Rapid Detection of Mycoplasma pneumoniae and Antimicrobial Susceptibilities of the M. pneumoniae Isolates

The throat swabs obtained from 1,098 adults and 432 children patients with respiratory diseases were examined for Mycoplasma pneumoniae infection detected by culture and polymerase chain reaction (PCR). Antimicrobial susceptibilities of the resulting 60 M. pneumoniae isolates were evaluated by testing minimum inhibitory concentrations (MICs) of erythromycin, minocycline, tetracycline, josamycin, sparfloxacin, ofloxacin, and ciprofloxacin by a broth micro-dilution method. In a preliminary screening, the detection rate of M. pneumoniae by PCR was 29.2% (277/948) for the adults and 28.3% (90/318) for the children. In the second survey, the isolation rate of M. pneumoniae by culture was 29.3% (44/150) for the adults, and 14.0% (16/114) for the children. The PCR detection rate was 36.7% (55/150) for the adults and 23.7% (27/114) for the children. The MIC90s of the M. pneumoniae isolates were 0.015 mg/ml for erythromycin, lower than 0.03 mg/ml for josamycin, 0.06 mg/ml for sparfloxacin and minocycline, 0.12 mg/ml for tetracycline, 0.5 mg/ml for ofloxacin and CFC-222, and 1.0 mg/ml for ciprofloxacin. The isolates were susceptible to erythromycin, josamycin, sparfloxacin, minocycline, tetracycline, and ofloxacin, but the 63.3% of them was resistant to ciprofloxacin. These results indicate that the PCR method has a significant potential as a rapid and sensitive method for early detection of M. pneumoniae infection in clinical specimens as compared with the culture method, but the PCR method could not provide any information concerning the biological chracteristics of M. pneumoniae strains. Erythromycin, josamycin, sparfloxacin, minocycline, and tetracycline could be recommended as the antimicrobial agents of choice in Korea.

A case of typhoid fever complicated with pleurisy and hepatitis / 대한내과학회지

Typhoid fever often manifests hepatic involvement but pleural involvement has rarely been reported to occur as a complication of typhoid fever. One case of typhoid pleurisy, in which Salmonella was isolated from the blood, is presented with the brief review of the literature. A 44 year old female was admitted to the hospital because of high fever, abdominal pain. Typhoid fever was diagnosed by blood culture, Widal test, and liver function test. Chest X-ray and pleural effusion examination demonstrated pleurisy. With the administration of ceftriaxone and pleural aspiration, she became afebrile with subsidence of pleural effusion.

A case of typhoid fever complicated with pleurisy and hepatitis / 대한내과학회지

Typhoid fever often manifests hepatic involvement but pleural involvement has rarely been reported to occur as a complication of typhoid fever. One case of typhoid pleurisy, in which Salmonella was isolated from the blood, is presented with the brief review of the literature. A 44 year old female was admitted to the hospital because of high fever, abdominal pain. Typhoid fever was diagnosed by blood culture, Widal test, and liver function test. Chest X-ray and pleural effusion examination demonstrated pleurisy. With the administration of ceftriaxone and pleural aspiration, she became afebrile with subsidence of pleural effusion.

A Case of Double Pylorus Associated with Chronic Bronchitis and Gastric Ulcer / 대한소화기내시경학회지

The double pylorus is a fistulous communication between gastric antrum and duodenal bulb. It appears to be an acquired lesion in the majority of cases. Upon routine endoscopic procedures, it is frequently seem to occur in males who are either alcoholics, diabetics, those with chronic renal failure, chronic lung disease. If it is no developing complications such as septal rupture, double pylorus is well response to medical treatment. A 51-year-old man who had been taking medication over a long period for the chronic bronchitis was admitted to this hospital because of epigastric soreness and indigestion for 1 month. Endosopic findings showed two large openings of the pyloric channel and gastric ulcer in the channel. We thought that this case was an acquired lesion reasult of repeated gastric ulcer. We report a case of double pylrous with the brief review of literatures.

