ABSTRACT
International migrants could be considered a risk group susceptible to vaccine-preventable diseases. We conducted a measles seroprevalence study among 419 marriage migrant women living in Sinan-gun and Wando-gun, South Jeolla Province, located in the southwestern part of Korea. The overall seroimmunity was 92.8%. The seroimmunity varied considerably according to the country of origin and increased with age. Our current analysis could be valuable in the context of discussions concerning vaccination policies for immigrants in Korea.
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Background@#Remdesivir is widely used for the treatment of coronavirus disease 2019 (COVID-19), but controversies regarding its efficacy still remain. @*Methods@#A retrospective cohort study was conducted to evaluate the effect of remdesivir on clinical and virologic outcomes of severe COVID-19 patients from June to July 2020. Primary clinical endpoints included clinical recovery, additional mechanical ventilator (MV) support, and duration of oxygen or MV support. Viral load reduction by hospital day (HD) 15 was evaluated by calculating changes in cycle threshold (Ct) values. @*Results@#A total of 86 severe COVID-19 patients were evaluated including 48 remdesivirtreated patients. Baseline characteristics were not significantly different between the two groups. Remdesivir was administered an average of 7.42 days from symptom onset. The proportions of clinical recovery of the remdesivir and supportive care group at HD 14 (56.3% and 39.5%) and HD 28 (87.5% and 78.9%) were not statistically different. The proportion of patients requiring MV support by HD 28 was significantly lower in the remdesivir group than in the supportive care group (22.9% vs. 44.7%, P = 0.032), and MV duration was significantly shorter in the remdesivir group (average, 1.97 vs. 5.37 days; P = 0.017). Analysis of upper respiratory tract specimens demonstrated that increases of Ct value from HD 1–5 to 11–15 were significantly greater in the remdesivir group than the supportive care group (average, 10.19 vs. 5.36; P = 0.007), and the slope of the Ct value increase was also significantly steeper in the remdesivir group (average, 5.10 vs. 2.68; P = 0.007). @*Conclusion@#The remdesivir group showed clinical and virologic benefit in terms of MV requirement and viral load reduction, supporting remdesivir treatment for severe COVID-19.
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Background@#South Korea has been experiencing a third wave of coronavirus disease 2019 (COVID-19) since mid-November 2020. Our hospital in Gwangju metropolitan city experienced a healthcare-associated COVID-19 outbreak early in the third wave. The first confirmed COVID-19 patient was a symptomatic neurosurgery resident with high mobility throughout the hospital. We analyzed the transmission routes of nosocomial COVID-19 and discussed infection control strategies. @*Methods@#We retrospectively analyzed the severe acute respiratory syndrome coronavirus 2 reverse transcription-polymerase chain reaction (RT-PCR) testing results according to time point and evaluated transmission routes. @*Results@#Since COVID-19 was first confirmed in a healthcare worker (HCW) on 11/13/2020, we performed RT-PCR tests for all patients and caregivers and four complete enumeration surveys for all HCWs. We detected three clusters of nosocomial spread and several sporadic cases. The first cluster originated from the community outbreak spot, where an asymptomatic HCW visited, which led to a total of 22 cases. The second cluster, which included patient-to-patient transmission, originated from a COVID-19 positive caregiver before diagnosis and the third cluster involved a radiologist and a banker. We took measures to isolate Building 1 of the hospital for 17 days and controlled the outbreak during a period of increasing community COVID-19 prevalence. Universal screening of all inpatients upon admission and resident caregivers was made mandatory and hospital-related employees are now screened monthly. @*Conclusion@#Infection control strategies to prevent the nosocomial transmission of emerging infectious diseases must correspond with community disease prevalence. Our data reinforce the importance of multi-time point surveillance of asymptomatic HCWs and routine surveillance of patients and caregivers during an epidemic.
