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1.
Yonsei Medical Journal ; : 698-704, 2020.
Artículo | WPRIM | ID: wpr-833322

RESUMEN

Purpose@#With changing fungal epidemiology and azole resistance in Aspergillus species, identifying fungal species and susceptibility patterns is crucial to the management of aspergillosis and mucormycosis. The objectives of this study were to evaluate performance of panfungal polymerase chain reaction (PCR) assays on formalin-fixed paraffin embedded (FFPE) samples in the identification of fungal species and in the detection of azole-resistance mutations in the Aspergillus fumigatus cyp51A gene at a South Korean hospital. @*Materials and Methods@#A total of 75 FFPE specimens with a histopathological diagnosis of aspergillosis or mucormycosis were identified during the 10-year study period (2006–2015). After deparaffinization and DNA extraction, panfungal PCR assays were conducted on FFPE samples for fungal species identification. The identified fungal species were compared with histopathological diagnosis. On samples identified as A. fumigatus, sequencing to identify frequent mutations in the cyp51A gene [tandem repeat 46 (TR46), L98H, and M220 alterations] that confer azole resistance was performed. @*Results@#Specific fungal DNA was identified in 31 (41.3%) FFPE samples, and of these, 16 samples of specific fungal DNA were in accord with a histopathological diagnosis of aspergillosis or mucormycosis; 15 samples had discordant histopathology and PCR results. No azole-mediating cyp51A gene mutation was noted among nine cases of aspergillosis. Moreover, no cyp51A mutations were identified among three cases with history of prior azole use. @*Conclusion@#Panfungal PCR assay with FFPE samples may provide additional information of use to fungal species identification. No azole-resistance mediating mutations in the A. fumigatus cyp51A gene were identified among FFPE samples during study period.

2.
Yonsei Medical Journal ; : 592-596, 2019.
Artículo en Inglés | WPRIM | ID: wpr-762074

RESUMEN

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious zoonosis caused by the SFTS virus. Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening syndrome associated with excessive immune activation. Cytokine storms are often seen in both SFTS and HLH, resulting in rapid disease progression and poor prognosis. The aim of this study was to identify whether SFTS cases complicated by HLH are related to higher rates of mortality. Descriptive analysis of the frequency of clinical and laboratory data, complications, treatment outcomes, and HLH-2004 criteria was performed. Cases presenting with five or more clinical or laboratory findings corresponding to the HLH-2004 diagnostic criteria were defined as SFTS cases complicated by HLH. Eighteen cases of SFTS were identified during a 2-year study period, with a case-fatality proportion of 22.2% (4 among 18 cases, 95% confidence interval 9%–45.2%). SFTS cases complicated by HLH were identified in 33.3% (6 among 18 cases). A mortality rate of 75% (3 among 4 cases) was recorded among SFTS cases complicated by HLH. Although there were no statistically significant differences in outcomes, fatal cases exhibited more frequent correlation with HLH-2004 criteria than non-fatal cases [3/14 (21.4%) vs. 3/4 (75%), p=0.083]. In conclusion, the present study suggests the possibility that SFTS cases complicated by HLH are at higher risk of poor prognosis.


Asunto(s)
Progresión de la Enfermedad , Resultado Fatal , Fiebre , Linfohistiocitosis Hemofagocítica , Mortalidad , Pronóstico , Trombocitopenia
3.
Yonsei Medical Journal ; : 843-851, 2018.
Artículo en Inglés | WPRIM | ID: wpr-716928

RESUMEN

PURPOSE: Severe sepsis is associated with functional disability among patients surviving an acute phase of infection. Efforts to improve functional impairment are important. We assessed the effects of early exercise rehabilitation on functional outcomes in patients with severe sepsis. MATERIALS AND METHODS: A prospective, single-center, case-control study was conducted between January 2013 and May 2014 at a tertiary care center in Korea. Patients with severe sepsis and septic shock were enrolled and randomized to receive standard sepsis treatment or intervention. Intervention involved early targeted physical rehabilitation with sepsis treatment during hospitalization. Participants were assessed at enrollment, hospital discharge, and 6 months after enrollment. Functional recovery was measured using the Modified Barthel Index (MBI), Functional Independence Measure (FIM), and Instrumental Activities of Daily Living (IADL). RESULTS: Forty participants (21 intervention patients) were included in an intention-to-treat analysis. There were no significant differences in baseline MBI, FIM, and IADL between groups. Intervention yielded greater improvement of MBI, FIM, and IADL in the intervention group at hospital discharge, but not significantly. Subgroup analysis of patients with APACHE II scores ≥10 showed significantly greater improvement of physical function at hospital discharge (MBI and FIM) in the intervention group, compared to the control group (55.13 vs. 31.75, p=0.048; 52.40 vs. 31.25, p=0.045). Intervention was significantly associated with improvement of MBI in multiple linear regression analysis (standardized coefficient 0.358, p=0.048). CONCLUSION: Early physical rehabilitation may improve functional recovery at hospital discharge, especially in patients with high initial severity scores.


