Parasitemia Characteristics of Plasmodium vivax Malaria Patients in the Republic of Korea

Parasitemia characteristics of Plasmodium vivax malaria in temperate regions may differ from those in tropical zones. However, most parasitological and clinical features of P. vivax malaria have been investigated in the latter. In this study, we investigated 383 malaria patients to clarify the parasitemia characteristics of a P. vivax strain in the Republic of Korea (ROK). The mean parasitemia (8,396/microL) was less than half of tropical P. vivax malaria, and multiple invasions of erythrocytes were not rare (53.5% of the patients, 2.4% of the total investigated RBCs), but less than the observations in tropical zones. The intervals between the first symptom onset and diagnosis were significantly longer in gametocyte (+) patients than in gametocyte (-) patients. Only half of the total patients had both genders of gametocytes (191 of 353), and the male gametocyte density (169/microL) was lower than that of P. vivax strains of a previous study. Multiple invasions of erythrocytes and gametocytemia were coincident factors of the degree of anemia in P. vivax malaria. The present findings demonstrate the P. vivax strain in ROK reveals relatively low parasitemia and low male to female gametocyte ratio. The low ratio may be related with low transmission efficacy.

Parasitemia Characteristics of Plasmodium vivax Malaria Patients in the Republic of Korea

Parasitemia characteristics of Plasmodium vivax malaria in temperate regions may differ from those in tropical zones. However, most parasitological and clinical features of P. vivax malaria have been investigated in the latter. In this study, we investigated 383 malaria patients to clarify the parasitemia characteristics of a P. vivax strain in the Republic of Korea (ROK). The mean parasitemia (8,396/microL) was less than half of tropical P. vivax malaria, and multiple invasions of erythrocytes were not rare (53.5% of the patients, 2.4% of the total investigated RBCs), but less than the observations in tropical zones. The intervals between the first symptom onset and diagnosis were significantly longer in gametocyte (+) patients than in gametocyte (-) patients. Only half of the total patients had both genders of gametocytes (191 of 353), and the male gametocyte density (169/microL) was lower than that of P. vivax strains of a previous study. Multiple invasions of erythrocytes and gametocytemia were coincident factors of the degree of anemia in P. vivax malaria. The present findings demonstrate the P. vivax strain in ROK reveals relatively low parasitemia and low male to female gametocyte ratio. The low ratio may be related with low transmission efficacy.

Lack of Effect of Dexamethasone on Growth of Orientia Tsutsugamushi Gilliam in Mouse L929 Cells

PURPOSE: Previous studies and our own clinical experience suggest that concurrent corticosteroid treatment for severe rickettsial disease with multiorgan failure may improve the clinical course or reduce mortality. However, the use of corticosteroids as adjunctive treatment for rickettsial diseases is controversial. We attempted to determine the influences of corticosteroid on the growth of Orientia tsutsugamushi in vitro to justify and evaluate the clinical applicability of corticosteroid in rickettsial disease. MATERIALS AND METHODS: L929 cells were infected with Orientia tsutsugamushi Gilliam. Dexamethasone was added to the cells at final concentrations of 10(1) and 10(7) pg/mL. Cultures were incubated at 35degrees C and processed for flow cytometry on the 6th day after addition of dexamethasone. RESULTS: Observation on the 6th day after treatment with dexamethasone in infected cultures revealed that there was no difference in fluorescence intensity among the treatment wells. Treatment of the cells with dexamethasone at concentrations of 10(1) and 10(7) pg/mL showed no influence on the growth of Orientia tsutsugamushi. CONCLUSION: Our results to show that isolated corticosteroid does not enhance the replication of Orientia tsutsugamushi in vitro. Concurrent use of anti-inflammatory or immunosuppressive doses of corticosteroids in conjunction with antibiotics may not have detrimental effects on the course of scrub typhus.

Successful Treatment of Vancomycin-Resistant Enterococcal Peritonitis with linezolid in a Patient on CAPD / 대한신장학회지

Peritonitis is one of the major complications of CAPD (continuous ambulatory peritoneal dialysis). Among its causative organisms, vancomycin-resistant enterococcus (VRE) is rare, but serious causative organism, because it is refractory to antibiotics commonly used for CAPD peritonitis. Some drugs such as linezolid and dalfopristin have been introduced for VRE infections nowadays, but reports about usefulness of those drugs in VRE peritonitis are rare. We experienced a case of CAPD peritonitis caused by VRE, which was treated successfully with removal of CAPD catheter and use of linezolid. We report our experience with review of the literature.

