Recent Trends in Transurethral Surgeries and Urological Outpatient Procedures: a Nationwide Populationbased Cohort Study

Background@#Demographic change and advances in technology affect transurethral surgery and outpatient procedures in the urologic field. There are few population-based studies that accurately assess the trend of transurethral surgery and outpatient procedures including diagnostic tests. We investigated the recent epidemiologic trends in transurethral surgeries and urological outpatient procedures from 2009 to 2016 in Korea using the entire populationbased cohort. @*Methods@#We analyzed medical service claim data of transurethral surgery, urological outpatient procedures submitted by medical service providers from the Health Insurance Review and Assessment Service from 2009 to 2016. @*Results@#Transurethral ureter surgery increased by 134.9% from 14,635 in 2009 to 34,382 in 2016 (B = 2,698; R 2 = 0.98; P 2 = 0.97; P 2 = 0.04; P = 0.617) and urethral surgery (B = −12; R 2 = 0.18; P = 0.289). The significantly increasing trends in cystoscopy (B = 5,260; R 2 = 0.95; P 2 = 0.99; P 2 = 0.77; P = 0.003) and electrical stimulation treatment (EST: B = −1,034; R 2= 0.87; P < 0.001) significantly decreased. @*Conclusion@#In Korea, transurethral ureter surgery and transurethral bladder surgery have been continuously increasing. Transurethral prostate surgery and transurethral urethral surgery remained constant with no increase or decrease. Cystoscopy and uroflowmetry continue to increase, while UDS and EST continue to decrease.

Short-term Results after Cementless Total Hip Arthroplasty Using a Fully Hydroxyapatite-coated Femoral Stem / 대한고관절학회지

PURPOSE: This study was accomplished to evaluate the clinical & radiological results of cementless total hip arthroplasty using a fully hydroxyapatite-coated femoral stem after follow up of at least, 2 years. MATERIALS AND METHODS: Thirty one hips in 28 patients, who underwent primary total hip arthroplasty using a fully hydroxyapatite-coated femoral stem between september 2007 and May 2009, were followed up for more than 2 years after surgery. The average age of patients was 67 years old, and the average duration of follow up was 35 months. Preoperative diagnosis was 17 cases of osteonecrosis and 10 cases of femoral neck fracture. Clinical evaluation was done by Harris hip score (HHS). Radiological evaluation was done in terms of stability of components, subsidence of femoral stem and occurrence of osteolysis. RESULTS: The average of HHS improved from 34.3 preoperatively to 82.6 at final follow-up. Radiologically, fixation by bony ingrowth was 23 cases(74%) and fibrous ingrowth was 8 cases(26%). Subsidence was within 2-4 mm and occurred within 6 weeks in all 5 cases. There were 4 cases of intra-operative femoral fracture, 1 case of superficial infection. CONCLUSION: Short-term clinical and radiological results of cementless total hip arthroplasty using a fully hydroxyapatite-coated femoral stem were not good enough. Radiologically, bony ingrowth were no more than 74%. Therefore, longer-term follow up would be necessary.

The Effects of Initial Empirical Antibiotics Regimens on the Outcomes of Staphylococcus aureus Bacteremia / 감염

BACKGROUND: Because of the concern for the emergence of resistance, the prudent use of vancomycin is essential. However, it is uncertain whether the initial delay in the effective treatment of Staphylococcus aureus bacteremia adversely affects the outcome. We performed this study to determine the outcome of an initial delay in the use of antistaphylococcal antibiotics for Staphylococcus aureus bacteremia (SAB). METHODS: We conducted a retrospective cohort study of 238 with SAB at a tertiary care hospital. Empirical antibiotics treatment was considered ineffective if the isolated strain was not susceptible, in vitro, to antibiotics given during the first 48 hours. The outcome was measured as SAB-related mortality within 8 weeks from the SAB. RESULTS: The mortality for the patients with ineffective empirical regimen (50/117, 42.7%) showed a trend toward being higher than that with effective empirical regimen (38/121, 31.4%), but it did not reach the statistical significance (OR 1.63 95% CI 0.96~2.77, P=0.07). However, in the subgroups of end-stage renal disease ineffective empirical antibiotics adversely affected the outcomes (OR 5.42, 95% CI 1.25~23.49, P=0.02) On multivariate logistic regression analysis, adjusted OR of ineffective empirical regimen for SAB-related mortality was 2.03 (95% CI 1.08~3.82, P=0.03). CONCLUSION: Our findings suggest that an initial delay in the use of antistaphylococcal antibiotics for the first 2 days might adversely affect the outcome when treating SAB, especially in the patients with end-stage renal disease.