Asunto(s)
Humanos , Actividades Cotidianas , APACHE , Estudios de Casos y Controles , Hospitalización , Corea (Geográfico) , Modelos Lineales , Estudios Prospectivos , Rehabilitación , Sepsis , Choque Séptico , Centros de Atención Terciaria
4.
Journal of Korean Medical Science ; : e296-2018.
Artículo en Inglés | WPRIM | ID: wpr-718081

RESUMEN

BACKGROUND: Antepartum, intrapartum, and postpartum preventive measures with antiretroviral drugs, appropriate delivery methods, and discouraging breastfeeding significantly decrease the risk of mother-to-child transmission of human immunodeficiency virus (HIV) infection. Herein, we investigated the pregnancy outcomes in HIV-infected Korean women. METHODS: We retrospectively reviewed medical records of childbearing-age HIV-infected women between January 2005 and June 2017 at four tertiary care hospitals in Korea. RESULTS: Among a total of 95 HIV infected women of child-bearing age with 587.61 years of follow-up duration, 15 HIV-infected women experienced 21 pregnancies and delivered 16 infants. The pregnancy rate was 3.57 per 100 patient-years. Among the 21 pregnancies, five ended with an induced abortion, and 16 with childbirth including two preterm deliveries at 24 and 35 weeks of gestation, respectively. The two preterm infants had low birth weight and one of them died 10 days after delivery due to respiratory failure. Among the 14 full-term infants, one infant was small for gestational age. There were no HIV-infected infants. CONCLUSION: The pregnancy rate of HIV-infected women in Korea is lower than that of the general population. Although several adverse pregnancy outcomes were observed, mother-to-child transmission of HIV infection was successfully prevented with effective preventive measures.


Asunto(s)
Femenino , Humanos , Lactante , Recién Nacido , Embarazo , Aborto Inducido , Lactancia Materna , Estudios de Seguimiento , Edad Gestacional , VIH , Infecciones por VIH , Recién Nacido de Bajo Peso , Recien Nacido Prematuro , Corea (Geográfico) , Registros Médicos , Parto , Periodo Posparto , Resultado del Embarazo , Índice de Embarazo , Insuficiencia Respiratoria , Estudios Retrospectivos , Atención Terciaria de Salud
5.
Infection and Chemotherapy ; : 149-152, 2018.
Artículo en Inglés | WPRIM | ID: wpr-721489

RESUMEN

Brucellosis is a zoonotic infection that is usually transmitted from cattle to humans through ingestion of animal milk, direct contact with animal parts, or inhalation of aerosolized particles. In Korea, brucellosis seem to be transmitted through close contact with blood, fetus, urine, and placenta of domestic cow that has been infected by Brucella abortus, or inhalation of B. arbortus while examining or slaughtering cow. Brucella melitensis infection is rare in Korea and there have been no reported cases of B. melitensis originating from other countries until now. This report details a case of complicated brucellosis with infective spondylitis in a 48-year-old male construction worker recently returned from Iraq. Infection with B. melitensis was confirmed using 16s rRNA sequencing and omp31 gene analysis. The patient was successfully treated using a combination of rifampin, doxycycline, and streptomycin, in accordance with WHO guidelines. This is the first reported case of complicated brucellosis with infective spondylitis in Korea caused by B. melitensis originating from Iraq.


Asunto(s)
Animales , Bovinos , Humanos , Masculino , Persona de Mediana Edad , Brucella abortus , Brucella melitensis , Brucella , Brucelosis , Doxiciclina , Ingestión de Alimentos , Feto , Inhalación , Irak , Corea (Geográfico) , Medio Oriente , Leche , Placenta , Rifampin , Espondilitis , Estreptomicina , Zoonosis
6.
Infection and Chemotherapy ; : 149-152, 2018.
Artículo en Inglés | WPRIM | ID: wpr-721994

RESUMEN

Brucellosis is a zoonotic infection that is usually transmitted from cattle to humans through ingestion of animal milk, direct contact with animal parts, or inhalation of aerosolized particles. In Korea, brucellosis seem to be transmitted through close contact with blood, fetus, urine, and placenta of domestic cow that has been infected by Brucella abortus, or inhalation of B. arbortus while examining or slaughtering cow. Brucella melitensis infection is rare in Korea and there have been no reported cases of B. melitensis originating from other countries until now. This report details a case of complicated brucellosis with infective spondylitis in a 48-year-old male construction worker recently returned from Iraq. Infection with B. melitensis was confirmed using 16s rRNA sequencing and omp31 gene analysis. The patient was successfully treated using a combination of rifampin, doxycycline, and streptomycin, in accordance with WHO guidelines. This is the first reported case of complicated brucellosis with infective spondylitis in Korea caused by B. melitensis originating from Iraq.


