A Case of Dengue Fever Complicated by Retinitis / 감염과화학요법

Dengue fever is an acute febrile disease caused by the dengue virus. As the numbers of reported patients with dengue fever are increasing, rare complications associated with dengue fever, such as rhabodomyolysis or meningitis, are increasing in Korea. We describe the case of a Korean male presenting with fever, myalgia, nausea, diarrhea and blurred vision, who as a result of serologic test and fundoscopy, was diagnosed with dengue fever complicated by retinitis. He completely recovered with conservative care.

A Case of Necrotizing Fasciitis Caused by Raoultella ornithinolytica / 감염과화학요법

Raoultella ornithinolytica (formerly Klebsiella ornithinolytica ) is a Gram-negative aerobic bacillus which belongs to the family Enterobacteriaceae. However, human infections caused by bacteria of the genus Raoultella are uncommon and their pathogenicity is not well known yet. Herein, we report a case of necrotizing fasciitis caused by R. ornithinolytica in a 51 years old female patient who presented with erythematous swelling after a plantar puncture wound from a thumbtack.

A Case of Escherichia Coli Empyema Preceded by Acute Pyelonephritis / 감염과화학요법

We experienced a case of acute pyelonephritis which progressed to Escherichia coli bacteremia and later complicated by empyema in a 65-year-old female. She was successfully treated with intravenous antibiotic therapy and percutaneous drainage of empyema.

A Case of Escherichia Coli Empyema Preceded by Acute Pyelonephritis / 감염과화학요법

We experienced a case of acute pyelonephritis which progressed to Escherichia coli bacteremia and later complicated by empyema in a 65-year-old female. She was successfully treated with intravenous antibiotic therapy and percutaneous drainage of empyema.

A case of pylephlebitis with Streptococcus viridans and Bacteroides fragilis bacteremia secondary to diverticulitis / 대한내과학회지

Pylephlebitis, a septic thrombophlebitis of the portal vein or one of its tributaries, is a life-threatening complication of intra-abdominal infection. The causes of pylephlebitis include acute diverticulitis, appendicitis, acute cholecystitis, necrotizing pancreatitis, inflammatory bowel disease, and bowel perforation. Although pylephlebitis is an unusual complication of diverticulitis, its morbidity and mortality remain high. Therefore, early diagnosis and initiation of adequate antibiotic therapy is important for improving the long-term prognosis of patients suffering from this rare disease. We report a case of pylephlebitis with Streptococcus viridans and Bacteroides fragilis bacteremia secondary to diverticulitis with a review of the literature.

A Case of Primary Infective Endocarditis Caused by Community-Associated Methicillin-Resistant Staphylococcus aureus in a Healthy Individual and Colonization in the Family

Primary community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) endocarditis has rarely been reported in healthy individuals without risk factors, such as skin and soft tissue infections, and intravenous drug abuse. We describe a case of infective endocarditis by CA-MRSA (ST72-PVL negative-SCCmec IVA) in previously healthy individuals with no underlying medical condition and CA-MRSA colonization in the family.

A Case of Stevens-Johnson Syndrome Associated with Mycoplasma pneumoniae Pneumonia in an Adult Patient / 감염과화학요법

Stevens-Johnson syndrome is an acute mucocutaneous syndrome that is related to drugs and infections. Mycoplasma pneumoniae infection is known as one of the causes of Stevens-Johnson syndrome in children and young adults. In Korea, Mycoplasma pneumoniae infection is rarely reported as a cause of Stevens-Johnson syndrome in adults. We report a case of Stevens-Johnson syndrome associated with Mycoplasma pneumoniae pneumonia in an adult patient. A 34-years old woman was admitted to our hospital and was diagnosed with mycoplasma pneumonia. At the time of admission, she had hemorrhagic crusts on her lips. On the 2nd day of admission, target lesions also developed on her skin. We diagnosed her disease as Stevens-Johnson syndrome associated with Mycoplasma pneumoniae pneumonia. She completely recovered from pneumonia and Stevens-Johnson syndrome after treatment with antibiotics and conservative management.