A Case of Community-Acquired Parainfluenza virus type 3 Pneumonia in a Allogeneic Bone Marrow Transplantation Recipient / 감염

Pneumonia, along with graft-versus-host disease, is a major cause of morbidity and mortality in patients receiving bone marrow transplantation. The community respiratory virus infections have been found to be large causes of pneumonia. Upper respiratory infection with Parainfluenza virus can progress to severe lower respiratory diseases in bone marrow transplant recipients, of which clinical findings are similar to those of pneumonia by exotic opportunistic pathogens. We report a patient with chronic myelogenous leukemia who had suffered a community-acquired pneumonia by Parainfluenza virus type 3 after bone marrow transplantation.

Frequency of Resistance to Aminog lycoside Antibiotics in Staphy lococcus aureus Isolated from Tertiary Hospitals / 감염

BACKGROUND: Staphylococcus aureus is one of the most important pathogens, causing severe morbidity and fatal infections. To date rapid evolution of antibiotic resistance in S. aureus, including recent emergence of vancomycin-resistant S. aureus (VRSA), has been a serious concern and an obstacle to the effective treatment. The purpose of this study is to update the resistance patterns against aminoglycoside antibiotics which play an important role in the therapy of serious staphylococcal infections. METHODS: Clinical isolates were collected from 8 university-affiliated hospitals during the period of June 1999 to January 2001. Susceptibility tests against 9 antibiotics were performed by disk diffusion method. Minimum inhibitory concentrations (MICs) of arbekacin against non-susceptible strains were determined by microbroth dilution method RESULTS: Among total 682 isolates exclusive of consecutive ones from the same patients, 199 (29%) were from pus, 152 (22%) from respiratory specimens, 137 (20%) from blood, 38 (6%) from urine. Of 682 isolates, 588 (87%) isolates were resistant to at least one of the aminoglycosides tested. Overall prevalence of MRSA was 64% (439/682), and resistance rates of MRSA were summarized as follows; kanamycin (KM) 98%, tobramycin (TOB) 98%, gentamicin (GM) 95%, amikacin (AMK) 90%, neomycin (NEO) 63%, streptomycin (SM) 31%, netilmicin (NET) 18%, arbekacin (ABK) 13%. MRSA isolates were resistant to multiple aminoglycosides, and 88% of them were resistant to all four aminoglycosides of KM, TOB, GM, and AMK. MICs of ABK against 58 non-susceptible strains ranged from 2 to 128 microgram/mL. CONCLUSION: More than 90% of MRSA isolates were resistant against kanamycin, tobramycin, gentamicin, and amikacin. Moreover, most of MRSA isolates were multi-drug resistant to all these four aminoglycosides. Resistance rates against arbekacin and netilmicin were less than 20%. Arbekacin was the most susceptible antibiotic of the aminoglycosides tested.

A Case of Septic Pneumonia Secondary to Community: acquired Campylobacter fetus Bacteremia / 감염

Campylobacter f etus has been increasingly associated with extraintestinal infections in patients with underlying diseases. Pulmonary involvement in human by this organism is rare. We report a case of septic pneumonia secondary to community-acquired C. f etus bacteremia in a 67 year-old man with chronic renal failure.

