An Assay of Measuring Platelet Reactivity Using Monoclonal Antibody against Activated Platelet Glycoprotein IIb/IIIa in Patients Taking Clopidogrel

BACKGROUND AND OBJECTIVES: Residual platelet reactivity in patients who are taking clopidogrel is commonly measured with VerifyNow assay, which is based on the principle of light transmission aggregometry. However, to evaluate the residual platelet reactivity, it would be more accurate if the reactivity of platelet glycoprotein (GP) IIb/IIIa is directly monitored. In this study, PAC1, a monoclonal antibody against activated platelet GP IIb/IIIa, was used to measure the residual platelet reactivity. SUBJECTS AND METHODS: Twenty seven patients with coronary artery disease taking clopidogrel were enrolled. Platelets in whole blood were stained with fluorescein isothiocyanate (FITC)-conjugated PAC1. Mean fluorescence intensity (MFI) and % positive platelets (PP) were measured with flow cytometry, and the binding index (BI; MFI x %PP/100) was calculated. P2Y12 reaction unit (PRU) and % inhibition of VerifyNow assay were also measured in the usual manner. RESULTS: PRU of VerifyNow assay correlated significantly with MFI, %PP, and BI at 10 microM (r=0.59, 0.73, and 0.60, respectively, all p<0.005) and 20 microM of adenosine diphosphate (ADP; r=0.61, 0.75, and 0.63, respectively, all p<0.005). The % inhibition also correlated significantly with MFI, %PP, and BI at 10 microM (r=-0.60, -0.69, and -0.59, respectively, all p<0.005) and 20 microM of ADP (r=-0.63, -0.71, and -0.62, respectively, all p<0.005). CONCLUSION: Direct measurements of the reactivity of platelet GP IIb/IIIa were feasible using PAC1 and flow cytometry in patients taking clopidogrel. Further clinical studies are required to determine the cut-off values which would define high residual platelet reactivity in patients on this treatment protocol.

Retraction: Experience of Therapeutic Plasma Exchange in Patients with Severe Fever with Thrombocytopenia Syndrome / 대한수혈학회지

In the process of obtaining the agreement of the authors while the paper submission, some authors did not consent due to a misunderstanding between the authors. We will avoid future recurrence of these things.

A Case of Acute Myeloid Leukemia Developing after Treatment for Brucellosis with Pancytopenia

Human brucellosis is an important zoonotic disease and has a wide clinical spectrum. Nonspecific hematologic abnormalities related to brucellosis are frequently found, but pancytopenia is uncommon. Malignant diseases have been infrequently reported as a rare cause of pancytopenia in patients with brucellosis. We describe a patient with brucellosis and pancytopenia who was later diagnosed with acute myeloid leukemia. A 71-yr-old man was admitted to a hospital with fever and pancytopenia. Brucella was cultured from blood, and the bone marrow findings were in accordance with brucellosis. The patient's clinical symptoms improved; however, he still showed pancytopenia after completion of medical treatment. After approximately 6 months, he was readmitted with pneumonia and pancytopenia. The second bone marrow examination revealed hypercellular marrow with increased number of blasts. The chromosome analysis showed 46,XY,trp(8)(q11.2q22)[8]/46,idem,del(7)(q22)[12]. The patient was diagnosed with acute myeloid leukemia with myelodysplasia-related changes. He refused further evaluation and therapy, and subsequently died while receiving conservative treatment.

Experience of Therapeutic Plasma Exchange in Patients with Severe Fever with Thrombocytopenia Syndrome / 대한수혈학회지

BACKGROUND: Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease recently issued in northeast Asia and China. The disease is caused by a new phlebovirus in the family Bunyaviridae, severe fever with thrombocytopenia syndrome virus (SFTSV); the transmission vector is believed to be a tick. The number of infections and resulting deaths has been increasing, but there is no effective treatment. METHODS: Clinical and laboratory features of SFTSV-positive patients during the period from May 2013 to October 2014 were reviewed retrospectively using medical records. In cases of patients who underwent therapeutic plasma exchange (TPE), the performance records were also investigated. RESULTS: During the study period, 14 patients were SFTSV-positive. The patients, who ranged in age from 47 to 82, had mostly outdoor activities before admission. The major symptoms included high fever, myalgia, and gastrointestinal symptoms. Laboratory findings showed decreased white blood cell (WBC), neutrophils and platelets and elevated activated partial thromboplastin time (aPTT), aspartate aminotransferase (AST), lactate dehydrogenase (LD), and creatine phosphokinase (CK). Two patients died during the study period, however, nine patients who received TPE showed improvement. CONCLUSION: We suppose that TPE can be used for treatment of serious SFTS and gives the effect of reducing the fatality rate.

