A Quantitative Comparison of Vaccinia Virus Shedding from Conventional Dressing Sites and Vaccination Lesions after Smallpox Vaccination / 감염과화학요법

BACKGROUND: We compared vaccinia virus shedding from the vaccine inoculation site (vaccination lesion) and two sites of a dressing covering the vaccination site; the outer surface of the semipermeable dressing (outer surface) and the inner surface of the semipermeable dressing, that is, the surface of a folded gauze under the semipermeable membrane (gauze surface) MATERIAL AND METHODS: Subjects were recruited from the volunteers who participated in a clinical trial of the efficacy of a 1:10 dilution of Lancy-Vaxina? (Berna Biotech, Switzerland), and were seen every 2-3 days (days 6, 8, 10, 13, and 15 after smallpox vaccination) for scheduled dressing changes. Swab specimens were obtained from the vaccination lesion, the outer surface, and the gauze surface. Quantitative viral culture assays for these specimens were done. RESULTS: Vaccinia virus was recovered from 126 (81%) of the 156 vaccination lesion samples collected from the 40 participants. A high virus titer was recovered from the vaccination lesion (geometric mean titer (log10)=3.91 on day 8). Of the 39 swab samples obtained from the gauze surface of the gauze, 16 (41%) were positive for virus. An intermediate titer was recovered from the gauze surface (geometric mean titer (log10)=0.91 on day 8). Of the 133 swab samples obtained from the outer surface, only one (0.8%) was positive for vaccinia. No virus was recovered from the outer surface on day 8. CONCLUSION: Our findings suggest that the addition of a semipermeable dressing to the folded gauze further reduces viral shedding and therefore increases protection.

A Quantitative Comparison of Vaccinia Virus Shedding from Conventional Dressing Sites and Vaccination Lesions after Smallpox Vaccination / 감염과화학요법

BACKGROUND: We compared vaccinia virus shedding from the vaccine inoculation site (vaccination lesion) and two sites of a dressing covering the vaccination site; the outer surface of the semipermeable dressing (outer surface) and the inner surface of the semipermeable dressing, that is, the surface of a folded gauze under the semipermeable membrane (gauze surface) MATERIAL AND METHODS: Subjects were recruited from the volunteers who participated in a clinical trial of the efficacy of a 1:10 dilution of Lancy-Vaxina? (Berna Biotech, Switzerland), and were seen every 2-3 days (days 6, 8, 10, 13, and 15 after smallpox vaccination) for scheduled dressing changes. Swab specimens were obtained from the vaccination lesion, the outer surface, and the gauze surface. Quantitative viral culture assays for these specimens were done. RESULTS: Vaccinia virus was recovered from 126 (81%) of the 156 vaccination lesion samples collected from the 40 participants. A high virus titer was recovered from the vaccination lesion (geometric mean titer (log10)=3.91 on day 8). Of the 39 swab samples obtained from the gauze surface of the gauze, 16 (41%) were positive for virus. An intermediate titer was recovered from the gauze surface (geometric mean titer (log10)=0.91 on day 8). Of the 133 swab samples obtained from the outer surface, only one (0.8%) was positive for vaccinia. No virus was recovered from the outer surface on day 8. CONCLUSION: Our findings suggest that the addition of a semipermeable dressing to the folded gauze further reduces viral shedding and therefore increases protection.

Clinical Identifiers and Pathogenic Significance of Pseudomonas aeruginosa Bacteremia, in Comparison with Klebsiella pneumoniae and Enterobacter species / 감염과화학요법