The Effect of Combination Therapy of Zidovudine, Lamivudine, and Indinavir in HIV Infected Patients / 감염

BACKGROUND: To evaluate the clinical efficacy, safety and tolerance of combination therapy of zidovudine, lamivudine and indinavir in HIV infected patients. METHODS: We reviewed medical records of HIV infected patients who had received combination therapy of zidovudine, lamivudine and indinavir at the Seoul National University Hospital between May 1998 and March 1999. The clinical end point was the time to the development of the opportunistic infection or death. Changes in plasma HIV-1 RNA levels and CD4 cell counts before and after combination treatments were also evaluated. RESULTS: Fifty-two patients were included in this study. Of these, 25 patients (48%) had continued the treatment more than 6 months, whereas 12 patients (23%) were lost to follow-up, and 15 patients (29%) had discontinued the treatment. The causes of discontinuation of the treatment were adverse drug effects in 67% (10/15), economic problem in 20% (3/15) and the development of drug resistance in 13% (2/15). Of the 25 patients who had been treated more than 6 months, 4 patients were excluded because they had not taken the necessary tests at the scheduled time points. Of the 21 evaluable patients, 3 patients (14%) developed opportunistic infections, but no patients died. In seventeen patients (81%), HIV RNA-1 titers decreased below the detectable level by 6 months of treatment. The mean decrease of HIV-1 RNA titer after 6 months of treatment was 2.65 log10 copies/mL. The mean increase of CD4 cell counts was 111 cells/mm3. CONCLUSION: Combination therapy of zidovudine, lamivudine and indinavir was effective in decrease of viral load and increase of CD4 cell counts. Half of the patients could not continue the combination therapy more than 6 months because of the adverse drug effects and/or economical problem.

Identification of New Subtype of Human Immunodeficiency Virus Type 1 in a Korean Patient / 감염

BACKGROUD: In the previous study, we determined subtypes of Human Immunodeficiency Virus type 1 (HIV-1) in Korean patients by partial sequence analysis. We showed that eighteen of the nineteen sequences of HIV-1 from Korean fell into subtype B and one fell into subtype A. At that study, HIV-1 identified as subtype A showed 40% diversity from reference sequences and presumed to be a variant of subtype A. The aim of present study is to determine the molecuar biological characteristics of HIV-1 previously identified as subtype A. METHODS: Growth curve was determined. SI/NSI phenotype was determined using a cocultivation assay using MT-2 cells. A complete genome sequence was obtained by amplifying overlapping PCR fragments. Cowork was done to identify the subtype of HIV-1 previously identified as variant A from Korea (97KR004), Cyprus (94CY017), Democratic Republic of Congo (97CDKTB48, 97CDKFE4, 97CDKS10, 97CDKP58). Phylogenetic analysis, distance analysis, diversity plot analysis, bootstrap anlysis were done to identify the subtype of these newly characterized strains. RESULTS: We found that 97KR004 was SI phenotype. Complete sequence of 97KR004 was determined (AF286239). Phylogenetic analysis showed that the four newly characterized strains (94CY017, 97CDKTB48, 97CDKFE4, 97CDKS10) were closely related to subtype A. Subtype distance tool showed that these four strains fell to sub-subtype A2. Diversity plot analysis and bootstrap analysis were done to identify subtype of 97KR004. Nine subtype reference strains and 94CY017 strain were used as reference sequences. These analyses confirmed that 97KR004 represented sub-subtype A2/subtype D recombinant. CONCLUSOIN: We showed that 97KR004 fell into newly identified sub-subtype A2.

Scrub Typhus in a Pregnant Woman: No Evidence of Intrauterine Infection / 감염

Pregnancy with scrub typhus is a rare condition. A 30-year-old woman was infected with scrub typhus at the 35th week of gestation. She was treated successfully with azithromycin, and delivered her baby uneventfully. The baby developed no signs for scrub typhus, and thrived well. IgM antibodies to O. tsutsugamushi were undetectable in the baby's sera, and titers of IgG antibodies did not rise. The polymerase chain reaction of the cord blood for O. tsutsugamushi was also negative. We concluded that transplacental infection did not occur in this pregnant woman.