Analysis of the Effectiveness in the Hospital Management of Methicillin-Resistant Staphylococcus aureus by Different Isolation Policies / 병원감염관리

BACKGROUND: The purpose of this study is to evaluate the evidence for the effectiveness of different isolation policies in reducing the incidence of methicillin-resistant Staphylococcus aureus (MRSA) infection in hospital in-patients. METHODS: We prospectively evaluated the effectiveness of an isolation policy on transmission of MRSA in the 745-beds hospital. First period, all patients with MRSA (March - July 2000) were not isolated Second period, strict isolation policies were performed (August 2000 - January 2002). All patients with MRSA were isolated in separated room, hand hygiene using alcohol handrub, gowning and g1oving, apply of MRSA notice sticker, criteria in isolation remove, separated disinfection and wastement. Third period, semi strict isolation policies were performed (February 2002 - August 2005). Some patients with MRSA were isolated in separated room and others were admitted in general ward for bed shortage. Only some practices were performed in hand washing and separated disinfection in general ward. RESULTS: The rates of MRSA nosocomial infection per patients during 1st, 2nd, and 3rd surveillance were reported 0.56, 0.23, and 0.42 (P<0.05). Patient-days rate of MRSA nosocomial infection during 1st, 2nd, and 3rd surveillance were reported 0.62, 0.27, and 0.38 (P<0.05). CONCLUSION: With many different isolation policies, it was possible to reduce nosocomial infection of MRSA. In this study, strict isolation policies (2nd period) were the most effective practices in reducing MRSA infection.

A Case of Dengue Fever Complicated by Rhabdomyolysis / 감염과화학요법

The dengue virus causes dengue fever and dengue hemorrhagic fever. It is an arbovirus and is transmitted by mosquitoes, Aedes aegypti. Dengue fever is an acute viral illness characterized by fever, skin rash, severe headache, myalgia and arthralgia. Rabdomyolysis rarely occurs in dengue fever in contrast with other viral infections. In this case, the patient was suffering from fever and severe myalgia, especially both lower extremities, after traveling to Philippines. He was diagnosed with dengue fever complicated by rhabdomyolysis as a result of serologic test and bone scan. He completely recovered with conservative care and nutritional support. We experienced a case of dengue fever complicated by rhabdomyolysis, which was treated successfully with conservative care.

A Case of Dengue Fever Complicated by Rhabdomyolysis / 감염과화학요법

The dengue virus causes dengue fever and dengue hemorrhagic fever. It is an arbovirus and is transmitted by mosquitoes, Aedes aegypti. Dengue fever is an acute viral illness characterized by fever, skin rash, severe headache, myalgia and arthralgia. Rabdomyolysis rarely occurs in dengue fever in contrast with other viral infections. In this case, the patient was suffering from fever and severe myalgia, especially both lower extremities, after traveling to Philippines. He was diagnosed with dengue fever complicated by rhabdomyolysis as a result of serologic test and bone scan. He completely recovered with conservative care and nutritional support. We experienced a case of dengue fever complicated by rhabdomyolysis, which was treated successfully with conservative care.

