Treatment of BK virus-associated hemorrhagic cystitis with low-dose intravenous cidofovir in patients undergoing allogeneic hematopoietic cell transplantation

BACKGROUND/AIMS: BK virus (BKV) has been associated with late-onset hemorrhagic cystitis (HC) in recipients of hematopoietic stem cell transplantation (HSCT). Cidofovir has been used at higher doses (3 to 5 mg/kg/wk) with probenecid prophylaxis; however, cidofovir may result in nephrotoxicity or cytopenia at high doses. METHODS: Allogeneic HSCT recipients with BKV-associated HC are treated with 1 mg/kg intravenous cidofovir weekly at our institution. A microbiological response was defined as at least a one log reduction in urinary BKV viral load, and a clinical response was defined as improvement in symptoms and stability or reduction in cystitis grade. RESULTS: Eight patients received a median of 4 weekly (range, 2 to 11) doses of cidofovir. HC occurred a median 69 days (range, 16 to 311) after allogeneic HSCT. A clinical response was detected in 7/8 patients (86%), and 4/5 (80%) had a measurable microbiological response. One patient died of uncontrolled graft-versus-host disease; therefore, we could not measure the clinical response to HC treatment. One microbiological non-responder had a stable BKV viral load with clinical improvement. Only three patients showed transient grade 2 serum creatinine toxicities, which resolved after completion of concomitant calcineurin inhibitor treatment. CONCLUSIONS: Weekly intravenous low-dose cidofovir without probenecid appears to be a safe and effective treatment option for patients with BKV-associated HC.

Refractory Clostridium difficile Infection Cured With Fecal Microbiota Transplantation in Vancomycin-Resistant Enterococcus Colonized Patient

The rates and severity of Clostridium difficile infections, including pseudomembranous colitis, have increased markedly. However, there are few effective treatments for refractory or recurrent C. difficile infections and the outcomes are poor. Fecal microbiota transplantation is becoming increasingly accepted as an effective and safe intervention in patients with recurrent disease, likely due to the restoration of a disrupted microbiome. Cure rates of >90% are being consistently reported from multiple centers. We cured a case of severe refractory C. difficile infection with fecal microbiota transplantation in a patient colonized by vancomycin-resistant enterococcus.

Rothia aeria Infective Endocarditis: a First Case in Korea and Literature Review

No abstract available.

Was 2009 Pandemic Influenza A (H1N1) Mild Among Pregnant Korean Women? / 전남의대학술지

Clinical and laboratory data from Western countries suggest that pregnant women are at an increased risk for severe illness and complications associated with 2009 pandemic influenza A (H1N1). However, previous data among Korean women suggested a less severe outcome. In this study performed at a single referral center in Korea, rates of admission, pneumonia, intensive care unit admission, and death related to 2009 pandemic influenza A (H1N1) were significantly higher in 33 pregnant women than in 723 nonpregnant women of reproductive age (p<0.05 each). We report two cases of 2009 pandemic influenza A (H1N1) in pregnant Korean women who were admitted to the intensive care unit because of severe pneumonia that led to maternal and fetal death in one of the patients. This case series suggests that pregnant Korean women were also at increased risk of severe illness and complications during the 2009 pandemic influenza A (H1N1) outbreak.

Was 2009 Pandemic Influenza A (H1N1) Mild Among Pregnant Korean Women? / 전남의대학술지

Clinical and laboratory data from Western countries suggest that pregnant women are at an increased risk for severe illness and complications associated with 2009 pandemic influenza A (H1N1). However, previous data among Korean women suggested a less severe outcome. In this study performed at a single referral center in Korea, rates of admission, pneumonia, intensive care unit admission, and death related to 2009 pandemic influenza A (H1N1) were significantly higher in 33 pregnant women than in 723 nonpregnant women of reproductive age (p<0.05 each). We report two cases of 2009 pandemic influenza A (H1N1) in pregnant Korean women who were admitted to the intensive care unit because of severe pneumonia that led to maternal and fetal death in one of the patients. This case series suggests that pregnant Korean women were also at increased risk of severe illness and complications during the 2009 pandemic influenza A (H1N1) outbreak.

