RESUMO
Hairy cell leukemia (HCL) is a rare chronic B cell leukemia morphologically characterized by cells with an abundant cytoplasm and hair-like projections that can be found in the peripheral blood and bone marrow. The treatment for HCL is splenectomy or chemotherapy with the purine analogs pentostatin and cladribine. However, patients continue to relapse. Retreatment with the same or alternate purine analogs produces lower response rates and a shorter duration of response. Fludarabine is another purine analog widely used in treating indolent lymphoid cancers, often in combination with rituximab. Here, we report a case of HCL variant in a 60-year-old man who experienced multiple relapses after splenectomy and retreatment with cladribine. The patient was then treated with fludarabine and rituximab combination chemotherapy. After the treatment, he achieved complete remission that continued for 35 months.
Assuntos
Humanos , Pessoa de Meia-Idade , Medula Óssea , Cladribina , Citoplasma , Tratamento Farmacológico , Quimioterapia Combinada , Leucemia de Células B , Leucemia de Células Pilosas , Pentostatina , Recidiva , Retratamento , Rituximab , EsplenectomiaRESUMO
Blood culture is important to detecting bacteremia and fungemia in patients with suspected sepsis. We observed a four-year trend of blood culture isolates in the frequency by age group and in vitro antimicrobial susceptibility patterns obtained at VHS Medical Center, the largest veterans hospital in Korea. Blood cultures collected between 2012 and 2015 were analysed retrospectively. Of 68,352 blood specimens, 7,901 isolates were identified during the study period. Seventy-two percent of the isolates were gram-positive cocci, 18% were gram-negative rods, and 6% were fungi. The frequency of bacteremia/fungemia in patients who were 80–89 years old was 43.8%, the highest rate among all age groups, and the mean age of patients diagnosed by blood culture was 77 years old. Coagulase-negative staphylococcus (52.3%), Staphylococcus aureus (8.3%), enterococci (7.5%), Escherichia coli (6.4%), and Klebsiella pneumoniae (3.9%) were the bacteria most commonly isolated. The percentage of methicillin-resistant S . aureus increased in 2015 (76%) relative to that in 2012–2014 (63%–65%), and that of vancomycin-resistant Enterococcus faecium was 17%–22% with no significant changes through time. Among the gram-negative isolates, the ciprofloxacin resistance rate increased to 51.4% (E. coli ) and 31.1% (K. pneumoniae ) in 2015, but imipenem or ertapenem resistance was still very rare, with resistance rates of less than 0.5%. Acinetobacter baumannii showed a high rate of resistance (over 70%) to imipenem and ciprofloxacin throughout the study. In Pseudomonas aeruginosa , the resistance rates of imipenem and ciprofloxacin increased dramatically over time. This analysis confirmed a decrease in antimicrobial susceptibility of gram-negative rods isolated by blood culture.
Assuntos
Humanos , Acinetobacter baumannii , Bacteriemia , Bactérias , Ciprofloxacina , Enterococcus faecium , Escherichia coli , Fungemia , Fungos , Cocos Gram-Positivos , Hospitais de Veteranos , Imipenem , Técnicas In Vitro , Klebsiella pneumoniae , Coreia (Geográfico) , Resistência a Meticilina , Pneumonia , Pseudomonas aeruginosa , Estudos Retrospectivos , Sepse , Staphylococcus , Staphylococcus aureus , VeteranosRESUMO
Polycythemia vera is a hematopoietic stem cell disease, characterized by sustained and excessive proliferation of erythrocytic, granurocytic and megakaryocytic cells in the bone marrow resulting in pancytosis in peripheral blood. There have been a few reports of glomerulonephritis with polycythemia vera, most of which were IgA nephropathy. We report a case of a polycythemia vera associated with proteinuria. We confirmed the polycythemia vera according to World Health Organization criteria. Renal pathology showed IgA nephropathy and minimal change disease. Periodic phlebotomy was done and hydroxyurea was administered without specific managements for renal disease. After 3-month treatment, hemoglobin level decreased and proteinurea disappeared.