Multicenter ICU Surveillance Study for Nosocomial Infection in Korea / 병원감염관리

Purpose: The purpose of this study is to determine the risk adjusted nosocomial infection (NI) rate and distribution of Nls and their causative pathogens in adult lCU. Methods: Prospective surveillance was performed at 12 lCU's of 5 acute care hospitals in Seoul and Kyonggi Do during a 3-months period from May to July 2002. The case finding was done by direct reviews of medical charts regularly for all patients by ICPs using CDC definitions. Results: Total NI rate was 10.18/1,000 patient-days in Medical-surgical ICU (MSICU) and 12.35/1,000 patient-days in Neurosurgucal ICU(NCI). Risk adjusted infection rate was 3.44 in indwelling catheter associated UTI 2.12 in central line associated BSI. 3.51/1,000 device-days in ventilator associated pneumonia in MSICU. There were 3.72, 2.26, 6.06/1,000 device-days in NCU. The infection rate by leu type showed no significant difference. The distribution of Nls were PNEU (28.99%). UTI (28.99%), BSI (18,84%), SSI(4.35%) in MSICU, and UTI(48.0%), PNEU(24.0%), BSI (14.0%), SSI(6.I) in NCU. The most commonly isolated organisms were Candida spp (38.6%), Enterococcus spp. (13.4%) in UTI, Staphylococcus aureus(36.2%), p. aeruginosa(18.8%) in PNEU and Coagulase negative staphylococcus(44.1%). S. aureus (14.7%) in BSL, S. aureus (19.8%) was the most common organism from overall nosocomial infections in the ICU, and 96.3% of S. aureus were MRSA. Conclusion: Distribution of site-specific nosocomial infection and isolated organisms were similar to the results of KOSNIC (Korea society for nosocomial infection control) surveillance in 1996. However, the total infection rate and a risk adjusted infection rate at MSJCU is lower than 1996's. This decrease is considered to be a result of efforts to prevention and control nosocomial infections.

A Multicenter Descriptive Study of Bloodborne Exposures among Health Care Workers in Seoul and Gyeonggi-Do / 병원감염관리

Background: The purpose of this study was to establish effective measures and preventive managements to the cases of bloodborne exposures among the health care workers. Method: We reviewed 331 cases that were reported to the infection control services of five hospitals from March 2000 to February 2002. The SPSS PC 10.0 was used to analyze the date. Result: The proportion of registered nurses, doctors, housekeepers, unrse aid and technicians were 48.0%, 27.8%, 10.0%, 6.0%, and 5.4% in order. The proportion of female exposures was 75.2%. Fifty six point eight percent of exposure have been working less than 3 years. The data also indicated that there were differences by their Occupations. Thirty nine point six percent of the exposures occurred at the general ward, and 16.6% of them occurred at the operation room and 13.0% of them occurred at the intensive care unit. Most of the bloodborne exposures occurred during blood sampling (26.3%), putting away the needle including the recapping(18.4%). and giving injection (14.5%). The major instruments of exposures were syring-needle (79.6%), blade (7.3%), suture needle (6.1%), and direct contact with blood (2.7%). The hands were the most common body parts of exposures (95.2%). The bloodborne pathogens were hepatitis B virus (HBV, 38.1%(126/331), hepatitis C virus (10.3%), syphilis (4.5%), and human immuno-dificiency virus (2.7%). Forty one point three percent(52/127) of health care workers(HCWs) usually didn't realize whether they had antibody to the HBV or not at the time of exposure; Seventy five percent (39/52) of them found out later to be positive for HBV antibody. Only 48.7% (19/39) of them could get the medical treatment since they didn't know about immunity before the test. The cases with completion of management at the time of exposure, those of follow-up evaluations, and the cases with lost follow-up were 40.7%, 38.6% and 20.7%. in order. None of the cases were led to actual infections. Conclusion: The results from this study can be applied to establish effective measures of prevention and managements of the bloodborne exposures among the HCWs. If the laboratory data of HCWs were available at the time of exposure, more effective management would be possible. Also the results from this study emphasized the need for the systematic and practical follow-up.

Infection Control Activities in National Health Insurance Corporation Ilsan Hospital / 병원감염관리

No abstract available.

Two cases of systemic inflammatory reactions after highly active antiretroviral therapy in HIV infected patients with tuberculosis / 대한내과학회지

Highly active antiretroviral therapy for HIV infection has led to substantial reduction in AIDS associated morbidity and mortality. Systemic inflammatory reactions after the initiation of HAART (highly active antiretroviral therapy) have recently been described in HIV infected patients. The pathogenesis of systemic inflammatory reaction after HAART has not yet been clearly explained, but immune restoration after HAART may explain this phenomenon. We report two cases of systemic inflammatory reactions after starting HAART in HIV-infected patients. In each cases, 5 or 18 days after starting combination antiretroviral therapy, spiking fever and infiltration on chest Xray were developed. The etiology of fever such as opportunistic infection, drug reaction, noncompliance, or malabsorption were evaluated, but cause for clinical deterioration was not found. We concluded that this phenomenon was systemic inflammatory reaction after HAART and we overcame the clinical deterioration by steroid use.