BACKGROUND: To identify specific risk factors for Pseudomonas aeruginosa and evaluate the relationship between the mortality rate and P. aeruginosa bacteraemia in bloodstream infections, we compared the clinical features and outcomes of patients with P. aeruginosa bacteremia with the patients with Klebsiella pneumoniae or Enterobacter bacteremia. MATERIALS AND METHODS: A total of 190 patients with P. aeruginosa bacteremia were identified from January 1998 to December 2002 and included in this retrospective analysis. During the same period, 377 patients with K. pneumoniae bacteremia and 183 patients with Enterobacter bacteremia were identified and compared with those with P. aeruginosa bacteremia. RESULTS: Factors associated with P. aeruginosa bacteremia in the multivariate analysis included pneumonia, soft tissue infection, nosocomial acquisition, neutropenia, and prior invasive procedure (All P<0.05). The 30-day mortality rate was 37.9% (72/190) in patients with P. aeruginosa bacteremia, 24.1% (91/377) in those with K. pneumoniae, and 25.7% (47/183) in those with Enterobacter bacteremia (P<0.001). However, in the analysis including patients who had received appropriate initial antimicrobial therapy (n=552), the mortality rate of P. aeruginosa bacteremia was not significantly higher than that of non-pseudomonas bacteremia (28.6% [18/63] vs. 22.5% [110/489]; P=0.282). Inappropriate initial antimicrobial therapy was found to be one of the significant independent predictors of mortality. P. aeruginosa bacteremia as a risk factor for mortality did not reach statistical significance (OR, 1.30; 95% CI, 0.73-2.32; P=0.371), after adjusting for underlying illness and adequacy of antimicrobial therapy. CONCLUSION: An initial empirical antimicrobial coverage of P. aeruginosa should be seriously considered in patients with pneumonia, soft tissue infection, neutropenia, and prior invasive procedure, when gram-negative sepsis was suspected in nosocomial infection.

Tuberculous Lymphadenitis in Patients with Myelogenous Leukemia / 감염과화학요법

During the neutropenic phase, leukemia patients receiving chemotherapy are prone to bacterial and, fungal infections; occasionally mycobacterial, viral and protozoal organisms may also cause infections. Mycobacterium tuberculosis infection was reported very rarely in these patients. This report describes four patients with M. tuberculosis infection identified from 185 adult patients who were diagnosed myelogenous leukemia between January 2003, and December 2004. There was no patient with M. tuberculosis infection from 44 lymphoid leukemia and 11 acute biphenotypic leukemia patients. Sites of infection were all lymph nodes. Three among four patients were presented with lymphadenopathy at initial diagnosis of leukemia, and the other one presented with lymphadenopathy after induction chemotherapy. There was no patient presented with lymphadenopathy during the neutropenic phase. Tuberculous lymphadenitis was presented in a patient with three acute myelogenous leukemia (FAB class 2 M4, 1 M2) and a chronic myelogenous leukemia, accelerated phase. An acute myelogenous leukemia patient had a leukemic cell and tubercle bacilli in the same lymph node. Tuberculosis should also be included as a differential diagnosis in myelogenous leukemia patient with lymphadenopathy, especially in the countries in which the disease is endemic.

Clinical Identifiers and Pathogenic Significance of Pseudomonas aeruginosa Bacteremia, in Comparison with Klebsiella pneumoniae and Enterobacter species / 감염과화학요법

BACKGROUND: To identify specific risk factors for Pseudomonas aeruginosa and evaluate the relationship between the mortality rate and P. aeruginosa bacteraemia in bloodstream infections, we compared the clinical features and outcomes of patients with P. aeruginosa bacteremia with the patients with Klebsiella pneumoniae or Enterobacter bacteremia. MATERIALS AND METHODS: A total of 190 patients with P. aeruginosa bacteremia were identified from January 1998 to December 2002 and included in this retrospective analysis. During the same period, 377 patients with K. pneumoniae bacteremia and 183 patients with Enterobacter bacteremia were identified and compared with those with P. aeruginosa bacteremia. RESULTS: Factors associated with P. aeruginosa bacteremia in the multivariate analysis included pneumonia, soft tissue infection, nosocomial acquisition, neutropenia, and prior invasive procedure (All P<0.05). The 30-day mortality rate was 37.9% (72/190) in patients with P. aeruginosa bacteremia, 24.1% (91/377) in those with K. pneumoniae, and 25.7% (47/183) in those with Enterobacter bacteremia (P<0.001). However, in the analysis including patients who had received appropriate initial antimicrobial therapy (n=552), the mortality rate of P. aeruginosa bacteremia was not significantly higher than that of non-pseudomonas bacteremia (28.6% [18/63] vs. 22.5% [110/489]; P=0.282). Inappropriate initial antimicrobial therapy was found to be one of the significant independent predictors of mortality. P. aeruginosa bacteremia as a risk factor for mortality did not reach statistical significance (OR, 1.30; 95% CI, 0.73-2.32; P=0.371), after adjusting for underlying illness and adequacy of antimicrobial therapy. CONCLUSION: An initial empirical antimicrobial coverage of P. aeruginosa should be seriously considered in patients with pneumonia, soft tissue infection, neutropenia, and prior invasive procedure, when gram-negative sepsis was suspected in nosocomial infection.

