Co-Infection of Scrub Typhus and Human Granulocytic Anaplasmosis in Korea, 2006

BACKGROUND: Scrub typhus, severe fever with thrombocytopenia syndrome (SFTS) and human granulocytic anaplasmosis (HGA) are important arthropod-borne infectious diseases in Korea and share a common point that they are transmitted by arthropod bites mostly during outdoor activities and there are considerable overlaps of epidemiologic and clinical features at presentation. We investigated the co-infection of these infections. METHODS: The study subjects were patients with laboratory-confirmed scrub typhus who were enrolled retrospectively in 2006. SFTS virus (SFTSV) infection was confirmed by a reverse transcriptase polymerase chain reaction (PCR) to amplify partial L segment of SFTSV for molecular diagnosis. HGA was confirmed by a nested PCR to amplify 16S rRNA gene of Anaplasma phagocytophilum. Direct sequencing of the positive PCR products was performed. Clinical features of co-infected subjects were described. RESULTS: One-hundred sixty-seven patients with scrub typhus were included in the analysis. Co-infection of A. phagocytophilum was identified in 4.2% of scrub typhus patients (7/167). The route of co-infection was uncertain. The co-infected patients had not different clinical manifestations compared to the patients with scrub typhus only. All the study subjects were negative for SFTSV. CONCLUSION: We found retrospective molecular evidence of the co-infection of scrub typhus and HGA in Korea. HGA may be more prevalent than expected and need to be considered as an important differential diagnosis of febrile patients in Korea.

Impact of Maximal Sterile Barrier during the Insertion of Central Venous Catheters in Adults Intensive Care Units / 병원감염관리

BACKGROUND: Catheter-related bloodstream infections (CR-BSIs) are common, costly, and potentially lethal. The purpose of this study was to ascertain the effect of maximal sterile barrier on CR-BSIs in intensive care units. METHODS: We monitored CR-BSIs in intensive care units of Sunlin Hospital in Pohang, before (September 2005 to May 2006) and after (June to December 2006) implementation of maximal sterile barrier. CR-BSIs were identified by using the definition of Centers for Disease Control and Prevention. RESULTS: During the intervention period, the proportion of conducting maximal sterile barrier was 84%. In the pre-intervention period, 10 episodes of CR-BSIs were recorded out of a total of 1,749 catheter-days, compared to 1 episode of CR-BSI out of a total of 1,277 catheter-days in the post-intervention period. The rate of CR-BSIs was significantly reduced from 5.72 to 0.57 per 1,000 catheter-days (P=0.03). CONCLUSION: Implementation of maximal sterile barrier resulted in a significant reduction in CR-BSIs.

Clinical Features and Prognostic Factors of Aeromonas Bacteremia / 감염과화학요법

BACKGROUND: Aeromonas is not a common cause of bacteremia, but can result in a grave outcome when present. In this study, clinical characteristics and prognostic factors of Aeromonas bacteremia were analysed. We also compared the clinical characteristics of community-acquired and nosocomial Aeromonas bacteremia. MATERIALS AND METHODS: We retrospectively reviewed 182 cases of Aeromonas bacteremia at Asan Medical Center from 1991 to 2000. RESULTS: Male patients predominated (67.0%) and the majority of cases occurred in the warmer months of the year. Almost all the patients (97.8%) had underlying conditions; liver disease (48.9%), biliary disease (30.2%), hematologic malignancy (10.9%), diabetes mellitus (10.9%), congestive heart failure (10.9%), and solid tumor (7.1%). An accompanying infection focus was found in 112 (61.5%) cases and the biliary tract was the most common site of infection. Compared to nosocomial bacteremia, patients with community-acquired Aeromonas bacteremia were more likely to have liver cirrhosis and complications (septic shock, altered consciousness). Nosocomial bacteremia occurred more often in patients with hematologic malignancy. Mortality directly related to Aeromonas bacteremia was 24.1%. Mortality was significantly associated with old age (> or =65 years), skin and soft tissue infection, septic shock, and altered consciousness by univariate analysis. Multivariate analysis revealed septic shock and altered consciousness as independent prognostic factors. CONCLUSION: Aeromonas bacteremia usually occurred in patients with hepatobiliary disease or malignancy and heralded a poor prognosis, especially when associated with complications (septic shock or altered consciousness).