Assuntos
Humanos , Medula Óssea , Glomerulonefrite , Glomerulonefrite por IGA , Células-Tronco Hematopoéticas , Hemoglobinas , Hidroxiureia , Imunoglobulina A , Nefrose Lipoide , Flebotomia , Policitemia , Policitemia Vera , Proteinúria , Organização Mundial da SaúdeRESUMO
BACKGROUND: In this study, we evaluated the BACTEC MGIT 960 system (Becton Dickinson Microbiology Systems, Sparks, Md, USA), which is fully automated, noninvasive and nonradiometric fluorescent indicator broth detection system, for the growth and detection of mycobacteria with body fluid specimens. METHODS: Total of 1,891 body fluid specimens were included (pleural fluid 752, ascitic fluid 629, cerebrospinal fluid 214, joint fluid 79, peritozol 54, others 163). Specimens were inoculated into MGIT and solid media (3% ogawa, Japan). Polymerase chain reaction was performed for the discrimination of Mycobacterium tuberculosis from Mycobacterium other than tuberculosis (MOTT). RESULTS: A total of 62 isolates of mycobacteria were recovered from all culture system. With MGIT system, 56 isolates were recovered, compared with solid system recovered 33 isolates. 29 isolates were recovered with MGIT only and 6 isolates recovered with solid media only. Among 62 isolates recovered, 11 isolates were positive in acid fast stain. 10 isolates were recovered with MGIT. One isolate was recovered with solid system. 51 isolates were negative in acid fast stain. Among this, 46 isolates were recovered with MGIT. The mean detection time was 14.2 days with MGIT system, and 38.2 days with solid media. Contamination rate for each system with body fluid specimens were 4.1% for MGIT and 1.7% for solid media. CONCLUSION: In body fluid, the MGIT system has the advantages of improved detection rate and rapid recovery than solid media to recover mycobacteria.
Assuntos
Líquido Ascítico , Líquidos Corporais , Líquido Cefalorraquidiano , Discriminação Psicológica , Articulações , Mycobacterium , Mycobacterium tuberculosis , Reação em Cadeia da Polimerase , TuberculoseRESUMO
BACKGROUND: Multidrug resistant tuberculosis (MDRTB) strains rely on the prompt availability of drug susceptibility test results. We evaluated the reliability and turnaround time of MGIT 960 system, automated version of the MGIT, for antimicrobial susceptibility test of Mycobacteria tuberculosis. METHODS: Ninety six isolates have been tested for susceptibility to isoniazid (INH), rifampin (RIF), ethambutol (EMB) and streptomycin (SM). Results were compared with those obtained by traditional solid media (absolute concentration method, indirect method). RESULTS: There was no statistically significant difference between the susceptibility testing results of the two methods except for EMB. Discrepant results were obtained for 8 isolates (8.3%) with INH, for 3 isolates (3.1%) with RIF, for 13 isolates (13.5%) with EMB, for 10 isolates (10.4%) with SM. Using the indirect method as the gold standard, the sensitivity of INH, RIF, EMB and SM susceptibility testing by the MGIT system were 94.1%, 98.8%, 86.7% and 90.0%, respectively. The specificity were 85.7%, for INH and RIF and 83.3%, for EMB and SM. Turnaround times were significant shorter in MGIT (average 12 days) than in solid media (average 57 days) (P < 0.05) CONCLUSIONS: These data demonstrate that the MGIT system is accurate and rapid for INH, RIF and SM susceptibility test of M. tuberculosis, but EMB susceptibility testing requires further evaluation.
Assuntos
Etambutol , Isoniazida , Mycobacterium tuberculosis , Mycobacterium , Rifampina , Sensibilidade e Especificidade , Estreptomicina , TuberculoseRESUMO
BACKGROUND: We evaluated the BACTEC MGIT 960 system(Becton Dickinson Microbiology Systems, Sparks, Md, USA), which is a fully automated, noninvasive and nonradiometric fluorescent indicator broth detection system for the growth and detection of mycobacteria with a capacity to incubate and continuously monitor 7 ml MGIT(Mycobacterium growth indicator tube) culture tube. METHODS: We studied 1,690 specimens(1,258 respiratory and 432 non-respiratory specimens). Processed specimens with 2% NaOH-NALC(final NaOH concentration: 1%) were inoculated into MGIT and solid media(3% Ogawa, Japan). Polymerase chain reaction was performed for the discrimination of Mycobacterium tuberculosis complex from Mycobacterium other than tuberculosis(MOTT). RESULTS: From all culture system, a total of 181 isolates of mycobacteria were recovered. The greatest number of isolates of mycobacteria was recovered with MGIT 960 system(174, 96.1%), followed by solid media(73, 40.3%). 108 isolates(59.7%) were recovered with MGIT only and 7(3.9%) recovered with solid media only( P value < 0.0001). From a total of 1,617 AFB smear negative specimens, 101(6.3%) were recovered with MGIT 960 system and 34(2.1%) recovered with solid media. The mean times to detection were average 11.1 days for MGIT 960 system and 31.6 days for solid media(P value < 0.0001). Contamination rates for each system were 14.9% for MGIT 960 and 2.6% for solid media. CONCLUSIONS: The newly introduced MGIT 960 system is easy to use and has advantages of high detection rate and rapid recovery than solid media, but there are some problems such as high contamination rate and high cost in the management of this liquid system.
