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1.
Article in English | WPRIM | ID: wpr-925969

ABSTRACT

Background@#Coronavirus disease 2019 (COVID-19) is often accompanied by secondary infections, such as invasive aspergillosis. In this study, risk factors for developing COVID-19-associated pulmonary aspergillosis (CAPA) and their clinical outcomes were evaluated. @*Methods@#This multicenter retrospective cohort study included critically ill COVID-19 patients from July 2020 through March 2021. Critically ill patients were defined as patients requiring high-flow respiratory support or mechanical ventilation. CAPA was defined based on the 2020 European Confederation of Medical Mycology and the International Society for Human and Animal Mycology consensus criteria. Factors associated with CAPA were analyzed, and their clinical outcomes were adjusted by a propensity score-matched model. @*Results@#Among 187 eligible patients, 17 (9.1%) developed CAPA, which is equal to 33.10 per 10,000 patient-days. Sixteen patients received voriconazole-based antifungal treatment. In addition, 82.4% and 53.5% of patients with CAPA and without CAPA, respectively, received early high-dose corticosteroids (P = 0.022). In multivariable analysis, initial 10-day cumulative steroid dose > 60 mg of dexamethasone or dexamethasone equivalent dose) (adjusted odds ratio [OR], 3.77; 95% confidence interval [CI], 1.03–13.79) and chronic pulmonary disease (adjusted OR, 4.20; 95% CI, 1.26–14.02) were independently associated with CAPA. Tendencies of higher 90-day overall mortality (54.3% vs. 35.2%, P= 0.346) and lower respiratory support-free rate were observed in patients with CAPA (76.3% vs. 54.9%, P = 0.089). @*Conclusion@#Our study showed that the dose of corticosteroid use might be a risk factor for CAPA development and the possibility of CAPA contributing to adverse outcomes in critically ill COVID-19 patients.

2.
Article in English | WPRIM | ID: wpr-925912

ABSTRACT

Background@#Numerous patients around the globe are dying from coronavirus disease 2019 (COVID-19). While age is a known risk factor, risk analysis in the young generation is lacking. The present study aimed to evaluate the clinical features and mortality risk factors in younger patients (≤ 50 years) with a critical case of COVID-19 in comparison with those among older patients (> 50 years) in Korea. @*Methods@#We analyzed the data of adult patients only in critical condition (requiring high flow nasal cannula oxygen therapy or higher respiratory support) hospitalized with PCR-confirmed COVID-19 at 11 hospitals in Korea from July 1, 2021 to November 30, 2021 when the delta variant was a dominant strain. Patients’ electronic medical records were reviewed to identify clinical characteristics. @*Results@#During the study period, 448 patients were enrolled. One hundred and forty-two were aged 50 years or younger (the younger group), while 306 were above 50 years of age (the older group). The most common pre-existing conditions in the younger group were diabetes mellitus and hypertension, and 69.7% of the patients had a body mass index (BMI) > 25 kg/m 2 .Of 142 younger patients, 31 of 142 patients (21.8%, 19 women) did not have these pre-existing conditions. The overall case fatality rate among severity cases was 21.0%, and it differed according to age: 5.6% (n = 8/142) in the younger group, 28.1% in the older group, and 38% in the ≥ 65 years group. Age (odds ratio [OR], 7.902; 95% confidence interval [CI], 2.754–18.181), mechanical ventilation therapy (OR, 17.233; 95% CI, 8.439–35.192), highest creatinine > 1.5 mg/dL (OR, 17.631; 95% CI, 8.321–37.357), and combined blood stream infection (OR, 7.092;95% CI, 1.061–18.181) were identified as independent predictors of mortality in total patients.Similar patterns were observed in age-specific analyses, but most results were statistically insignificant in multivariate analysis due to the low number of deaths in the younger group.The full vaccination rate was very low among study population (13.6%), and only three patients were fully vaccinated, with none of the patients who died having been fully vaccinated in the younger group. Seven of eight patients who died had a pre-existing condition or were obese (BMI > 25 kg/m 2 ), and the one remaining patient died from a secondary infection. @*Conclusion@#About 22% of the patients in the young critical group did not have an underlying disease or obesity, but the rate of obesity (BMI > 25 kg/m2 ) was high, with a fatality rate of 5.6%. The full vaccination rate was extremely low compared to the general population of the same age group, showing that non-vaccination has a grave impact on the progression of COVID-19 to a critical condition. The findings of this study highlight the need for measures to prevent critical progression of COVID-19, such as vaccinations and targeting young adults especially having risk factors.