Clinical Features and Prognostic Factors of Aeromonas Bacteremia / 감염과화학요법

BACKGROUND: Aeromonas is not a common cause of bacteremia, but can result in a grave outcome when present. In this study, clinical characteristics and prognostic factors of Aeromonas bacteremia were analysed. We also compared the clinical characteristics of community-acquired and nosocomial Aeromonas bacteremia. MATERIALS AND METHODS: We retrospectively reviewed 182 cases of Aeromonas bacteremia at Asan Medical Center from 1991 to 2000. RESULTS: Male patients predominated (67.0%) and the majority of cases occurred in the warmer months of the year. Almost all the patients (97.8%) had underlying conditions; liver disease (48.9%), biliary disease (30.2%), hematologic malignancy (10.9%), diabetes mellitus (10.9%), congestive heart failure (10.9%), and solid tumor (7.1%). An accompanying infection focus was found in 112 (61.5%) cases and the biliary tract was the most common site of infection. Compared to nosocomial bacteremia, patients with community-acquired Aeromonas bacteremia were more likely to have liver cirrhosis and complications (septic shock, altered consciousness). Nosocomial bacteremia occurred more often in patients with hematologic malignancy. Mortality directly related to Aeromonas bacteremia was 24.1%. Mortality was significantly associated with old age (> or =65 years), skin and soft tissue infection, septic shock, and altered consciousness by univariate analysis. Multivariate analysis revealed septic shock and altered consciousness as independent prognostic factors. CONCLUSION: Aeromonas bacteremia usually occurred in patients with hepatobiliary disease or malignancy and heralded a poor prognosis, especially when associated with complications (septic shock or altered consciousness).

Invasive Aspergillosis and the Clinical Management / 대한의진균학회지

Invasive aspergillosis remains a major cause of morbidity and mortality in immunocompromised patients. And there has been substantial increase in the number of cases documented at autopsy in all developed nations. There are probably many factors responsible for this substantial increase, but they include the following: greater numbers of transplantation patients; more aggressive chemotherapy for such conditions as myeloma, breast cancer, and certain lymphomas; more aggressive immunosuppressive regimens for patients with autoimmune disease; and the emergence of AIDS. The use of hepafiltration and, in particular, laminar air flow reduces the risk of invasive aspergillosis. The portal of entry for Aspergillus include the respiratory tract, damaged skin or other operative wounds, the cornea, and the ear. The majority of patients (80~90%) have pulmonary disease, but some have other manifestations of disease, including aspergillus rhinosinusitis. Prognosis of invasive aspergillosis has in general relied on making a prompt diagnosis of infection, and early treatment. Unfortunately, the rapid diagnosis of invasive aspergillosis is difficult, as no rapid methods to establish definitely the diagnosis of infection are available in most clinical settings. An ELISA for detecting Aspergillus galactomannan is used to establish an early diagnosis in Western Europe. Invasive aspergillosis carries a nearly 100% mortality if untreated. There are currently two antifungal agents with activity against Aspergillus-amphotericin B and itraconazole. Several novel agents are under investigation, including Liposomal nystatin (Nyotran), Voriconazole, Posaconazole, Caspofungin. The most advanced azole is the voriconazole, which has shown good clinical efficacy and tolerability among immunocompromised patients with invasive aspergillosis.

A Case of Intraductal Papillary Mucinous Tumor Arising from the Accessory Pancreatic Duct / 대한소화기내시경학회지

Mucin-producing tumors of the pancreas were first reported by Ohhashi and Takagi in 1980. Since then, many cases of intraductal papillary mucinous tumor (IPMT) of the pancreas, which is almost homonymous to mucin-producing tumors of the pancreas, have been reported. IPMTs are generally regarded as tumors with a favorable prognosis. Some IPMTs have invasiveness and this is always associated with a poor prognosis. Most IPMTs arise from the main pancreatic duct and IPMTs arising from the accessory pancreatic duct are relatively rare. Only 6 cases have been reported in the literature so far. Our patient was a 43-year old man who was admitted to the hospital due to recurrent pancreatitis. An endoscopic retrograde pancreatography revealed a patulous minor papilla orifice extruding mucin and a cystic lesion in a branch of the accessory duct. A pancreaticoduodenectomy was performed and a pathologic examination of the resected specimen showed intraductal papaillary mucinous neoplasm, low grade malignancy, in the accessory pancreatic duct and its branch. We herein report this interesting case with a review of the literature.

