12 serotype isolates revealed that all of the isolates except one strain were OF negative. In PFGE profile analysis to Em-Cm resistance isolates, of the twenty seven, Em-Cm resistance of T12 serotype isolates, 26 strains showed identical PFGE profile and all of these isolates revealed that OF negative. Eighty four percent of Em-Cm resistance S. pyogenes isolates had identical phenotype and PFGE profile. These results strongly suggested that the Em-Cm resistant S. pyogenes isolates from Seoul area showed close genetic correlation and PFGE could be available tool for molecular epidemiology.

An Epidemiologic Investigation of Shigella Sonnei Outbreak at a Primary School in Taegu city / 한국역학회지

PURPOSES: This study was conducted to determine the source of infection and mode of transmission of the shigellosis outbreak on March 27, 1998 at a primary school in Taegu city. METHODS: On-site interview using a standard questionnaire and rectal swab were conducted to 1,629 peoples who ate lunch on March 26 and 1,389 peoples who contacted with suspected cases. And bacteriological examination for 91 environmental materials and 25 food items were performed. RESULTS: Of the 1,629 persons who ate lunch on March 26, seventy three had culture-confirmed S. sonnei infection(first attack rate: 4.5%). And additional fifty four had shigellosis among those 1,389 persons who might be exposed to the suspected cases(second attack rate: 3.9%). A total of 730 persons who complained one of four typical symptoms or more were treated as suspected cases(first attack rate of suspected cases: 44.8%). S. sonnei was never isolated from water, foods, and other environmental materials. The median incubation period was estimated about two days. The common symptom reported were diarrhea(88.7%), fever(73.4%), abdominal pain(54.7%), and vomiting episode(38.4%) in order. The shorter duration of the outbreak and the large proportion of cases involving students who ate lunch on March 26 are consistent with fecal-oral transmission, although the limited epidemiologic data obtainable do not clearly define the route of transmission. CONCLUSIONS: Thus the outbreak reported here appear to be related to the unsanitary conditions of food facility in this school.

National Surveillance of Vibrio vulnificus Infections in 1998 / 감염

Surveillance for Vibrio vulnificus infections was performed by Korea National Institute of Health to investigate the epidemiological characteristics of recent occurence and to provide basic information for V. vulificus infection control. In 1998, a total of 44 cases of V. vulnificus infections were confirmed bacteriologically. The age groups of the patients ranged from thirties to seventies and 13 (29.5%) patients were in their fifties. Thirty-six (81.8%) patients had chronic liver diseases. Twenty-five (56.8%) had drinking habits. Eating uncooked seafood (fish, shrimp, and small octopus) produced in tideland was the main suspected source of infections and 32 (72.8%) cases were associated with raw seafood consumption. Two cases were associated with contaminated chopping board and 5 were infected through the wound. The incubation period ranged from less than 1 day to 7 days (median 2 days). The case fatality rate was 48%. In conclusion, V. vulnificus infection, a highly fatal disease, is not rare in Korea. Therefore, attention should be given to prevent V. vulnificus infections.

Plasmid Profile and B - Lactamase Type of Multidrug - Resistant Salmonella typhi Isolated from Korea, 1997

Eight strains of multidrug-resistant (MDR) Salmonella typhi were isolated from Kyonggi area during January-February,1997. They were resistant to ampiciUin, amoxicillin, carbeniciillin, tetracycline, chloramphenicol, trimethoprim/sulfamethoxazole, trimethoprim. Eight strains had one plasmid respectively which size was approximately M.W 220 kb and showed same restriction pattern by endonuclease HindIII. The plasmid was similar to the plasmid in size that was related to multidrug resistant S. typhi isolated from southeast Asia. It were transferred by conjugation to recipient E, coli K-12 in frequency of 2.43 x10-4 - 1.73 x 10-2 and transconjugant showed same drug-resistant pattem with donor cells. All of 8 strains produced B-lactamase that was assummed to TEM-1 type by isoelectric focusing and PCR.