Analysis of Fresh Frozen Plasma Usage at a Regional Hospital / 대한수혈학회지

BACKGROUND: Fresh frozen plasmas (FFPs) do not seem to be effectively managed compared to red blood cells and prophylactic transfusions of FFPs still occur in many cases. We evaluated appropriateness of FFP transfusion and analyzed the conditions of FFP usage in a regional hospital. METHODS: The conditions of FFP usage were investigated over one year from January 2012 to December 2012 using computerized medical records and archived documents. Results of coagulation tests before transfusion, appropriateness of FFP usage, and the reason for discarding FFP were investigated, and the assessment of the appropriateness of FFP transfusion was based on the transfusion guidelines published by the Korea Centers for Disease Control and Prevention. RESULTS: During the study period, 2,675 units of FFP were transfused to 364 patients over 752 episodes. FFP transfusions were inappropriate in 33.1% of episodes, and empirically used FFPs without performing pre-transfusion coagulation tests or when the test results were in the reference range occupied 25.7% of inappropriate FFP transfusions. Improper use of FFPs was most common in the Department of Emergency Medicine. During the three-year period, discarding rate of FFPs was 1.3% and the most common cause was the death or worsening condition of patients. Discarding FFPs was greatest in the Department of Thoracic Surgery and Cardiology. CONCLUSION: Many FFPs were inappropriately transfused. This was due to a general lack of understanding of the transfusion guidelines among physicians. Continuous training and education as well as ongoing monitoring of FFP usage are necessary.

Anti-inflammatory Activity of Carpinus tschonoskii Leaves Extract in R848-stimulated Bone Marrow-derived Macrophages and Dendritic Cells

The present study aims to evaluate the anti-inflammatory effect of methanol extract from leaves of Carpinus tschonoskii (CE) on R848-stimulated primary bone marrow-derived macrophages (BMDMs) and dendritic cells (BMDCs). Primary BMDMs and BMDCs were used for pro-inflammatory cytokine production. Human embryonic kidney cell line 293T (HEK293T) was used to access NF-kappaB activity. In all cases, R848 was used to stimulate the cells. The CE (0~150 microg/ml) was treated to BMDMs, BMDCs, and HEK293T cells. CE pre-treatment in R848-stimulated BMDMs and BMDCs showed a dose-dependent inhibitory effect on pro-inflammatory cytokine (e.g., IL-12 p40, IL-6, and TNF-alpha) production as compared to non-treated controls. In NF-kappaB reporter gene assay, the CE pre-treatment inhibited NF-kappaB-dependent luciferase activity in a dose-dependent manner. Overall, our findings suggest that CE has significant inhibitory effect on pro-inflammatory cytokine production and deserve further studies concerning potentials of CE for medicinal uses.

Analysis of Turnaround Times of Blood Issue at an Island Hospital / 대한수혈학회지

BACKGROUND: Transfusion service, as a task directly affecting the patient's life, must be performed as expeditiously as possible. However, for various reasons, we have experienced difficulty in supplying blood products in a timely manner. In this study, we analyzed the turnaround time (TAT) of blood issue and attempted to find a solution. METHODS: We evaluated the TATs for the request and preparation of blood transfusions in our hospital from January to December 2011. The time of blood issue, from acceptance of the request to preparation in the blood bank, was calculated from computerized medical records. In cases in which the TAT exceeded 24 hours, we investigated the type of blood component and the cause of the delay. RESULTS: A total of 12,856 units of blood were issued during the study year. Of these, 1,333 units (10.4%) had TATs exceeding 24 hours. These units included 148 units of red blood cells (RBC) (2.1%), 49 units of leukocyte-filtered red blood cells (F-RBC) (69.0%), 92 units of fresh frozen plasma (FFP) (3.9%), six units of cryoprecipitates (CRYO) (7.4%), 818 units of platelets (PLT) (27.1%), and 220 units of apheresis platelets (A-PLT) (66.5%). The preparation times for PLT and A-PLT were more delayed. The cause of the delays was lack of inventory at the blood center. CONCLUSION: We recommend that the blood center keep blood products even at the risk that they will be discarded for exceeding the expiration date. In addition, we suggest that testing of donated blood be performed within the region.

