Clinical aspects of an outbreak of Serratia marcescens infections in neonates / 소아과

PURPOSE: We evaluated an outbreak of Serratia marcescens infections in 24 neonates in a neonatal intensive care unit(NICU). METHODS: From January to August, 2004 a nosocomial outbreak of S. marcescens occurred in our NICU. We describe the clinical characteristics of the outbreak and analyse the risk factors for infections with S. marcescens. After the outbreak stopped, 7 isolates from blood were typed using rapid amplified polymorphic DNA analysis(RAPD). RESULTS: S. marcescens was isolated from 24 neonates, 19 infected and 5 colonized. Seven out of nineteen neonates had bacteremia, 4 had ventilator associated pneumonia, 4 had purulent conjunctivitis, 2 had UTI, 1 had meningitis and 1 had a wound infection. Three neonates died due to S. marcescens infection, 2 of 3 had ventilator associated pneumonia, 1 had meningitis complicated with abscess. The mortality rate of S. marcescens infection was 15.8%. Factors associated with S. marcescens infections were previous antibiotic therapy, indwelling catheter and use of ventilators. The isolated strains were resistant to most antibiotics, but frequently sensitive to imipenem, bactrim and amikacin. RAPD typing results show that at least 3 epidemic strains were related with this outbreak. But one genotype was predominant type in this outbreak. The control measures were instituted and the outbreak stopped within 2 months. CONCLUSION: S. marcescens can cause rapidly spreading outbreaks associated with fatal infections in neonates. If S. marcescens is isolated from clinical specimens, meticulous infection control measures and epidemiologic investigations should be done at an early stage of the outbreak.

Relationship between Matrix Metalloproteinase (MMP)-2, 9 Expressions and VEGF Expression and Microvessel Density in Ductal Carcinoma in Situ of the Breast

PURPOSE: MMPs are involved in the degradation of the extracellular matrix, which is an important step in tumor invasion and metastasis. Among the MMPs, a positive correlation between the expressions of MMP-2 and MMP-9, and the aggressive behavior of breast carcinomas has been reported, but the role of the MMP-2 and MMP-9 expressions in DCIS is still not known. Angiogenesis has a crucial role in tumor growth and metastasis. The aim of this study was to investigate the relationships between the expressions of the MMPs, the angiogenic factor (VEGF) and the microvessel density (MVD) in a ductal carcinoma in situ (DCIS) of the breast. METHODS: 42 cases of DCIS, diagnosed at the Busan Paik Hospital, between 1992 and 2002, were the subjects of this study. The rates of MMP-2 and 9 expressions and VEGF were evaluated using immunohistochemistry, and the MVD was measured by CD 34 immunohistochemical staining. The statistical analyses between the expressions of MMP-2, MMP-9 and VEGF and the MVD, patient's age (more than 50 years old, less than 50 years old), histological subtype (comedo or non-comedo) and nuclear grade (I, II, III), and their correlation were exained. RESULTS: The expressions of MMP-2 and MMP-9 were noted in 20 (47.6%) and 22 (52.4%) of the 42 cases, respectively. There were no significant relationships between the expressions of MMP-2 and MMP-9 and the patient's age and histological subtype, but the expression rate of MMP-9 showed an increased tendency in cases with nuclear grades II and III compared with the cases with nuclear grade I (P=0.0863), but no significant difference between the MMP-2 expression and the nuclear grades was noted. The VEGF was expressed in 47.6% of the cases, and the mean MVD was 21 per x200 field, with 13 (30.9%) of the 42 cases showing increased MVD. The VEGF expression rate showed an increasing tendency in the cases younger than 50 years old (P= 0.1011), but no significant differences according to the histological subtype and nuclear grades were seen. There were no relationships between the MVD and the clinico-pathological factors. The MVD showed an increasing tendency in cases with a non-comedo histological type compared to the comedo type (P=0.0536). No positive correlation between the expression of VEGF and MVD was noted. No significant relationship between expressions of MMP-2 and VEGF and the MVD were seen, but the rate of MMP-9 expression was significantly higher in the VEGFpositive cases (P=0.0293), however, no relationship between MMP9 expression and MVD was found. CONCLUSION: The expressions of MMP-2 and MMP-9 in DCIS are suggestive of their involvement in the development of breast cancers. However, with non-invasive lesions, and the positive correlation between the MMP-9 and VEGF expressions and the nuclear grades, means that the expression of MMP-9 may represent the biological behavior of DCIS, but the role of MMP-2 expression is still uncertain in the development of breast carcinomas.