3.
Article in Korean | WPRIM | ID: wpr-901479

ABSTRACT

About 30~50% COVID-19 hospital inpatients is reported to have mild clinical presentation, and the clinical course is known to be good even in the older population. In order to compare the clinical symptoms of mild patients with COVID-19 infection by age, the clinical symptoms and laboratory results were analyzed by dividing mild patients admitted to a dedicated hospital into three groups: under the age of 64, 65-84, and above 85 years of age.There was no difference in gender ratio by age among 555 mild cases. Concomitant diseases with significant differences by age were hypertension, diabetes, stroke, and coronary artery disease.Among the symptoms, cough and sore throat were different by age, and cough was significantly higher in the group under 64 years of age. Among the symptoms, cough and sore throat were different by age, and cough was significantly higher in the group under 64 years of age.The white blood cell count (WBC), neutrophil count, monocyte, blood sugar, procalcitonin, and creatinine were significantly higher in the 85 years old or older group, and the hemoglobin, albumin, and glomerular filtration rate (GFR) were significantly lower in the 85 years old or older group.

4.
Korean Journal of Radiology ; : 1265-1272, 2020.
Article | WPRIM | ID: wpr-833567

ABSTRACT

Objective@#We investigated the prevalence of pneumonia in novel coronavirus disease 2019 (COVID-19) patients using chest radiographs to identify the characteristics of those with initially negative chest radiographs, who were positive for pneumonia on follow-up. @*Materials and Methods@#Retrospective cohort data of 236 COVID-19 patients were reviewed. Chest radiography was performed on admission, with serial radiographs obtained until discharge. The ‘positive conversion group’ was defined as patients whose initial chest radiographs were negative but were positive for pneumonia during follow-up. Patients with initially positive chest radiographs were defined as the ‘initial pneumonia group.’ Patients with negative initial and follow-up chest radiographs were defined as the ‘non-pneumonia group.’ Clinical and laboratory findings were compared between groups, and predictors of positive conversion were investigated. @*Results@#Among 236 patients, 108 (45.8%) were in the non-pneumonia group, 69 (29.2%) were in the initial pneumonia group, and 59 (25%) were in the positive conversion group. The patients in the ‘initial pneumonia group’ and ‘positive conversion group’ were older, had higher C-reactive protein (CRP) and lactate dehydrogenase levels, and lower absolute lymphocyte counts than those in the ‘non-pneumonia group’ (all p 0.5 mg/dL (OR: 3.91, 95% CI: 1.54–9.91, p = 0.004) were independent predictors for future development of pneumonia. @*Conclusion@#More than a half of COVID-19 patients initially had normal chest radiographs; however, elderly patients (≥ 45 years of age) with abnormal laboratory findings (elevated CRP and low absolute lymphocyte counts) developed pneumonia on follow-up radiographs.

5.
Article | WPRIM | ID: wpr-832330

ABSTRACT

Background@#Coronavirus disease 2019 (COVID-19) is a global pandemic that had affected more than eight million people worldwide by June 2020. Given the importance of the presence of diabetes mellitus (DM) for host immunity, we retrospectively evaluated the clinical characteristics and outcomes of moderate-to-severe COVID-19 in patients with diabetes. @*Methods@#We conducted a multi-center observational study of 1,082 adult inpatients (aged ≥18 years) who were admitted to one of five university hospitals in Daegu because of the severity of their COVID-19-related disease. The demographic, laboratory, and radiologic findings, and the mortality, prevalence of severe disease, and duration of quarantine were compared between patients with and without DM. In addition, 1:1 propensity score (PS)-matching was conducted with the DM group. @*Results@#Compared with the non-DM group (n=847), patients with DM (n=235) were older, exhibited higher mortality, and required more intensive care. Even after PS-matching, patients with DM exhibited more severe disease, and DM remained a prognostic factor for higher mortality (hazard ratio, 2.40; 95% confidence interval, 1.38 to 4.15). Subgroup analysis revealed that the presence of DM was associated with higher mortality, especially in older people (≥70 years old). Prior use of a dipeptidyl peptidase-4 inhibitor or a renin-angiotensin system inhibitor did not affect mortality or the clinical severity of the disease. @*Conclusion@#DM is a significant risk factor for COVID-19 severity and mortality. Our findings imply that COVID-19 patients with DM, especially if elderly, require special attention and prompt intensive care.