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Background@#Remdesivir is widely used for the treatment of coronavirus disease 2019 (COVID-19), but controversies regarding its efficacy still remain. @*Methods@#A retrospective cohort study was conducted to evaluate the effect of remdesivir on clinical and virologic outcomes of severe COVID-19 patients from June to July 2020. Primary clinical endpoints included clinical recovery, additional mechanical ventilator (MV) support, and duration of oxygen or MV support. Viral load reduction by hospital day (HD) 15 was evaluated by calculating changes in cycle threshold (Ct) values. @*Results@#A total of 86 severe COVID-19 patients were evaluated including 48 remdesivirtreated patients. Baseline characteristics were not significantly different between the two groups. Remdesivir was administered an average of 7.42 days from symptom onset. The proportions of clinical recovery of the remdesivir and supportive care group at HD 14 (56.3% and 39.5%) and HD 28 (87.5% and 78.9%) were not statistically different. The proportion of patients requiring MV support by HD 28 was significantly lower in the remdesivir group than in the supportive care group (22.9% vs. 44.7%, P = 0.032), and MV duration was significantly shorter in the remdesivir group (average, 1.97 vs. 5.37 days; P = 0.017). Analysis of upper respiratory tract specimens demonstrated that increases of Ct value from HD 1–5 to 11–15 were significantly greater in the remdesivir group than the supportive care group (average, 10.19 vs. 5.36; P = 0.007), and the slope of the Ct value increase was also significantly steeper in the remdesivir group (average, 5.10 vs. 2.68; P = 0.007). @*Conclusion@#The remdesivir group showed clinical and virologic benefit in terms of MV requirement and viral load reduction, supporting remdesivir treatment for severe COVID-19.
ABSTRACT
Background@#South Korea has been experiencing a third wave of coronavirus disease 2019 (COVID-19) since mid-November 2020. Our hospital in Gwangju metropolitan city experienced a healthcare-associated COVID-19 outbreak early in the third wave. The first confirmed COVID-19 patient was a symptomatic neurosurgery resident with high mobility throughout the hospital. We analyzed the transmission routes of nosocomial COVID-19 and discussed infection control strategies. @*Methods@#We retrospectively analyzed the severe acute respiratory syndrome coronavirus 2 reverse transcription-polymerase chain reaction (RT-PCR) testing results according to time point and evaluated transmission routes. @*Results@#Since COVID-19 was first confirmed in a healthcare worker (HCW) on 11/13/2020, we performed RT-PCR tests for all patients and caregivers and four complete enumeration surveys for all HCWs. We detected three clusters of nosocomial spread and several sporadic cases. The first cluster originated from the community outbreak spot, where an asymptomatic HCW visited, which led to a total of 22 cases. The second cluster, which included patient-to-patient transmission, originated from a COVID-19 positive caregiver before diagnosis and the third cluster involved a radiologist and a banker. We took measures to isolate Building 1 of the hospital for 17 days and controlled the outbreak during a period of increasing community COVID-19 prevalence. Universal screening of all inpatients upon admission and resident caregivers was made mandatory and hospital-related employees are now screened monthly. @*Conclusion@#Infection control strategies to prevent the nosocomial transmission of emerging infectious diseases must correspond with community disease prevalence. Our data reinforce the importance of multi-time point surveillance of asymptomatic HCWs and routine surveillance of patients and caregivers during an epidemic.
ABSTRACT
On March 11, 2020, the World Health Organization declared coronavirus disease (COVID-19), caused by the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a pandemic. During the COVID-19 pandemic, an age-associated vulnerability in the burden of disease has been uncovered. Understanding the spectrum of illness and the pathogenic mechanism of the disease in a vulnerable population is critical, especially during the pandemic. Herein, we reviewed published COVID-19 epidemiology data from several countries to identify any consistent trends in the relationship between age and COVID-19-associated morbidity or mortality. We also reviewed the literature for studies explaining the difference in the host response to SARS-CoV-2 infection according to age. The insights from these data will be useful in determining the treatment policies and preventive measures of COVID-19.
