Comparative evaluation of fluconazole susceptibility methods for Candida species: Broth microdilution test, E test and disk diffusion test / 대한임상병리학회지

BACKGROUND: Currently fungal infections have been increasing in clinical aspect. Among them Candida albicans is considered as the most pathogenic. National Committee for Clinical Laboratory Standards(NCCLS) recommends broth macrodilution method for antifungal susceptibility test, but it is difficult to perform. E test is a relatively easy method to perform for the susceptibility testing. So in this study, antifungal susceptibility procedures were compared to determine MIC for fluconazole against 130 Candida strains isolated from clinical specimens. METHOD: The tests including were microdilution method, E test and disk diffusion method. The latter two tests were performed in casitone agar and the former test performed in RPMI 1640 media(Sigma Chemical co. St. Louis, USA). MIC was determined after 24 hrs of incubation. We used Candida albicans ATCC 90018 and Candida parapsilosis ATCC 90028 as controls. A total of 130 strains(93 C. albicans, 29 C. tropicalis, 5 C. parapsilosis and 3 C. glabrata) were tested. RESULTS: The MIC50 and MIC90 of broth microdilution test for C. albicans was > OR =64 microgram/mL equivalently. Agreement of > OR = +/-2 dilution between broth microdilution test and E test was 54 %, and the concordance rate was 55%. The concordance rate between E test and disk diffusion was 90%. CONCLUSIONS: From this study, we conclude that E test can be used as a alternative and convenient method to macrodilution method to determine MIC of fluconazole. But it is necessary for attention to microcolonies surrounding the E test strip. Disk diffusion method is rapid and also can be used as an alternative and convenient method.

A Case of Multiple Brain Abscess Mimicking Cystic Brain Metastases / 감염

Multiple intracerebral space-occupying lesions (SOL) demonstrated by computed tomography (CT), magnetic resonance imaging (MRI), and radionuclide brain scanning or cerebral arteriography often present a diagnostic enigma. The differential diagnosis between brain abscess and brain tumor is occasionally difficult to determine on the basis of imaging studies and clinical judgement, especially in the case of brain SOL with mainly cystic or necrotic component. Elderly patients with a history suggestive of hidden malignancy and the above radiological features are usually presumptively diagnosed as having multiple cerebral metastases. We experienced a case of multiple brain abscess which was confirmed by diagnostic surgery, in a 67- year old male who showed clinical and radiological findings of mimicking cystic brain metastases with undetermined primary focus. Even with long-term therapy with antibiotics and supportive care, the patient suffered from massive ventriculitis and subsequently died.

Changing Patterns of Salmonella Infection & Changes In Antimicrobial Resistance of Salmonella strains Isolated in 1987-1995 / 대한내과학회지

