Reliability of Quadruplicated Serological Parameters in the Korean Genome and Epidemiology Study / 한국역학회지

OBJECTIVES: The aim of this study was to evaluate whether clinical test values from different laboratories in the Korean Genome and Epidemiology Study (KoGES) can be integrated through a statistical adjustment algorithm with appropriate intra- and inter-laboratory reliability. METHODS: External quality control data were obtained from the Korean Society for Laboratory Medicine and quadruplicated standardized serological samples (N=3,200) were manufactured in order to check the intra- and inter-laboratory reliability for aspartic acid transaminase (AST), alanine transaminase (ALT), gamma-glutamyl transpeptidase (gamma-GTP), blood urea nitrogen (BUN), creatinine, uric acid (UA), fasting blood sugar (FBS), cholesterol, and triglyceride (TG). As an index of inter- and intra-rater reliability, Pearson's correlation coefficient, intraclass correlation coefficients and kappa statistics were estimated. In addition, to detect the potential for data integration, we constructed statistical compensation models using linear regression analysis with residual analysis, and presented the R-square values. RESULTS: All correlation coefficient values indicated good intra- and inter-laboratory reliability, which ranged from 0.842 to 1.000. Kappa coefficients were greater than 0.75 (0.75-1.00). All of the regression models based on the trial results had strong R-square values and zero sums of residuals. These results were consistent in the regression models using external quality control data. CONCLUSION: The two laboratories in the KoGES have good intra- and inter-laboratory reliability for ten chemical test values, and data can be integrated through algorithmic statistical adjustment using regression equations.

Reliability and Data Integration of Duplicated Test Results Using Two Bioelectrical Impedence Analysis Machines in the Korean Genome and Epidemiology Study / 예방의학회지

OBJECTIVES: The Korean Genome and Epidemiology Study (KoGES), a multicenter-based multi-cohort study, has collected information on body composition using two different bioelectrical impedence analysis (BIA) machines. The aim of the study was to evaluate the possibility of whether the test values measured from different BIA machines can be integrated through statistical adjustment algorithm under excellent inter-rater reliability. METHODS: We selected two centers to measure inter-rater reliability of the two BIA machines. We set up the two machines side by side and measured subjects' body compositions between October 2007 and December 2007. Duplicated test values of 848 subjects were collected. Pearson and intra-class correlation coefficients for inter-rater reliability were estimated using results from the two machines. To detect the feasibility for data integration, we constructed statistical compensation models using linear regression models with residual analysis and R-square values. RESULTS: All correlation coefficients indicated excellent reliability except mineral mass. However, models using only duplicated body composition values for data integration were not feasible due to relatively low R2 values of 0.8 for mineral mass and target weight. To integrate body composition data, models adjusted for four empirical variables that were age, sex, weight and height were most ideal (all R2>0.9). CONCLUSIONS: The test values measured with the two BIA machines in the KoGES have excellent reliability for the nine body composition values. Based on reliability, values can be integrated through algorithmic statistical adjustment using regression equations that includes age, sex, weight, and height.

Cytokine response in Balb/c mice infected with Francisella tularensis LVS and the Pohang isolate

We investigated the immune response induced by the Francisella (F.) tularensis live vaccine strain (LVS) and the Pohang isolate. After the Balb/c mice were infected intradermally (i.d) with 2 x 10(4) cfu of F. tularensis LVS and Pohang, respectively, their blood and organs were collected at different times; 0, 3, 6, 24, 72, 96, 120 and 168 h after infection. Using these samples, RT-PCR and ELISA analysis were carried out for the comparative study of the cytokines, including TNF-alpha, INF-gamma, IL-2, IL-4, IL-10 and IL-12. In the Pohang-infected mice at 120 h, the liver showed a 53 times higher level of TNF-alpha and a 42 times higher level of IFN-gamma than the respective levels at the early time points after infection. The levels of TNF-alpha and IFN-gamma induced by LVS were 5 times lower than those induced by the Pohang isolate. Also, the organs from the Pohang-infected mice showed higher levels of TNF-alpha, IFN-gamma, IL-10 and IL-12 than the levels in the LVS-infected mice. The blood from the Pohang-infected mice at 120 h revealed about a 40 times increased level of IFN-gamma, and IL-10 was also increased by 4 times at 96 h compared to an early infection time point, while IL-4 was not induced during the whole infection period. These results suggest that F. tularensis may induce a Th1-mediated immune response to in vivo infection and the Pohang isolate has a higher capacity than the LVS to induce an acute immune response in Blab/c mice.

A Case of Human Brucellosis Who had No Contact with Infected Animal: Sero-epidemiology Study on Market, by-product, Stock-raising

Brucellosis is a world-wide zoonotic disease. We report the first case of brucellosis in South Korea that is not related to direct contract with intected cattles. The patient had been working in the market of by-product, stock raising for twenty years and complained of 1-month history of fever, chill, and intermittent epistaxis. We confirmed brucellosis by anti-brucella antibody test and PCR. After 6 weeks' treatment with rifampicin and doxycycline, fever and chilling subsided, and, generalized weakness and oral intake improved. We performed seroepidemiology study against workers who were working in the same market as the patient. However, we couldn't find out other cases with seropositivity. We concluded that although the workers of by-product market have a risk of getting brucellosis, the risk is low.