Prevalence of Staphylococcus aureus with Reduced Susceptibility to Vancomycin in a Tertiary Hospital / 감염

BACKGROUND: Recently isolates of S. aureus with intermediate (VISA) and heterogeneous resistance (hetero-VRSA) to vancomycin, which has been the only effective against MRSA infections, were identified. Several infections due to these isolates did not respond to adequate antibiotic treatments. In Japan, the prevalences of hetero-VRSA ranged from 0 to 48%. The aim of this study was to determine the prevalence of S. aureus heterogenously resistant to vancomycin and VISA. METHODS: The isolates were collected at Seoul National University Hospital from April 1998 to August 1999. To detect S. aureus with reduced susceptibility to vancomycin, brain heart infusion (BHI) agar with 4 mg/L of vancomycin and Mu-3 agar were used. Analysis of resistant subpopulations of bacteria (population analysis) was done. Minimum inhibitory concentration (MIC) for vancomycin was determined by microbroth and agar dilution methods, respectively according to NCCLS and Hiramatsu's recommendation. Coagulase type was determined with type I-VIII antisera. RESULTS: Total 235 MRSA, including 88 isolates from blood and 147 from other specimens, were collected. After 88 blood isolates were inoculated on BHI agar with 4 mg/L of vancomycin, 14 isolates (16 %) grew in variable colonies. But there were no subclones with vancomycin MIC > or =8 mg/L on population analysis and no isolates which grew confluently on Mu-3 agar with beta-lactam disks. In addition, 147 isolates from other specimens did not grow confluently on Mu-3 agar. Among 64 MRSA and 32 MSSA isolates, coagulase type II (49, 77%) and Vll(8, 25%) were respectively the most common types. CONCLUSION: In our tertiary-care hospital, there were no MRSA isolates with reduced susceptibilities to vancomycin.

Molecular Epidemiology and Surveillence of Vancomycin-resistant Enterococci at Seoul National University Hospital / 감염

BACKGROUND: The purpose of this study is to investigate the epidemiology and microbiological susceptibility patterns of vancomycin-resistant enterococci (VRE) in Seoul National University Hospital. METHODS: The VRE isolates between May 1998 and October 1999 were studied. We reviewed the medical records of VRE-isolated patients for clinical and epidemiologic data. The susceptibility of VRE to ampicillin, vancomycin, teicoplanin, gentamicin, streptomycin, ciprofloxacin, imipenem, rifampin, tetracyclin were determined by micro-dilution method. PCR for genotyping and PFGE for molecular epidemiology were performed. RESULTS: Twenty-nine VRE isolates were identified from 14 patients, 12 patients from clinical specimens and two from only rectal surveillence cultures. All strains were E. faecium and expressed vanA genotype. The vancomycin MIC and teicoplanin MIC were >128microgram/mL for all isolates. All isolates also resistant to most other antibiotics tested (ampicillin 84.2%, gentamicin 73.7%, streptomycin 73.7%, ciprofloxacin 84.2%, tetracycline 63.2%, rifampin 84.2%, imipenem 94.7%). PFGE analysis revealed 17 distinct PFGE strain types from 14 patients and there were no predominent types. Two patterns, each of them represented by two isolates, were identical. One of which was not associated epidemiologically but the other was associated with direct spread from colonized patient at the intensive care unit. CONCLUSION: The majority of VRE cases occurring at Seoul National University Hospital were not caused by epidemiologic strains but sporadic isolations although there was one case of patient to patient spread.

Antibiotic Susceptibility of Enterococcal Isolates causing Bacteremia / 감염

BACKGROUND: Enterococci have emerged as an important nosocomial pathogen. Enterococcal infections are a therapeutic challange because of antibiotics resistance, especially high-level aminoglycoside resistance and vancomycin resistance. METHODS: We reviewed the medical records of enterococcal bacteremia patients admitted to Seoul National University Hospital between April 1996 and May 1998. The susceptibility of enterococci to ampicillin, vancomycin, teicoplanin, gentamicin, streptomycin, ciprofloxacin, imipenem, rifampin, and tetracyclin were determined by micro-dilution method. RESULTS: Forty-two episodes of enterococcal bacteremia were identified. Of the 42 bacteremia, 74% (31/42) were caused by E. faecalis, and 26% (11/42) by E. faecium. The most common underlying diseases were hepatobiliary diseases (24%) and cardiovascular diseases (24%). Cholangitis (21%), pneumonia (14%), catheter-related infection (10%), peritonitis (7%), urinary tract infection (7%) were the frequent primary infections for the enterococcal bacteremia. Of the 31 isolates of E. faecalis, 29 (94%) were susceptible to ampicillin, whereas only 36% (4/11) of E. faecium were susceptible to ampicillin. Of the isolates of E. faecalis, 61% (19/31) were highly resistant to gentamicin, 39% (12/31) highly resistant to streptomycin, and 32% (10/31) highly resistant to both gentamicin and streptomycin. Of the isolates of E. faecium, 45% (5/11), 55% (6/11), and 27% (3/11) were highly-resistant to gentamicin, streptomycin, and both gentamicin and streptomycin, respectively. Only one isolate of E. faecium showed resistance to vancomycin. CONCLUSION: Approximately one third of enterococcal blood isolates showed high-level resistance to gentamicin and streptomycin.

