Hospital-based Influenza Morbidity and Mortality (HIMM) Surveillance for A/H7N9 Influenza Virus Infection in Returning Travelers

Since 2013, the Hospital-based Influenza Morbidity and Mortality (HIMM) surveillance system began a H7N9 influenza surveillance scheme for returning travelers in addition to pre-existing emergency room (ER)-based influenza-like illness (ILI) surveillance and severe acute respiratory infection (SARI) surveillance. Although limited to eastern China, avian A/H7N9 influenza virus is considered to have the highest pandemic potential among currently circulating influenza viruses. During the study period between October 1st, 2013 and April 30th, 2016, 11 cases presented with ILI within seven days of travel return. These patients visited China, Hong Kong, or neighboring Southeast Asian countries, but none of them visited a livestock market. Seasonal influenza virus (54.5%, 6 among 11) was the most common cause of ILI among returning travelers, and avian A/H7N9 influenza virus was not detected during the study period.

Severe Influenza Treatment Guideline / 대한내과학회지

No abstract available.

Evaluation of Transnasal Esophagogastroduodenoscopy as a Surveillance Endoscopy in a General Medical Checkup

BACKGROUND/AIMS: Transnasal esophagogastroduodenoscopy (T-EGD) has been reported to be well tolerated and is known to reduce patient discomfort that occurs with conventional EGD (C-EGD) performed via an oral route. We aimed to evaluate factors that influence preferences for T-EGD as a surveillance EGD in a general medical checkup. MATERIALS AND METHODS: A total of 658 subjects (median age, 49 years; 45% men) underwent T-EGD procedures by 8 endoscopists using a 5.2-mm diameter endoscope. All examinees and endoscopists were asked to assess the T-EGD examinations using the post-endoscopy questionnaire. The post-endoscopy questionnaire included a 10-point visual analogue scale, which asked the patient to place a cross on the line according to examinee's or endoscopist's experience of the endoscopy procedure. Zero represented the worst experience and 10 the best experience. RESULTS: T-EGD was feasible in 96.6% of the subjects. Younger age ( or =35 years) or male examines preferred T-EGD as the modality for the next examination. The endoscopist's overall discomfort level was higher in the beginner group than in the expert group. CONCLUSIONS: The T-EGD may be better tolerated than C-EGD and offers a more comfortable surveillance endoscopic procedure to older (> or =35 years), male, or sedated C-EGD-experienced examinees in a general medical checkup. More experience with and education about T-EGD may help to improve the tolerance of the beginner group of endoscopists.

Guideline on the Prevention and Control of Seasonal Influenza in Healthcare Setting / 대한내과학회지

No abstract available.

Severe influenza treatment guideline

No abstract available.

Guideline on the prevention and control of seasonal influenza in healthcare setting

No abstract available.

Endoscopic Management for Colocutaneous Fistula as a Complication of Percutaneous Endoscopic Gastrostomy

Percutaneous endoscopic gastrostomy (PEG) has become a safe and effective technique for enteral feeding. Colocutaneous fistula, which is a rare complication of PEG, is thought to be formed during insertion of the original PEG tube when the colon becomes interposed between the stomach and the abdominal wall. We present a patient who developed colocutaneous fistula after PEG tube exchange. Three years ago, a PEG tube for enteral feeding was placed in a 27-year-old male with cerebral palsy and severe scoliosis. Two months after PEG tube exchange, he was admitted to our hospital because fecal material was observed in the tube and exit site. The diagnosis of colocutaneous fistula was made after injection of gastrografin in the fistula opening of the abdominal wall. Endoscopic management for the fistula opening of the colon was successfully performed using metal-clips and we were able to avoid surgical therapy for the fistula.