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Vibrio vulnificus infection was first reported as a necrotizing skin disease of unknown cause in Korea in 1979. In the early days, this disease caused panic across the country due to dreadful wound and its high mortality. Since then, the nature of the disease has become better understood and the overwhelming public fear has dissipated. However, there are still a certain number of infected patients each year and the high mortality rate remains a major health and social problem. From this review on historical and clinical perspective, better understanding of V. vulnificus infection would provide valuable information for public health planning.
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Objective@#The COVID-19 is overwhelming health care systems globally. Hospital isolation may generate considerable psychological stress. However, there has been scarce evidence on psychological interventions for these patients due to maintain staff safety. We investigated the feasibility and effectiveness of telephone based interventions for psychological problems in hospital isolated patients with COVID-19. @*Methods@#Psychiatrists visited the ward where the patients were hospitalized and interventions were given by using a ward telephone for 30 minutes. All patients were approached to receive a two-week psychological intervention program and/or pharmacotherapy whenever needed. Psychological problems were assessed at baseline, one, and two weeks. For the assessment of anxiety and depressive symptoms, the Hospital Anxiety and Depression Scale was administered to patients once a week. Insomnia severity index and Beck Depression Inventory 9 item were checked weekly to assess insomnia and suicide idea. @*Results@#Of 33 enrolled, clinically meaningful psychological symptoms were found in 6 (18%) patients for anxiety; 13 (39%) for depression; 10 (30%) for insomnia; and 3 (9%) for suicidal ideation. In 9 patients (27%), psychotropic medications were prescribed to manage anxiety, agitation, depressed mood, insomnia, impulsivity, and suicide idea.Compared to baseline, significant improvements were found in anxiety, depression, and suicidal ideation at one week.There were no statistical differences between the values evaluated at baseline and at two weeks. @*Conclusion@#Our report at least indicates potential usefulness of telephone based interventions in hospital isolated patients with COVID-19, and will hopefully form the basis for future randomized clinical trials.
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Background@#This study was performed to compare the viral load and kinetics of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in saliva with those in standard nasopharyngeal/oropharyngeal (NP/OP) swabs. @*Methods@#Fifteen patients with SARS-CoV-2 infection from four hospitals were prospectively enrolled and matched samples of nasopharyngeal/oropharyngeal swabs and saliva were collected at Day 1 of admission and every other day till consequently negative for two times. Real-time reverse transcription polymerase chain reaction (rRT-PCR) was performed to detect the envelope (E) and RNA-dependent RNA polymerase (RdRP) genes. @*Results@#The cycle threshold values of saliva were comparable to those of NP/OP swabs overall (P = 0.720, Mann–Whitney U test). However, the overall sensitivity of rRT-PCR using saliva was 64% (34/53), which is lower than the 77% (41/53) using NP/OP swabs. The sensitivity of rRT-PCR using saliva was especially lower in early stage of symptom onset (1–5 days; 8/15; 53%) and in patients who did not have sputum (12/22; 55%). @*Conclusion@#Saliva sample itself is not appropriate for initial diagnosis of coronavirus disease 2019 (COVID-19) to replace NP/OP swabs, especially for the person who does not produce sputum. COVID-19 cannot be excluded when the test using saliva is negative, and it is necessary to retest using NP/OP swabs.
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In recent years, the taeniasis has been rarely reported in the Republic of Korea (Korea). But in this study, we intend to report 4 taeniasis cases caused by Taenia saginata during a 5-month period (February to June 2018) at a unversity hospital in Gwangju, Korea. Worm samples (proglottids) discharged from all cases were identified by phenotypic and molecular diagnostics. Mitochondrial cytochrome c oxidase subunit I sequences showed 99.4–99.9% identity with T. saginata but, differed by 4% from T. asiatica and by 7% from T. multiceps, respectively. We found that tapeworms in 2 cases (Cases 2 and 3) yielded exactly the same sequences between them, which differed from those in Cases 1 and 4, suggesting intra-species variation in tapeworms. These taeniasis cases by T. saginata infection in this study, which occurred within a limited time period and region, suggest the possibility of a mini-outbreak. This study highlights the need for further epidemiological investigation of potentially overlooked cases of T. saginata infection in Korea.
