Serotype Distribution and Antimicrobial Resistance of Invasive and Noninvasive Streptococcus pneumoniae Isolates in Korea between 2014 and 2016

BACKGROUND: Several factors contribute to differences in Streptococcus pneumoniae serotype distribution. We investigated the serotype distribution and antimicrobial resistance of S. pneumoniae isolated between 2014 and 2016 in Korea. METHODS: We collected a total of 1,855 S. pneumoniae isolates from 44 hospitals between May 2014 and May 2016, and analyzed the serotypes by sequential multiplex PCR. We investigated the distribution of each serotype by patient age, source of the clinical specimen, and antimicrobial resistance pattern. RESULTS: The most common serotypes were 11A (10.1%), followed by 19A (8.8%), 3 (8.5%), 34 (8.1%), 23A (7.3%), and 35B (6.2%). The major invasive serotypes were 3 (12.6%), 19A (7.8%), 34 (7.8%), 10A (6.8%), and 11A (6.8%). Serotypes 10A, 15B, 19A, and 12F were more common in patients ≤5 years old, while serotype 3 was more common in patients ≥65 years old compared with the other age groups. The coverage rates of pneumococcal conjugate vaccine (PCV)7, PCV10, PCV13, and pneumococcal polysaccharide vaccine 23 were 11.8%, 12.12%, 33.3%, and 53.6%, respectively. Of the 1,855 isolates, 857 (46.2%) were multi-drug resistant (MDR), with serotypes 11A and 19A predominant among the MDR strains. The resistance rates against penicillin, cefotaxime, and levofloxacin were 22.8%, 12.5%, and 9.4%, respectively. CONCLUSIONS: There were significant changes in the major S. pneumoniae serotypes in the community. Non-PCV13 serotypes increased in patients ≤5 years old following the introduction of national immunization programs with the 10- and 13-polyvalent vaccines.

Distribution and Antimicrobial Resistance of Streptococcus pneumoniae at Four University Hospitals in Busan and Gyeongnam / 대한임상미생물학회지

BACKGROUND: Streptococcus pneumoniae is the most common human pathogen causing community-acquired pneumonia. There is little information on the recent antimicrobial susceptibility patterns of S. pneumoniae in Busan and Gyeongnam of Korea. The aim of this study was to investigate the distribution and antimicrobial resistance of S. pneumoniae at 4 university hospitals in Busan and Gyeongnam. METHODS: We collected and analyzed the antimicrobial susceptibility results of 850 S. pneumoniae strains isolated from regional 4 university hospitals during the last 2 years from July 2013 through June 2015. RESULTS: Among 850 S. pneumoniae strains, 635 strains were isolated from respiratory specimens, followed by blood (N=121), CSF (N=13), and others (N=81). Antimicrobial susceptibility rates to penicillin, cefotaxime and ceftriaxone were 79.4%, 76.6% and 83.6%, respectively. The resistant rates to erythromycin and clindamycin were 80.9% and 68.2%, respectively. The resistant rates to levofloxacin were 9.2%. There were some differences in resistant rates by age groups, years, and specimen types. CONCLUSION: We found the changes of antimicrobial resistance of S. pneumoniae during the last 2 years. It is necessary to monitor the antimicrobial susceptibility of S. pneumoniae regularly for empirical therapy and for early detection of the changes of resistance.

A Case of Intra-Abdominal Esophageal Duplication Cyst / 대한소아소화기영양학회지

Esophageal duplication cysts are quite uncommon benign lesions of the esophagus that have previously been described as occurring only in the thoracic cavity. We experienced a rare case of completely intra-abdominal esophageal duplication cyst in a 10-year-old boy who has suffered from epigastric abdominal pain. Surgical excision is recommended at the time of cyst discovery whether symptoms present or not.