A Case of Human Brucellosis Who had No Contact with Infected Animal: Sero-epidemiology Study on Market, by-product, Stock-raising

Brucellosis is a world-wide zoonotic disease. We report the first case of brucellosis in South Korea that is not related to direct contract with intected cattles. The patient had been working in the market of by-product, stock raising for twenty years and complained of 1-month history of fever, chill, and intermittent epistaxis. We confirmed brucellosis by anti-brucella antibody test and PCR. After 6 weeks' treatment with rifampicin and doxycycline, fever and chilling subsided, and, generalized weakness and oral intake improved. We performed seroepidemiology study against workers who were working in the same market as the patient. However, we couldn't find out other cases with seropositivity. We concluded that although the workers of by-product market have a risk of getting brucellosis, the risk is low.

The First Case of Human Brucellosis in Korea

Brucellosis is usually transmitted to human by direct contact with infected animals or by ingestion of unpasteurized dairy products. Because of the wide spectrum of its clinical manifestations, brucellosis may appear as other infections and asymptomatic conditions and, therefore, the diagnosis of the disease is frequently missed or delayed. A 41-years-old livestock worker was attended at a local clinic with headache, undulating fever, fatigue, weight loss presentations but the symptoms were not improved in spite of symptomatic therapy of the disease for 6 weeks. Epidemiological background showed that the patient had often ingested unpasteurized cow milk. We confirmed Brucella abortus infection by STA, ELISA and PCR methods. Symptomatic therapy of the disease with appropriate antibiotics (streptomycin, doxicyclin), had favourable outcome. It's the first case report of human brucellosis caused by direct contact of brucella infected milk cow or ingestion of raw milk in Korea, since its original identification in 1939.

The First Case of Human Brucellosis in Korea

Brucellosis is usually transmitted to human by direct contact with infected animals or by ingestion of unpasteurized dairy products. Because of the wide spectrum of its clinical manifestations, brucellosis may appear as other infections and asymptomatic conditions and, therefore, the diagnosis of the disease is frequently missed or delayed. A 41-years-old livestock worker was attended at a local clinic with headache, undulating fever, fatigue, weight loss presentations but the symptoms were not improved in spite of symptomatic therapy of the disease for 6 weeks. Epidemiological background showed that the patient had often ingested unpasteurized cow milk. We confirmed Brucella abortus infection by STA, ELISA and PCR methods. Symptomatic therapy of the disease with appropriate antibiotics (streptomycin, doxicyclin), had favourable outcome. It's the first case report of human brucellosis caused by direct contact of brucella infected milk cow or ingestion of raw milk in Korea, since its original identification in 1939.

Distribution of Antibodies to Coxiella burnetii in Patients with Unknown Fever and Atypical Pneumonia

Coxiella burnetii is the causative agent of Q fever worldwide in human and animals. While several clinical cases of Q fever were reported in Korea till the middle of 1990s, nobody has reported a case thereafter. However possibilities for an outbreak have still been raised. In this study, antibody titers to C. burnetii in patients with unknown fever and atypical pneumonia were tested by an indirect immunofluorescence method using the phase II antigen. In addition, the validity of a PCR method in indentifying C. burnetii directly from human sera was tested. Among the 560 specimens from atypical pneumonia patients, 23 sera (4.29%) reacted positively to the phase II antigen of C. burnetii. IgG antiphase II antigen titers were 1:16 in 16, 1:32 in 2, 1:64 in 2, 1:128 in 2, and > or =1:256 in one serum. IgM and IgA antibodies anti-phase II antigen were detected in 6 and 3 sera at 1:16, respectively. And each two sera had IgM antibodies at 1:32 and 1:64. Anti-phase II antigen IgG antibody titers in the patients with unknown fever were 1:16 in 5, 1:32 in 2, 1:128 in 1, and 1:256 in 3 sera. However, IgM antibody wasn't detected in this group. Of the 202 sera from abattoir workers, 5 (2.47%) reacted with phase II antigen. Among 448 sera of healthy controls, anti-phase II antigen IgG titer of 1:16 was found in 7 and 1:32 in 1 and 1:64 in 3 sera. In the case of IgM titer, two sera were reactive at 1:16 and 1:32, each. Significant differences among the test groups were not noted in the present study. The PCR assay to detect C. burnetii com-1 and plasmid genes did not show reliable specificity and sensitivity for the diagnosis of Q fever. So, the usefulness of the PCR for laboratory diagnosis of Q fever still remains controversial.

Expression and use of Truncated Recombimnant Flagellin Protein ( FlaB ) in ELISA for Diagnosis of Leptospirosis

No Abstract Available.

A Case of Community-acquired Legionnaires' Disease in a Renal Transplant Recipient / 감염

Legionella species are causative agents of both community-acquired and nosocomial pneumonia. The spectrum of disease ranges from asymptomatic infection to serious disease and two specific syndromes are identified, i.e., Legionnaires' disease and Pontiac fever. Legionnaires' disease tends to occur in patients with underlying illnesses, so Legionella pneumonia should be included in the differential diagnosis of severe community-acquired pneumonia, especially in immunocompromised patients. Herein we report a case of community- acquired Legionnaires' disease in a patient with renal transplantation. A 63-year old man was admitted because of fever, chills, and dyspnea. Thirteen years ago, he had undergone kidney transplantation and he had received immu-nosuppressive agents, including deflazacort and cyclosporin A. On physical examination crackles were heard in the middle area of the right lung and the chest radiograph showed multifocal patchy consolidations on both lung fields. Serologic tests for Legionella pneumophila antibody, urinary antigen assay for L. pneumophila serogroup 1, and polymerase chain reaction for Legionella DNA fragments (5S rRNA, IPC, mip target sequence) were positive. The patient was treated with roxithromycin for twenty eight days and recovered without complication.