Assuntos
Discriminação Psicológica , Mycobacterium , Mycobacterium tuberculosis , Reação em Cadeia da PolimeraseRESUMO
BACKGROUND: The recently developed nucleic acid amplification methods may provide us with very sensitive, specific and rapid tests for the detection of M. tuberculosis. So the aim of this study was to compare the commercial Amplicor M. tuberculosis kit and our in-house polymerase chain reaction (PCR) with the conventional culture and direct AFB staining method. Materials and METHODS: Among the total of 2,340 clinical specimens, 1,314 sputum samples were tested for the presence of M. tuberculosis by Amplicor PCR and 1,026 sputum samples were tested by in-house PCR performing with resin matrix preparation and DNA extraction, synthesized primer pair, detection using agarose gel electrophoresis. RESULTS: One hundred-seventeen specimens were positive by Amplicor PCR, 105 were positive by in-house PCR, 185 were positive by culture. The sensitivity of the Amplicor PCR for all of the specimens and for smear-positive and smear-negative specimens was 92.9%, 97.9% and 88.2%, respectively after discrepant analysis. The sensitivity of the in-house PCR for all of the specimens and for smear-positive and smear-negative specimens was 80.0%, 93.6% and 65.5%, respectively after discrepant analysis. The specificity of the Amplicor PCR and in-house PCR for all of the specimens was 97.9% and 99.0%, respectively. CONCLUSIONS: Amplicor PCR was more sensitive than in-house PCR, but there was another problems such as high false positive rate and high cost. So PCR may certainly become very useful in microbiological laboratories if PCR method is selected according to the laboratory conditions.
Assuntos
DNA , Eletroforese em Gel de Ágar , Mycobacterium tuberculosis , Mycobacterium , Reação em Cadeia da Polimerase , Sensibilidade e Especificidade , Escarro , TuberculoseRESUMO
BACKGROUND: In many developing countries, typhoid fever remains an important cause of morbidity and mortality. In Korea, the disease is endemic with a high incidence. For an effective surveillance for this important human disease, the availability of detailed and accurate data on the molecular epidemiology of Salmonella typhi is crucial. In the present study, the pulsed-field gel electrophoresis (PFGE) technique, which has been used successfully to perform a comparative chromosomal DNA analysis, was used to assess the extend of molecular diversity among the strains of S. typhi isolated in Korea. METHODS: Included in the study were 51 strains of S. typhi isolated at Asan Medical Center (during the period from 1989 to 1996) and 16 isolates from other hospitals in Seoul, Chunbuk, Kyungpook, Pusan, Chonbuk and Chonnam. The isolates were analyzed by PFGE following XbaI digestion of DNA. PFGE patterns were assigned arbitrary types, compared by calculating a similarity coefficient and analyzed to generate dendrogram. RESULTS: PFGE analysis produced multiple patterns consisting of 15 to 19 fragments ranging in size 20 to 600 kb. These were arbitarily assigned 7 types, A, B, C, D, E, F, and G, and 5 and 10 subtypes within A and B, respectively. Of 54 isolates from Seoul, 9 showed the identical PFGE pattern, indicating that an outbreak of typhoid fever had occurred. Many of the identical patterns were also shared between isolates from Seoul and other areas. Similarity coefficient was between 0.606 and 1.0. CONCLUSIONS: Although a considerable genetic diversity exists among S. typhi isolates from different areas in Korea, suggesting a sporadic occurrence of typhoid fever, the identical PFGE patterns were also found among isolates from the same geographical areas of Seoul, indicating that some outbreaks had occurred. More efforts should be directed toward the epidemiological investigation of the cases to detect outbreaks and prevent further spread of the infection. The findings that many PFGE patterns are present among the Korea isolates of S. typhi suggest that PFGE may be used effectively with a considerable degree of discriminating power for the epidemiological investigation of typhoid fever.