Clinical Characteristics and Atypical Cases of Subacute Necrotizing Lymphadenitis / 감염

BACKGROUND: Subacute necrotizing lymphadenitis (SNL) or Kikuchi-Fujimoto disease, first described in 1972, is a benign process of lymphatic system that consists of lymphadenopathy which may be accopanied by fever, rash and some hematologic alterations. It affects usually young people, mostly women. Even though this disease is self-limited, many cases are misidentified as malignant lymphoma. The purpose of this study is to report the clinical characteristics, many laboratory tests and pathologic finding and to elaborate the criteria that are useful in distinguishing from fever cause. We are going to present some rare cases and fatal cases. METHODS: Authors evaluated 116 patients, who were diagnosed as Subacute necrotizing lymphadenitis on excisional biopsy with retrospective chart review at Yonsei Medical Center from January 1993 to May 2000. RESULTS: The mean age was 26.4+/-0.9 years (range : 5~63 years) and the male to female ratio was 1 : 2.28. The most common symptoms were cervical lymphadenopathy (89.7%) and fever (57.8%), and the duration of symptom was generally less than 8 weeks. Leukopenia (74.4%), relative lymphocytosis (33.3%) and DIC (7 cases) were hematologic abnormalities. Recently, we experienced patients showing atypical clinical findings which were pancytopenia, DIC (disseminated intravascular coagulopathy), hypotension or debilitating symptoms. Steroid pulse or high dose steroid and immunosuppressant therapy were performed in atypical cases. Sj gren some cases were rarely associated with systemic diseases such as systemic lupus erythematosus (4 cases), Sj gren disease (2 cases), rheumatoid arthritis (3 cases), aseptic meningitis (2 cases) or adult Still's disease (1 case). Thirteen cases (10.9%) were recurrent, and two cases died. CONCLUSION: Subacute necrotizing lymphadenitis should be considered in the differential diagnosis of fever cause in the patients which had localized cervical adenopathy, unresponsive to antibiotic therapy, especially in young women. We report atypical or fatal cases and need clinical attention to this kind of possibility.

Clinical Study for the Efficacy and Safety of Piperacillin/sulbactam (Combicin(R)) in the Treatment of Urinary Tract Infection (Phase III) / 감염

BACKGROUND: Combicin(R) is a new product of beta- lactam and beta-lactamase inhibitor combination which has antibacterial activity against aerobic and anaerobic bacteria, comprised of piperacillin and sulbactam. A phase III randomized clinical trial of Combicin(R) was done to evaluate and compare the efficacy and safety of piperacillin/sulbactam (Combicin(R)) with piperacillin in the treatment of urinary tract infection. METHODS: A total of 128 adult patients with acute urinary tract infection were enrolled and randomized into one of the two treatment groups during the period from August 1997 to September 1999 in Severance Hospital and Asan Medical Center, Seoul, Korea. Sixty-five patients were excluded in the analysis according to the exclusion criteria, and the rest 63 patients (3 men, 60 women) were eligible for the study. Clinical and bacteriologic responses were evaluated at entry and during the study period. Adverse effects were monitored by daily examination of the patients and periodic evaluations of laboratory findings. Statistical analyses were done by Chi-square test, Fisher's exact test, and Student t-test. RESULTS: Symptoms and signs such as fever, pyuria, dysuria, frequency, tenesmus, and costovertebral angle tenderness showed improvement in both group. Most commonly isolated microorganism was E. coli. The bacteriological eradication was found in 96.7% of the Combicin(R)-treated patients and in 90.9% of the piperacillin-treated patients. Adverse drug reactions in Combicin(R)-treated patients and piperacillin-treated patients occurred in 3.33% (2/60) and 5.88% (4/68) of the patients, respectively. Adverse events included liver function test elevation, drug fever, rash, indigestion, leukopenia, and nausea. Combicin(R) was well tolerated and side effects were negligible. CONCLUSION: Combicin(R) is safe and effective in the treatment of urinary tract infections.