A Case of Disseminated Varicella-zoster Virus Infection with Pneumonia in a Patient with AIDS / 감염

Varicella-zoster virus (VZV) infection is common in HIV seropositive patients, but disseminated VZV infection with pneumonia is rare in adult HIV seropositive patients. We report a case of disseminated VZV infection in a 28 year-old female patient with acquired immunodeficiency syndrome. The patient presented with dyspnea and disseminated cutaneous lesions. Chest radiograph showed multiple patchy lesions on the whole lung field. VZV was isolated from vesicular fluid of the cutaneous lesions. The patient was successfully treated with intravenous acyclovir.

Infections in Patients with Acute Leukemia (1993~1996) / 대한혈액학회지

BACKGROUND: Infection is one of the major complications in patients with hematologic malignancies. Clinical spectrums of infectious diseases are changing due to the recent progress in the conservative management. The objective of this study was to determine the patterns and trends of infections in patients with acute leukemia. METHODS: The medical records for 253 adult patients with acute leukemia admitted at the Seoul National University Hospital from January 1993 to December 1996 were reviewed retrospectively. RESULTS: Clinical data of 186 subjects were available. Four hundred and four febrile episodes developed in 161 (86.6%) patients. Median duration of neutropenia, defined as absolute neutrophil count (ANC)<500/, was 18 days and ANC on the 1st day of infection was 0 (0~73,360)/microliter. Fever resolved in a median duration of 4 (1~73) days. Clinically-defined infection, microbiologically-defined infection and unknown fever accounted for 44.3, 36.6 and 19.1%, respectively. Pneumonia occured in 19.0% (62/327), infection of oral cavity in 15.6%, and perianal infection in 13.8%. Of 164 bacterial isolates, 100 were gram-negative, 62 gram-positive, and 2 Mycobacterium tuberculosis. Escherichia coli (32 isolates) was the most common organism, followed by Klebsiella pneumonia (24), Staphylococcus aureus (21) and Pseudomonas aeruginosa (18). Ten fungi including 1 Pneumocystis carinii and 6 Candida species were isolated. Out of 404 cases, 33 patients (8.2%) expired despite aggressive treatment. Twenty-eight patients died of infectious complications, including 17 pneumonia and 4 primary bacteremia. CONCLUSIONS: There was a tendency to a increased proportion of microbiologically-defined infection, a fall in the frequency of P. aeruginosa and treatment outcomes significantly improved.

Incidence and Risk Factors of Tuberculosis in Human Immunodeficiency Virus-Infected Patients in Korea / 감염