OBJECTIVES: Salmonellosis is one of the most common bacterial infections in the Korea. The incidence of salmonellosis has changed dramatically. The incidence of typhoid fever tends to decrease as environmental & personal sanitations improve, whereas that of nontyphoid salmonellae have markedly increased. Antimicrobial resistance is increasing in Salmonella strains. Increasing emergence in multiple-drug resistant Sallmonella strains has important clinical & public implications for populations at risk and the treatment of invasive salmonellosis is complicated by the increasing resistance among Salmonella strains to commonly used antimicrobial agents. This study is performed to fine out the pattern and the antimicrobial susceptibility of isolated Salmonella strains and the clinical charateristics of Salmonella infection. METHODS: We reviewed medical records of all patients with culture-confirmed Salmonella infection in Kyung Hee University Hospital for the period January 1987 through December 1995. RESULTS: 1) The mean age of the patients was 31.0 years and the ratio of male to female was 1.03:1. 2) The frequency of isolation of specific serogroups is ordered as followings : serogroup B(47.9%), serogroup D(23.3%), S. typhi(16.2%), serogroup C(9.6%), serogroup E(1.8%), serogroup A(1.2%). 3) The sites of isolation were as follows : stool(68.6%), blood(24.0%), pus(3.5%), urine(2.2%), bone marrow(2.2%), bile juice(0.4%), ascites(0.4%), CSF(0.2%), sputum(0.2%). 4) The isolation rate of resistant strains of specific serogroups was as follows in order : serogroup B(52.4%), serogroup C(33.3%), serogroup E(25%), serogroup D(9.8%), S. typhi(4.2%), serogroup A(0%). 5) The frequency of animicrobial resistance in Salmonella strains to tested 8 antimicrobial agents was as follows : ampicillin(28.8%), carbenicillin(28.1%), chloramphenicol(16.4%), kanamycin(5.9%), trimethoprim-sulfamethoxazole(5.3%), cephalothin(2.3%), gentamicin(0.9%), amikacin(0.5%). 6) The most of antimicrobial-resistant Salmonella(95.0% of resistant strains) has multiple drug resiatance. 7) The frequency of clinical manifestations of nontyphoid salmonellosis was as follows : enterocolitis(80.1%), bacteremia without focal infection(13.1%), focal infection(6.8%). 8) The clinical variables statistically significant between resistant and sensitive Salmonella infection are frequency of bacteremia and duration of admission. CONCLUSION: Different serogroups of Salmonella isolates reveal the different frequency & pattern in antimicrobial resistance. The frequency of antimicrobial resistance for Salmonella isolates is markely increased during recent 9 years. In preparation for the future outbreaks of multiresistant sallmonellosis, nationwide studies should be carried out periodically to monitor effectively trends in the antimicrobial resistance of Salmonella and the development of effective and practical alternative therapy for resistant salmonellosis is clearly needed.

1 case of imported Plasmodium vivax malaria with delayed manifestations due to inadequate chemoprophylaxis / 대한내과학회지

Malaria is the world's most important parasitic infec tion. Although it has been eradicated from temperate zones including Korea , increasing numbers of travellers visit tropical malarious countries and imported malaria becomes important medical problem in the developed countries. In Korea with increasing travellers to malaria endemic area, the incidence of imported malaria shows rising tendency same as the developed countries. It beco mes important to provide general personal protective me asures and chemoprophylaxis to trevellers, when employed in appropriate manner, that can be highly effective in preventing malaria . We recently experienced a case of imported Plasmodium vivax malaria with delayed mani festations due to inadequate chemoprophylaxis. A 53- year-old woman with history of trevel to East Africa 4 months ago and chief complaint of fever was diagnosed as tertian malaria. She had irregularly taken prophylatic antimalarial during travel and had not taken it after return but should have taken it at least 4 weeks after return.

A Case of Liver Abscess Due to Klebsiella pneumoniae Complicated with Bacteremia, Endophthalmitis and Prostatic Abscess / 감염

Metastatic infections were rare complications of Klebsiella p neumoniae liver abscess and bacteremia. However, over the past 15 years, they have become prevalent infectious complications in diabetic patients in Taiwan. A 72-year old man was admitted to Kyung-Hee University Hospital with fever, chill, dysuria, and frequency. On rectal examination the prostate gland was tender. Abdominal sonogram showed liver abscess. On hospital day 3, orbital pain, eyelid edema, conjunctival chemosis, hypopyon, and absence of light perception were noted in the right eye. K. pneumoniae was isolated from blood culture. The antimicrobial susceptibility test showed susceptibility to all antibiotics, except ampicillin. He was treated with ceftriaxone and astromicin intravenously for 3 weeks and follow up-transrectal sonogram revealed formation of prostatic abcess. We report a case of K. p neumoniae liver abscess complicated with bacteremia, endophthalmitis, and prostatic abscess.

Pseudoinfections Due to Benzalconium-chloride Solution Contaminated with Burkholderia cepacia / 감염

No abstract available.