Tuberculous Lymphadenitis in Patients with Myelogenous Leukemia / 감염과화학요법

During the neutropenic phase, leukemia patients receiving chemotherapy are prone to bacterial and, fungal infections; occasionally mycobacterial, viral and protozoal organisms may also cause infections. Mycobacterium tuberculosis infection was reported very rarely in these patients. This report describes four patients with M. tuberculosis infection identified from 185 adult patients who were diagnosed myelogenous leukemia between January 2003, and December 2004. There was no patient with M. tuberculosis infection from 44 lymphoid leukemia and 11 acute biphenotypic leukemia patients. Sites of infection were all lymph nodes. Three among four patients were presented with lymphadenopathy at initial diagnosis of leukemia, and the other one presented with lymphadenopathy after induction chemotherapy. There was no patient presented with lymphadenopathy during the neutropenic phase. Tuberculous lymphadenitis was presented in a patient with three acute myelogenous leukemia (FAB class 2 M4, 1 M2) and a chronic myelogenous leukemia, accelerated phase. An acute myelogenous leukemia patient had a leukemic cell and tubercle bacilli in the same lymph node. Tuberculosis should also be included as a differential diagnosis in myelogenous leukemia patient with lymphadenopathy, especially in the countries in which the disease is endemic.

Community-Acquired versus Nosocomial Klebsiella pneumoniae Bacteremia: Clinical Features, Treatment Outcomes, and Clinical Implication of Antimicrobial Resistance

We conducted this study to compare clinical features, outcomes, and clinical implication of antimicrobial resistance in Klebsiella pneumoniae bacteremia acquired as community vs. nosocomial infection. A total of 377 patients with K. pneumoniae bacteremia (191 community-acquired and 186 nosocomial) were retrospectively analyzed. Neoplastic diseases (hematologic malignancy and solid tumor, 56%) were the most commonly associated conditions in patients with nosocomial bacteremia, whereas chronic liver disease (35%) and diabetes mellitus (20%) were the most commonly associated conditions in patients with community-acquired bacteremia. Bacteremic liver abscess occurred almost exclusively in patients with community-acquired infection. The overall 30-day mortality was 24% (91/377), and the mortality of nosocomial bacteremia was significantly higher than that of community-acquired bacteremia (32% vs. 16%, p<0.001). Of all community-acquired and nosocomial isolates, 4% and 33%, respectively, were extended-spectrum cephalosporin (ESC)-resistant, and 4% and 21%, respectively, were ciprofloxacin (CIP)-resistant. In nosocomial infections, prior uses of ESC and CIP were found to be independent risk factors for ESC and CIP resistance, respectively. Significant differences were identified between community-acquired and nosocomial K. pneumoniae bacteremia, and the mortality of nosocomial infections was more than twice than that of community-acquired infections. Antimicrobial resistance was a widespread nosocomial problem and also identified in community-acquired infections.

Five Cases of Arcanobacterium haemolyticum Isolated from Skin Ulcer and Peritonsillar Abscess / 대한진단검사의학회지

Arcanobacterium haemolyticum is a cause of chronic skin ulcers in diabetic patients and respiratory infection, especially pharyngitis in healthy person. Less frequently, it is a cause of osteomyelitis, meningitis, pneumonia, abscess, endocarditis and sepsis. We isolated A. haemolyticum from 5 patients including foot or back ulceration in 3 diabetic patients, wound on calcaneus in a chronic osteomyelitis patient and peritonsillar abscess in a pharyngitis patient. A. haemolyticum is usually isolated with other microorganisms and coryneform bacilli which are often considered to be nonpathogenic normal flora or contaminants in wound infections. The correct diagnosis of this microorganism is important for proper treatment and prevention of serious infections.