BACKGROUND: Tuberculosis is the most frequent opportunistic infection in HIV-infected patients in Korea. We examined the incidence and risk factors for tuberculosis in HIV-infected patients. METHODS: We reviewed the medical records of 143 HIV-infected patients between January 1988 and June 1997 at the Seoul National University Hospita The incidence of tuberculosis was determined by the number of new tuberculosis per 100 patients divided by a total duration of follow-up (cases/100 person- years). The incidence of tuberculosis was analyzed with respect to CD4+ lymphocyte count, status of tuberculin skin reaction, and status of delayed hypersensitivity skin reaction. RESULTS: The total duration of follow-up was 229.6 person-years. During follow-up, 22 patients developed tuberculosis [9.6 cases per 100 person-years (95% CI, 6.0 to 14.5)]. The incidence of tuberculosis according to sex and transmission route showed no significant difference. Tuberculosis occurred more frequently in patients with minimum CD4+ T lympho-cyte counts of less than 200 cells/mm3 (14.2 cases/100 person-years) than in those with higher T lymphocyte counts (3.9 cases/100 person-years) [relative risk, 4.02 (95% CI 1.32 to 12.5), P=0.009]. The incidence of tuberculosis was higher among tuberculin- positive patients [17.0 cases/100 person-years (95% CI, 9.0 to 29.0)] than among tuberculin-negative [8.0 cases/100 person-years (95% CI, 3.2 to 16.6)], but the difference was not statistically significant [relative risk, 2.35 (95% CI, 0.88 to 6.26, P=0.078)]. The rate of tuberculosis in patients with negative delayed hypersensitivity test was not significantly different from that in patients with positive results (P=0.510). CONCLUSION: The incidence of tuberculosis was 9.6 cases per 100 person-years. CD4+ lymphocyte count (<200 cells/mm3) was the most useful predictor for the development of tuberculosis in HIV patients in Korea.

Epidemiology of and Risk Factors for Methicillin Resistance in Community-acquired and Nosocomial Staphylococcus aureus Bacteremia / 감염

BACKGROUND: Strains of methicillin-resistant Staphylococcus aureus (MRSA) have emerged as important pathogens affecting primarily hospitalized patients. However, some investigators reported an increase in the frequency of community-acquired MRSA infections among persons who did not appear to have any of the recognized risk factors associated with nosocomial acquisition of MRSA. We designed this study to assess the proportion of MRSA in S. aureus bacteremia in the community and risk factors for MRSA bacteremia. METHODS: We reviewed the medical records of 334 cases during 1991~1992 and 1996~1997 and 93 cases in the emergency room of the Seoul National University Hospital during 1993~1995, in which S. aureus was isolated from blood samples. We retrospectively analyzed 210 cases (154 and 56 cases, respectively), which satisfied the definition of clinically significant bacteremia and of which medical records were available. RESULTS: Of 154 bacteremia cases reviewed, 32 (20.8%) were community-acquired and 122 (79.2%) were nosocomial during 1991~1992 and 1996~1997. MRSA occupied 18.8% (6 of 32) in community- acquired S. aureus bacteremia and 44.3% (54 of 122) in our hospital cases. We could not find a statistically significant increase in the rate of methicillin resistance in the community and our hospital. All of 15 cases classified as community-acquired MRSA bacteremia during 1991~1997 had more than one predisposing risk factor for MRSA infection. Nosocomial MRSA bacteremia were more frequently observed among the patients treated in the intensive care unit. (32.4% vs 10.2%, P=0.001). CONCLUSION: MRSA bacteremia occupied 18.8% of community-acquired S. aureus bacteremia. All cases with community-acquired MRSA bacteremia had more than one predisposing risk factor for MRSA infection. We did not observe a statistically significant increase in the proportion of MRSA bacteremia in S. aureus bacteremia.

