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1.
Korean Journal of Medicine ; : 759-763, 2013.
Artículo en Coreano | WPRIM | ID: wpr-35121

RESUMEN

Septic pulmonary thromboembolism resulting from fungal infection is rare. A 32-year-old woman with acute paraquat intoxication was treated with high-dose intravenous steroid and cyclophosphamide pulse therapy. She presented with a prolonged fever, dyspnea, and multiple pneumonic infiltrations. Central venous catheterization was necessary for total parenteral nutrition. The response to antibiotic therapy was disappointing and Candida tropicalis was cultured in the blood repeatedly. Vegetations were found in the superior vena cava on echocardiography and both pulmonary arteries had massive thromboembolism on computed tomography (CT). Intravenous amphotericin B and anticoagulation therapy showed improvement. When patients with central venous catheters and recurrent fungemia present with dyspnea and fever, septic pulmonary thromboembolism and other disseminated infections, such as infective endocarditis or endophthalmitis, should be kept in mind.


Asunto(s)
Femenino , Humanos , Anfotericina B , Candida , Candida tropicalis , Cateterismo Venoso Central , Catéteres Venosos Centrales , Ciclofosfamida , Disnea , Ecocardiografía , Endocarditis , Endoftalmitis , Fiebre , Fungemia , Paraquat , Nutrición Parenteral Total , Arteria Pulmonar , Embolia Pulmonar , Tromboembolia , Trombosis , Vena Cava Superior
2.
Korean Journal of Medicine ; : 759-763, 2012.
Artículo en Coreano | WPRIM | ID: wpr-741101

RESUMEN

Staphylococcus aureus is a well-known pathogen involved inright-sided endocarditis with predisposing factors, and the clinical course may be acute and rapidly progressive. Intravenous drug abuse, pacemakers or central vascular catheters, and congenital heart diseases are well-known predisposing factors. However, right-sided endocarditis as a result of S. aureus infection is very rare in patients without these predisposing factors. Here, we report the case of a previously healthy 25-year-old male with native tricuspid valve infective endocarditis by methicillin-sensitive Staphylococcus aureus, complicating multiple septic pneumonia and septic pulmonary artery thrombosis. The patient was treated with antibiotics and surgical thromboembolectomy with tricuspid valve repair.


Asunto(s)
Adulto , Humanos , Masculino , Antibacterianos , Endocarditis , Cardiopatías , Neumonía , Arteria Pulmonar , Staphylococcus , Staphylococcus aureus , Abuso de Sustancias por Vía Intravenosa , Trombosis , Válvula Tricúspide , Dispositivos de Acceso Vascular
3.
Korean Journal of Medicine ; : 759-763, 2012.
Artículo en Coreano | WPRIM | ID: wpr-187677

RESUMEN

Staphylococcus aureus is a well-known pathogen involved inright-sided endocarditis with predisposing factors, and the clinical course may be acute and rapidly progressive. Intravenous drug abuse, pacemakers or central vascular catheters, and congenital heart diseases are well-known predisposing factors. However, right-sided endocarditis as a result of S. aureus infection is very rare in patients without these predisposing factors. Here, we report the case of a previously healthy 25-year-old male with native tricuspid valve infective endocarditis by methicillin-sensitive Staphylococcus aureus, complicating multiple septic pneumonia and septic pulmonary artery thrombosis. The patient was treated with antibiotics and surgical thromboembolectomy with tricuspid valve repair.


Asunto(s)
Adulto , Humanos , Masculino , Antibacterianos , Endocarditis , Cardiopatías , Neumonía , Arteria Pulmonar , Staphylococcus , Staphylococcus aureus , Abuso de Sustancias por Vía Intravenosa , Trombosis , Válvula Tricúspide , Dispositivos de Acceso Vascular
4.
Korean Journal of Medicine ; : 200-207, 2012.
Artículo en Coreano | WPRIM | ID: wpr-208721