Risk Factors for Infection and Treatment Outcome of Bloodstream Infections due to Extended Spectrum beta-Lactamases Producing Klebsiella pneumoniae / 감염과화학요법

BACKGROUND: This study was conducted to evaluate risk factors for infection and treatment outcome of bloodstream infection due to extended spectrum beta-lactamases(ESBL)-producing K. pneumoniae. METHODS: ESBL production was evaluated by NCCLS guidelines and/or double-disk synergy test in K. pneumoniae blood isolates stored from January, 1998 to April, 2002. Sixty patients with bloodstream infection due to ESBL-producing K. pneumoniae (case patients) were compared with 159 matched control patients with bloodstream infection of non-ESBL-producing K. pneumoniae. Retrospective case-control study was performed. RESULTS: There were no significant differences in age, sex, APACHE II score, and the primary site of infection between the case and control groups. In multivariate analysis, significant independent risk factors associated with bloodstream infection due to ESBL-producing K. pneumoniae were urinary catheterization, invasive procedure within previous 72 hours, and the number of antibiotics administered within previous 30 days. In clinical response at 72 hours after initial antibiotic treatment, complete response rate was higher in the controls (13.3% vs. 40.3%, respectively, P<0.001), however, treatment failure rate was higher in the cases (33.3% vs. 11.9%, respectively, P<0.001). Overall 7- day mortality rates in the cases and the controls were was 20% (12/60) and 15.7% (25/159) (P= 0.451), respectively, and overall 30-day mortality rates were 30% (18/60) and 24.5% (39/159), respectively (P=0.410). When the patients with bloodstream infection of ESBL-producing organism were evaluated and the patients who received inadequate definitive antibiotic treatment were excluded, delayed effective antibiotic treatment was found to be not associated with higher mortality. CONCLUSION: In patients infected with ESBL-producing K. pneumoniae bacteremia, clinical response rate at 72 hours after antimicrobial therapy was lower, but the increase of mortality rate was not significant. Delayed effective antibiotic treatment was not associated with higher mortality, when definitive appropriate antibiotic treatment was prescribed.

Risk Factors for Infection and Treatment Outcome of Bloodstream Infections due to Extended Spectrum beta-Lactamases Producing Klebsiella pneumoniae / 감염과화학요법

BACKGROUND: This study was conducted to evaluate risk factors for infection and treatment outcome of bloodstream infection due to extended spectrum beta-lactamases(ESBL)-producing K. pneumoniae. METHODS: ESBL production was evaluated by NCCLS guidelines and/or double-disk synergy test in K. pneumoniae blood isolates stored from January, 1998 to April, 2002. Sixty patients with bloodstream infection due to ESBL-producing K. pneumoniae (case patients) were compared with 159 matched control patients with bloodstream infection of non-ESBL-producing K. pneumoniae. Retrospective case-control study was performed. RESULTS: There were no significant differences in age, sex, APACHE II score, and the primary site of infection between the case and control groups. In multivariate analysis, significant independent risk factors associated with bloodstream infection due to ESBL-producing K. pneumoniae were urinary catheterization, invasive procedure within previous 72 hours, and the number of antibiotics administered within previous 30 days. In clinical response at 72 hours after initial antibiotic treatment, complete response rate was higher in the controls (13.3% vs. 40.3%, respectively, P<0.001), however, treatment failure rate was higher in the cases (33.3% vs. 11.9%, respectively, P<0.001). Overall 7- day mortality rates in the cases and the controls were was 20% (12/60) and 15.7% (25/159) (P= 0.451), respectively, and overall 30-day mortality rates were 30% (18/60) and 24.5% (39/159), respectively (P=0.410). When the patients with bloodstream infection of ESBL-producing organism were evaluated and the patients who received inadequate definitive antibiotic treatment were excluded, delayed effective antibiotic treatment was found to be not associated with higher mortality. CONCLUSION: In patients infected with ESBL-producing K. pneumoniae bacteremia, clinical response rate at 72 hours after antimicrobial therapy was lower, but the increase of mortality rate was not significant. Delayed effective antibiotic treatment was not associated with higher mortality, when definitive appropriate antibiotic treatment was prescribed.

A case of Sweet's syndrome with pulmonary involvement / 대한내과학회지

Sweet's syndrome is a rare disorder presenting with painful erythematous plaques or nodules of the skin with fever, leukocytosis, arthralgia and conjunctivitis.Sweet's syndrome occurs in association with malignant tumors in 10~20% of cases. Eighty five percent of the malignant tumors are hematologic malignancies, acute myelogenous leukemia being most common. Sweet's syndrome occurring in a patient with solid tumor is rare and pulmonary involvement of Sweet's syndrome occurring in a patient with a solid tumor has not been reported in world literature so far. We report a case of Sweet's syndrome presenting with pulmonary nodules in a patient with hepatocellular carcinoma.