Effects of Recombinant Human Granulocyte-Colony Stimulating Factor on Neutrophil Functions in Diabetic Patients with Foot Infections / 감염

BACKGROUND: Treatment of diabetic foot infection remains difficult, due partly to defective neutrophil functions. Granulocyte-colony stimulating factor (G-CSF) increases neutrophil counts in peripheral blood and enhances neutrophil functions in healthy peoples and patients with hematologic diseases. We performed this study to evaluate neutrophil functions in diabetic patients with foot infections and the effect of rhG-CSF on neutrophil functions in vitro. METHODS: Twelve patients with diabetic foot infections and 12 normal volunteers were enrolled. Venous blood was collected in heparin-containing tubes, and neutrophils were isolated immediately. The isolated neutrophils were incubated with rhG-CSF (50 ng/mL) for 20 minutes. Assays of superoxide anion production of neutrophils were based on the reduction of ferricytochrome C. Assays of phagocytosis by neutrophils were done using Staphylococcus aureus and the weighted phagocytic index (WPI) was calculated by counting the number of phagocytosing neutrophils on the slides. RESULTS: Superoxide anion production of neutrophils in diabetic patients was 4.7 (unit: nmol/2105cells/30min), which was significantly lower than that of controls (7.6) (P<0.05). rhG-CSF increased the superoxide anion production of neutrophils to 9.8 in diabetic patients and to 15.6 in the controls (P<0.05). WPI in diabetic patients was 0.77, which was not significantly different from that of the controls (0.69). WPI was increased significantly by rhG-CSF in diabetic patients (0.88) and in controls (0.79). CONCLUSION: rhG-CSF enhanced neutrophil functions in vitro, which were evaluated by superoxide anion production and phagocytosis in diabetic patients with foot infections. These results suggest that rhG-CSF can be useful in the treatment of diabetic foot infections.

Incidence and Risk Factors of Tuberculosis in Human Immunodeficiency Virus-Infected Patients in Korea / 감염

BACKGROUND: Tuberculosis is the most frequent opportunistic infection in HIV-infected patients in Korea. We examined the incidence and risk factors for tuberculosis in HIV-infected patients. METHODS: We reviewed the medical records of 143 HIV-infected patients between January 1988 and June 1997 at the Seoul National University Hospita The incidence of tuberculosis was determined by the number of new tuberculosis per 100 patients divided by a total duration of follow-up (cases/100 person- years). The incidence of tuberculosis was analyzed with respect to CD4+ lymphocyte count, status of tuberculin skin reaction, and status of delayed hypersensitivity skin reaction. RESULTS: The total duration of follow-up was 229.6 person-years. During follow-up, 22 patients developed tuberculosis [9.6 cases per 100 person-years (95% CI, 6.0 to 14.5)]. The incidence of tuberculosis according to sex and transmission route showed no significant difference. Tuberculosis occurred more frequently in patients with minimum CD4+ T lympho-cyte counts of less than 200 cells/mm3 (14.2 cases/100 person-years) than in those with higher T lymphocyte counts (3.9 cases/100 person-years) [relative risk, 4.02 (95% CI 1.32 to 12.5), P=0.009]. The incidence of tuberculosis was higher among tuberculin- positive patients [17.0 cases/100 person-years (95% CI, 9.0 to 29.0)] than among tuberculin-negative [8.0 cases/100 person-years (95% CI, 3.2 to 16.6)], but the difference was not statistically significant [relative risk, 2.35 (95% CI, 0.88 to 6.26, P=0.078)]. The rate of tuberculosis in patients with negative delayed hypersensitivity test was not significantly different from that in patients with positive results (P=0.510). CONCLUSION: The incidence of tuberculosis was 9.6 cases per 100 person-years. CD4+ lymphocyte count (<200 cells/mm3) was the most useful predictor for the development of tuberculosis in HIV patients in Korea.

Two Cases of Tsutsugamushi Disease in the Spring / 감염

We report two cases of tsutsugamushi disease which occurred in the spring of 1998. One patient presented with fever, rash, lymphadenopathy and eschar. He was exposed to bush areas on March 29, 1998 and developed symptoms starting April 6, 1998. The other patient visited our hospital because of fever, headache, and vomiting which developed since May 21, 1998. Physical examination revealed rash, lymphadenopathy, and eschar. Cerebrospinal fluid was positive for Orientia tsutsugamushi by using polymerase chain reaction. Most tsutsugamushi cases occur between October and December in Korea. The seasonal variation in the incidence of tsutsugamushi disease is probably related to the life cycle of the vector mite. The frequency of Leptotrombidium pallidum, a major vector mite in Korea, shows a large peak in autumn and a smaller peak in spring. Our cases confirm that tsutsugamushi disease can occur in the spring in Korea.

Epidemiology of HIV infection in the Republic of Korea

Since the first case of human immunodeficiency virus (HIV) infection in the Republic of Korea (ROK) was detected in 1985, 876 HIV-infected patients have been reported, as of December 1998. The male to female ratio was 6.8:1, and 87% of the patients were between 20 and 49 years of age. The major modes of transmission were sexual contacts, accounting for 86% of the cases (65% heterosexuals and 21% homosexuals). Transmission through blood and blood products accounted for 28 cases (3.2%), and vertical transmission for one case. No cases among intravenous drug abusers were reported. The seroprevalence among the blood donors was approximately one in 100,000. Subtypes A, B, C, D, E, and G of HIV-1 have been introduced into the ROK, and subtype B is the most predominant subtype. The frequency of the a deletion in the CCR5 gene, a coreceptor of HIV-1, was less than 1% among Koreans.

A Case of Oropharyngeal Anthrax by Eating Raw Bovine Liver / 감염

An outbreak of anthrax occurred in a village of Kyungsangbookdo province in February, 1994. The source of infection was raw meat and liver from an infected cow. Among those who ate the meat or liver, 28 developed gastrointestinal anthrax, and 3 patients died. We report a patient with anthrax tonsillitis. She ate raw bovine liver. The diagnosis was confirmed by the isolation of Bacillus anthracis from a tonsillarswab. Epidemiologically anthrax in Korea occurs as an outbreak of gastrointestinal anthrax by the ingestion of beef. Gastrointestinal anthrax should be considered in the differential diagnosis of a food-borne outbreak caused by ingestion of raw bovine meat.

Seroprevalence of HIV Infection in Patients with Sexually Transmitted Diseases / 감염

To assess the prevalence of HIV infection in patients with sexually-transmitted diseases(STD), we screened STD patients who visited STD clinics in Seoul area during the period of April 1993-Octorber 1993. Blood samples were collected by unlinked anonymous method, and antibodies against HIV were screened. Fi-ve hundred and thirty patients with STD werescreened. Median age of the patients was 23 year. Male to female ratio was 1:2.8. None of the patients had HIV antibody. The prevalence of HIV infection in STD patients was estimated to be less than 5%.

A seroepidemiological study of Tsutsugamushi disease in ryral population in Korea / 감염

No abstract available.