6.
Article | WPRIM | ID: wpr-831696

ABSTRACT

Background@#s: The severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) has spread worldwide. Cardiac injury after SARS-CoV-2 infection is a major concern. The present study investigated impact of the biomarkers indicating cardiac injury in coronavirus disease 2019 (COVID-19) on patients' outcomes. @*Methods@#This study enrolled patients who were confirmed to have COVID-19 and admitted at a tertiary university referral hospital between February 19, 2020 and March 15, 2020. Cardiac injury was defined as an abnormality in one of the following result markers: 1) myocardial damage marker (creatine kinase-MB or troponin-I), 2) heart failure marker (N-terminal-pro B-type natriuretic peptide), and 3) electrical abnormality marker (electrocardiography). The relationship between each cardiac injury marker and mortality was evaluated. Survival analysis of mortality according to the scoring by numbers of cardiac injury markers was also performed. @*Results@#A total of 38 patients with COVID-19 were enrolled. Twenty-two patients (57.9%) had at least one of cardiac injury markers. The patients with cardiac injuries were older (69.6 ± 14.9 vs. 58.6 ± 13.9 years old, P = 0.026), and were more male (59.1% vs. 18.8%, P = 0.013).They showed lower initial oxygen saturation (92.8 vs. 97.1%, P = 0.002) and a trend toward higher mortality (27.3 vs. 6.3%, P = 0.099). The increased number of cardiac injury markers was significantly related to a higher incidence of in-hospital mortality which was also evidenced by Kaplan-Meier survival analysis (P = 0.008). @*Conclusion@#The increased number of cardiac injury markers is related to in-hospital mortality in patients with COVID-19.

7.
Article | WPRIM | ID: wpr-831627

ABSTRACT

Background@#The mortality risk of coronavirus disease 2019 (COVID-19) is higher in patients with older age, and many elderly patients are reported to require advanced respiratory support. @*Methods@#We reviewed medical records of 98 patients aged ≥ 65 years who were hospitalized with COVID-19 during a regional outbreak in Daegu/Gyeongsangbuk-do province of Korea. The outcome measures were in-hospital mortality and the treatment with mechanical ventilation (MV) or high-flow nasal cannula (HFNC). @*Results@#The median age of the patients was 72 years; 55.1% were female. Most (74.5%) had at least one underlying condition. Overall case fatality rate (CFR) was 20.4%, and median time to death after admission was 8 days. The CFR was 6.1% among patients aged 65–69 years, 22.7% among those aged 70–79 years, and 38.1% among those aged ≥ 80 years. The CFR among patients who required MV was 43.8%, and the proportion of patients received MV/HFNC was 28.6%. Nosocomial acquisition, diabetes, chronic lung diseases, and chronic neurologic diseases were significant risk factors for both death and MV/HFNC. Hypotension, hypoxia, and altered mental status on admission were also associated with poor outcome. CRP > 8.0 mg/dL was strongly associated with MV/HFNC (odds ratio, 26.31; 95% confidence interval, 7.78–88.92; P < 0.001), and showed better diagnostic characteristics compared to commonly used clinical scores. @*Conclusion@#Patients aged ≥ 80 years had a high risk of requiring MV/HFNC, and mortality among those severe patients was very high. Severe initial presentation and laboratory abnormalities, especially high CRP, were identified as risk factors for mortality and severe hospital course.