The Measurement of Neonatal Pulmonary Artery Pressure by Echocardiography

PURPOSE: The main purpose of this study was to conduct accurate noninvasive measurement of the pulmonary artery pressure(PAP) in the neonatal period. The other purpose was to find some descriminant factors that are correlated with pulmonary artery pressure even when there is no tricuspid regurgitation(TR) or patent ductus arteriosus(PDA). METHODS: 32 cases of premature and full term infants with definite tricuspid regurgitation were examined by echocardiography. Correlations between PAP and factors such as peak flow velocity of TR, peak flow velocity of PDA, ventricular septal curvature ratio, ratio between pulmonary artery diameter at systole and diastole, systolic time interval(STI), and ratio between right ventricular acceleration time and ejection time(RVAT/ET) were analyzed. RESULTS: There was a significant correlation between the PAP detected by the peak velocity of TR and the PAP calculated by the transductal pressure gradient(r2=0.70, P<0.01). PAP measured by the peak flow velocity of TR and factors such as ventricular septal curvature ratio, the ratio of the pulmonary artery diameter at systole and diastole, STI, and RVAT/ET had no significant correlation. STI was higher when there was PDA(P<0.01) and the acceleration time was also significantly increased in those cases(P<0.01). The ratio of the PAD at systole and diastole was higher with PDA(P<0.01). In cases with PDA, STI has negative correlation with the transductal pressure gradient(P<0.01). CONCLUSION: Measuring PAP in the neonatal period by echocardiography is a relatively accurate noninvasive method. The PAP was influenced by several factors during the measurement. Those factors were the patency itself of the ductus arteriosus and the transductal pressure gradient.

A Case of Nonsyndromic Intrahepatic Bile Duct Paucity with Congenital Bilateral Vocal Cord Paralysis and 13q Deletion / 대한소아소화기영양학회지

Nonsyndromic intrahepatic bile duct paucity is known to be associated with several kinds of etiology such as infection, chromosomal anomaly, metabolic disease and idiopathic. We report a rare case of intrahepatic bile duct paucity with congenital bilateral vocal cord paralysis and 13q deletion.

Acute Bacterial Meningitis: Causative Organisms, Clinical Characteristics and Prognosis

BACKGROUND: There is a lack of basic epidemiological information on bacterial meningitis in children and adults in Korea. Therefore, more research is needed to investigate the causative organisms, clinical manifestations, and prognosis in Korean children and adults. METHODS: We analyzed retrospectively 148 medical records with final diagnosis of bacterial meningitis. The diagnosis of bacterial meningitis was based on culture-positive cases. RESULTS: Out of a total 148 patients, 71 were children and 77 were adults. In the children with community acquired meningitis, infection-related meningitis was the most common predisposing factor (23.3%). In adults, otitis media was the most common (21.7%). There were more frequent seizures in children than adults (38.1%, 17.1%, p50 years), seizure (p<0.05), and mental change (p<0.001). CONCLUSIONS: Although a causative organism is not documented, we believe that our study will help to properly treat acute bacterial meningitis in children and adults regardless if it is community acquired or nosomial.

MRI features of infarcts with potential cardiac source of embolism in the Yonsei Stroke Registry (YSR), Korea

The determination of the embolic source is crucial to understanding the pathogenesis of ischemic stroke, the initiation of appropriate therapy, and the prevention of recurrent infarctions. In this study we undertook to identify the characteristic features on magnetic resonance images of patients who had suffered from stroke due to cardiac embolism (CE), as classified by TOAST (possible and probable). We retrospectively studied magnetic resonance imaging (MRI) findings of patients with ischemic stroke from the Yonsei Stroke Registry (YSR). On the basis of the TOAST classification, 92 patients were identified to have a potential cardiac source of embolism (PCSE), in which 69 patients were found to have high-risk PCSE and 23 patients medium-risk PCSE. To compare their imaging characteristics, another group of 49 patients who were found to have had a stroke due to large artery-to-artery (ATA) embolism-common or internal carotid artery (CCA, ICA)-were identified. Involvement of the simultaneous superficial and deep territories (58.7%; 6.1%, p < 0.001), and combined new anterior and old posterior circulation (15.2%; 2.0%, p = 0.016) were more frequent in PCSE than ATA embolism. Bilateral anterior hemispheric involvement was also more frequent in the PCSE group, but it did not reach statistical significance (13.0%; 4.1%, p = 0.090). ATA embolism tended to involve only superficial territories compared to PCSE (71.4%; 28.3%, p < 0.001). There were no topographic differences between the high-risk and medium-risk groups. With respect to the etiology of PCSE in our population, atrial fibrillation was the most common. Characteristic MRI features of patients with PCSE, which were not documented previously by computed tomography (CT) included: old and new, involvement of multiple different vascular territories, bilateral anterior hemisphere, as well as anterior and posterior circulation. These MRI features, together with simultaneous superficial and deep territorial involvement, help to differentiate the underlying embolic sources, whether they are cardiac or ATA in origin.