Incidence and Epidemiological Characteristics of 2009 Pandemic Influenza A (H1N1) Among School-Based Populations in Korea / 감염과화학요법

BACKGROUND: During the 2009 influenza pandemic in Korea, school-age children were mostly attacked by the novel influenza A virus (H1N1). Nevertheless, there is limited information on the cumulative incidence of the 2009 influenza pandemic among school populations. The aim of this study was to estimate the incidence of 2009 H1N1 influenza and influenza-like illness (ILI), and characterize the epidemiology among school-based populations in Korea. MATERIALS AND METHODS: This study analyzed the data collected by the daily school influenza reporting system for laboratory-confirmed influenza (H1N1 2009 pdm) and ILI in elementary, middle and high schools in Korea during the period, July 1 to December 20, 2009. RESULTS: Between July 1 and December 20, 2009, a total of 525,668 cases of H1N1 2009 pdm were reported from the schools analyzed. The cumulative incidence of H1N1 2009 pdm was highest in elementary school children between 8 and 13 years of age (11,058 per 100,000 population), followed by middle school students between 14 and 16 years of age (10,080 per 100,000), and high school students between 17 and 19 years of age (8,886 per 100,000). With the alignment of the epidemic curves by the three levels of school education, the age group-specific differences in the timing of the infection became apparent. The infections peaked 1 week earlier in both middle and high school students (November 3, 2009) than in elementary school children (November 10, 2009). The infections occurred an average of 7.3 [95% confidence interval(CI): 7.2-7.4] and 3.4 (95% CI: 3.3-3.5) days earlier in the middle and high school students, respectively, than elementary school children (P<0.001). The overall trend of the epidemic waves from the school reporting system data was similar to that of the national surveillance date from the Korea Centers for Disease Control and Prevention. CONCLUSIONS: This study suggests that during the 2009 pandemic, one student in every 10 was infected with H1N1 2009 pdm, which is double that estimated from the national surveillance data. In addition, middle and high school students were important drivers of H1N1 2009 pdm transmission in 2009. During the 2009 influenza pandemic, the daily school reporting system provided valuable information for estimating the incidence as well as the epidemiological characteristics in school-based populations.

Clinical Practice Guideline for Antiviral Treatment and Chemoprophylaxis of Seasonal Influenza / 감염과화학요법

Influenza, a highly communicable disease, causes variable epidemics annually and imposes public health problems and socioeconomic burden. In addition to vaccine, antiviral medication has an important role in treatment and prevention of influenza virus infection. As influenza virus is undergoing change of antigenicity and antiviral susceptibility, proper use of antiviral medication is important. This guideline encompasses treatment and chemoprophylaxis with antiviral medications for seasonal influenza based on the current influenza situation in Korea. These recommendations were intended for physicians in all medical specialties who provide care for influenza patients.

Influenza Vaccination Coverage Rate and Factors Associated with Vaccination in People with Chronic Disease / 감염과화학요법

BACKGROUND: Influenza is a serious illness that causes significant morbidity and mortality, especially in high risk patients. The purpose of this study was to investigate influenza vaccination coverage rate and perceptions of people with chronic disease on vaccination in Korea. MATERIALS AND METHODS: Patients with diabetes, chronic kidney disease undergoing hemodialysis, and asthma were surveyed. Individual interviews were performed to patients with diabetes visiting the endocrinology department in a university hospital and patients undergoing maintenance hemodialysis in 4 local clinics and 2 university hospitals. Questionnaires were mailed to patients who were registered to have asthma in a university hospital and were asked to mail back. Demographic data, history of vaccination in season 2005-2006, and perceptions on vaccination were asked. RESULTS: Five hundred and five diabetes patients, 260 hemodialysis patients and 123 asthma patients were analyzed. Influenza vaccination coverage rate was 37.4% in diabetes patients and statistically significant factors associated with vaccination were as follows: lower education level, provider recommendation, previous vaccination, belief in efficacy of vaccination. Forteen and two tenth of patients were recommended to receive influenza vaccine, and the most frequent recommenders were doctors (43.6%). Influenza vaccination coverage rate was 81.9% in patients undergoing hemodialysis and statistically significant factors associated with vaccination were as follows: provider recommendation, previous vaccination, belief in efficacy of vaccination. Sixty six and five tenth of patients were recommended to get influenza vaccination, and the most frequent recommenders were doctors (45.3%) closely followed by nurses (43.6%). Seventy and seven tenth of patients with asthma received influenza vaccination. Previous vaccination was the only statistically significant factor associated with vaccination. Sixty six and nine tenth were recommended to get a vaccination and the most frequent recommenders were doctors (39.8%). CONCLUSIONS: Influenza vaccination coverage was considerably different among different chronic illnesses. The rate was relatively high in patients with chronic kidney disease undergoing hemodialysis and asthma while it was low in patients with diabetes. The rate of vaccine recommendation was low in all patients and active recommendations by health-care workers should be made.