Clinical Significance of Aeromonas Bacteremia / 대한내과학회지

OBJECTIVES: Aeromonas species is a gram-negative, facultative anaerobe of the family Vibrionaceae. The organism has been recognized as a pathogen associated with illness in human, such as acute gastroenteritis, cellulitis, septicemia, and other rare diseases. METHODS: To evaluate the clinical significance of Aeromonas bacteremia in Korea and it's susceptibility of antibiotics, we evaluated the 17patients with Aeromonas bacteremia. Identification was done by use of API 20E system and antibiotic susceptibility was tested with disk diffusion method. RESULTS: Male to female ratio was 11:6, and mean age was 54.1years(8-85years) old. Liver cirrhosis was the most common underlying disease(10cases of 17patients, 58.8%a). Other underlying diseases were as follows: gallstone in 2cases, cholangiocarcinoma in 2cases, and aplastic anemia in 1case, cerebral infarction in 1case. But one had no underlying disease. So Aeromonas bacteremia were occurred in 14immunocompromised patients(82.3%), and in 10patients with hepatobiliary diseases, A. hydrophila was most commonly isolated(13cases, 764%), and the A sobria(4cases, 23.5%) was infrequently isolated. The overall fatality was 47%, and there had no significant difference in fatality between A. hydrophila and A sobria All Aeromonas species had resistance to ampicillin and carbenicillin. CONCLUSION: Because Aeromonas bacteremia may occur through water-borne route, especially in immunocompromised host. We should pay attention to immunocompromised patients, espacially having hepatobiliary disease.

A Clinical Study on Staphylococcus Aureus Bacteremia / 대한내과학회지

OBJECTIVE: Staphylococcus aureus has persisted and is now resurging as an important hospital and community pathogen. Nosocomial infection caused by methicillin-resistant S.aureus(MRSA) is a major problem which may be connected with heavy or prolonged use of antibiotics S.aureus bacteremia caused acute complications, which occasionally resulted in death, and infectious/suppurative complications, which necessitated prolonged antibiotic therapy, sometimes in conjunction with surgery. Therefore, S.aureus bacteremia is a serious medical problem in association with high morbidity and mortality. METHODS: 130 patients with S.aureus bacteremia who were admitted in the Kyung Hee University Hospital from January, 1991 to December, 1994 were analyzed retrospectively. We compared the clinical and laboratory characteristics, and antibiotics resistances between MRSA and MSSA bacteremia and also we evaluated risk factors that contribute to fatal outcome in patients with S.aureus bacteremia. RESULTS: 1) of 130cases, 80 were male and 50 were female. The mean age was 44.5+/-25.1 years. 2) 84(65%) of S.aureus bacteremia were nosocomial and 46(35%) were community-acpuired. The percentage of MRSA stains studied was 55%(71/130) and The percentage of MRSA bacteremia in hospital-acpuired and community-accquired S. aureus bacteremia were 64% (54/84) and 36%(17/46), respectively. Sources of bacteremia were uncertain in 85(65%) with intravascular catheter(20%) and skin wound sites (8%) being the most common sources in remainder(35%) 3) 110(85%) of 130 patients had one or more underlying diseases. Common underlying dieases were cerebrovascular disease(33%), malignancy(17%), Diabetes mellitus(15%), chronic renal failure(8%) and liver cirrhosis(6%). 4) Acute complications occurred in 35 patients and were fatal in 21 5) The risk factors associated with MRSA bacteremia were various severe underlying diseases, vairous invasive procedures, IV catheter-associated infection, hypoalbuminemia, previous use of antibiotics, male sex and old age. 6) The Case fatality rate for patients with S. aureus bacteremia was 18% and those for patients with MRSA and MSSA bactermia were 20% and 12%, respectively. The risk factors that contribute to the increment of mortality rate in patients with S. aureus bacteremia were acute complication, low serum level of total protein, hypoalbuminemia, various invasive procedures and IV catheter-associated infection, 7) In the antibiotic sensitivity test S. aureus was resistant to penicillin in 98.5%, ofloxacin in 73%, cefotaxime in 67%, erythromycin in 58%, aztreonam in 56%, clindamycin in 52%, vancomycin in 0%. 8) In the multiple antibiotic resistance of S. aureus, 43(68%) of MRSA was resistant to more than 10 antibotics, revealing multiply resistant nature of strains, While all but one MSSA was resistant to 1 to 4 antibiotics, one revealing resistance to 8 antibiotics. CONCLUSION: S. aureus bacteremia is a cause of considerable morbidity and mortality in hospitalized patients who especially, exposed to various risk factors. MRSA revealed higher resistance rate to most antibiotics tested and more marked multiply resistant nature than MSSA. But there was no significant difference in case fatality rate between patients with MRSA and MSSA bacteremia.