RESUMEN

BACKGROUND/AIMS: Endogenous endophthalmitis (EE) is rare. However, the visual outcome of patients with EE is very poor. Many cases of EE caused by Gram-negative bacterial infections have recently been reported. This study was conducted to explore the most frequent pathogens, diagnosis, and treatment outcomes of EE. METHODS: A retrospective analysis was carried out in 23 patients diagnosed with EE through clinical manifestations and ophthalmic examinations in three hospitals between January 2000 and April 2011. Samples from 23 patients with EE were analyzed microbiologically. RESULTS: Pathogens were identified in 18 (78%) of the 23 blood, liver aspirate, and/or vitreous humor samples. Klebsiella pneumoniae was the most frequent organism (13/23, 57%). Abdomino-pelvic imaging (21/23, 91%) was performed to evaluate the primary site of infection. The most common primary infection was liver abscess (14/23, 61%). Despite administration of intravenous antibiotics and intravitreal injection, only six of 23 patients showed improvements in visual acuity. Thirteen (57%) experienced worse visual acuity. Four (17%) were eventually enucleated. CONCLUSIONS: In patients diagnosed with EE, abdomino-pelvic CT is required to exclude the presence of liver abscess. If a liver abscess is identified, percutaneous drainage should be considered. Considering the rapid progression and poor prognosis of EE, early diagnosis and immediate management are vital. We currently suggest that empiric antibiotics for treatment of EE should have activity against Gram-negative bacilli such as K. pneumoniae.


Asunto(s)
Humanos , Antibacterianos , Drenaje , Diagnóstico Precoz , Endoftalmitis , Infecciones por Bacterias Gramnegativas , Inyecciones Intravítreas , Klebsiella , Klebsiella pneumoniae , Hígado , Absceso Hepático , Neumonía , Pronóstico , Estudios Retrospectivos , Agudeza Visual , Cuerpo Vítreo
5.
The Korean Journal of Internal Medicine ; : 171-179, 2012.
Artículo en Inglés | WPRIM | ID: wpr-28114

RESUMEN

BACKGROUND/AIMS: Frequent pathogens of nosocomial meningitis were investigated and the adequacy of empiric antibiotic therapy was assessed. Outcomes of nosocomial meningitis were also evaluated. METHODS: Ninety-one patients, who were diagnosed and treated for nosocomial meningitis at a single tertiary hospital in Daegu, Korea for 10 years, were included. Medical record and electronic laboratory data on the causative pathogens, antibiotics used, and outcomes were retrospectively investigated. RESULTS: Coagulase-negative Staphylococcus (40.9%) was the most common pathogen, followed by Acinetobacter (32.5%). Both were cultured as a single organism in cerebrospinal fluid (CSF). Seventy-eight patients (85.7%) had infections related to external ventricular drains (EVD). The most common empirical antibiotics were extended-spectrum beta-lactam antibiotics plus vancomycin (35/91, 38.6%). Of the 27 patients who had cultured Acinetobacter in CSF, 10 (37%) were given the wrong empirical antibiotic treatment. Seven of the 27 patients (26.9%) with cultured Acinetobacter died, and overall mortality of the 91 patients was 16.5%. In the multivariate analysis, the presence of combined septic shock (p < 0.001) and a persistent EVD state (p = 0.021) were associated with a poor prognosis. CONCLUSIONS: Acinetobacter is one of the leading pathogens of nosocomial meningitis and may lead to inadequate coverage of empiric antibiotic therapy due to increasing resistance. An EVD should be removed early in cases of suspected nosocomial meningitis, and carbapenem might be required for the poor treatment response.


Asunto(s)
Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Acinetobacter/clasificación , Infecciones por Acinetobacter/líquido cefalorraquídeo , Antibacterianos/uso terapéutico , Líquido Cefalorraquídeo/microbiología , Infección Hospitalaria/líquido cefalorraquídeo , Farmacorresistencia Bacteriana , Modelos Logísticos , Meningitis Bacterianas/líquido cefalorraquídeo , Análisis Multivariante , Oportunidad Relativa , República de Corea , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Infecciones Estafilocócicas/líquido cefalorraquídeo , Staphylococcus/clasificación , Factores de Tiempo , Resultado del Tratamiento
6.
The Korean Journal of Internal Medicine ; : 203-210, 2012.
Artículo en Inglés | WPRIM | ID: wpr-28110