8.
Article in Korean | WPRIM | ID: wpr-893775

ABSTRACT

About 30~50% COVID-19 hospital inpatients is reported to have mild clinical presentation, and the clinical course is known to be good even in the older population. In order to compare the clinical symptoms of mild patients with COVID-19 infection by age, the clinical symptoms and laboratory results were analyzed by dividing mild patients admitted to a dedicated hospital into three groups: under the age of 64, 65-84, and above 85 years of age.There was no difference in gender ratio by age among 555 mild cases. Concomitant diseases with significant differences by age were hypertension, diabetes, stroke, and coronary artery disease.Among the symptoms, cough and sore throat were different by age, and cough was significantly higher in the group under 64 years of age. Among the symptoms, cough and sore throat were different by age, and cough was significantly higher in the group under 64 years of age.The white blood cell count (WBC), neutrophil count, monocyte, blood sugar, procalcitonin, and creatinine were significantly higher in the 85 years old or older group, and the hemoglobin, albumin, and glomerular filtration rate (GFR) were significantly lower in the 85 years old or older group.

9.
Infection and Chemotherapy ; : 130-141, 2019.
Article in English | WPRIM | ID: wpr-914580

ABSTRACT

BACKGROUND@#Escherichia coli and Klebsiella pneumoniae are two of the most common causes of urinary tract infection. The purpose of this study was to compare clinical characteristics and antimicrobial susceptibility of acute pyelonephritis (APN) between E. coli and K. pneumoniae.@*MATERIALS AND METHODS@#We retrospectively reviewed medical records of patients with APN due to E. coli and K. pneumoniae between February 2014 and October 2017.@*RESULTS@#A total 329 patients were enrolled; 258 cases of E. coli and 71 cases of K. pneumoniae. Among them, 219 cases were categorized into community-onset APN; 194 cases of E. coli and 25 cases of K. pneumoniae, and 110 patients were categorized into healthcare-associated APN; 64 cases of E. coli and 46 cases of K. pneumoniae. Catheter-associated APN was more frequently observed in K. pneumoniae in both community-onset and healthcare-associated APN. Neurogenic bladder, obstructive uropathy, urinary tract stone, bacteremia, and severe APN were more related to E. coli in healthcare-associated APN. In multivariate analysis, urinary catheter was more associated with K. pneumoniae (odds ratio [OR] 9.643, 95% confidence intervals [CI] 4.919-18.904, P = 0.001) and neurogenic bladder was more associated with E. coli (OR 3.765, 95% CI 1.112-12.772, P = 0.033). Extended-spectrum β-lactamase (ESBL) production was observed in 29.0% of E. coli in community-onset APN. Among ESBL, antimicrobial susceptibility of piperacillin/tazobactam was significantly higher in E. coli and ciprofloxacin was significantly higher in K. pneumoniae.@*CONCLUSION@#K. pneumoniae were more associated with urinary catheter while E. coli tended to be more associated with urogenital problems. ESBL positivity showed no significance in healthcare-associated APN. In community-onset APN, ESBL producing E. coli was more observed than K. pneumoniae.

10.
Annals of Dermatology ; : 563-566, 2019.
Article in English | WPRIM | ID: wpr-762371

ABSTRACT

The Alternaria species are dematiaceous fungi. Human infection due to dematiaceous fungi is uncommon. Most reported cases of alternariosis have occurred in patients with immunodeficiency. The majority of cases were solid-organ transplantation recipients. Cutaneous alternariosis lesions are usually asymptomatic solitary nodules, plaques of ulcers or subcutaneous cysts. Here we report a case of a 77-year-old female who presented with hemorrhagic skin necrosis in right arm that had developed from hemorrhagic bullae. Her prior medical history included iatrogenic Cushing's syndrome, hypertension, interstitial lung disease and congestive heart failure. Following administration of itraconazole, her lesions improved.