A Case of Vertebral Osteomyelitis with Spinal Epidural Abscess Caused by Streptococcus constellatus / 감염과화학요법

We report a case of vertebral osteomyelitis with epidural abscess caused by Streptococcus constellatus. The patient was present with fever, back pain, and dyspnea for 1 week. The patient was previously healthy and did not have any predisposing factor. After evaluation, the patient was diagnosed as Streptococcus constellatus vertebral osteomyelitis. He was successfully treated with surgical debridement and antibiotic therapy. To the best of our knowledge, this is the first case of S. constellatus vertebral osteomyeltis with epidural abscess to be reported in Korea.

A Case of Humeral Osteomyelitis and Soft Tissue Abscess Accompanied with Streptococcus anginosus Bacteremia / 감염과화학요법

Streptococcus anginosus is a normal flora found in multiple body sites and belongs to the Streptococcus milleri group. It has often been associated with pyogenic infection, such as perio-dontitis, endocarditis, pulmonary abscess and abdominal or cerebral abscess. Also uncommonly, it can cause osteomyelitis. A 42-year-old man was admitted due to gastric ulcer perforation. At 12th hospital day, left humeral osteomyelitis and soft tissue abscess developed. Streptococcus anginosus grew in blood culture. He was treated with intravenous penicillin and surgical debridement of the necrotic tissue which lead to a satisfactory result. We report a rare case of Streptococcus anginosus-induced humeral osteomyelitis and soft tissue abscess.

A Case of Stevens-Johnson Syndrome Associated with Mycoplasma pneumoniae Pneumonia in an Adult Patient / 감염과화학요법

Stevens-Johnson syndrome is an acute mucocutaneous syndrome that is related to drugs and infections. Mycoplasma pneumoniae infection is known as one of the causes of Stevens-Johnson syndrome in children and young adults. In Korea, Mycoplasma pneumoniae infection is rarely reported as a cause of Stevens-Johnson syndrome in adults. We report a case of Stevens-Johnson syndrome associated with Mycoplasma pneumoniae pneumonia in an adult patient. A 34-years old woman was admitted to our hospital and was diagnosed with mycoplasma pneumonia. At the time of admission, she had hemorrhagic crusts on her lips. On the 2nd day of admission, target lesions also developed on her skin. We diagnosed her disease as Stevens-Johnson syndrome associated with Mycoplasma pneumoniae pneumonia. She completely recovered from pneumonia and Stevens-Johnson syndrome after treatment with antibiotics and conservative management.

A Case of Vertebral Osteomyelitis with Spinal Epidural Abscess Caused by Streptococcus constellatus / 감염과화학요법

We report a case of vertebral osteomyelitis with epidural abscess caused by Streptococcus constellatus. The patient was present with fever, back pain, and dyspnea for 1 week. The patient was previously healthy and did not have any predisposing factor. After evaluation, the patient was diagnosed as Streptococcus constellatus vertebral osteomyelitis. He was successfully treated with surgical debridement and antibiotic therapy. To the best of our knowledge, this is the first case of S. constellatus vertebral osteomyeltis with epidural abscess to be reported in Korea.

A Case of Humeral Osteomyelitis and Soft Tissue Abscess Accompanied with Streptococcus anginosus Bacteremia / 감염과화학요법

Streptococcus anginosus is a normal flora found in multiple body sites and belongs to the Streptococcus milleri group. It has often been associated with pyogenic infection, such as perio-dontitis, endocarditis, pulmonary abscess and abdominal or cerebral abscess. Also uncommonly, it can cause osteomyelitis. A 42-year-old man was admitted due to gastric ulcer perforation. At 12th hospital day, left humeral osteomyelitis and soft tissue abscess developed. Streptococcus anginosus grew in blood culture. He was treated with intravenous penicillin and surgical debridement of the necrotic tissue which lead to a satisfactory result. We report a rare case of Streptococcus anginosus-induced humeral osteomyelitis and soft tissue abscess.