Inappropriateness of Quinolone in Scrub Typhus Treatment Due to gyrA Mutation in Orientia tsutsugamushi Boryong Strain

The use of quinolone for treatment of rickettsial diseases remains controversial. Recent clinical studies suggest that quinolone is not as effective as others in patients with rickettsial diseases including scrub typhus, although the mechanism is not well understood. In this study, we evaluated the mutation in gyrA associated with quinolone resistance. We prospectively enrolled scrub typhus patients, collected blood samples and clinical data from October, 2010 to November, 2011. Among the 21 patients enrolled, one initially received ciprofloxacin for 3 days but was switched to doxycycline due to clinical deterioration. We obtained the gyrA gene of Orientia tsutsugamushi from 21 samples (20 Boryong strain, 1 Kato strain) and sequenced the quinolone resistance-determining region. All of 21 samples had the Ser83Leu mutation in the gyrA gene, which is known to be associated with quinolone resistance. This suggests that quinolones may be avoided for the treatment of serious scrub typhus.

Lemierre Syndrome Caused by Arcanobacterium haemolyticum Alone in a Healthy Man / 전남의대학술지

Arcanobacterium haemolyticum was isolated from the blood cultures of a previously healthy 37-year-old man who met all the criteria of Lemierre syndrome, including a primary oropharyngeal infection, evidence of thrombophlebitis of the internal jugular vein, and metastatic infections. To the best of our knowledge, this is the first case of Lemierre syndrome caused by A. haemolyticum in Korea and shows that A. haemolyticum alone can cause Lemierre syndrome.

Lemierre Syndrome Caused by Arcanobacterium haemolyticum Alone in a Healthy Man / 전남의대학술지

Arcanobacterium haemolyticum was isolated from the blood cultures of a previously healthy 37-year-old man who met all the criteria of Lemierre syndrome, including a primary oropharyngeal infection, evidence of thrombophlebitis of the internal jugular vein, and metastatic infections. To the best of our knowledge, this is the first case of Lemierre syndrome caused by A. haemolyticum in Korea and shows that A. haemolyticum alone can cause Lemierre syndrome.

Endovascular Stent in Traumatic Thoracic Aortic Dissection

Traumatic thoracic aortic injury is typically fatal. However, recent improvements in pre-hospital care and diagnostic modalities have resulted in an increased number of patients with traumatic aortic injury arriving alive at the hospital. Also, the morbidity and mortality associated with endovascular repair are significantly lower than with conventional open surgery in traumatic thoracic aorta injury. We experienced two cases of successful management of traumatic thoracic aortic dissection with endovascular stents caused by traffic accidents.

A Case of Candida pelliculosa Prosthetic Valve Endocarditis Treated with Anidulafungin and Valve Replacement / 감염과화학요법

Candida pelliculosa is a rare cause of human infection. In this report, we describe a case of infective endocarditis caused by C. pelliculosa in a patient with a prosthetic heart valve. A 72-year-old female presented with a complaint of blurred vision, which she had been experiencing over a period of four weeks. Transthroasic echocardiography showed vegetation on the prosthetic mitral valve. A blood culture isolate was confirmed as C. pelliculosa.

A Case of Burkholderia cepacia Bacteremia and Infective Spondylitis, Treated with Ceftazidime and Trimethoprim-Sulfamethoxazole Combination Therapy, which did not Respond to Carbapenem Monotherapy / 감염과화학요법

Burkholderia cepacia is an aerobic gram-negative rod that causes healthcare-associated infections through contaminated disinfectants, fluids, and medical equipment. This bacterium shows resistance to various antibiotics. For this reason, available therapeutic antimicrobial agents are limited, and the optimal antimicrobial therapeutic regimen was still not well-determined in the case of infective spondylitis. We experienced a case of B. cepacia bacteremia with infective spondylitis and paraspinal abscesses which did not respond to carbapenem monotherapy, but was did respond to ceftazidime and sulfamethoxzaole/trimethoprim combination therapy.

A case of pyomyositis caused by Vibrio cholerae non-O1 in a patient with liver cirrhosis / 대한내과학회지

Vibrio cholerae non-O1 mainly causes gastroenteritis and rarely causes extraintestinal infections, such as bacteremia. Skin and soft tissue infections are also possible, but the incidence rate is very low. Although the most common cause of pyomyositis is Staphylococcus aureus, Gram-negative organisms such as Vibrio species may also cause pyomyositis in patients with chronic liver disease. Pyomyositis caused by Vibrio cholerae non-O1 has not been reported in Korea. Here, we report a case of pyomyositis caused by V. cholerae non-O1 bacteremia in a patient with liver cirrhosis following seafood exposure. This case study suggests that V. cholerae, as well as V. vulnificus, should be considered when soft tissue infections occur in patients with liver cirrhosis after seafood exposure. In addition, physicians should consider imaging studies for a prompt diagnosis if the patient complains of severe pain disproportionate to the skin manifestation.