Right Anterior Thalamic Infarction Presenting Only with Cognitive Dysfunction

A 60 year-old right-handed man developed a sudden inability to find his way home from work. Neurologic examina-tions revealed no focal neurological deficit. Neuropsychological tests showed a memory deficit especially in the visu-ospatial domain along with visuospatial and frontal-executive dysfunction. A brain MRI revealed a small but discrete lesion in the right thalamus. The majority of the lesion was confined to the dorsomedial nucleus. These results suggest that a small unilateral thalamic infarction affecting the anterior area may be sufficient to produce "strategic-infarct dementia" without focal neurological deficit.

Right Anterior Thalamic Infarction Presenting Only with Cognitive Dysfunction

A 60 year-old right-handed man developed a sudden inability to find his way home from work. Neurologic examina-tions revealed no focal neurological deficit. Neuropsychological tests showed a memory deficit especially in the visu-ospatial domain along with visuospatial and frontal-executive dysfunction. A brain MRI revealed a small but discrete lesion in the right thalamus. The majority of the lesion was confined to the dorsomedial nucleus. These results suggest that a small unilateral thalamic infarction affecting the anterior area may be sufficient to produce "strategic-infarct dementia" without focal neurological deficit.

Cardiac Effect of Pulse Dexamethasone Therapy in Infants with Bronchopulmonary Dysplasia / 대한주산의학회잡지

PURPOSE: To examine the cardiac function, incidence and natural history of cardiac hypertrophy (CH) and the association of side effects with CH after pulse dexamethasone therapy in infants with bronchopulmonary dysplasia. METHODS: Twelve infants, gestational age 28.6+/-1.6(26-31)weeks, birth weight 1243+/-186 (1010- 1620)g, received a pulse course of dexamethasone, starting at 0.5mg/kg/d for three days and readministered ten days thereafter at a median of 19 days of age. Serial echocardiographic measurement of septal thickness(ST), left ventricular(LV) posterior wall thickness(PWT), LV diameter(LVD), LV length(LVL), LV mass, ejection fraction(EF) and acceleration time to right ventricular ejection time ratio(AT/RVET) were taken before, and 4, 11 days after starting dexamethasone. For infants diagnosed as CH, echocardiography was performed weekly until the parameters were normalized. Side effects of dexamethasone such as leukocytosis, hypertension, hyperglycemia and insulin therapy were recorded and compared. RESULTS: CH occurred in 5 of 12 infants(47%). ST, PWD, and AT/RVET increased significantly at 4 days and 11 days after starting dexamethasone than baseline. LVD decreased significantly at 4 days and 11 days after the administration of dexamethasone than before. Other parameter such as LVL, LV mass and EF were not changed and the evidence of left ventricular outflow obstruction was not observed. The incidence of hyperglycemia and insulin therapy were higher in CH group than in no CH group(p<0.05). Five infants with CH recovered until five weeks after starting dexamethasone on serial echocardiography, CONCLUSION: Infants receiving a pulse course of dexamethasone developed evidence of septal hypertrophy, thickened left ventricular wall and impaired filling of left ventricle immediately after starting dexamethasone but always resolved within five weeks Serial echocardiography is not probably routinely required in preterm infants with bronchopulmonary dysplasia receiving pulse dexamethasone therapy.