A case of gas gangrene caused by Streptococcus constellatus / 대한내과학회지

Gas gangrene is usually caused by clostridial species; non-clostridial gas gangrene is infrequently reported. S. constellatus belongs to the Streptococcus milleri group, which are considered part of the normal flora and frequently associated with abscess formation. We report a rare case of spontaneous gas gangrene caused by S. constellatus. An 86-year-old man was admitted with gas gangrene of the left hip. He was treated with surgical debridement of the necrotic tissue, and antibiotic therapy, and had a satisfactory clinical course.

A case of emphysematous pyelonephritis in a non-diabetic patient / 대한내과학회지

Emphysematous pyelonephritis is characterized by acute necrotizing renal parenchymal infection with gas formation. It is a serious, life-threatening infection that tends to occur in patients with diabetes mellitus and/or urinary tract obstruction. Early diagnosis and prompt intervention combined with surgical and medical treatment are required for survival. In Korea, there have been a number of cases of emphysematous pyelonephritis reported in patients with diabetes mellitus or urinary tract obstruction. We describe a case of emphysematous pyelonephritis in a patient without diabetes mellitus or urinary tract obstruction.

Pseudooutbreak of Acinetobacter spp. Bacteriuria Confirmed by 16S rRNA Gene Sequence Analysis / 감염과화학요법

BACKGROUND: Acinetobacter spp. is increasingly implicated in hospital-acquired infections. We experienced a pseudooutbreak of Bordetella bronchiseptica bacteriuria identified with biochemical tests, that was later identified as Acinetobacter spp. by using 16S rRNA gene sequence analysis. MATERIALS AND METHODS: Five in-ward patients were found to have B. bronchiseptica bacteriuria without symptoms of urinary tract infection between September 23 and 26 of 2005. We conducted pulsed field gel electrophoresis (PFGE) of the bacteria and epidemiological investigation of this pseudooutbreak. In addition, 16S rRNA gene sequence analysis was performed for the verification of the strains. RESULTS: All 5 isolates were identified as B. bronchiseptica with similar antibiogram by VITEK system. There was no evidence of any symptom or sign of urinary tract infection. The source of this pseudooutbreak was not detected even after performing environmental culture and interviews with healthcare workers. We could not get the appropriate results from the first PFGE with XbaI restriction enzyme. B. bronchiseptica is an unusual organism in human so we conducted 16S rRNA gene sequence analysis for verification. The analysis of 16S rRNA gene sequence with 5 isolates demonstrated 99-100% similarity to a sequence of Acinetobacter spp. (AU1523). According to the results of 16S rRNA gene sequence analysis, we performed the second PFGE with SmaI restriction enzyme, which showed indistinguishable pattern among the all 5 isolates. CONCLUSION: This investigation suggests that the combined method of 16s rRNA gene sequence analysis and PFGE would be helpful for investigation of outbreak caused by unusual organisms

A Case of Acute Pyelonephritis Caused by Community Acquired Methicillin-Resistant Staphylococcus aureus / 감염과화학요법

In the past decade, methicillin-resistant staphylococcus aureus (MRSA) have emerged in the community, causing serious infection in young and healthy persons without established risk factors for MRSA acquisition. This community acquired methicillin- resistant S. aureus (CA-MRSA) has been usually reported to cause the skin and soft tissue infection and necrotizing pneumonia. We have experienced a case of acute pyelonephritis caused by CA-MRSA without health care-associated risk factors. The staphylococcal cassette chromosome mec (SCCmec) typing and multilocus sequence typing (MLST) revealed the ST5- MRSA-IV clone, which showed SCCmec type IV and MLST allelic profile of ST5 (1-4-1-4-12-1-10).