Analysis of Turnaround Times of Blood Issue at an Island Hospital / 대한수혈학회지

BACKGROUND: Transfusion service, as a task directly affecting the patient's life, must be performed as expeditiously as possible. However, for various reasons, we have experienced difficulty in supplying blood products in a timely manner. In this study, we analyzed the turnaround time (TAT) of blood issue and attempted to find a solution. METHODS: We evaluated the TATs for the request and preparation of blood transfusions in our hospital from January to December 2011. The time of blood issue, from acceptance of the request to preparation in the blood bank, was calculated from computerized medical records. In cases in which the TAT exceeded 24 hours, we investigated the type of blood component and the cause of the delay. RESULTS: A total of 12,856 units of blood were issued during the study year. Of these, 1,333 units (10.4%) had TATs exceeding 24 hours. These units included 148 units of red blood cells (RBC) (2.1%), 49 units of leukocyte-filtered red blood cells (F-RBC) (69.0%), 92 units of fresh frozen plasma (FFP) (3.9%), six units of cryoprecipitates (CRYO) (7.4%), 818 units of platelets (PLT) (27.1%), and 220 units of apheresis platelets (A-PLT) (66.5%). The preparation times for PLT and A-PLT were more delayed. The cause of the delays was lack of inventory at the blood center. CONCLUSION: We recommend that the blood center keep blood products even at the risk that they will be discarded for exceeding the expiration date. In addition, we suggest that testing of donated blood be performed within the region.

Blood Transfusion in Brain Surgery: A Comparison of Elective versus Emergency Operations / 대한수혈학회지

BACKGROUND: Blood transfusion is often performed to support successful brain surgery. In this study, we looked at two groups of surgery patients to analyze the transfusion requirements for patients undergoing brain surgery in our hospital. Group A patients received elective surgery, whereby blood products were prepared in advance, and Group B patients required emergency surgery which is often accompanied massive bleeding, and therefore adequate transfusion blood may not be available in advance. METHODS: During a one year period, patients who received brain surgery were classified as requiring either elective (Group A) or emergency (Group B) surgery. In each group, operation time and blood transfusion requirements were compared. RESULTS: Of the 35 total patients included in this study, 14 cases were Group A and 21 cases were group B. Average operation time was 4 hours and 13 minutes (253 minutes), and 2 hours and 50 minutes (170 minutes), respectively for Groups A and B. Red Blood Cell (RBC) transfusion was conducted in more than 90% of all patients. Average volume of RBC transfusion per operation was 2.5 units (Group A) and 3.1 units (Group B). Fresh frozen plasma (FFP) was transfused in 21% of Group A patients and in 38% of Group B patients. Platelet Concentrate (PC) was transfused in 19% of Group B patients, only. CONCLUSION: FFP and PC were more frequently transfused in patients who received emergency surgery than those who received elective surgery. Preparation of, not only RBC, but FFP and PC is required for emergency brain surgery. Therefore, efforts to retain adequate amounts of blood are needed to support emergency brain surgery.

Association of ENPP1 K121Q Polymorphism with Metabolic Syndrome / 가정의학회지

BACKGROUND: Metabolic syndrome is a cluster of several metabolic disorders (central obesity, dyslipidemia, hyperglycemia, and hypertension). It is closely related to the cardiovascular risk factors. ENPP1 is an inhibitor of insulin-induced activation of the insulin receptor. The aim of this study was to investigate the association between ENPP1 K121Q polymorphism and metabolic syndrome in Korean. METHODS: We measured BMI, waist circumference, blood pressure, lipid profile, fasting glucose in the participants who visited Health Promotion Center, Jeju National University Hospital from February to July 2008. ENPP1 K121Q polymorphism was determined by restriction fragment-length polymorphism polymerase chain reaction in 84 patients with metabolic syndrome and 114 control group. RESULTS: The frequencies of ENPP1 K121Q polymorphism were 27.4% in metabolic syndrome and 9.6% in control group. BMI, waist circumference, blood pressure were increased in male K121Q group and triglyceride was increased in female K121Q group. CONCLUSION: K121Q polymorphism was more frequent in the patients with metabolic syndrome among Koreans. There were differences of the metabolic components according to the genotype. It supports the K121Q polymorphism was associated with the genetic susceptibility for metabolic syndrome.