One Case of Clinically Suspected Hemorrhagic Fever Accompanied by Acute Pericarditis with Pericardial Effusion / 감염

The hemorrhagic fever with renal syndrome (HFRS) is an acute febrile infectious disease with clinical characteristics of fever, bleeding tendency, gastrointestinal symptoms and renal failure. It has been known that most patients with hemorrhagic fever with renal syndrome were spontaneously recovered without any significant complication. However, there are several complications of HFRS such as chronic renal failure, bleeding, hypopituitarism, pyelonephritis, and acute pancreatitis. Rarely, cardiac complications were reported. The cardiac complications include severe bradycardia, hypertension, atrial dilatation, atrial hemorrhage, atrial fibrillation, complete atrioventicular block, atrioventricular junctional tachycardia, heart failure and myocarditis. However, there was no previous report about hemorrhagic fever with renal syndrome accompanied by acute pericarditis with pericardial effusion. We experienced a patient with hemorrhagic fever with renal syndrome complicated by acute pericarditis and pericardial effusion. A 28 year-old woman visited this hospital with complaints of fever, chill and epigastric pain. She was diagnosed as hemorrhagic fever with renal syndrome by serologic test and clinical manifestations. Pericardial effusion was observed on transthoraic echocardiography. She recovered with conservative treatment. Therefore, we report this case with brief review of related articles.

Efficacy of Various Treatment Modalities and Clinical Characteristics of Invasive and Noninvasive Fungal Sinusitis / 대한의진균학회지

BACKGROUND: There are three basic types of fungal sinusitis: noninvasive, invasive, and allergic. Both noninvasive and invasive fungal sinusitis necessarily require surgery with or without antifungal treatment. This study was performed to evaluate the efficacy of treatment modalities and clinical characteristics between pathologically proven noninvasive and invasive fungal sinusitis. METHODS: 40 patients pathologically proven to have fungal sinusitis from July, 1990 to January, 2000 were enrolled in this study. This retrospective study was performed in Severance Hospital, Yong-Dong Severance Hostpital and Ah-Joo University Hospital. The efficacy of treatment modalities and prognosis between pathologically proven noninvasive group (group A) and invasive group (group B) were evaluated. RESULTS: Of the total 40 patients, 13 were male and 27 were female, and the mean age was 51.6+/-14.2 years. 32 patients belonged to noninvasive group and 8 patients belonged to invasive group. Of the total 40 patients, 20 (50%) patients had underlying diseases, such as 8 cases of Diabetes Mellitus, 3 cases of hematologic malignancy, 2 cases of solid cancer, 1 case of steroid overuse, and the others 6 cases. In group A, only 12 patients (37.5%) had underlying diseases, however, all 8 patients (100%) in group B had underlying diseases. All 32 patients of group A went chronic course but in group B, all 8 patients appeard to be acute in course. The pathogens were classified to 36 cases of Aspergillus spp. (69.2%), 3 cases of Rhizopus spp. (5.8%), and 1 case of Candida spp. (1.9%). As for the treatment modalities, in group A, 30 cases had surgery only and 2 cases performed surgery and antifungal treatment. Both showed 100% of treatment efficacy. In group B, 5 cases were treated with antifungal therapy only and 2 cases performed surgery and antifungal treatment. The former showed 20% and the latter, 33% of treatment efficacy. Noninvasive fungal sinusitis revealed good results even in surgery only therapy, but invasive fungal sinusitis tended to reveal better results in both surgery and antifungal treatment. CONCLUSION: The pathologic type of fungal sinusitis is now thought to be very important for the choice of treatment modalities and efficacy of treatment. Also the type of pathogens, immunologic state of patients, and early diagnosis of fungal sinusitis attribute to the treatment efficacy of fungal sinusitis.