A Case of Spondylodiskitis Caused by Injection Site Infection with Methicillin-Resistant Staphylococcus aureus / 감염과화학요법

Infections of the intervertebral disc and adjacent vertebrae may present with spondylitis, discitis and spondylodiscitis and are hematogenous origin in most cases. Potential sources of hematogenous infection are skin and soft tissue infection, genitourinary tract infection, infective endocarditis, intravenous drug abuse, respiratory tract infection and infected intravenous injection site. We have experienced a case of pyogenic spondylitis caused by methicillin-resistant Staphylococcus aureus (MRSA) bacteremia with peripheral injection site infection. He was successfully treated with surgical debridement and antibiotics.

A Case of Adult Hemorrhagic Varicella with Pneumonia / 감염과화학요법

Chickenpox is a common benign childhood disease caused by varicella-zoster virus, typically associated with fever and a characteristic exanthematous vesicular rash. The clinical manifestations in adults are more severe and more commonly complicated with varicella pneumonia. Hemorrhagic varicella, also called malignant chickenpox, is very rare and potentially fatal. Bleeding can occur in the form of hemorrhages within the rash and surrounding skin or within the mucous membrane. We report a case of hemorrhagic varicella complicated with pneumonia in a immunocompromised host. We emphasize on the successful treatment with continuous acyclovir infusion.

Pseudooutbreak of Acinetobacter spp. Bacteriuria Confirmed by 16S rRNA Gene Sequence Analysis / 감염과화학요법

BACKGROUND: Acinetobacter spp. is increasingly implicated in hospital-acquired infections. We experienced a pseudooutbreak of Bordetella bronchiseptica bacteriuria identified with biochemical tests, that was later identified as Acinetobacter spp. by using 16S rRNA gene sequence analysis. MATERIALS AND METHODS: Five in-ward patients were found to have B. bronchiseptica bacteriuria without symptoms of urinary tract infection between September 23 and 26 of 2005. We conducted pulsed field gel electrophoresis (PFGE) of the bacteria and epidemiological investigation of this pseudooutbreak. In addition, 16S rRNA gene sequence analysis was performed for the verification of the strains. RESULTS: All 5 isolates were identified as B. bronchiseptica with similar antibiogram by VITEK system. There was no evidence of any symptom or sign of urinary tract infection. The source of this pseudooutbreak was not detected even after performing environmental culture and interviews with healthcare workers. We could not get the appropriate results from the first PFGE with XbaI restriction enzyme. B. bronchiseptica is an unusual organism in human so we conducted 16S rRNA gene sequence analysis for verification. The analysis of 16S rRNA gene sequence with 5 isolates demonstrated 99-100% similarity to a sequence of Acinetobacter spp. (AU1523). According to the results of 16S rRNA gene sequence analysis, we performed the second PFGE with SmaI restriction enzyme, which showed indistinguishable pattern among the all 5 isolates. CONCLUSION: This investigation suggests that the combined method of 16s rRNA gene sequence analysis and PFGE would be helpful for investigation of outbreak caused by unusual organisms

A Case of Acute Pyelonephritis Caused by Community Acquired Methicillin-Resistant Staphylococcus aureus / 감염과화학요법

In the past decade, methicillin-resistant staphylococcus aureus (MRSA) have emerged in the community, causing serious infection in young and healthy persons without established risk factors for MRSA acquisition. This community acquired methicillin- resistant S. aureus (CA-MRSA) has been usually reported to cause the skin and soft tissue infection and necrotizing pneumonia. We have experienced a case of acute pyelonephritis caused by CA-MRSA without health care-associated risk factors. The staphylococcal cassette chromosome mec (SCCmec) typing and multilocus sequence typing (MLST) revealed the ST5- MRSA-IV clone, which showed SCCmec type IV and MLST allelic profile of ST5 (1-4-1-4-12-1-10).