Annual Report on External Quality Assessment in Blood Bank Tests in Korea (2009) / 임상검사와정도관리

BACKGROUND: We report here the results of surveys for external quality assessment of blood bank tests performed in 2009. METHODS: Survey specimens were sent three times to 488, 491 and 490 participant institutes, and the response rates for the 1st, 2nd and 3rd trial were 97.7%, 98.0%, and 98.0%, respectively. Test items for the surveys were ABO grouping, Rh (D) typing, crossmatching, direct antiglobulin test, antibody screening and antibody identification test. RESULTS: The average accuracy rates of ABO grouping and Rh typing were 99.6-100% and 98.5-100%, respectively. In crossmatching test, the accuracy rates were 99.3-99.8% for the compatible samples, 92.7-100% for the incompatible samples, and 92.6-93.1% for the samples which could be detected as incompatible only by antiglobulin method. The accuracy rates of direct antiglobulin test were 98.5-100% for negative samples and 98.1-98.8% for positive samples. The correctresults were reported by 98.0-100% of the surveyed institutions for antibody screening test and 82.9-100% for antibody identification test. Nineteen institutions gave repeatedly incorrect answers for crossmatching test. Eight institutions out of them gave incorrect answers for all the test specimens sent out 3 times last year. CONCLUSIONS: The overall results of this survey were good, however, it is required that the institutions where the incorrect results were reported should perform corrective actions for quality improvement.

Annual Report on External Quality Assessment in Blood Bank Tests in Korea (2008) / 임상검사와정도관리

We report here the results of surveys for external quality assessment of blood bank tests performed in 2008. Survey specimens were sent three times to 460, 470 and 473 participant institutes, and the response rates for the 1st, 2nd and 3rd trial were 97.6%, 97.7%, and 97.7%, respectively. Test items for the surveys were ABO grouping, Rh (D) typing, crossmatching, direct antiglobulin test, antibody screening and antibody identification test. The average accuracy rates of ABO grouping and Rh typing were 100% and 98.3-100%, respectively. In crossmatching test, the accuracy rates were 97.5-99.7% for the compatible samples, 92.4-99.2% for the incompatible samples, and 88.2-98.9% for the samples which could be detected as incompatible only by antiglobulin method. The accuracy rates of direct antiglobulin test were 98.4-99.7% for negative samples and 93.4-99.7% for positive samples. The correct results were reported by 99.6-100% of the surveyed institutions for antibody screening test and 98.2-100% for antibody identification test. Twenty-three institutions gave repeatedly incorrect answers for crossmatching test. Ten institutions out of them gave incorrect answers for all the test specimens sent out 3 times last year.

Annual Report on External Quality Assessment in Blood Bank Tests in Korea (2007) / 임상검사와정도관리

We report here the results of external quality assessment of blood bank tests performed in 2007. Survey specimens were sent three times to 448, 450, and 455 participant institutes, and the response rates were 99.3%, 97.3%, and 98.0%, respectively. Test items for the surveys were ABO grouping, Rh(D) typing, crossmatching, direct antiglobulin test, antibody screening and identification test. The average accuracy rates of ABO grouping and Rh typing were in the range of 99.5-100% and 98.9-100%, respectively. In crossmatching test, the accuracy rates were 96.0-97.1% for the compatible samples, 89.6-92.4% for the incompatible samples, and 89.6-92.4% for the samples which could be detected as incompatible only by antiglobulin method. The accuracy rates of direct antiglobulin test were 98.0-99.7% for negative samples and 96.3-99.0% for positive samples. The correct results were reported by 95.7-100% of the surveyed institutions for antibody screening test and 98.2-100% for identification test. Fifteen institutions gave repeatedly incorrect answers for crossmatching. Five institutions out of them gave incorrect answers for all the test specimens sent out 3 times last year.

Annual Report on External Quality Assessment in Blood Bank Tests in Korea (2007) / 임상검사와정도관리

We report here the results of external quality assessment of blood bank tests performed in 2007. Survey specimens were sent three times to 448, 450, and 455 participant institutes, and the response rates were 99.3%, 97.3%, and 98.0%, respectively. Test items for the surveys were ABO grouping, Rh(D) typing, crossmatching, direct antiglobulin test, antibody screening and identification test. The average accuracy rates of ABO grouping and Rh typing were in the range of 99.5-100% and 98.9-100%, respectively. In crossmatching test, the accuracy rates were 96.0-97.1% for the compatible samples, 89.6-92.4% for the incompatible samples, and 89.6-92.4% for the samples which could be detected as incompatible only by antiglobulin method. The accuracy rates of direct antiglobulin test were 98.0-99.7% for negative samples and 96.3-99.0% for positive samples. The correct results were reported by 95.7-100% of the surveyed institutions for antibody screening test and 98.2-100% for identification test. Fifteen institutions gave repeatedly incorrect answers for crossmatching. Five institutions out of them gave incorrect answers for all the test specimens sent out 3 times last year.