Multidrug-resistant Salmonella typhimurium and Salmonella enteritidis identified by multiplex PCR from animals

Antibiotic resistance in Salmonella enteritidis and S. typhimurium, one of most frequent etiologic pathogens of food-borne bacterial gastroenteritidis in humans, is a serious health problem worldwide. Fifteen and 22 each of S. enteritidis and S. typhimurium were isolated from animals from 1983 to 1999 in Korea and tested for their antibiotic resistance patterns and phage types. S. enteritides isolates were highly resistant to sulfonamides (86.7%) and four of them (26.6%) showed multiple antibiotic resistance. The most frequent phage type (PT) of S. enteritids was PT1 (33.3%) even though none of them had multiple antibiotic resistance. S. typhimurium isolates were highly resistant to streptomycin, sulfonamides, and tetracycline, 100%, 95.5%, and 86.4% respectively. The incidence of multiple antibiotic resistance of S. typhimurium isolates was extremely high (100%) comparing to S. enteritidis isolates (26.7%). Two of the five ACSSuT type S. typhimurium isolates, resistant to ampicillin, chloramphenicol, streptomycin, sulfonamides, and tetracycline, were phage type DT104. All S. typhimurium isolates were sensitive to florfenicol. For the rapid detection of multiple antibiotic resistant S. enteritidis and S. typhimurium isolates, particularly ACSSuT type S. typhimurium DT104, antibiotic resistance genes, cmlA/tetR, PSE-1, and TEM, and Salmonella spp. Specific gene, SipB/C, were amplified using four pairs of primers in hot-started multiplex polymerase chain reaction. Two Korean isolates of S. typhimurium DT104 showed TEM amplicons instead of PSE-1 for the ampicillin resistance. The multiplex PCR used in this study was useful in rapid detection of ACSSuT type S. typhimurium and identification of b-lactamase gene distribution among Salmonella isolates.

Comparision of Three Trichomonas Antigens for the Detection of IgG Antibody in Serum / 대한임상미생물학회지

BACKGROUND: Direct wet mount examination of vaginal secretion, widely applied for the diagnosis of Trichomonas vaginalis infection in woman patients, is rapid and economical. However, the sensitivity of this technique is not so high. In this study enzyme-linked immunosorbent assay(ELISA) was employed for the detection of serum anti-T. vaginalis IgG antibodies from vaginal trichomoniasis patients. METHODS: Eighty sera from trichomonoasis patients who visited a Dr. Yoon Kyong's Obstetric & Gynecologic Clinic in Songnam and 30 non-infected healthy men were tested for detection of anti-T. vaginalis IgG antibody. Soluble lysate and excretory-secretory antigen prepared by mixing of six isolates of T. vaginalis, and lysate from one isolate(KT4) were used as antigen for ELISA. RESULTS: The sensitivity of ELISA using lysate of six isolates was 95.0%, and the sensitivity of the lysate from KT4 and mixed excretory-secretory antigen from 6 isolates were 86.4% and 76.3%, respectively. Specificities of ELISA by three 93.3%, 96.3% and 92.0%, respectively. CONCLUSION: It is suggested that ELISA using mixed lysate of T. vaginalis six isolates could be useful tools for the diagnosis of trichomoniasis.

A Case of a Gastric Submucosal Lymphatic Cyst Associated with Early Gastric Cancer / 대한소화기내시경학회지

A lymphatic cyst of the stomach is rare benign tumor which is composed of thin-walled lymphatic space lined by benign-appearing endothelial cells. It rarely manifests clinical symptoms, so it is found incidentally in most cases. Recently, a case of submucosal lymphatic cyst associated with early gastric cancer was experienced. An endoscopy revealed a slightly elevated, edematous lesion adjacent to the malignant ulcer. This case is herein reported with a brief review of related literature.

A Case of Inflammatory Linear Verrucous Epidermal Nevus

Inflammatory linear verrucous epidermal nevus(ILVEN) is a relatively rare skin disorder, characterized by chronic inflammatory psoriasiform pattern. This chronic skin disorder is generally believed to be resistant to various treatments, although some authors have reported success with 13-cis-retinoic acid and 585 nm pulsed laser therapy. We experienced a 15-month aged female ILVEN patient who has been suffered from linear erythematous verrucous pathes mainly located on left inguinal area, hand, and foot with persistent itching sense. This skin lesion have been developed at birth, and more spread out toward right extremity after 1 year old age . We initially treated this skin lesion with topical corticosteroids and oral anti-histamines, but this treatment was not successful. So we retreated this patient with etretinate(oral retinoid) and topical 13-cis-retinoic acids, we found that therapeutic responses to these applications were more remarkable. Now, we closely observe this patient's clinical course further more.

Detection of IgG antibodies with immunofluorescent antibody technique in human trichomoniasis

The indirect fluorescent antibody(IFA) test was used to detect serum IgG and IgM antibodies to Trichomonas vaginalis in 31 vaginal trichomoniasis, 7 candidiasis and in 20 non-infected healthy wonem with antigen prepared from axenic culture of Trichomonas vaginalis isolated from vulvovaginitis patient. The results were as follows: In 31 vaginal trichomoniasis the positive reactions of IgG antibody were 27 in the 1/8 dilution or higher and 4 in the 1/4 dilution whereas in healthy women the reaction showed signigicantly low as in the 1/4 dilution of below. The sensitivity and specificity of IFA test for IgG antibody to trichomonad antigen in this study were 87.1% and 100%, respectively. No significant difference of IgM antibody levels between vaginal trichomoniasis and healthy women was observed. No relation between the levels of IgG and IgM antibodies to trichomonad antigen by IFA test was observed. No relation between the time lapse and the level of serum IgG antibodies in IFA test of vaginal trichomoniasis was regarded. In conclusion the present study suggests that IFA test in trichomoniasis could be a useful tool for detection of anti-trichomonad IgG antibodies and applicable as an immundiagnostic method.