Asunto(s)
Animales , Bovinos , Humanos , Masculino , Persona de Mediana Edad , Brucella abortus , Brucella melitensis , Brucella , Brucelosis , Doxiciclina , Ingestión de Alimentos , Feto , Inhalación , Irak , Corea (Geográfico) , Medio Oriente , Leche , Placenta , Rifampin , Espondilitis , Estreptomicina , Zoonosis
7.
Infection and Chemotherapy ; : 297-300, 2017.
Artículo en Inglés | WPRIM | ID: wpr-102692

RESUMEN

Acinetobacter baumannii is an aerobic Gram-negative coccobacillus that causes nosocomial pneumonia in patients on mechanical ventilation or previously treated with broad-spectrum antibiotics. Nevertheless, community-acquired pneumonia (CAP) caused by A. baumannii, especially multi-drug resistant (MDR) strains, is rare. We experienced the first case of CAP caused by MDR A. baumannii in Korea in a 78-year-old man. This case shows that MDR A. baumannii can cause CAP in Korea.


Asunto(s)
Anciano , Humanos , Acinetobacter baumannii , Acinetobacter , Antibacterianos , Corea (Geográfico) , Neumonía , Respiración Artificial
8.
Infection and Chemotherapy ; : 199-208, 2016.
Artículo en Inglés | WPRIM | ID: wpr-28870

RESUMEN

BACKGROUND: Septic shock remains a leading cause of death, despite advances in critical care management. The Surviving Sepsis Campaign (SSC) has reduced morbidity and mortality. This study evaluated risk factors for mortality in patients with septic shock who received treatment following the SSC bundles. MATERIALS AND METHODS: This retrospective cohort study included patients with septic shock who received treatments following SSC bundles in an urban emergency department between November 2007 and November 2011. Primary and secondary endpoints were all-cause 7- and 28-day mortality. RESULTS: Among 436 patients, 7- and 28-day mortality rates were 7.11% (31/436) and 14% (61/436), respectively. In multivariate analysis, high lactate level (odds ratio [OR], 1.286; 95% confidence interval [CI], 1.016–1.627; P=0.036) and low estimated glomerular filtration rate (OR, 0.953; 95% CI, 0.913–0.996; P=0.032) were independent risk factors for 7-day mortality. Risk factors for 28-day mortality were high lactate level (OR, 1.346; 95% CI, 1.083–1.673; P=0.008) and high Acute Physiology and Chronic Health Evaluation II score (OR, 1.153; 95% CI, 1.029–1.293; P=0.014). CONCLUSION: The risk of mortality of septic shock patients remains high in patients with high lactate levels and acute kidney injury.


Asunto(s)
Humanos , Lesión Renal Aguda , APACHE , Causas de Muerte , Estudios de Cohortes , Cuidados Críticos , Servicio de Urgencia en Hospital , Tasa de Filtración Glomerular , Ácido Láctico , Mortalidad , Análisis Multivariante , Estudios Retrospectivos , Factores de Riesgo , Sepsis , Choque Séptico
9.
Yeungnam University Journal of Medicine ; : 112-115, 2016.
Artículo en Inglés | WPRIM | ID: wpr-90947

RESUMEN

Lymphocytic interstitial pneumonia (LIP) is a rare benign lymphoproliferative disorder characterized by diffuse infiltration of the pulmonary parenchymal interstitium by polyclonal lymphocytes and plasma cells. LIP has been associated with a variety of clinical conditions; such as connective tissue disorders and other immune system abnormalities. Treatment usually involves administration of corticosteroids and other immunosuppressants. We report on a 38-year-old female patient who complained of shortness of breath, dry mouth, and dry eyes for more than 1 month, and was positive for Raynaud's phenomenon. Based on surgical biopsy, she was diagnosed as having LIP accompanied by Sjögren's syndrome. The patient was treated with high-dose steroids followed by maintenance therapy for approximately 2 years, and her condition improved.


Asunto(s)
Adulto , Femenino , Humanos , Corticoesteroides , Biopsia , Tejido Conectivo , Disnea , Sistema Inmunológico , Inmunosupresores , Labio , Enfermedades Pulmonares Intersticiales , Linfocitos , Trastornos Linfoproliferativos , Boca , Células Plasmáticas , Esteroides
10.
Korean Journal of Anesthesiology ; : 289-292, 2012.
Artículo en Inglés | WPRIM | ID: wpr-74334

RESUMEN

Although paraganglioma (PGL), an extra-adrenal retroperitoneal pheochromocytoma (PHEO), is a rare catecholamine-secreting neuroendocrine tumor, it can cause severe hypertensive crisis during anesthesia or surgery if undiagnosed preoperatively. Extraluminal perigastric masses may be presumed to be gastrointestinal stromal tumors (GISTs) or soft tissue sarcomas even when histologic confirmation is not possible. Therefore, without a histologic diagnosis or symptoms of excessive catecholamine secretion, PGL may be mistaken for GIST. We report a case of preoperatively undiagnosed PGL which caused hypertensive crisis during anesthesia for retroperitoneal mass excision.


Asunto(s)
Anestesia , Tumores del Estroma Gastrointestinal , Tumores Neuroendocrinos , Paraganglioma , Feocromocitoma , Sarcoma , Células del Estroma
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