Infections in Bone Marrow Recipients (1985~1996) / 감염

BACKGROUND: Infection and graft-versus-host disease (GVHD) are major causes of morbidity and mortality following bone marrow transplantation (BMT). The objective of this study was to define the incidence, type, and timing of infectious complications in bone marrow recipients. METHODS: Ninety-four patients, including 71 allogeneic and 23 autologous cases, underwent BMT at the Seoul National University Hospital. Their medical records were reviewed retrospectively. RESULTS: Medical records of 74 subjects (53 allogeneic, 21 autologous) were available. In allogeneic recipeints the majority of patients had a diagnosis of leukemia (47.9%) and in autologous ones lymphoma (66.7%). Median duration of follow-up was 11 (0~82) months and 3 (1~45) months in each group. Out of 40 allogeneic and 17 autologous recipients, 95 and 27 febrile episodes occurred, respectively. During pre-engraftment, post-engraftment (to day 100), and post-transplantation period (100 days or later), 57, 45, and 19 episodes developed, respectively. Clinically-defined infection, microbiologically-defined infection, and un-known fever accounted for 52.5% (64/112), 33.6% (41/112) and 13.9% (17/112), respectively. Infection of the oral cavity occurred in 27.6% (28/105), skin infection in 21.9% (23/105), and pneumonia in 14.3% (15/105). Fourteen (58.3%) of 24 bacterial infections were caused by gram-negative bacilli and 10 (41.7%) by gram-positive cocci, most often coagulase-negative staphylococci. Fungi, including Pneumocystis carinii, and viruses were involved in 16.0% (7/44) and 29.5% (13/44), respectively. Ten of 122 cases (8.2%) expired despite treatment; eight patients died due to infectious complications, including 7 with pneumonia and 1 with primary bacteremia, and 2 dies due to non-infectious complications. CONCLUSION: Infections are the most frequent serious complications of bone marrow transplantation. The majority occurred by day 100 after BMT and oral mucositis was the most common type of infection.

A Case of Asymptomatic Plasmodium vivax Malaria Mimicking Idiopathic Thrombocytopenic Purpura / 감염

Malaria is a reemerging infectious disease in Korea. We experienced a case of asymptomatic P. vivax malaria accompanied by thrombocytopenia, mimicking immune thrombocytopenic purpura. The patient was exposed to mosquito 12 weeks ago. She experienced a characteristic febrile episode lasting for 2 weeks and remained asymptomatic thereafter. It was 7 weeks after the characteristic febrile episode when the diagnosis was established by the parasitemia. Malaria should be considered in the differential diagnosis of thrombocytopenia in Korea, especially in patients with febrile episodes.

A Case of Acute Retroviral Syndrome Presenting as a Fever of Unknown Origin / 감염

We report a case of acute retroviral syndrome presen-ting as a fever of unknown origin. A 22-year-old man was admitted to the hospital because of fever. He had been well untill 20 days earlier when he experienced fe-ver and headache. Three days before admission diarrhea, vomiting, sore throat and myalgia developed. Physical examination revealed skin rash, and multiple lymphadeno-pathy. Acute human immunodeficiency virus (HIV) infec- tion was confirmed by seroconversion. As the number of patients with HIV infection is increasing in Korea, acute retroviral syndrome should be included in the differential diagnosis of fever of unknown origin.

Opportunistic Infections and Malignancies in 173 Patients with HIV Infection / 감염

BACKGROUND: The frequency and type of major opportunistic infections (OI' s) in HIV-infected patients are different among various countries. To determine major OI' s in Korea, we analyzed OI' s in HIV-infected patients at an university-affiliated teaching hospital in Korea. METHODS: We reviewed medical records for the HIV-infected patients seen at Seoul National University Hospital from 1985 to April 1998. OI' s were diagnosed according to the definition proposed by CDC (1993). RESULTS: One hundred and seventy three patients were analyzed. Over 70% of the patients were followed for more than 6 months. CD4 + lymphocyte counts at the initial visit ranged 200 to 500/mm 3 in 55% of the patients, and was less than 200/mm 3 in 26%. Tuberculosis was the most frequent OI (25%), followed by candidiasis (21%), herpes zoster (20%), and pneumocystis carinii pneumonia (10%). Kaposi' s sarcoma developed in 3 patients (2%), non-Hodgkin' s lymphoma in 2 (1%). Eleven patients (6%) developed peripheral neuropathy, and 8 patients (5%) had HIV encephalopathy. There was no case of toxoplasmosis. The AIDS defining conditions for the 61 AIDS patients was comprised of 39 (64%) tuberculosis, 6 (10%) esophageal candidiasis, and 6 (10 %) pneumocystis carinii pneumonia. Twenty four patients died; 7 patients died of pneumonia and 4 patients committed suicide. There was no long-term nonprogressor. CONCLUSION: Tuberculosis was the most frequent OI in Korean HIV-infected patients. Candidiasis, herpes zoster, and cytomegalovirus diseases were also common. Compared to those in the United States and European countries, the prevalence of toxoplasmosis and Kaposi' s sarcoma were relatively low. Pneumonia was the major cause of death.