Subject(s)
Cestoda , Electron Transport Complex IV , Korea , Pathology, Molecular , Republic of Korea , Taenia saginata , TaeniasisABSTRACT
Mycobacterium marinum infection in humans occurs mainly as a granulomatous infection after exposure of traumatized skin to contaminated water. It is usually confined to the skin and soft tissue. Disseminated disease involving other organs rarely occurs in immunocompetent patients. Here, we report a case of disseminated M. marinum infection involving not only the cutaneous tissue, but also the lung of a male patient with uncontrolled diabetes and a previous history of steroid injection who was employed by a deep-water fishery.
Subject(s)
Humans , Male , Diabetes Mellitus , Fisheries , Lung , Mycobacterium marinum , Mycobacterium , Skin , Steroids , WaterABSTRACT
Mycobacterium marinum infection in humans occurs mainly as a granulomatous infection after exposure of traumatized skin to contaminated water. It is usually confined to the skin and soft tissue. Disseminated disease involving other organs rarely occurs in immunocompetent patients. Here, we report a case of disseminated M. marinum infection involving not only the cutaneous tissue, but also the lung of a male patient with uncontrolled diabetes and a previous history of steroid injection who was employed by a deep-water fishery.
Subject(s)
Humans , Male , Diabetes Mellitus , Fisheries , Lung , Mycobacterium marinum , Mycobacterium , Skin , Steroids , WaterABSTRACT
BACKGROUND/AIMS: BK virus (BKV) has been associated with late-onset hemorrhagic cystitis (HC) in recipients of hematopoietic stem cell transplantation (HSCT). Cidofovir has been used at higher doses (3 to 5 mg/kg/wk) with probenecid prophylaxis; however, cidofovir may result in nephrotoxicity or cytopenia at high doses. METHODS: Allogeneic HSCT recipients with BKV-associated HC are treated with 1 mg/kg intravenous cidofovir weekly at our institution. A microbiological response was defined as at least a one log reduction in urinary BKV viral load, and a clinical response was defined as improvement in symptoms and stability or reduction in cystitis grade. RESULTS: Eight patients received a median of 4 weekly (range, 2 to 11) doses of cidofovir. HC occurred a median 69 days (range, 16 to 311) after allogeneic HSCT. A clinical response was detected in 7/8 patients (86%), and 4/5 (80%) had a measurable microbiological response. One patient died of uncontrolled graft-versus-host disease; therefore, we could not measure the clinical response to HC treatment. One microbiological non-responder had a stable BKV viral load with clinical improvement. Only three patients showed transient grade 2 serum creatinine toxicities, which resolved after completion of concomitant calcineurin inhibitor treatment. CONCLUSIONS: Weekly intravenous low-dose cidofovir without probenecid appears to be a safe and effective treatment option for patients with BKV-associated HC.