A case of Klebsiella pneumoniae pituitary abscess cured by medical treatment / 대한내과학회지

Pituitary abscesses are rare, but potentially life-threatening. Drainage of the abscess through a transsphenoidal approach is the standard treatment for a pituitary abscess. Recently, we experienced a patient with a Klebsiella pneumoniae pituitary abscess who was cured using antibiotics, without surgery. A 52-year-old man had a chronic, persistent headache for 1 month. Magnetic resonance imaging showed a fluid collection in his pituitary fossa. Pituitary hormone tests showed mild hypopituitarism. He was put on antibiotics and discharged after 6 weeks without sequelae. An early diagnosis and adequate antibiotics treatment for this life-threatening infection can result in an excellent prognosis.

Incidence of complications and risk factors for nosocomial pneumonia in patients with tetanus / 대한내과학회지

BACKGROUND/AIMS: Tetanus is a fatal disease and various complications affect its prognosis. In Korea, tetanus cases have been reported, but no studies, thus far, have examined its complications. We investigated the complications of tetanus and analyzed the risk factors for nosocomial pneumonia, one of most common complications of tetanus. METHODS: We retrospectively reviewed the clinical features, treatment, and complications of 42 patients diagnosed with tetanus at Chonnam National University Hospital from January 1999 through June 2008. The severity of tetanus was assessed using the APACHE II and Ablett scores. We compared two groups, one with nosocomial pneumonia and the other without it, and analyzed the risk factors for nosocomial pneumonia. RESULTS: Forty-two patients (13 men, 29 women) were enrolled. Only three of them had received a primary tetanus vaccination; the others had not received primary or booster vaccinations. Twenty-one patients needed mechanical ventilation. The most common infectious complication was pneumonia (47.4%), followed by blood stream (15.8%) and urinary tract (13.2%) infections. Regarding noninfectious complications, dysautonomia was also common, including fluctuating blood pressure (31.6%), arrhythmias (26.3%), and cardiac arrest (7.9%). Nosocomial pneumonia was associated with autonomic disturbance (OR=32.0, 95% CI 1.9-524.2; p=0.005) and length of stay in the intensive care unit (OR=1.145, 95% CI 1.02-1.29; p=0.024) in the multivariate analysis. CONCLUSIONS:Careful monitoring and treatment of complications are essential in managing tetanus, along with specific therapy for tetanus itself. Education and tetanus immunization are important for preventing the disease, especially in high-risk areas.

Investigation of Prophylactic Antibiotic Usage for Interventional Radiology in Korea / 감염과화학요법

Every interventional procedure can result in infectious complication even though its incidence is very low. Increases in both indication of procedures and number of immunocompromised patients are likely to result in increase of infectious complications. However, no randomized controlled trials to evaluate the effectiveness of prophylactic antibiotics in interventional procedures have ever been performed. This study was performed to investigate the actual pattern of practice and awareness of medical providers concerning the antibiotic prophylaxis following vascular and nonvascular interventional procedures. A questionnaire regarding prophylactic antibiotic usage was sent to the interventional radiologists in 40 hospitals. A total of 12.2-30.3% responders used prophylactic antibiotics for vascular procedure. More than 80-90% of responders answered that vascular procedures except catheter insertion, are not clear indications of prophylactic antibiotics. In contrast, 31.3% and 51.5% of responders used prophylactic antibiotics for genitourinary and biliary drainage respectively. About 60-70% of responders considered both genitourinary and biliary drainage as clear indications of antibiotic prophylaxis. Further study assessing the appropriate antibiotic usage in interventional procedures is warranted.

Investigation of Prophylactic Antibiotic Usage for Interventional Radiology in Korea / 감염과화학요법

Every interventional procedure can result in infectious complication even though its incidence is very low. Increases in both indication of procedures and number of immunocompromised patients are likely to result in increase of infectious complications. However, no randomized controlled trials to evaluate the effectiveness of prophylactic antibiotics in interventional procedures have ever been performed. This study was performed to investigate the actual pattern of practice and awareness of medical providers concerning the antibiotic prophylaxis following vascular and nonvascular interventional procedures. A questionnaire regarding prophylactic antibiotic usage was sent to the interventional radiologists in 40 hospitals. A total of 12.2-30.3% responders used prophylactic antibiotics for vascular procedure. More than 80-90% of responders answered that vascular procedures except catheter insertion, are not clear indications of prophylactic antibiotics. In contrast, 31.3% and 51.5% of responders used prophylactic antibiotics for genitourinary and biliary drainage respectively. About 60-70% of responders considered both genitourinary and biliary drainage as clear indications of antibiotic prophylaxis. Further study assessing the appropriate antibiotic usage in interventional procedures is warranted.