The Clinical Usefulness of the SD Bioline Influenza Antigen Test(R) for Detecting the 2009 Influenza A (H1N1) Virus

Though the 2009 worldwide influenza A (H1N1) pandemic has been declared to have ended, the influenza virus is expected to continue to circulate from some years as a seasonal influenza. A rapid antigen test (RAT) can aid in rapid diagnosis and allow for early antiviral treatment. We evaluated the clinical usefulness of RAT using SD Bioline Influenza Antigen Test(R) kit to detect the influenza virus, considering various factors. From August 1, 2009 to October 10, 2009, a total of 938 patients who visited the outpatient clinic at Korea University Guro Hospital with influenza-like illnesses were enrolled in the study. Throat or nasopharyngeal swab specimens were obtained from each of the patients. Using these specimens, we evaluated the influenza detection rate by rapid antigen test based on the real-time reverse-transcriptase polymerase chain reaction (rRT-PCR) method. In comparison with rRT-PCR, the sensitivity and specificity of the RAT were 44.0% and 99.9%, respectively. The cyclic threshold values of RAT negative specimens were higher than RAT positive specimens (30.1+/-3.1 vs. 28.3+/-3.9, p=0.031). The sensitivity of the RAT kit was higher in patients who visited clinics within two days of symptom onset (60.4% vs. 11.1%, p=0.026). The results of this study show that the RAT cannot be recommended for general use in all patients with influenza-like illness because of its low sensitivity. The RAT may be used, only in the settings with limited diagnostic resources, for patients who visit a clinic within two days of symptom onset.

A case of Haemophilus aphrophilus native valve endocarditis / 대한내과학회지

Haemophilus aphrophilus, a fastidious, gram-negative oropharyngeal species grouped as a HACEK organism, is a rare cause of infective endocarditis. Three cases of endocarditis with Haemophilus aphrophilus were reported in Korea, and all of them required valve replacement surgery. We describe a case of native valve infective endocarditis with cerebral embolism and infarction caused by Haemophilus aphrophilus in a 61-year-old woman who was successfully treated with antibiotic therapy for 6 weeks without valve replacement surgery.

Characteristics of Non-typhoidal Salmonella Isolates from Human and Broiler-chickens in Southwestern Seoul, Korea

Non-typhoidal Salmonella (NTS) is an important commensal microorganism. The purpose of this study was to determine the epidemiological relation between NTS isolates from livestock and NTS isolates from human by analyzing antimicrobial susceptibilities and performing molecular typing. We determined the serotypes of 36 human clinical isolates and 64 livestock isolates, performed antimicrobial susceptibility testing against 8 antibiotics, and determined the molecular types of isolated NTS spp. by pulsed field gel electrophoresis (PFGE). In human isolates, S. enteritidis was the most common serotype (17 isolates; 47.2%) and S. typhimurium the second most (8 isolates; 22.2%). In livestock isolates, S. typhimurium was the most common serotype (15 isolates; 23.44%), and S. enteritidis was the second most (14 isolates; 21.88%). Ampicillin and tetracycline resistance were 50% (32/64 isolates) each among broiler-chicken NTS isolates. No human or livestock NTS isolates showed resistance to ciprofloxacin, TMP-SMX, or ceftriaxone. However, 19.4% (7/36) and 46.8% (30/64) of the human and livestock NTS isolates were resistant to nalidixic acid (MIC > or =16 mg/mL), respectively. The presence of the three identical PFGE molecular types from human and broiler-chicken NTS isolates suggests the possibility of transmission from livestock to humans.

Persistent bacteremia and fungemia-risk factors and clinical significance / 대한내과학회지