RESUMEN

BACKGROUND/AIMS: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are predominantly known as medication-induced diseases. However, at our institution, we have experienced more cases of non-drug-related SJS and TEN than expected. Therefore, we studied the difference between non-drug-related and drug-related SJS and TEN in terms of clinical characteristics and prognoses. METHODS: The etiologies, clinical characteristics, and treatment outcomes for 82 adult patients with SJS and TEN were retrospectively reviewed. RESULTS: A total of 71 patients (86.6%) were classified as having SJS, and the other 11 patients (13.4%) were classified as having TEN. Drug-related cases were more common (43, 52.4%) than non-drug-related cases (39, 47.6%). Anticonvulsants (12/82, 14.6%) and antibiotics (9/82, 11%) were the most common causative medications. Anemia (p = 0.017) and C-reactive protein of > or = 5 mg/dL (p = 0.026) were more common in the drug-related cases than in the non-drug-related cases. Intravenous steroid therapy was used as the main treatment regimen (70/82, 85.4%). Of the 82 patients, 8 (9.8%) died during the clinical course. A univariate analysis for mortality showed statistical significance for the following: kidney function abnormality, pneumonia, hemoglobin of < 10 g/dL, and combined underlying diseases. In a multivariate analysis, only pneumonia was statistically significant (odds ratio, 25.79; p = 0.009). CONCLUSIONS: Drugs were the most frequent cause of these diseases. However, non-drug-related causes also contributed to a significant proportion of cases. Physicians should keep this in mind when documenting patient history. In addition, early recognition and treatment may be important for better outcomes.


Asunto(s)
Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Distribución de Chi-Cuadrado , Síndrome de Stevens-Johnson/diagnóstico , Modelos Logísticos , Análisis Multivariante , Oportunidad Relativa , República de Corea , Medición de Riesgo , Factores de Riesgo , Síndrome de Stevens-Johnson/inducido químicamente , Análisis de Supervivencia , Resultado del Tratamiento
7.
Korean Journal of Medicine ; : 266-274, 2011.
Artículo en Coreano | WPRIM | ID: wpr-38999

RESUMEN

Good's syndrome (GS) is a rare cause of acquired combined B- and T-cell immunodeficiency in adults. GS is also known as a rare form of paraneoplastic syndrome of thymoma that may persist after thymectomy. Some reported GS cases have been related to various diseases as a result of humoral immunodeficiency, but no report to date has related GS to cytomegalovirus (CMV) retinitis in Korea. We report two cases of CMV retinitis as a manifestation of GS with severe cellular immunodeficiency. In the first case, a 61-year-old woman was diagnosed with GS manifesting as CMV retinitis combined with coincident pulmonary tuberculosis and soft-tissue tuberculosis. In the second case, a 56-year-old man had CMV retinitis and CMV pneumonia. Both patients had a history of thymoma and had received total thymectomies, and were diagnosed with GS a few years thereafter.


Asunto(s)
Adulto , Femenino , Humanos , Persona de Mediana Edad , Citomegalovirus , Retinitis por Citomegalovirus , Síndromes de Inmunodeficiencia , Corea (Geográfico) , Síndromes Paraneoplásicos , Neumonía , Retinitis , Linfocitos T , Timectomía , Timoma , Tuberculosis , Tuberculosis Pulmonar
8.
Korean Journal of Medicine ; : 82-86, 2010.
Artículo en Coreano | WPRIM | ID: wpr-201325

RESUMEN

A 72-year-old man with end-stage renal disease who was taking oral steroids and immunosuppressive agents to control rheumatoid arthritis was admitted with complaints of anorexia and general weakness. Based on endoscopic findings and a histologic examination, the patient was diagnosed with infective esophagitis caused by Candida spp. and cytomegalovirus co-infection. Cytomegalovirus and Candida spp. are common causes of opportunistic infections; however, cytomegalovirus and Candida spp. co-infection is very rare. The patient was treated with ganciclovir and fluconazole. Endoscopic examination after 3 weeks showed improvement of the esophagitis. When endoscopy examination shows typical white spots that are indicative of Candida esophagitis, histologic and microbiologic studies should be encouraged for cytomegalovirus and Candida co-infection, especially in immunocompromised patients.


Asunto(s)
Anciano , Humanos , Anorexia , Artritis Reumatoide , Candida , Candidiasis , Coinfección , Citomegalovirus , Caries Dental , Endoscopía , Esofagitis , Fluconazol , Ganciclovir , Huésped Inmunocomprometido , Inmunosupresores , Fallo Renal Crónico , Esteroides
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