Assuntos
Humanos , Países em Desenvolvimento , Digestão , Surtos de Doenças , DNA , Eletroforese em Gel de Campo Pulsado , Variação Genética , Incidência , Coreia (Geográfico) , Epidemiologia Molecular , Mortalidade , Salmonella typhi , Salmonella , Seul , Febre TifoideRESUMO
The thalassemias are congenital disorders in which globin chains are present in decreased amount or absent. Beta-thalassemia, a quite common disorder in Central Africa, the Middle East, and Southeast Asia, has been reported sporadically in Korea since 1988, and some mutations have been identified. We recently analyzed the beta-gene complexes of a family diagnosed with beta-thalassemia minor. The patient was a 20-year-old female who visited our hospital because of anemia and jaundice since her childhood. Through blood tests and hemoglobin electrophoresis, she was diagnosed as having beta-thalassemia minor. Subsequently, DNAs from the patient and her parents were analyzed in search of mutations in beta-gene complex. It was revealed that the patient and her father, a 50-year-old male, have G to A substitutions at position 1 in the second intervening sequence (IVS II-1, G-->A). The mutation was associated with silent mutation of C to T substitution at the codon 91 (CTG-->TTG). To our knowledge, this mutation has not been previously reported in Korea.
Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , África Central , Anemia , Sudeste Asiático , Talassemia beta , Códon , Doenças e Anormalidades Congênitas, Hereditárias e Neonatais , DNA , Eletroforese , Pai , Globinas , Testes Hematológicos , Íntrons , Icterícia , Coreia (Geográfico) , Oriente Médio , Pais , Mutação Puntual , TalassemiaRESUMO
The hepatitis C vims(HCV) is now known to be the chief cause of transfusion-associated non-A, non-B hepatitis. The ultimate goal of blood donor screening for anti-HCV antibodies is the specific exclusion of vital carriers from the blood donor population. Recently, a third generation anti-HCV screening(Green Cross Center Innotest HCV 3.0 Genedia HCV 3.0 ) and immunoblot assay, Inno-Lia HCV Ab III (Innogenetics) using antigens derived from the core and different nonstructural regions(NS3, NS4 and Ns5) of the HCV viral genome were developed. To evaluate the usefulness of these assays, anti-HCV reaction patterns of the Inno-Lia HCV Ab III or presence of HCV-RNA detected by reverse transcriptase-polymerase chain reaction(RT-PCR) were examined samples in which were repeatedly positive or discrepant with Abbott EIA-2, Innotest HCV 3.0 Genedia HCV 3.0 The reaction intensity of Innotest HCV 3.0 Genedia HCV 3.0 was higher than that of Abbott EIA-2. The sensitivity and specificity of Innotest HCV 3.0 and Genedia HCV 3.0 were 92.9% and 86.8%, respectively, and the positive and negative predictive values were 72.2% and 97.1%. both. The sensitivity and specificity of Abbott EIA-2 were 100% and 78.9%, respectively, and the positive and negative predictive values were 63.6% and 100%, respectively. We concluded that the new third generation HCV EIA reagents can decrease a false positivity of second generation EIA reagents and correlate well with detection of HCV-RNA by RT-PCR.
Assuntos
Humanos , Doadores de Sangue , Genoma Viral , Hepacivirus , Anticorpos Anti-Hepatite C , Hepatite C , Hepatite , Técnicas Imunoenzimáticas , Indicadores e Reagentes , Programas de Rastreamento , Sensibilidade e EspecificidadeRESUMO
We report a case of weak subgroup A in a patient diagnosed as myelodysplastic syndrome. The patient's red cells was typed as O and his serum had anti-B. Red blood cell antibody screening test was negative. Am was confirmed by adsorption-elution test and saliva study.