Subject(s)
Aged , Alternaria , Alternariosis , Arm , Cushing Syndrome , Female , Fungi , Heart Failure , Humans , Hypertension , Itraconazole , Lung Diseases, Interstitial , Necrosis , Phaeohyphomycosis , Skin , Ulcer
11.
Article in Korean | WPRIM | ID: wpr-715578

ABSTRACT

Tigecycline is a broad spectrum antibiotic which has been used for complicated intra-abdominal infection and complicated skin and soft tissue infection by multi-drug resistant bacteria. However recent meta-analysis studies have raised a concern for adverse events of tigecycline. We analyzed retrospectively adverse events, associated factors of adverse events in multi-drug resistant bacteria caused infections treated with tigecycline in Korean patients. One hundred-sixty patients treated with tigecycline from July 2009 to September 2013 were enrolled in this study. Their clinical and microbiologic data were reviewed. History of invasive procedure within 7 days and recent operation within 3 months were associated with adverse events. The most common adverse events were nausea and vomiting. Associated factors of nausea were soft tissue injury and recent operation within 3 months. In this study, nausea was the most common adverse event in patients who received tigecycline. Although it is not serious complication, monitoring of adverse events is required to increase compliance.


Subject(s)
Bacteria , Compliance , Drug-Related Side Effects and Adverse Reactions , Humans , Incidence , Intraabdominal Infections , Nausea , Retrospective Studies , Skin , Soft Tissue Infections , Soft Tissue Injuries , Vomiting
12.
Article in English | WPRIM | ID: wpr-714632

ABSTRACT

BACKGROUND/AIMS: Klebsiella pneumoniae is second most common organism of gram-negative bacteremia in Korea and one of the most common cause of urinary tract infection, and intra-abdominal infection. METHODS: We compared clinical and microbiological characteristics about K. pneumoniae bacteremia in a tertiary hospital between 10 years. Group A is who had K. pneumoniae bacteremia at least one time from January 2004 to December 2005. Group B is from January 2012 to December 2013. We also analyzed antibiotic resistance, clinical manifestation of the K. pneumoniae bacteremia divided into community-acquired infections, healthcare associated infections, and nosocomial infections. RESULTS: The resistance for ampicillin, aztreonam, cefazolin, and cefotaxime significantly increased compared to 10 years ago. Extended spectrum β-lactamase positivity surged from 4.3% to 19.6%. Ten years ago, 1st, 2nd cephalosporin, and aminoglycoside were used more as empirical antibiotics. But these days, empirical antibiotics were broad spectrum such as 3rd and 4th cephalosporin. In treatment outcome, acute kidney injury decreased from 47.5% to 28.7%, and mortality decreased from 48.9% to 33.2%. In community-acquired infections, there was similar in antimicrobial resistance and mortality. In healthcare-associated and nosocomial infections, there was significantly increasing in antibiotic resistance, decreasing in mortality, and acute kidney injury. CONCLUSIONS: In community-acquired infections, broader antibiotics were more used than 10 years ago despite of similar antimicrobial resistance. When K. pneumoniae bacteremia is suspected, we recommend to use the narrow spectrum antibiotics as initial therapy if there are no healthcare-associated risk factors, because the antibiotic resistance is similar to 10 years ago in community-acquired infections.


Subject(s)
Acute Kidney Injury , Ampicillin , Anti-Bacterial Agents , Aztreonam , Bacteremia , Cefazolin , Cefotaxime , Community-Acquired Infections , Cross Infection , Drug Resistance , Drug Resistance, Microbial , Intraabdominal Infections , Klebsiella pneumoniae , Klebsiella , Korea , Mortality , Pneumonia , Risk Factors , Tertiary Care Centers , Treatment Outcome , Urinary Tract Infections
13.
Article in Korean | WPRIM | ID: wpr-155822

ABSTRACT

The incidence of bacteremia in human immunodeficiency virus (HIV)-infected patients is significantly decreased by highly active antiretroviral therapy (HAART). However, bacteremia remains a major cause of morbidity and mortality in HIV-infected patients. A 43-year-old male who had fever and cough for 1 week presented to the emergency room. He was diagnosed with acquired immunodeficiency syndrome combined with atypical pneumonia and started on antibiotics plus HAART. After 3 days, Streptococcus pneumoniae was grown in blood cultures. Three weeks later, acid-fast bacilli cultures of blood and bronchoalveolar lavage fluid grew Mycobacterium avium complex (MAC); hence, the patient was treated with antimycobacterial drugs. HIV-infected patients with persistent fever despite administration of appropriate antibiotics should be examined for simultaneous infection by other organisms, such as nontuberculous mycobacteria. We report a case of simultaneous detection of MAC and S. pneumoniae in the blood of a treatment-naïve HIV-infected patient.