Characteristics of Microorganisms Isolated from Blood Cultures at a University Hospital Located in an Island Region During 2003~2007 / 대한임상미생물학회지

BACKGROUND: The referral hospital is somewhat isolated from the mainland due to its island status; thus, microorganisms isolated from blood cultures might have a distinct pattern in their frequency and antibiogram. We attempted to uncover these characteristics. METHODS: The isolates from blood cultures at the Cheju University Hospital during 2003~2007 were analysed. After inoculation in aerobic and anaerobic bottles, blood specimens were cultured using BacT/ Alert system, and the isolates were identifieded and antimicrobial susceptibilities were tested using Vitek II system. RESULTS: The overall positive rate of blood cultures was 9.6% and contamination rate was 3.6%. The most commonly isolated pathogens were Escherichia coli, Staphylococcus aureus, and Klebsiella pneumoniae. Gram positive rod, gram negative cocci, and anaerobes were not isolated, but fungi were isolated in 0.6% of blood cultures. The prevalence of methicillin-resistant S. aureus (MRSA) was 68.0% in 2003, 41.4% in 2004, 48.1% in 2005, 54.5% in 2006, and 65.2% in 2007. The prevalence of vancomycin-resistant enterococcus (VRE) was 0% in 2003 and 2004, 16.7% in 2005, 10.0% in 2006, and 9.5% in 2007. CONCLUSION: The most commonly isolated pathogens were similar to those from other hospitals, but the isolation rates of MRSA and VRE by year showed different patterns. Also, gram positive rods, gram negative cocci and anaerobes were not isolated. To help the choice of empirical antibiotic treatments, we need complementary measures to upgrade microorganism isolation systems and further studies including the monitoring of antibiotic use.

Patterns of Antimicrobial Susceptibility of the Causative Bacteria of Urinary Tract Infections in Recent Years in an Island Region / 대한임상미생물학회지

BACKGROUND: In order to provide a guideline for empirical treatment of urinary tract infections, we studied a change in causative organisms and antimicrobial susceptibility in our region of an island. METHODS: We reviewed the results of antimicrobial susceptibility and the hospital charts of 3,064 patients with a significant bacteriuria (more than 105 colony forming unit/mL in urine cultures); the patients had been admitted to or seen at the out-patient clinic of Cheju University Hospital during the period from January 2002 to December 2005. RESULTS: The most common pathogens were Escherichia coli (44.9%), Klebsiella spp. (8.1%), and Pseudomonas spp. (7.0%). In E. coli, the mean percent resistance to ampicillin, trimethoprim-sulfamethoxazole, and ciprofloxacin during the 4-year period was 69.0%, 32.5%, and 24.7%, respectively. CONCLUSION: An increasing resistance of common urinary pathogens to known empirical agents such as ampicillin, trimethoprim-sulfamethoxazole, and ciprofloxacin caused a need for a more updated guideline in our region of an island.

Annual Report on External Quality Assessment in Blood Bank Tests in Korea (2005) / 임상검사와정도관리

We report here the results of surveys for external quality assessment of blood bank tests performed in 2005. Response rates for the 1st, 2nd and 3rd trial were 97.0%, 96.8%, and 97.1% respectively. Test items for the surveys were ABO grouping, Rh(D) typing, crossmatching, direct antiglobulin test, antibody screening and identification test. The average accuracy rates of ABO grouping and Rh typing were in the range of 99.5-100% and 99.7-100% respectively. In crossmatching test, the accuracy rates were 94.3-98.2% for the compatible samples, 88.5-92.9% for the incompatible samples, and 88.5-92.9% for the samples which could be detected as incompatible only by antiglobulin method. The accuracy rates of direct antiglobulin test were 98.9-99.3% for negative samples and 89.2-96.9% for positive samples. The correct results were reported by 98.3-100% of the surveyed institutions for antibody screening test and 98.9-100% for identification test. Seventeen institutions gave repeatedly incorrect answers for crossmatching. Thirteen institutions out of them gave incorrect answers for all the test specimens sent out 3 times last year.