A Case of Disseminated Trichosporon beigelii Infection in a Patient with Myelodysplastic Syndrome after Chemotherapy

Trichosporonosis is a potentially life-threatening infection with Trichosporon beigelii, the causative agent of white piedra. The systemic infection by this fungus has been most frequently described in immunocompromised hosts with neutropenia. Here, we report the first patient with disseminated infection by T. beigelii in Korea, acquired during a period of severe neutropenia after chemo-therapy for myelodysplastic syndrome. The patient recovered from the infection after an early-intensified treatment with amphotericin B and a rapid neutrophil recovery. The disseminated infection by T. beigelii is still rare, however, is an emerging fatal mycosis in immunocompromised patients with severe neutropenia.

A Case of Candida parapsilosis Arthritis / 대한의진균학회지

Candida parapsilosis was not considered pathogenic, until it had been reported as the cause of the fatal case of infective endocarditis in intravenous narcotic addicts in 1940. More recently this species has emerged as an important nosocomial pathogen in many clinical infections, such as fungemia, endocarditis, endophthalmitis, septic arthritis, and peritonitis. Among them C. parapsilosis arthritis is still very rare, which is mainly caused by invasive procedures such as prosthetic arthroplasty, intraarticular steroid injection and contamination of hyperalimentation solutions. We experienced a 53 year-old male patient who had chronic elbow pain and was diagnosed as the first case of C. parapsilosis arthritis in Korea. Herein we report the case with a review of the literature.

A Prospective Multicenter Study of Community-acquired Pneumonia in Adults with Emphasis on Bacterial Etiology / 감염

BACKGROUND: Community-acquired pneumonia (CAP) is one of the leading causes of mortality and morbidity. Despite progress in diagnostic techniques and treatments, management of pneumonia remains challenging, because the precise etiology remains uncertain in as many as 49 % of cases. The limitaions of identifying etiologic agents make it necessary to use empiric antibiotics in almost all patients, and furthermore emergence of antibiotic-resistant organisms pose difficulties to the selection of an empiric antibiotic regimen. For the optimal choice of empirical antibiotics, we should know the frequency of etiologic agents and antimicrobial resistance rates in the community. METHODS: A prospective multicenter study of community-acquired pneumonia in Korea was carried out between May 1997 and April 2000. The microbiologic diagnosis was based on the results of sputum culture, blood culture and pleural culture. RESULTS: Five hundred eighty eight cases of community-acquired pneumonia in 562 patients admitted to the hospitals. The mean age was 59.9 with male predominance (58.3%), and 370 (63%) had underlyin gillness. The etiologic agents were identified in 38.3%, and the list of individual agents, in decreasing order, was Streptococcus pneumoniae (21.7%), Klebsiella pneumoniae (14.8%) Pseudomonas aeruginosa (9.8%), Staphylococcus aureus (9.5%), viridans group streptococci (5.7%), Enterobacter cloacae (4.2%), Hemophillus Influenza (3.8%). The rates of admission to the intensive care unit was 10.4%. The motality was 7.1%. Susceptible rates of S. pneumoniae to penicillin was 36.6% and showed multidrug resistant. Forty percents of S. aureus were methicillin-resistant S. aureus. K. penumoniae were susceptible to cephalosporin and quinolone. CONCLUSION: In Korea, S. pneumoniae is the most important agent causing community-acquired pneumonia. Susceptible rates of S. pneumoniae to penicillin was 36.6 % and showed multidrug resistant. Gram negative bacteria such as K. pneumoniae, P. aeruginosa showed high incidence when compared with that of other countries. Most of them had underlying diseases including bronchiectasis and chronic obstructive pulmonary diseases.

Viral Etiology of Community-acquired Pneumonia in Korean Adults / 감염

PURPOSES: To investigate the viral etiology of community-acquired pneumonia in Korean adults, we have detected respiratory viruses (Respiatory syncytial virus, adenovirus, influenza virus and parainfluenza virus) in the way of prospective, multi-center study. METHODS: From July 1997 to April 2000, nasal aspirates or sputum were obtained from adults patients with community pneumonia admitted to the participating hospitals and transferred immediately to the central laboratory in the Seoul National University Children's Hospital. The specimens were divided into three parts. One part was used for indirect immunofluorescent test for respiratory viruses, the other part for the culture of RSV and adenovirus in HEp-2 cell monolayer. Another part was used for the culture of influenza virus and parainfluenza virus in MDCK or LLC- MK2 cell monolayers. RESULTS: Of 317 samples, 32 (10.1%) specimens were positive for viral isolation by indirect IF staining or culture, including one dual-infected specimen (adenovirus and parainfluenza virus). Influenza virus was most commonly detected (16 specimens). Parainfluenza virus, adenovirus and RSV were detected in 10, 4 and 3 patients, respectively. All isolated influenza viruses were type A (H3N2 in 9 patients, H1N1 in 2 and unspecified in 5), and 8 out of 10 parainfluenza virus isolates were type 3. CONCLUSION: Similar to previous foreign reports, a significant portion of community-acquired pneumonia in Korean adult is caused by respiratory viruses. Our data empathized the need of referral system for viral diagnosis and of nationwide investigation on respiratory virus infections.