Subject(s)
Acquired Immunodeficiency Syndrome , Adult , Anti-Bacterial Agents , Antiretroviral Therapy, Highly Active , Bacteremia , Bronchoalveolar Lavage Fluid , Cough , Diagnosis , Emergency Service, Hospital , Fever , HIV , Humans , Incidence , Male , Mortality , Mycobacterium avium Complex , Mycobacterium avium , Mycobacterium , Nontuberculous Mycobacteria , Pneumonia , Sepsis , Streptococcus pneumoniae
14.
Infection and Chemotherapy ; : 127-131, 2016.
Article in English | WPRIM | ID: wpr-51104

ABSTRACT

Kikuchi-Fujimoto disease (KFD) is a benign, self-limiting disease, with a specific histopathology. It can be diagnosed clinically, and specific symptoms include fever and cervical lymphadenopathy. The histological finding of KFD in cervical lymph nodes includes necrotizing lymphadenitis. KFD needs conservative treatments. If KFD persists for a long period, steroids or nonsteroidal antiinflammatory drugs can be used to control symptoms. Previous studies have reported the treatment of KFD with hydroxychloroquine (HC) in patients unresponsive to steroids. Herein, we report a case of a 25-year-old female patient diagnosed with KFD unresponsive to steroids, and was successfully treated with HC.


Subject(s)
Adult , Female , Fever , Histiocytic Necrotizing Lymphadenitis , Humans , Hydroxychloroquine , Lymph Nodes , Lymphadenitis , Lymphatic Diseases , Steroids
15.
Keimyung Medical Journal ; : 98-104, 2016.
Article in Korean | WPRIM | ID: wpr-110510

ABSTRACT

Candidemia is increasing cause of mortality, especially in intensive care unit patients. And Candida endophthalmitis, developed with or without symptoms, has poor outcome. Prompt use of antifungal agents and early diagnosis of Candida endophthalmitis are clinically important to treat candidemia. In this study, we compared clinical, microbiological, ophthalmological characteristics and treatment outcomes whether infectious disease (ID) specialists mediate candidemia or not in a tertiary hospital by retrospective chart review. Group A includes patients who had candidemia at least one time from January 2012 to July 2013, without ID specialists mediation. Group B includes patients who had candidemia at least one time from August 2013 to December 2014, with ID specialists surveillances and mediations. We compared clinical manifestations of candidemia, uses of antifungal agent, ophthalmologic evaluations and treatment outcomes between two groups. In group A, rate of ophthalmologic evaluations was 4.4% and mean duration was 64.60 hours from blood culture to use of antifungal agents. In group B, the rate of ophthalmologic evaluations was 43.2% and mean duration was 50.15 hours. There was no statistically significant difference in clinical characteristics and 30-day mortality between two groups. Increasing rate of ophthalmologic evaluations and decreasing mean duration from blood culture to use of antifungal agents was shown in surveillance and mediation group.


Subject(s)
Antifungal Agents , Candida , Candidemia , Communicable Diseases , Early Diagnosis , Endophthalmitis , Humans , Intensive Care Units , Mortality , Negotiating , Retrospective Studies , Specialization , Tertiary Care Centers
16.
Korean Journal of Medicine ; : 301-307, 2014.
Article in Korean | WPRIM | ID: wpr-62564