A Case of Cerebral Sparganosis: Technetium-99m-ECD Brain SPECT experience

Cerebral sparganosis is a rare intracranial parasitic infectious disease. The best treatment seems to be the surgical removal of the worm and granuloma. However, it has not been proved possible to determine whether the worm is dead or alive by a single Brain CT or MRI findings. We report clinical and technetium-99m-ethyl cysteinate dimer (99mTc-ECD) cerebral perfusion SPECT findings in a case with 57-year-old cerebral sparganosis patient. During 3 years of follow-up, the patient did not have any newly developed neurological signs. Follow-up serum/CSF ELISA tests for sparganosis were positive and the worm was presumed to be in a dormant stage. Cerebral perfusion SPECT showed an irregular shaped area with decreased 99mTc-ECD uptake. The brain SPECT findings in our patient could not be exactly explained with the worm 's natural history. However, the brain SPECT may be helpful in determining the treatment of newly diagnosed cerebral sparganosis patients.

Comparison of Clinical Feature, CSF Cytology, Neuroimaging, and CSF Biochemical Marker in Leptomeningeal Metastasis

Background: It is important to make the accurate diagnosis of leptomeningeal metastasis(LM) because the institution of appropriate therapy may produce symptomatic improvement, prevent neurologic deterioration, and prolong survival. To evaluate the appropriate diagnostic methods of LM, we conducted the comparison of diagnostic yield in each diagnostic method and analyzed factors influencing the diagnostic results. METHODS: We analyzed 62 patients of LM with following inclusion criteria: positive CSF cytology, or abnormal neuroimaging, or elevated CSF biochemical marker, or characteristic clinical symptom and abnormal routine CSF examination. RESULTS: Primary cancer of LM was following; lung cancer 21, lymphoma 15, stomach cancer 13, breast cancer 9, rhabdomyosarcoma 2, bladder cancer 1, and colon cancer 1. The positive yield in the diagnosis of LM was 54.5% in CSF cytology, 55.9% in neuroimaging, 62.5% in CSF biochemical marker. As each diagnostic method was combined, the positive yield was increased to 86.4-88.5% with the highest in combination of CSF cytology with neuroimaging. The relationship between CSF cytology and neuroimaging is complementary in the diagnosis of LM (p=0.01). In positive group of CSF cytology, the count of CSF WBC was higher than in negative group (p=0.026), and clinical feature revealed a tendency of combined cerebral and cranial symptom than isolated symptom. The interval from the diagnosis of primary cancer to diagnosis of LM was most prolonged in breast cancer with a mean of 38.2 month. CONCLUSIONS: Combination of each diagnostic method increases the diagnostic yield, and CSF cytology and neuroimaging must be performed with each other.

D3 and D5 Dopamine Receptor mRNA Expression in Peripheral Blood Mononuclear Cells from Patients with Parkinson's Disease

BACKGROUND: Among 5 subfamilies of dopamine receptors (DAR), D3 and D5 DAR are expressed on peripheral blood mononuclear cells (PBMC). Recently, those DARs have been reported to change in Parkinson's disease (PD). METHODS: We measured the DAR mRNA expression in PBMC from 15 PD patients who had never taken antiparkinson medication, and 16 age-matched healthy people by reverse transcription and quantitative competitive polymerase chain reaction. The beta-actin mRNA expression was also measured to evaluate the relative expression of DAR mRNA. RESULTS: The D3 and D5 DAR mRNA expression was not different between patients and controls. In patients, no significant cor-relation was found between DAR mRNA expression in PBMC and clinical variables such as severity and duration of symptoms, and patients' age. CONCLUSIONS: We confirmed the presence of D3 and D5 DAR in PBMC. However, their mRNA expressions were not influenced by the disease process of PD.

Measurement of inferior vena cava diameter, alpha-human-atrial natriuretic peptide and cyclic guanosine 3':5'-monophosphate for estimation of dry weight and intravascular volume change in hemodialysis patients / 대한내과학회지

