Coinfection of Severe Fever With Thrombocytopenia Syndrome Virus and Coxiella burnetii in Developmental Stage of Hard Ticks in Subtropical Region of Korea

Background@#Severe fever with thrombocytopenia syndrome virus (SFTSV) is transmitted through tick bites. Ticks are potential vectors for the bacterium Coxiella burnetii that causes Query fever. Here, we analyzed SFTSV and C. burnetii co-infection rates in ticks in rural areas of Jeju Island, South Korea. @*Methods@#Free ticks were collected from the natural environment of the island between 2016 and 2019, and SFTSV RNA was extracted. Additionally, ribosomal RNA gene sequencing was used to identify Coxiella species. @*Results@#Haemaphysalis longicornis was the most common tick species followed by H. flava. Tick number gradually increased from April, peaked in August, and was lowest in March. Of all the collected ticks, 82.6% (2,851/3,458) were nymphs, 17.9% (639/3,458) adults, and 0.1% (4/3,458) larvae. SFTSV-infected ticks comprised 12.6% of all ticks; their numbers were the lowest in November–December, increased from January, and were mostly identified in the adult stage during June–August. C. burnetii infections were detected in 4.4% of the SFTSVinfected H. longicornis ticks. C. burnetii co-infection was mainly observed in the nymph stage of H. longicornis, with the highest infection rate in January, followed by December and November. @*Conclusion@#Our findings suggest that Jeju Island has a high SFTSV and potential C. burnetii infection in ticks. This study provides important insights regarding SFTS and Q fever risk to humans in South Korea.

Isolated Bilateral Abducens Nerve Palsy Caused by Basilar Artery Dissecting Aneurysm

Bilateral abducens nerve palsy is mediated mainly by increased intracranial pressure, accompaniment to subarachnoid hemorrhage and others, relatively direct involvement of abducens nerve nucleus or its intracranial pathway is unusual case. A 45-year-old male patient complaining of double vision showed isolated bilateral abducens palsy. Cerebral angiography revealed a dissecting aneurysm of the basilar artery. Bilateral abduction deficit has resolved after stent assisted coil embolization. We suggest that basilar artery dissecting aneurysm should be included as a cause of bilateral abducens nerve palsy.

The Utility of Three-Dimensional of the T1-Weighted MR Cholangiography with Gd-EOB-DTPA for the Evaluation of a Common Bile Duct Obstruction

PURPOSE: To prospectively assess the utility of the three-dimensional T1 weighted magnetic resonance cholangiography (MRC) with Gd-EOB-DTPA (Primovist(R)) in patients suspected of having a mild common bile duct obstruction. MATERIALS AND METHODS: A total of 30 patients suspected of having a mild common bile duct obstruction were enrolled in this study. A T2 weighted MRC and a three-dimensional T1 weighted MRC with Gd-EOB-DTPA (Primovist(R)) were performed. Within 48 h of the MRC, we performed direct cholangiographies by way of an endoscopic retrograde cholangiography and a surgical cholangiography. Reviews of the data by two experienced radiologists were in consensus. RESULTS: Within 40-60 min of the injection of contrast fluid, the contrast showed the maximum intensity within a common bile duct in 26 of the 30 patients (87%). However, the contrast was poorly visible for as long as 2 hours after injection in 4 of the 30 patients (13%). The sensitivity, specificity, as well as the positive and negative predictive values of the three-dimensional T1 weighted MR cholangiography were 92%, 40%, 88%, and 50%, respectively. CONCLUSION: The three-dimensional, T1 weighted MRC with Gd-EOB-DTPA (Primovist(R)) may be a useful ancillary diagnostic modality for evaluating a patient with mild common bile duct obstruction.

Hepatocellular Carcinoma with Neuroendocrine Differentiation: Clinical and Imaging Findings in Five Patients

PURPOSE: To describe the clinical and imaging findings of hepatocellular carcinoma with neuroendocrine differentiation, which is an extremely rare variant of hepatocellular carcinoma. MATERIALS AND METHODS: We collected five patients who had histopathologically proven hepatocellular carcinoma with neuroendocrine differentiation, and described morphologic feature, enhancement pattern of tumors, extrahepatic manifestation and clinical findings. RESULTS: At CT, the tumor size ranged from 8 to 17 cm (mean : 12 cm) in maximum diameter. The tumor margin was well-defined and smooth in four patients and all tumors were heterogeneously hypoattenuating. Four tumor showed rim enhancement on arterial and portal phases. Local invasion to the portal vein, intrahepatic duct and gallbladder were seen. Extrahepatic manifestations included hepatic metastases, lymph node metastasis. At ultrasonography, the tumor showed heterogeneously hyperechoic in all patients and hypoechoic rim was found in four patients. Of four patients who were followed up, one survived for 16 months after initial diagnosis, while the other three died within 3 months after initial diagnosis. CONCLUSION: As described above, clinical and imaging findings of hepatocellular carcinoma with neuroendocrine differentiation were not specific. However, this rare variant of hepatocellular carcinoma could be considered when hepatic tumor is found in an advanced stage and shows persistent rim enhancement at CT.

A case of reactive airway dysfunction syndrome due to chlorine gas exposure / 천식및알레르기

The reactive airway dysfunction syndrome (RADS), a subset of irritant-induced asthma, has been described following exposure to various irritant gas. We describe a case of RADS occuring following a single exposure to high levels of chlorine gas in the workplace. No documented pre-existing respiratory illness and atopy was identified. Cough, dyspnea, and wheezing were developed with the single accidental exposure to chlorine gas and methacholine provocation test was positive. He was completely recovered with the treatment of corticosteroid and oxygen therapy.