The Fungicidal Effect of Apolactoferrin on Aspergillus fumigatus / 감염

BACKGROUND: The incidence of aspergillosis is rising with the increased use of antimicrobial agents and immunosuppressive drugs for the treatment of malignant diseases, acquired immunodeficiency syndrome, or organ transplant recipients. However, treatment failures are also increasing which brings up the need for the development of new and more effective agents and/or compounds which support the activity of common antifungal agents. Apolactoferrin is one of the nonspecific host defence factors present in saliva that exhibit antifungal activity. We studied the in vitro antifungal effect of apolactoferrin in combination with amphotericin-B against Aspergillus fumigatus. METHODS: Preparation of the inoculum and the growth conditions used were those recommended by the National Committee for Clinical Laboratory Standards M38-P (Conidium-forming filamentous fungi: proposed standard). Aspergillus fumigatus test inoculum was prepared to a concentration of 0.4 X 104~5 X 104 cells/mL. Appropriate concentrations of the antifungal agents were added to the wells (50 microliter) and after inoculation, plates were incubated for 48 h at 35Celsius. Turbidity measurement was performed at 48 h at 630 nm and the MIC was defined as the lowest concentration of antifungal agents that inhibited growth of the organism as detected visually. RESULTS: In the combination of experiments, we observed a pronounced cooperative activity against growth of Aspergillus fumigatus by using apolactoferrin and amphotericin-B. The MIC of amphotericin-B was reduced by 1/10 in the presence of apolactoferrin. CONCLUSION: The combined use of apolactoferrin and amphotericin-B against severe infections with Aspergillus fumigatus is an attractive therapeutic option. Clinical studies to further elucidate the potential utility of this combination therapy have been initiated.

A Case of Korean Hemorrhagic Fever with Suspected Acute Pancreatitis / 감염

The Korean hemorrhagic fever (KHF) is an acute febrile disease with characteristic of fever, bleeding tendency, and renal failure. There are many complications of Korean hemorrhagic fever such as infection, anemia, internal bleeding, hypopituitarism, respiratory, and neurologic complication. A few cases were reported on acute pancreatitis with hemorrhagic fever abroad, but there was no case about Korean hemorrhagic fever with acute pancreatitis in this country. We experienced a case of Korean hemorrhagic fever associated with suspected acute pancreatits. With review of articles, we report a case of 51 year-old woman with KHF, where acute pancreatitis developed during management.

A comparison of causes of fever of unknown origin between the 1980s and the 1990s / 대한내과학회지

BACKGROUND: Physicians find fever of unknown origin (FUO) a difficult problem to solve. Analysis of the causes of FUO may be useful in the diagnosis of FUO. We investigated the causes of FUO in the last two decades from 1980 to 1999 and compared the two decades to seek for a trend of changes of the causes of FUO. METHODS: Among 854 patients diagnosed as FUO on discharge, we retrospectively reviewed 278 patients compatible with the Petersdorf's criteria through inpatient and outpatient medical records. RESULTS: There were 144 (51.5%) men and 134 (48.2%) women. Among the 98 patients in the 1980s, infectious disease was the cause in 37 (37.8%) patients, collagen vascular disease in 17 (17.3%), malignancy in 8 (8.2%), miscellaneous in 11 (11.2%), and unidentifiable cause in 25 (25.5%) patients. Among the 180 patients in the 1990s, infectious disease was the cause in 45 (25.0%) patients, collagen vascular disease in 37 (20.5%), malignancy in 34 (18.9%), miscellaneous in 45 (25.0%), and unidentifiable cause in 19 (10.6%) patients. According to the order of frequency, the causes of infectious disease were pulmonary tuberculosis (19.4%), extrapulmonary tuberculosis (8.2%), liver abscess (4.1%) in the 1980s and extrapulmonary tuberculosis (17.2%), pulmonary tuberculosis (4.4%), liver abscess (1.1%) in the 1990s. The diagnostic methods for evaluation of FUO were culture (45.6%), radiology (17.6%), serology (16.2%), and biopsy (10.3%) in the 1980s and radiology (31.5%), biopsy (26.9%), culture (21.5%) and serology (20.0%) in the 1990s. CONCLUSION: Among the causes of FUO, infectious disease decreased and collagen disease and malignancy increased with time. The most common cause of infectious disease was pulmonary tuberculosis in the 1980s but extrapulmonary tuberculosis in the 1990s. Use of radiology and biopsy as diagnostic methods for FUO increased.