BACKGROUND: A correct estimation of volume status and dry weight in dialysis patients remains a difficult clinical problem. Clinical status and chest X-ray are not sensitive enough, while invasively measured central venous pressures are not routinely available. Recently, the ultrasonographic determination of the diameter and collapse index of the inferior vena cava has been proposed as a noninvasive method for estimating intravascular volume. We tried to evaluate the clinical relevance of this method in dialysis patients by comparing it with alphahuman-atrial natriuretic peptide (alpha-h-ANP) and cyclic guanosine 3:5-monophosphate (cGMP) levels. METHODS: Using echocardiography, the diameter of the inferior vena cava (VCD) and its decrease on deep inspiration (collapse index : CI) were evaluated in 27 hemodialysis patients. Echocardiography of the inferior vena cava (IVC) was performed in the supine position after 10 minutes rest. The transducer was placed in the subxiphoid region and long and short axis views of the IVC were obtained just below the diaphragm in the hepatic segment. VCD was measured before the P-wave on the electrocardiogram to avoid interference with A-wave and V-wave on the venous pressure curve, and corrected for body surface area. Preand post-hemodialysis levels of the plasma alpha-h-ANP and cGMP were measured by radioimmunoassay. The relationship between VCD, CI determined by echocardiography, and alpha-h-ANP and cGMP concentrations were studied. RESULTS: The levels of alpha-h-ANP and cGMP were markedly elevated before hemodialysis and significantly lower values were found after hemodialysis (alpha-hANP : 162.7 102.6 pg/ml vs 90.6 61.0 pg/ml , cGMP : 35.3 8.8 pmol/ml vs 21.3 6.2 pmol/ml). A significant correlation was found between VCD and alpha-h-ANP before (r=0.81, p 0.05) and also no relation was observed between the decrease of cGMP during hemodialysis and VCD before hemodialysis (r=0.12, p > 0.05). A significant correlation between the percent change in body weight and the percent change in VCD during hemodialysis (r=0.91, p<0.05) and also significant relation was observed between the pecent change in body weight and the percent change in alpha-h-ANP levels (r=0.40, p , 0.05). CONCLUSION: Echocardiography of the inferior vena cava allow an estimation of changes of intravascular volume in ESRDpatients without cardiac filling impairment as shown by the correlation to other indices of intravascular volume, such as alpha-h-ANP. In this study, CI and cGMP levels were less informative. Inferior vena cava echocardiography is noninvasive and easily available and serial measurements of VCD and alphah-ANP levels allow an estimation of chages of intravascular volume in ESRD patients on maintenance hemodialysis.

Comparison of Treatment Course and Outcome between Medically and Surgically Treated Patent Ductus Arteriosus in Preterm Infants

PURPOSE: Early intervention is needed to treat patent ductus arteriosus (PDA) as it is a major cause of increased mortality in preterm infants. However, it is uncertain which is better, medical versus surgical management. We reviewed medical records to compare the treatment course and outcome between medically and surgically treated preterm PDA infants. METHODS: Thirth-two Mechanically ventilated pretem infants (gestational age<34 wks, birth weight<2,000gm) who survived beyond 30 days were studied. Treatment course and outcome were compared between indomethacin-treated (INDO, n=15) and surgically treated who have not responded to indomethacin (Surg, n=17). RESULTS: Volume of administered fluid and urine output during the first five days of life were similar, however, initial weight loss were lower in the SURG group than INDO group (p=0.031). Size of PDA on the echocardiogram were larger in SURG group (mean 3.4 mm) than INDO group (mean 2.5 mm) (p=0.046). Duration of hospitalization was longer in the SURG group (mean 46 days) than INDO group (mean 72 days) (p=0.033), however, time to start feeding, ventilator duration and weaning time were similar in both groups. Incidence of intraventricular hemorrhage was lower in the SURG group (47%) than INDO group (6%) (p=0.009). CONCLUSION: Preterm infants with poor initial weight loss and large size of PDA were likely to become surgical candidates and required longer periods of hospitalization and showed increased incidence of IVH. Although surgical treatment of PDA in preterm infants is definitive, fluid restriction and medical management at early postnatal period is recommended.

Listerial peumonia and bacteremia in pregnant woman / 대한내과학회지

No abstract available.