Clinical Features of Stenotrophomonas Maltaphilia Infection / 대한내과학회지

OBJECTIVE: Stenotrophomonas maltophilia has been emerging as an important nosocomial pathogen in recent years in patients with impaired host- defense mechanism or who has been exposed to large amount of inocula. This organism is usually resistant to multiple (commonly used) antimicrobial agents, particularly to those of the beta-lactam class. To evaluate the clinical feature of Stenotrophomonas maltophilia infection and in vitro anti- microbial susceptibility, we performed a retrospective study. METHODS: We analyzed the result of in vitro antimicrobial susceptibility test for 200 isolates of S. maltophilia and the annual isolation rate during the period between January 1990 and December 1994 in our institution, and performed a retrospective study for the available records of 165 cases among them. The data were obtained with only the first isolation of the organism for each patients. RESULTS: Total of 165 initial isolates, the isolates were from wounds in 50(30.3%), urine in 47(28.5%), the respiratory tract in 37(22.4%), blood in 9(5.5%), bile in 6(3.6%), and miscellaneous sources in 16(9.7%). The 84.2% of isolates were hospital-acquired isolate and 58.3% of these patients had received antecedent antibiotic therapy: polymicrobial growth was demonstrated in 61.9% of the cases. In vitro antimicrobial susceptibiiity test, ofloxacin was active against the isolates in 89.2%, moxalactam in 85.9%, ciprofloxacin in 83.9%, TMP-SMX(trimethoprim-sulfamethoxazole) in 64.2%, As expected, S. maltophilia isolates were, in general, not susceptible to cephalosporins, penicillins. The annual isolation rate at Kyung Hee University hospital was not increased significantly from 1990 to 1994, 19.53 per 10,000 patients dismissals in 1990, 13.56 in 1994. The major underlying diseases of patients were malignancy(17.6%), cerebrovascular disorder(17%), diabetic mellitus(13.3%). Mortality rate is 10.3%. CONCLUSION: S. maltophilia has been emerging as an important nosocomial pathogen in immunocompromised patients, especially those receiving broad-spectrum antimicrobial therapy. And this organism is resistant to multiple antimicrobial agents, particularly to those of the beta-lactam class. When antimicrobial treatment is necessary, the clinician should be guided by results of in vitro susceptibility testing because of the notable in vitro resistance of S. maltophilia to commonly used antibiotics. And when S. maltophilia has been recovered from a patient, wound and contact isolation is warranted.

A Case of Infected Aortic Aneurysm Caused by Salmonella Group B / 대한내과학회지

We experienced a case of the rupture of infected aortic aneurysm caused by Salmonella group B. A 75-year-old diabetic female patient was admitted with lower back pain and fever. Abdominal CT scan showed the abdominal aneurysm and the abscess of retroperitoneal space. We confirmed the ruptured aortic anecrysm with retroperitoneal abscess by obermter. The blood culture, and the pus obrained by operan yielded growth of Salmonella group B. After oration the patient was recovered completely by anrotics. We report this case with literature

Appraisal of the Results of Throat Swab Culture Obtained from Pediatric Outpatient Clinic

No abstract available.

A case report of cerebral sparganosis associated with seizure / 감염

No abstract available.

A case of primary pulmonary cryptococcosis misdiagnosed as lung cancer / 감염

No abstract available.

A case of primary pulmonary cryptococcosis misdiagnosed as lung cancer / 감염

No abstract available.

A case of arthritis of hip joint caused by salmonella typhi / 감염

No abstract available.

Unusual case report as imported sparganosis / 감염

No abstract available.

Clinical evaluation of cefodizime in lower respiratory tract infections / 감염

No abstract available.

A case of human thelaziasis wearing the contact lens / 감염

No abstract available.

A case of arthritis of Knee joint caused by salmonella typhi / 감염

No abstract available.