Serologic and histopathologic study of Chlamydia pneumoniae infection in atherosclerosis: a possible pathogenetic mechanism of atherosclerosis induced by Chlamydia pneumoniae

Chronic infection and inflammation have recently been implicated as important etiologic agents for atherosclerosis in general and, in particular, ischemic heart disease. Several agents have been suggested as possible candidates for the chronic inflammation including cytomegalovirus, Helicobacter pylori and Chlamydia pneumoniae. We hypothesized that a vascular infection with C. pneumoniae may induce a chronic inflammatory reaction in the host vascular tissue and activated inflammatory cells may express inflammatory mediators such as cyclooxygenase-2 (COX-2) and matrix metalloproteinases (MMPs). At first, we evaluated the relationship between C. pneumoniae infection and atherosclerosis indirectly by serologic study, and then, to confirm our hypothesis, we performed an immunohistochemical study of atherosclerotic plaques. The seropositive rate of anti-Chlamydia pneumoniae IgG was higher in the disease group (Group I, 59.8%, n = 254) than in the negative control group (Group III, 47.4%, n = 97) (p = 0.041), but the anti-Chlamydia pneumoniae IgA was not different in seropositivity between the two groups (Group I, 64.6%; Group III, 57.7%). The simultaneous seropositive rates of both IgG and IgA were 56.7% in Group I and 43.3% in Group III (p = 0.033). In subgroups without the conventional risk factors of atherosclerosis, these findings were more prominent. Furthermore, we performed immunohistochemical staining on the atherosclerotic aortic tissues obtained from patients that were seropositive to C. pneumoniae (n = 5), by using antibodies to C. pneumoniae, COX-2, and MMP-9. The immunoreactivity for COX-2 and MMP-9 increased in the atherosclerotic plaques itself, predominantly in the surrounding area of immunoreactive C. pneumoniae. These findings support our hypothesis and C. pneumoniae may participate in a pathogenetic mechanism for atherogenesis or progression of atherosclerosis. The present study may open a promising perspective concerning future therapeutic trials of chronic inflammation related atherogenesis under pathophysiological conditions.

The Effect of Body Fat Disribution on Glucose, Lipid Metabolism and Grewth Hormone Secretion in Obesity / 대한내분비학회지

BACKGROUND: Body fat distribution, rather than the level of obesity per se, appears to be a strong predictor of abnormalities in metabolic complication. Visceral fat accumulation is significantly correlated with glucose intolerance and constitutes as an independent risk factor for the diabetes mellitus. METHODS: We investigated the impact of body fat distribution on the glucose, lipid metabolism and growth hormone secretion in obese subjects with varying glucose tolerance and lean controls matched with sex and age. 69 obese Koreans (34 men, 35 women; 43.8 yrs) and 21 lean Koreans (10 men, 11 women; 40.8 yrs) were recruited. Anthropometric measurement and impedence for measurement of total body fat, and computed tomography for visceral and subcutaneous fat area at umbilicus level were performed. All subjects underwent a standard oral glucose tolerance test and GH stimulation test by L-dopa. RESULTS: The results are summarized as follows. 1. Obese patients had greater ideal body weight (%, IBW) and lean body mass (LBM) than lean controls. But no significant differences were found in IBW and LBM between 3 obese groups. 2. The 25 obese NIDDM had the highest FFA-AUC during OGTI and the lowest GH-AUC to L-Dopa stimulation test. The insulin-AUC during OGTT was the highest in 24 obese subjects with normal glucose tolerance. 3. All male groups have VSR of more than 0.4, which has been designated visceral fat obesity. In contrast all female groups have VSR of lesser than 0.4 but obese DM subjects have the highest VSR. Visceral fat area per body weight ratio(VWR) showed increasing tendency in obese, IGT, and DM group. 4. Waist circumference and VWR showed strong correlation with metabolic parameters among anthropometric parameters. They were positively correlated with FFA-AUC during OGTT and negatively correlated with GH-AUC to L-dopa stimulation. CONCLUSION: Visceral fat accumulation are associated with insulin resistance, dyslipidemia and impairment of growth hormone secretion via increase of free fatty acid. The simple waist circumference may provide a more practical indicator that correlated with aMominal fat distribution and metabolic complications associated with obesity.