The Pathophysiology of the Transient Neonatal Tricuspid Regurgitation

PURPOSE: This study was carried out to evaluate the role of the septal leaflet of the tricuspid valve. The hypothesis was that the neonatal tricuspid regurgitation (TR) was related to a transient elevation of right ventricular pressure in the neonatal period, that deviated ventricular septum and pull the anchored septal leaflet of the tricuspid valve. The pulled septal leaflet created the incomplete coaptation between the tricuspid valves and the regurgitation. METHODS: We used cross-sectional echocardiography, Doppler and color Doppler echocardiography to measure the normalized ventricular curvature at end-systole, the angle of the septal leaflet of the tricuspid valve, the type of coaptation of the tricuspid valve, the direction of regurgitation and the peak flow rate of regurgitation in 114 normal newborn babies (87 with TR, 27 without TR). RESULTS: The normalized septal curvature ratio (p=.0113), the angle of the septal leaflet (p=.0023) and the corrected diameter of the tricuspid valve annulus (p=.0008) were related statistically to the presence of TR (not in the angle of the anterior septum). But in the TR group, right ventricular pressure (calculated through peak velocity of TR) had no correlation with the above variables except the grade of TR (p=.002). CONCLUSIONS: One of the pathophysiological aspects of the neonatal TR is mainly related to the septal leaflet of the tricuspid valve, but the exact pathophysiology of neonatal TR may also be combined with other factors.

Characterization of the basal temporal language area

Basal temporal language area (BTLA), demonstrated by electric stimulation of the cortex in epilepsy patients rarely cause significant language problems after it resection. Recently, we experienced a patient who developed severe language deficits after the resection of BTLA. To characterize the language function of BTLA we compared the language characteristics in our patient with those of the previously reported characteristics of BTLA observed by either its resection or electrical stimulation. The BTLA was thought to play a major function in access to naming pool and in the comprehension partly through Wernicke's area. Also the visually associated language function, reading aloud and reading comprehension were known to be more damaged than visually unassociated function. Previous studies showed that BTLA identified by electrical stimulations in patients with epilepsy was usually found to be clinically insignificant for only minor and transient ]anguage deficits being noticed after its surgical resection with only rare exceptions. Our patient developed severe language deficits which lasted for at least several weeks after the resection of the epileptogenic lesion located in the BTLA. She had a calcified granuloma in inferior temporal gyrus and the WADA test in this patient revealed a strongly lateralized language and memory function to the resected temporal lobe. The precise neural mechanisms of severe language deficits found in this patient in unclear, however, our experience suggest that BTLA is involved in the language function to a significant degree at least in some patients. Further prospective investigations to preoperatively identify the patient group at risk of developing severe language deficits after the resection of BTLA are needed.

Characterization of the basal temporal language area

Basal temporal language area (BTLA), demonstrated by electric stimulation of the cortex in epilepsy patients rarely cause significant language problems after it resection. Recently, we experienced a patient who developed severe language deficits after the resection of BTLA. To characterize the language function of BTLA we compared the language characteristics in our patient with those of the previously reported characteristics of BTLA observed by either its resection or electrical stimulation. The BTLA was thought to play a major function in access to naming pool and in the comprehension partly through Wernicke's area. Also the visually associated language function, reading aloud and reading comprehension were known to be more damaged than visually unassociated function. Previous studies showed that BTLA identified by electrical stimulations in patients with epilepsy was usually found to be clinically insignificant for only minor and transient ]anguage deficits being noticed after its surgical resection with only rare exceptions. Our patient developed severe language deficits which lasted for at least several weeks after the resection of the epileptogenic lesion located in the BTLA. She had a calcified granuloma in inferior temporal gyrus and the WADA test in this patient revealed a strongly lateralized language and memory function to the resected temporal lobe. The precise neural mechanisms of severe language deficits found in this patient in unclear, however, our experience suggest that BTLA is involved in the language function to a significant degree at least in some patients. Further prospective investigations to preoperatively identify the patient group at risk of developing severe language deficits after the resection of BTLA are needed.

A Case of Dandy-Walker Syndrome with Complex Cardiac Anomaly

The Dandy-Walker syndrome is a developmental disorder of the brain characterized by cystic dilatation of the fourth ventricle and agenesis or hypoplasia of the cerebellar vermis. We experinced a case of Dandy-Walker syndrome with complex cardiac anomaly in female newborn who presented with apnea at birth. Physical examination showed coloboma on left eye, low estting malformed ear, and high arched palate. Autopsy revealed cystic dilatation of the fourth ventricle with secondary loss of cerebellar vermis. The floor of the fourth ventricle is exposed through this defect. Heart showed aortic atresia and univentricular heart. The case is reported with the review of the literatures.