Association of T Antigens with emm Genotypes of Group A Streptococci / 대한임상미생물학회지

BACKGROUND: T typing has been used as a screening test for epidemiologic studies of group A streptococci (GAS) infections or carriers, and M typing has been performed for virulence studies. However, M typing is difficult to perform in routine laboratories. Recently, genotyping of the emm gene, which encodes the M protein, has become available. We investigated which T antigen is closely associated with a certain emmgenotype. METHODS: GAS were collected from the children in Jinju who were asymptomatic carriers (N=349) or had acute pharyngitis (N=122) during the 3 year-period from 2002 through 2004. T typing was performed by a slide aggulutination, and emmgenotyping by PCR and DNA sequencing. RESULTS: More than 90% of T1, T3, T6, T12, T25, and T5/27/44 antigens were associated with emm1, emm3, emm6, emm12 and 22, emm75, and emm44/61 genotypes, respectively; however, other T antigens, such as T2, T4, T7, T11, and B3264, were not associated with any particular emm genotypes. CONCLUSION: Several T antigens are so closely associated with particular emm genotypes that one could predict emmgenotypes based on the result of T typing.

Evaluation of ADVIA Centaur HCV Assay for the Detection of Hepatitis C Virus Antibody: A Comparison Study with AxSYM HCV Version 3.0 Assay / 대한진단검사의학회지

BACKGROUND: The detection of antibody to hepatitis C virus (anti-HCV) is the most useful method to investigate past or current HCV infections. We performed a clinical evaluation of ADVIA Centaur HCV assay, a new third generation assay for the qualitative detection of IgG antibody. METHODS: Included in the study were a total of 323 samples (108 positive and 215 negative), for which HCV reverse transcription polymerase chain reaction (RT-PCR) was requested. ADVIA Centaur HCV assay (Bayer Healthcare LLC, Diagnostics Division, Tarrytown, NY, USA) was compared with a currently available and widely used AxSYM HCV version 3.0 assay (Abbott Laboratories, Abbott Park, IL, USA). Samples with discrepant results were retested with each assay, and further tested with a recombinant immunoblot assay (RIBA, LG HCD Confirm, LG Chemical Co., Seoul, Korea). Reproducibility of Centaur assay was evaluated in five groups (two samples in each group) with different index values. RESULTS: The overall concordance rate was 91.6% (296/323) between Centaur and AxSYM assays. It was 100% (108/108) in RT-PCR positive samples and 87.4% (188/215) in RT-PCR negative samples. Discrepant samples (8.4%, 27/323) were all RT-PCR negative, and all except two were Centaur negative and AxSYM positive. In discrepant samples, RIBA showed negative results except for two samples with indeterminate results. The sensitivity and specificity of Cenyaur assay were 98.1% and 65.6%, and the respective figures for AxSYM assay were 98.1% and 54.9%. Reproducibility of Centaur assay was satisfactory. CONCLUSIONS: The overall concordance between Centaur and AxSYM assays was satisfactory. Sensitivity and specificity of Centaur assay were equivalent to or better than those of AxSYM assay. ADVIA Centaur HCV assay seems to be a reliable and useful method for the detection of anti-HCV in clinical laboratories.

Clinical features of tsutsugamushi disease in Chuncheon / 대한내과학회지

BACKGROUND: Tsutsugamushi disease is an acute febrile disease in Korea. Some patients with tsutsugamushi disease have severe illness, which needs care in intensive care unit, and may die due to the disease. We analyzed the cases with tsutsugamushi disease who lived in Chuncheon and neighboring communities to find out clinical manifestations, laboratory findings especially in severe cases. METHODS: We reviewed the clinical records of the 81 cases who were diagnosed as tsutsugamushi in Chuncheon Sacred Heart Hospital from April, 1997 to December, 2002. We analyzed the clinical and laboratory findings of the 81 cases, and the treatment results of 79 cases who recieved the treatment in this hospital. We also compared the characteristics of the patients between admission to general ward and intensive care unit (ICU). RESULTS: Seventy three cases developed the disease in autumn. Seventy cases had fever. 58 cases had eschar in their bodies. With the doxycycline treatment, forty five cases subsided the fever within 48 hours, but in 13 cases, fever continued after 5 days of treatment. Twenty five cases were admitted to ICU, 8 cases among them were treated with ventilator, 3 cases died due to the multi-organ failure. When we compared the clinical characteristics of the patients admitted to ICU with those to general wards, leukocyte count, the level of BUN and creatinine were higher, the albumin level was lower in ICU patients than those of general ward patients. CONCLUSION: Tsutsugamushi disease can progress to severe disease, and be fatal to the patients. So it is necessary to diagnose early and treat carefully. We suggest that leukocyte count, BUN, creatinine, or albumin can be used to predict the prognosis.