Antibiotic Susceptibility of Helicobacter pylori and the Combination Effect of Antibiotics on the Antibiotic - Resistant H . pylori Strains

The purpose of this study was to evaluate the existence of amoxicillin, clarithromycin, and metronidazole resistance Helicobacter pylori and to determine the in-vitro MIC of two and three kinds of antibiotic concominant administration in the isolates. The antimicrobial agents tested against 169 H. pylori included metronidazole, amoxicillin, ciprofloxacin, clarithromycin, omeprazole, josamycin, erythromycin, and tetracycline. MIC of each antimicrobial agents was determined by broth microdilution method. The 169 strains of H. pylori were isolated from biopsy specimens of patients with gastric cancer. MIC50 of clarithromycin, amoxicillin, metronidazole, omeprazole, erythromycin, josamycin, tetracycline, and ciprofloxacin was 2.0, 1.0, 4.0, 8.0, 0.5, 0.5, and 0.5 ug/ml, respectively. MIC90 of clarithromycin, amoxicillin, metronidazole, omeprazole, erythromycin, josamycin, tetracycline, and ciprofloxacin was 64.0, 64,0, 32.0, 16.0, 8.0, 2.0, and 1.0 ug/ml, respectively. H. pylori isolates were detected in the following resistaince rates: 34.3% to clarithromycin, 31.9% to metronidazole, 20.7% to amoxicillin, 12.4% to erythromycin, and 10,1% to josamycin. The prevalence of the antibiotic resistant strains of H. pylori were detected 18.1% for two kind of antibiotics and 9.6% for three kind of antibiotics, and 3.9% for four kind of antibiotics. The MIC90 of clarithromycin-, metronidazole-,and amoxicillin-resistant H. pylori was decreased under the 1 ug/ ml by the two or three kind of antibiotic concomitant administration in-vitro. These results suggest that two or three antibiotics concomitant administration could be more effective for the treatment of clarithromycin-, amoxicillin-, metronidazole-, and josamycin-resistant H. pylori strains.

Incidence of Vaculating Toxin Producing Helicobacter pylori from Patients with Gastric Diseases / 대한내과학회지

OBJECTIVES: This study was carried out to survey the prevalence of Helicobacter pylori infection and the incidence of vacuolating toxin producing H. pylori. A further aim of this study was to evaluate the quantitative assay for cell vacuolation on the basis of the rapid uptake of neutral red dye by vaculoes of the cells. METHODS: We studied the gastric biopsy specimens of patients with 154 cases of gastritis, 74 cases of gastric ulcer, and 167 cases of gastric cancer and in 44 cases of healthy persons. One of the biopsy specimen was placed into a CLOtest plate for rapid urease test and the other one of the biopsy spcimen was inoculated on Brain Heart Infusion blood agar for culture. The culture supernatant of isolated H. pylori was serially diluted with BHI broth. After 24 hour incubation of cultured RK-13 cells treated with the culture supernatant of H. pylori, cytoplasmic vacuolation of the cells were observed microscopically. RESULTS: The positivity of urease test and the rate of isolation of H. pylori from urease positive gastric biopsy materials were 34.1% and 93.3% in healthy person, 55.8% and 70.9% in gastritis, 60.8% and 71.1% in gastric ulcer, and 56.3% and 96.8% in gastric cancer. The isolation rate of H. pylori from patients between 20 and 39 years old was 16.8%, for patients between 40 and 59 years old it was 51.9%, and for patients above 60 years old it was 31.2%. The isolation rate of the vacuolating toxin producing H. pylori from gastric biopsy specimens was 66.7% in a healthy person, 76.6% in gastritis, 79.4% in gastric ulcer, and 80% in gastric cancer. CONCLUSIONS: The isolation rate of H. pylori from the patients with gastric diseases is higher than the rate of H. pylori from healthy persons, but the isolation rate of the vacuolating toxin producing H. pylori is not different between the patients with gastric diseases and healthy persons. The titers of vacuolating toxin produced by some H. pylori isolated from the patients with gastric diseases are higher than those from healthy persons.