BACKGROUDN: Persistent bloodstream infection is known to cause high mortality and a prolonged hospital stay. We performed a study examining risk factors and the clinical significance of persistent bacteremia and fungemia. METHODS: This was a case-controlled study. Medical records of patients with bacteremia or fungemia in one university hospital in Korea from May 1999 to February 2005 were retrospectively reviewed. Patients with persistent positive blood cultures regardless of antibiotic treatment for more than three days were assigned to the persistent group. Patients with positive blood cultures only on the same calendar days with the persistent group but negative on follow-up were assigned to the short-term group. RESULTS: A total of 64 patients were enrolled in the persistent group, and 146 patients in the short-term group among 1,737 patients with positive blood cultures. The persistent group was associated with previous antibiotic usage within 1 month (p=0.033), nosocomial infection (p=0.026), having an abscess (p=0.008), and infection by mixed organisms (p=0.001), independently. Candida sp. as a causative organism, treatment with inappropriate empirical antibiotics, having a central venous catheter, or ICU care at the time of blood culture was higher in the persistent group as well. The persistent group had a prolonged number of hospital-days (p=0.010), but there was no difference in mortality between the two groups. CONCLUSIONS: Patients with a persistent bloodstream infection should be assessed about previous antibiotic usage within 1 month, nosocomial infection, having an abscess, infection by mixed organisms, Candida sp. as a causative organism, treatment with inappropriate empirical antibiotics, having central venous catheter, or ICU care at the time of blood culture.

Lower Respiratory Tract Infection Caused by Respiratory Syncytial Virus in Immunocompromised Adults:2 Case Reports / 감염과화학요법

Respiratory syncytial virus (RSV) is a common etiological agent in children and infants causing pneumonia, bronchitis and bronchiolitis. RSV is rarely associated with lower respiratory tract infection in immunocompetent adults. But in immunocompromised host, the elderly and patients with cardiopulmonary cormobidities, RSV can cause life threatening infections. Nevertheless, this disease is unrecognized by most internists, in part because the possibility of RSV is not considered but also because diagnosis is difficult to make during the acute illness. Early suspicion of RSV infection is important in making accurate diagnosis and preventing unnecessary antibiotic use. The authors report two cases of RSV pneumonia: one in a 62 year old woman with multiple myeloma and the other in a 72 year old woman with malignant lymphoma.

Epidemiology and Clinical Significance of Bacteriuria Caused by Vancomycin-Resistant Enterococci / 감염과화학요법

BACKGROUND: Vancomycin-resistant enterococci (VRE) have been important pathogen of nosocomial infections and isolated most commonly from urine specimens. However, the clinical significance of VRE bacteriuria remains unknown. The objectives of this study are to describe the frequency, related factors and outcomes of VRE bacteriuria, and to compare epidemiologic data and outcomes between the subgroups: symptomatic urinary tract infection (UTI), asymptomatic bacteriuria, and colonization. MATERIALS AND METHODS: For patients with urine culture positive for VRE between August 1, 2002 and June 30, 2005, we collected clinical data and performed a retrospective analysis. According to Centers for Disease Control and Prevention (CDC), patients were classified as symptomatic UTI, asymptomatic bacteriuria, colonization and undetermined. RESULTS: Total 144 episodes (2.88%), in 58 patients, of 5,008 urine specimens were positive for VRE during the study period. Frequency of antimicrobial exposure history, especially 3rd generation cephalosporin, indwelling urinary catheter, and ICU stay at the time of culture was high in patients with VRE bacteriuria. In VRE bacteriuria, symptomatic UTI was only 24.5%. Instead the majority of the patients (71.4%) was colonized in urine with VRE or had asymptomatic bacteriuria. In comparison between symptomatic UTI group and combined group of asymptomatic bacteriuria and colonization, most demographic data and clinical features including hospital day and mortality had no significant difference except one, male sex. CONCLUSION: Most patients with VRE bacteriuria were classified as asymptomatic bacteriuria and colonization and only one-fourth of patients with VRE bacteriuria require antibiotic therapy. Therefore, clinicians should decide to initiate antibiotic therapy after consideration of clinical significance of VRE bacteriuria.

Lower Respiratory Tract Infection Caused by Respiratory Syncytial Virus in Immunocompromised Adults:2 Case Reports / 감염과화학요법

Respiratory syncytial virus (RSV) is a common etiological agent in children and infants causing pneumonia, bronchitis and bronchiolitis. RSV is rarely associated with lower respiratory tract infection in immunocompetent adults. But in immunocompromised host, the elderly and patients with cardiopulmonary cormobidities, RSV can cause life threatening infections. Nevertheless, this disease is unrecognized by most internists, in part because the possibility of RSV is not considered but also because diagnosis is difficult to make during the acute illness. Early suspicion of RSV infection is important in making accurate diagnosis and preventing unnecessary antibiotic use. The authors report two cases of RSV pneumonia: one in a 62 year old woman with multiple myeloma and the other in a 72 year old woman with malignant lymphoma.