Subject(s)
Adult , Female , Humans , Male , Administration, Intravenous , Antiviral Agents/administration & dosage , BK Virus/drug effects , Cystitis/diagnosis , Cytosine/administration & dosage , Drug Administration Schedule , Hematopoietic Stem Cell Transplantation/adverse effects , Immunocompromised Host , Organophosphonates/administration & dosage , Polyomavirus Infections/diagnosis , Retrospective Studies , Time Factors , Transplantation, Homologous , Treatment Outcome , Tumor Virus Infections/diagnosis , Viral LoadABSTRACT
No abstract available.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Infant, Newborn , Male , Middle Aged , Anti-Bacterial Agents/pharmacology , Ceftriaxone/pharmacology , Echocardiography , Endocarditis, Bacterial/diagnosis , Immunosuppressive Agents/therapeutic use , Microbial Sensitivity Tests , Micrococcaceae/drug effects , RNA, Ribosomal, 16S/chemistry , Republic of KoreaABSTRACT
Clinical and laboratory data from Western countries suggest that pregnant women are at an increased risk for severe illness and complications associated with 2009 pandemic influenza A (H1N1). However, previous data among Korean women suggested a less severe outcome. In this study performed at a single referral center in Korea, rates of admission, pneumonia, intensive care unit admission, and death related to 2009 pandemic influenza A (H1N1) were significantly higher in 33 pregnant women than in 723 nonpregnant women of reproductive age (p<0.05 each). We report two cases of 2009 pandemic influenza A (H1N1) in pregnant Korean women who were admitted to the intensive care unit because of severe pneumonia that led to maternal and fetal death in one of the patients. This case series suggests that pregnant Korean women were also at increased risk of severe illness and complications during the 2009 pandemic influenza A (H1N1) outbreak.
Subject(s)
Female , Humans , Pregnancy , Fetal Death , Influenza, Human , Intensive Care Units , Korea , Pandemics , Pneumonia , Pregnant Women , Referral and ConsultationABSTRACT
Clinical and laboratory data from Western countries suggest that pregnant women are at an increased risk for severe illness and complications associated with 2009 pandemic influenza A (H1N1). However, previous data among Korean women suggested a less severe outcome. In this study performed at a single referral center in Korea, rates of admission, pneumonia, intensive care unit admission, and death related to 2009 pandemic influenza A (H1N1) were significantly higher in 33 pregnant women than in 723 nonpregnant women of reproductive age (p<0.05 each). We report two cases of 2009 pandemic influenza A (H1N1) in pregnant Korean women who were admitted to the intensive care unit because of severe pneumonia that led to maternal and fetal death in one of the patients. This case series suggests that pregnant Korean women were also at increased risk of severe illness and complications during the 2009 pandemic influenza A (H1N1) outbreak.
Subject(s)
Female , Humans , Pregnancy , Fetal Death , Influenza, Human , Intensive Care Units , Korea , Pandemics , Pneumonia , Pregnant Women , Referral and ConsultationABSTRACT
BACKGROUND: Bortezomib administration leads to a transient decrease in CD4+ T cells, increasing the susceptibility to opportunistic infections. The activation and proliferation of CD4+ T cells are particularly important in the host's defense against tuberculosis infection. The aim of this study was to determine the incidence and clinical significance of tuberculosis infection in patients with multiple myeloma (MM) treated with a bortezomib-containing regimen. METHODS: We retrospectively investigated the incidence of Mycobacterium tuberculosis in 115 patients with MM who were given a bortezomib-containing regimen and studied the disease prognosis. RESULTS: All patients received chemotherapy prior to bortezomib administration, and the median duration from diagnosis to bortezomib administration was 12.4 months (range, 0.2-230). We diagnosed tuberculosis in 8 patients (8/115, 7%): 7 patients had a pulmonary granulomatous lesion prior to chemotherapy and 1 developed reactivation of tuberculosis, but none of them died of uncontrolled tuberculosis infection. In 50% of patients with tuberculosis, bortezomib-containing therapy was interrupted. This resulted in significantly lower response rates to the bortezomib-containing therapy (P<0.05) and significantly shorter overall survival times amongst tuberculosis vs. non-tuberculosis patients (P=0.017). CONCLUSION: Tuberculosis infection was not uncommon among the patients with MM who were treated with bortezomib-containing therapy, and tuberculosis infection in these patients resulted in an interruption of bortezomib administration, which significantly affected patient outcomes. Therefore, early diagnosis and treatment of tuberculosis infection are critical to avoid worsening outcomes in such patients.