Antibiotic Susceptibility to Helicobacter pylori Isolated from Patients with Gastric Cancer

This investigation was evaluated for in vitro antibacterial activity against 169 Helicobacter pylori strains isolated from patients with gastric cancer in Pusan, Korea. The minimum inhibitory concentration (MIC) of 6 antibiotics was determined by broth microdilution method. The isolation rate of H. pylori was 39.3% in the patients with gastric cancer, and which was not observed any differences between male and female or age group. The MIC50amoxacillin, clarithromycin, and amoxacillin plus clarithromycin against H. pylori isolates was 4.0, 2.0, 0.5, 0.5, 0.5, 1.0, and 1.0 microgram/ml, respectively. The MIC50 of the metronidazole, erythromycin, ciprofloxacin, tetracycline, amoxacillin, clarithromycin, and amoxacillin plus clarithromycin against H. pylori isolates was 32.0, 16.0, 1.0, 1.0, 4.0, 16.0, and 8.0 microgram/ml, respectively. The prevalence of one kind of antibiotic resistant strains of H. pylori was 31.9% for metronidazole, 31.9% for erythromycin, 23.1% for clarithromycin, 11.2% for amoxacillin, 6.5% for ciprofloxacin, and 9.5% for amoxacillin and for clarithromycin. The prevalence of two kinds of antibiotic resistant strains of H. pylori was 8.3% for amoxacillin and clarithromycin, 4.1% for metronidazole and erythromycin, 1.3% for metronidazole and ciprofloxacin, 1.3% for erythromycin and ciprofloxacin. The prevalence of three kinds of antibiotic resistant strains of H. pylori was 5.9% for metronidazole, amoxaciltin, and ciprofloxacin, 2.4% for metronidazole, erythromycin, and ciprofloxacin. The prevalence of four kinds of antibiotic resistant strains of H. pylori was 1.3% for metronidazole, erythromycin, tetracycline, and ciprofloxacin.

A Case of Gas-forming Pyogenic Liver Abscess in a Diabetic Patient / 감염

Gas-forming pyogenic liver abscess is an uncommon, life-threatening, necrotizing infection that is usually found in poorly-controlled diabetic patients. Herein, we report a case of gas-forming liver abscess caused by Klebsiella pneumoniae, as proven by aspirated pus culture, in a 70-year old woman with diabetes mellitus. The patient was successfully managed with broadspectrum antibiotics and transhepatic percutaneous drainage and was discharged after 3 weeks of hospitalization. In conclusion, strict control of diabetes mellitus is the most important factor in the prevention of gas-forming pyogenic liver abscess.

Effect of Ginseng Extracts on Production of Vacuolating Toxin by Helicobacter pylori

This study was carried out to survey the prevalence of Helicobacter pylori infection and the incidence of vacuolating toxin producing H. pylori from the gastric biopsy specimens of patients with 178 gastritis, 57 gastric ulcer, 455 gastric cancer and 44 healthy person in Pusan, Korea. Further aim of this study was to evaluate the effect of ginseng extract, sofalcone, ginsenosides (F1, Rb3, Re, Rgl), sangwha, green, arrowroot, ginger, and jujube tea on the activity and production of vacuolating toxin by H. pylori in vitro. The isolation rates of H. pylori by culture method from gastric biopsy specimens were 34.1% in healthy person, 42.1% in gastritis, 36.8% in gastric ulcer, and 39.3% in gastric cancer. The isolation rates of vacuolating toxin producing H. pylori from gastric biopsy specimens were 80% in healthy person, 82.7% in gastritis, 81% in gastric ulcer, and 83.8% in gastric cancer. The growth of H. pylori was not influenced by the addition of 10 ug/ml or 100 ug/ml of Ginseng extract and 10 ug/ml of sofalcone in the medium, but the production of vaculating toxin of H. pylori was significantly inhibited by the addition of 100 ug/ml of Ginseng extract and sofalcone. The activity of vacuolating toxin in the culture supernatant of H. pylori was significantly diminished (1/2-1/16 compared to control) by the addition of 10 mg/ml of sangwha, green, arrowroot, and ginger tea, and 1 ug/ml of ginsenosides F1, Rb3, Re, and Rgl. These results suggest that the isolation rates of vacuolating toxin producing H. pylori were significantly higher than that of the foreign reports. Ginseng extract and sofalcone have direct inhibitory effect on the activity of vacuolating toxin production by H. pylori without considerable growth inhibition and sangwha, green, arrowroot, and ginger tea have direct inhibitory effect on the activity of vacuolating toxin of H. pylori.