A Clinical and Epidemiological Analysis on an Outbreak of Typhoid Fever During 1996 Summer Through Autumn in Chunju Area / 감염

BACKGROUND: We experienced an outbreak of typhoid fever in Chunju area which manifested as severe symptoms and signs, and variable complications. To chracterize the epidemic and to identify a possible source of infection, the clinical findings of patients from the outbreak were analyzed, and the patterns of antimicrobial susceptibility and phage typing of Salmonella Typhi isolates were determined. METHODS: We analyzed a total of 232 patients from the outbreak who admitted to Chunju Presbyterian Medical Center during 1996 August through October. The medical records of the patients were reviewed retrospectively. All isolates of S. Typhi from the outbreak were analyzed for serotyping, antibiogram, and phage typing. Phage typing were performed using Vi- phages for 50 strains isolated from the patients who showed atypical clinical manifestations and unusal complications. RESULTS: The outbreak attacked mainly young femalegroup. The complications observed were: 155 casesof hepatitis, 47 pancytopenia, 20 acute pancreatitis, 13 urinary tract infection, 12 intestinal hemorrhage, 5 disseminated intravascular coagulation, 4 meningitis, 3 septic shock, 2 sensorineural hearing loss, 2 myocardial ischemia, 2 pneumonia, 1 stillbirth, and 1 death. S. Typhi were isolated in 129 cases including 111 from blood, 17 stool and 1 urine. All isolates were susceptible to all antimicrobial agents tested. All 50 isolates from severe patients with unusal complications were identified as Salmonella, serogroup D1, serotype Typhi, phage type D1. CONCLUSIONS: We experienced an outbreak of typhoid fever associated with severe, atypical symptoms and unusual complications, caused by Salmonella, serogroup D1, serotype Typhi, phage type D1.

A Case of Diabetes Insipidus Following Tuberculous Meningitis / 대한내과학회지

Tuberculous menigitis is relatively common disease and delay in treatment is associated with many neurologic sequelae. Of the neurologic disorder, diabets insipidus is extreamly rare. Diabetes insipidus is a syndrome characterized by the excretion of abnormally large volumes of dilute urine. It is divided into central diabets insipidus, nephrogenic diabetes insipidus, primary polydipsia and gestational daibetes insipidus. In this four type of diabetes insipidus, central diabetes insipidus is a polyuric disorder results from a lack of sufficient antidiuretic hormone to effect appropriate concentration of the urine for water conservration. We report a 25-year old male who had prolonged head ache and subsequently followed by polyuria. He was dia gonsed as the tuberculous meningitis by laboratory find ing and smear of CSF, and diagnosed central diabetes insipidus by serum osmolality & Na+ & AVP (arginine va sopressin), urine osmolality & specific gravity, adminis tration of vasopressin. He maintained the water balance of body by administration of vasopressin, but without im provement of mental status, sudden cardiac arrest occurs on 20th hospital day