Subject(s)
Humans , Boronic Acids , Early Diagnosis , Incidence , Multiple Myeloma , Mycobacterium , Mycobacterium tuberculosis , Opportunistic Infections , Pyrazines , Retrospective Studies , T-Lymphocytes , Tuberculosis , BortezomibABSTRACT
BACKGROUND: Bortezomib administration leads to a transient decrease in CD4+ T cells, increasing the susceptibility to opportunistic infections. The activation and proliferation of CD4+ T cells are particularly important in the host's defense against tuberculosis infection. The aim of this study was to determine the incidence and clinical significance of tuberculosis infection in patients with multiple myeloma (MM) treated with a bortezomib-containing regimen. METHODS: We retrospectively investigated the incidence of Mycobacterium tuberculosis in 115 patients with MM who were given a bortezomib-containing regimen and studied the disease prognosis. RESULTS: All patients received chemotherapy prior to bortezomib administration, and the median duration from diagnosis to bortezomib administration was 12.4 months (range, 0.2-230). We diagnosed tuberculosis in 8 patients (8/115, 7%): 7 patients had a pulmonary granulomatous lesion prior to chemotherapy and 1 developed reactivation of tuberculosis, but none of them died of uncontrolled tuberculosis infection. In 50% of patients with tuberculosis, bortezomib-containing therapy was interrupted. This resulted in significantly lower response rates to the bortezomib-containing therapy (P<0.05) and significantly shorter overall survival times amongst tuberculosis vs. non-tuberculosis patients (P=0.017). CONCLUSION: Tuberculosis infection was not uncommon among the patients with MM who were treated with bortezomib-containing therapy, and tuberculosis infection in these patients resulted in an interruption of bortezomib administration, which significantly affected patient outcomes. Therefore, early diagnosis and treatment of tuberculosis infection are critical to avoid worsening outcomes in such patients.
Subject(s)
Humans , Boronic Acids , Early Diagnosis , Incidence , Multiple Myeloma , Mycobacterium , Mycobacterium tuberculosis , Opportunistic Infections , Pyrazines , Retrospective Studies , T-Lymphocytes , Tuberculosis , BortezomibABSTRACT
The use of quinolone for treatment of rickettsial diseases remains controversial. Recent clinical studies suggest that quinolone is not as effective as others in patients with rickettsial diseases including scrub typhus, although the mechanism is not well understood. In this study, we evaluated the mutation in gyrA associated with quinolone resistance. We prospectively enrolled scrub typhus patients, collected blood samples and clinical data from October, 2010 to November, 2011. Among the 21 patients enrolled, one initially received ciprofloxacin for 3 days but was switched to doxycycline due to clinical deterioration. We obtained the gyrA gene of Orientia tsutsugamushi from 21 samples (20 Boryong strain, 1 Kato strain) and sequenced the quinolone resistance-determining region. All of 21 samples had the Ser83Leu mutation in the gyrA gene, which is known to be associated with quinolone resistance. This suggests that quinolones may be avoided for the treatment of serious scrub typhus.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Amino Acid Sequence , Anti-Bacterial Agents/therapeutic use , Bacterial Proteins/genetics , Ciprofloxacin/therapeutic use , DNA Gyrase/genetics , Doxycycline/therapeutic use , Drug Resistance, Bacterial , Genotype , Molecular Sequence Data , Mutation , Orientia tsutsugamushi/classification , Phylogeny , Prospective Studies , Scrub Typhus/drug therapy , Sequence Alignment , Sequence Analysis, DNAABSTRACT
Candida pelliculosa is a rare cause of human infection. In this report, we describe a case of infective endocarditis caused by C. pelliculosa in a patient with a prosthetic heart valve. A 72-year-old female presented with a complaint of blurred vision, which she had been experiencing over a period of four weeks. Transthroasic echocardiography showed vegetation on the prosthetic mitral valve. A blood culture isolate was confirmed as C. pelliculosa.