ABSTRACT

BACKGROUND/AIMS: Most scrub typhus patients have normal electrocardiography (ECG) findings. Recently, however, several cases with ECG changes were reported. However, few studies have examined the ECG changes in scrub typhus. METHODS: The ECG and demographic data of patients infected with Orientia tsutsugamushi seen at Dongsan Medical Center from January 2008 to June 2012 were reviewed retrospectively. Patients with pre-existing cardiac disease were excluded. The initial and follow-up ECG findings, demographic characteristics, and laboratory findings was examined. RESULTS: The group in which the initial ECG showed an arrhythmia had a higher blood urea nitrogen (BUN) level than the normal and ischemic groups (median 26.0 vs. 15.0 vs. 15.5 mg/dL, p = 0.041). The group with a sustained abnormality in the follow-up ECG had higher BUN (median 17.0 vs. 15.0 mg/dL, p = 0.022) and creatinine (median 1.30 vs. 0.90 mg/dL, p = 0.026) levels than the normal ECG group. In addition, the group with a sustained abnormality in the follow-up ECG had a higher rate of intensive care unit (ICU) admission (30.8% vs. 5.3%, p = 0.015) and longer treatment period (average 9 vs. 6 days, p = 0.027) than the other groups. CONCLUSIONS: In our study, more than 30% of the patients with scrub typhus showed ECG abnormalities. Those with an arrhythmic ECG change on presentation had high BUN levels. The sustained ECG abnormality group had high BUN and creatinine levels, and an increased ICU admission rate and length of stay. We should pay attention to the ECG findings on presentation and during the treatment of scrub typhus.


Subject(s)
Arrhythmias, Cardiac , Blood Urea Nitrogen , Creatinine , Electrocardiography , Follow-Up Studies , Heart Diseases , Humans , Intensive Care Units , Length of Stay , Orientia tsutsugamushi , Retrospective Studies , Scrub Typhus
17.
Korean Journal of Medicine ; : 362-366, 2014.
Article in Korean | WPRIM | ID: wpr-62552

ABSTRACT

Thrombocytopenia is a common manifestation of rickettsial disease. However, the pathogenesis of thrombocytopenia in many rickettsial diseases is poorly understood. Thrombocytopenia may be associated with consumption due to widespread endothelial damage or disseminated intravascular coagulation, hypersplenism, decreased marrow production, and immune-mediated platelet destruction. Some reports have found anti-platelet antibodies detected in thrombocytopenic patients with rickettsial disease. In addition to thrombocytopenia, facial palsy and Guillain-Barre syndrome were also reported as immune-mediated phenomena in scrub typhus. Here we report a case diagnosed as immune-mediated thrombocytopenia associated with scrub typhus. This is the first report of immune thrombocytopenic purpura (ITP) associated with scrub typhus in Korea. The patient exhibited eschar with a high titer of anti-tsutsugamushi antibody, thrombocytopenia, severe gastrointestinal hemorrhage, and purpura on the lower region of both legs. After steroid treatment, the sustained thrombocytopenia recovered.


Subject(s)
Antibodies , Blood Platelets , Bone Marrow , Disseminated Intravascular Coagulation , Facial Paralysis , Gastrointestinal Hemorrhage , Guillain-Barre Syndrome , Humans , Hypersplenism , Korea , Leg , Purpura , Purpura, Thrombocytopenic, Idiopathic , Scrub Typhus , Thrombocytopenia
18.
Infection and Chemotherapy ; : 339-342, 2013.
Article in English | WPRIM | ID: wpr-188973

ABSTRACT

Rhodotorula species live in the environment, but can also colonize human epithelium, as well as respiratory, and gastrointestinal tracts. Reports of infection, especially in the past 2 decades, have noted increasing numbers of Rhodotorula infections, particularly in immunocompromised hosts, leading it to be considered emerging opportunistic pathogen. The major risk factors for infection were prolonged use of central venous catheters in patients with hematological and solid malignancies who are taking corticosteroids or cytotoxic drugs. Herein, we report a case of catheter-associated fungemia due to R. mucilaginosa in an immunocompetent host. The patient was admitted to the intensive care unit with mechanical ventilation for treatment of community-acquired pneumonia. After 10 days, the patient developed new-onset fever confirmed to be a result of catheter-associated blood-stream infection by R. mucilaginosa. It was successfully treated by catheter removal and intravenous amphotericin B.


Subject(s)
Adrenal Cortex Hormones , Amphotericin B , Catheters , Central Venous Catheters , Colon , Epithelium , Fever , Fungemia , Gastrointestinal Tract , Humans , Immunocompromised Host , Intensive Care Units , Pneumonia , Respiration, Artificial , Rhodotorula , Risk Factors
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