A Prospective Multicenter Study of the Etiological Analysis in Adults with Community-Acquired Pneumonia: Legionella, Leptospira, Hantaan virus and Orientia tsutsugamushi / 감염

BACKGROUND: Despite rigorous investigations, the etiology of community-acquired pneumonia remains unknown in about 50% of hospitalized patients. The diagnosis of the etiological agent is becoming more challenging and more critical as number of newer pathogens have been recognized in recent years. In the 3-year period prospective study we investigated adult patients with community-acquired pneumonia for Legionella, Leptospira, Hantaan virus and Orientia tsutsugamushi as potential etiologic agents. METHODS: A prospective multicenter study was performed from May 1997 to April 2000. A total of 431 patients with community-acquired pneumonia under the inclusion criteria were examined for specific microbial diagnosis; sputum culture and PCR, and serologic teats including indirect immunofluorescence antibody (IFA) test for Legionella, and hemagglutination tests for Leptospira, Hantaan virus and O. tsutsugamushi. Etiologic diagnosis was determined on the basis of the review of case record forms and specific laboratory diagnostic criteria. RESULT: During the study period a total of 385 sputum and 283 serum samples were examined. Legionella pneumonia was diagnosed in 2.3% (10/431) of the cases examined: 1.4% cases with PCR-positive (5/ 367) and 2.1% with positive IFA test (6/283). Leptospirosis and scrub typhus were diagnosed in 0.4% (1/ 252) and 2.0% (5/252), respectively. All 5 cases diagnosed as scrub typhus occurred in late fall, and rash or eschar was not found. None of cases was Hantaan virus infection. CONCLUSION: The results suggest that Legionella, Leptospira, and O. tsutsugamushi should be considered in the etiologic diagnosis and in empirical antibiotic therapy of community-acquired pneumonia.

Seroepidemiologic Survey of Haemorrhagic Fever With Renal Syndrome from 1994 till 2000

No abstract available.

Microbial Features and Antibiotic Prophylaxis of Prosthetic Joint Infection / 감염

BACKGROUND: Success in orthopedic implant surgery relies on reducing infection by preventive methods including antibiotic prophylaxis. The lack of published data on orthopedic implant infections with methicillin-resistance Staphylococcus aureus (MRSA) and methicillin-resistance coagulase-negative staphylococcus (MRCNS) makes it difficult to choose correct prophylactic antibiotics. We therefore reviewed the etiology of prosthetic joint infection and the effectiveness of current antibiotic prophylaxis. METHODS: We reviewed retrospectively the clinical notes and microbial records of patients with prosthetic joint infection who had admitted in Asan Medical Center from June 1989 to July 1999. RESULTS: During a eleven-year period, prosthetic joint infections occurred in 18 (0.9%) of 2,028 patients who received a total hip or total knee arthroplasty at Asan Medical Center (AMC). The cephalosporins were administered to most of patients before surgery for prophylaxis. Twenty two patients were referred to our institution because of prosthetic joint infection. Thirty five patients had positive bacteriological cultures from tissue removed at the time of surgery or joint aspiration. Staphylococci were the most common pathogens and accounted for twenty four (68.8%) of the 35 isolates. Seven (50%) of the fourteen isolates of coagulase-negative staphylococci were MRCNS. Eight (80 %) of the ten ioslates of S. aureus were MRSA. Gram-negative bacilli accounted for five (14.3%) of the isolates and included Escherichia coli, Serratia marcescens, Pseudomonas aeruginosa. CONCLUSION: First-or second-generation cephalosporins were effective prophylatic antibiotics in total hip or total knee arthroplasty because the rate of prosthetic joint infections was low (0.9%). But the prevalence of MRCNS or MRSA prosthetic joint infection was high, we must consider glycopeptides prophylaxis if there is, or has been, infection or carriage with MRCNS or MRSA.