Epidemiology and Clinical Significance of Bacteriuria Caused by Vancomycin-Resistant Enterococci / 감염과화학요법

BACKGROUND: Vancomycin-resistant enterococci (VRE) have been important pathogen of nosocomial infections and isolated most commonly from urine specimens. However, the clinical significance of VRE bacteriuria remains unknown. The objectives of this study are to describe the frequency, related factors and outcomes of VRE bacteriuria, and to compare epidemiologic data and outcomes between the subgroups: symptomatic urinary tract infection (UTI), asymptomatic bacteriuria, and colonization. MATERIALS AND METHODS: For patients with urine culture positive for VRE between August 1, 2002 and June 30, 2005, we collected clinical data and performed a retrospective analysis. According to Centers for Disease Control and Prevention (CDC), patients were classified as symptomatic UTI, asymptomatic bacteriuria, colonization and undetermined. RESULTS: Total 144 episodes (2.88%), in 58 patients, of 5,008 urine specimens were positive for VRE during the study period. Frequency of antimicrobial exposure history, especially 3rd generation cephalosporin, indwelling urinary catheter, and ICU stay at the time of culture was high in patients with VRE bacteriuria. In VRE bacteriuria, symptomatic UTI was only 24.5%. Instead the majority of the patients (71.4%) was colonized in urine with VRE or had asymptomatic bacteriuria. In comparison between symptomatic UTI group and combined group of asymptomatic bacteriuria and colonization, most demographic data and clinical features including hospital day and mortality had no significant difference except one, male sex. CONCLUSION: Most patients with VRE bacteriuria were classified as asymptomatic bacteriuria and colonization and only one-fourth of patients with VRE bacteriuria require antibiotic therapy. Therefore, clinicians should decide to initiate antibiotic therapy after consideration of clinical significance of VRE bacteriuria.

A Case Report on Cryptococcal Lymphadenitis in an Immunocompetent Adult Patient / 감염과화학요법

Cryptococcus neoformans is an organism that mainly causes opportunistic infection in immunocompromised patients. It can also cause various infections in immunocompetent patients, but cryptococcal lymphadenitis is rare. We have experienced a case of cryptococcal lymphadenitis in an immunocompetent adult patient who presented with cervical lymphadenopathy and fever that did not subside for 3 weeks. Neck and chest CT scan showed multiple lymph node enlargements with central low density and peripheral enhancement on both hilar, mediastinal, and right supraclavicular areas. Cryptococcus lymphadenitis was diagnosed by tissue biopsy, PAS and GMS stain, and culture. This case emphasizes that when an immunocompetent patient presents with lymphadenopathy, cryptococcal lymphadenitis should always be considered in the differential diagnosis.

Etiology of Adult Patients with Fever of Unknown Origin (FUO) Observed in A University Hospital in Korea from 1998-2003 / 감염과화학요법

BACKGROUND: Due to advances in various diagnostic methods, recent studies reported changes in the pattern of etiology of fever of unknown origin (FUO). To identify the current pattern of the causes of FUO, we analyzed the etiology of recently diagnosed FUO at a university hospital in Korea. MATERIALS AND METHODS: We reviewed 69 cases that fulfilled the criteria of classic FUO and retrospectively analyzed the etiology and decisive methods of diagnosis. RESULTS: The etioloies of FUO were infectious disease, non-infectious inflammatory disease, malignancy and miscellaneous cases in 22 (31.9%), 8 (11.6%), 4 (2.3%) and 21 (30.4%) patients, respectively. In 15 (21.7%) cases the cause could not be identified. Among infectious diseases, tuberculosis and suspected typhoid fever were the most common causes of infection (8 case, 11.7%) with tuberculosis being the most common confirmed infection. Adult onset Still's disease (13 cases, 4.4%) and drug-related fever (13 cases, 18.8%) were the most common cause of non-infectious inflammatory disease and miscellaneous causes, respectively. Decisive methods of final diagnosis were by observation of clinical course in 35 (64.8%), radiologic examination in 10 (18.5%), serologic or biochemical test in 5 (9.3%) and tissue biopsy in 4 (7.4%); none were diagnosed by culture. CONCLUSION: Infection remains the most common etiology of classic FUO in Korea and observing the clinical course is the most commonly used method for decisive diagnosis and its importance should be emphasized in approaching patients with FUO.