Perioperative Risk Factors of the Hepatic Resection

This study was conducted to investigate the risk factors for postoperative mortality and morbidity in 322 consecutive hepatic resections. The indications for the hepatic resection were 178 intrahepatic stones, 81 hepatocellular carcinomas, 21 cholangiocarcinomas, 16 benign liver tumors, 12 metastatic liver cancers, 7 liver abscesses, and 7 other diseases. The overall in-hospital mortality and morbidity rates were 0.9% and 39.4%, respectively. Various postoperative complications developed, including 60 wound infections (18.6%), 49 pulmonary complications (15.2%), 19 bile leakages (5.9%), 13 intraabdominal abscesses (4.0%), 13 ascites (4.0%), 4 bleedings (1.2%), 3 hepatic failures (0.9%), 3 cholangitis (0.9%) and 28 other complications (8.7%). Among the risk factors, perioperative transfusion was significantly associated with more frequent wound infections (p=0.004), pulmonary complications(p=0.008), and bile leakages (p=0.039). Coexisting hepatitis was related to increased pulmonary complication rate (p=0.0223) and ascites formation (p=0.0157). Diabetes, was associated with increased wound infection rate (p=0.0433), and preexisting heart disease was associated with higher pulmonary complication rate (p= 0.0213). However, age, presence of liver cirrhosis, extent of resection, operative time, pulmonary disease or combined bowel surgery had no influence on the outcome. In conclusion, minimizing perioperative blood loss and transfusion is essential to reduce postoperative complications in hepatectomy.

The Predictive Factors of Recurrence in Resected Hepatocellular Carcinoma / 한국간담췌외과학회지

To establish predictors of prognosis and recurrence of hepatocellular carcinoma (HCC) after curative resection, retrospective analyses of clinical and pathologic factors were done in 85 hepatectomized patients of HCC. The median follow-up duration was 30.5(range: 3-134) months. Two postoperative mortalities and five palliative resections were excluded from analysis of recurrence. The overall 1, 3, 5 year survival rates in 85 patients were 78.6%, 63.6%, 45.6%. The 1, 3, 5 year survival rates in 78 curative resections were 81.8%, 70.2%, 50.3%. The 1, 2, 3 year survival rates of the palliative resections(5 cases) were 60%, 20%, 0%. The 1, 3, 5 year recurrence-free survival rates in the curative resections were 64.4%, 43.2%, 27.5%. Included prognostic variables were age, gender, viral hepatitis, cirrhosis, serum alpha-FP level, ICG-R15, diabetes, preoperativeTACE, tumor size, tumor capsulation, number of tumors, vascular invasion, tumor histologic grading, stage of the chronic hepatitis, and anatomic resection. The significant factors affecting recurrence were number of tumors and vascular invasion.

Purification and Characterisation of Extracellular Proteinase from Trichophyton rubrum / 대한의진균학회지

BACKGROUND: Trichophyton rubrum is the most common dermatophyte isolated from human and has ability to invade the tissues such as stratum comeum, nail and hair. The potential role of proteinases as virulence factors of F rMSrMm has been discussed at length. OBJECTIVE: As a first step towards assessing its virulence role, we report on the purification and characterization of proteinase from T. rubrum isolate culture filtrates. METHODS: An extracellular serine proteinase has been purified from culture filtrates of Trichophyton rubrum HP-9 by ultrafiltration, gel filtration chromatography, and affinity column chromatography. Azocoll and keratin azure were employed as the substrates of enzyme activities. Peak of proteolytic activity was analyzed by gelatin co-polymerized gel electrophoresis. RESULTS: The molecular weight of the purified enzyme was approximately exhibited to 14.0 kDa on sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). The optimum pH and molality of 14.0 kDa proteinase activity was 6.0 and 100mM, respectively. The activity was inhibited by serine proteinase inhibitor, phenylmethylsulfonyl fluoride (PMSF). The proteinase degraded gelatin, collagen type VI, and keratin from human epidermis but not hemoglobin. CONCLUSION: The 14,000 Mr extracellular serine proteinase purified from T. rubrum NP-9 culture filtrates has neutral pH optimum 6.0 and activities against gelatin, collagen type VI, and keratin.