emm Types and Clusters of Group A Streptococcus Causing Acute Pharyngitis in Changwon Korea, 2018–2019 / 대한임상미생물학회지

Background@#Group A streptococcus (GAS) is the most common cause of bacterial pharyngitis. This study aimed to characterize the molecular epidemiology of GAS infection using an emm-typing and emm-clustering approach. @*Methods@#A total of 372 patients from Changwon who showed pharyngitis symptoms were recruited during the sampling period of 2018–2019 and throat cultures were obtained from them. emm typing was performed using polymerase chain reaction (PCR) and direct sequencing. emm genotypes and GAS clusters were classified based on a web-based database. @*Results@#Of the 372 throat swab specimens, 101 (27.2%) were positive for GAS. emm typing analysis was performed on 59 GAS isolates. The most prevalent emm type was emm89 (20.3%), followed by emm12 (16.9%). Seven emm clusters were identified: E4 (emm89/ emm28, 32.2%), A-C4 (emm12, 16.9%), E1 (emm4, 13.6%), A-C5 (emm3, 10.2%), E6 (emm75, 8.5%), M6 (emm6, 8.5%), and A-C3 (emm1, 6.8%). @*Conclusion@#Diverse and temporal changes were observed in the distribution of emm types and clusters of GAS. Continuous surveillance based on emm genotyping is needed to monitor the epidemiological characteristics of GAS pharyngitis.

Diagnostic Impact of Clinical Manifestations of Group A Streptococcal Pharyngitis

This study aims to identify the clinical characteristics for diagnosing streptococcal pharyngitis. The correlation between eighteen clinical manifestations and rapid antigen detection test results was analyzed. Among 205 patients, five clinical manifestations, pharyngeal hemorrhage (odds ratio [OR] = 11.85), palatal hemorrhage (OR = 9.32), tonsillar swelling (OR = 4.37), rash (OR = 3.02), and enlarged cervical nodes (OR = 1.91), were significantly correlated with group A Streptococcus (GAS) pharyngitis. Traditional indicators such as fever, pharyngeal redness, acute onset, headache, rhinorrhea, cough, tonsillar exudate, and cervical tenderness were not statistically related to GAS pharyngitis. Therefore, physicians should be cautious in using these traditional indicators

Diagnostic Impact of Clinical Manifestations of Group A Streptococcal Pharyngitis

This study aims to identify the clinical characteristics for diagnosing streptococcal pharyngitis. The correlation between eighteen clinical manifestations and rapid antigen detection test results was analyzed. Among 205 patients, five clinical manifestations, pharyngeal hemorrhage (odds ratio [OR] = 11.85), palatal hemorrhage (OR = 9.32), tonsillar swelling (OR = 4.37), rash (OR = 3.02), and enlarged cervical nodes (OR = 1.91), were significantly correlated with group A Streptococcus (GAS) pharyngitis. Traditional indicators such as fever, pharyngeal redness, acute onset, headache, rhinorrhea, cough, tonsillar exudate, and cervical tenderness were not statistically related to GAS pharyngitis. Therefore, physicians should be cautious in using these traditional indicators

Performance Evaluation of STANDARD F Strep A Ag FIA for Diagnosis of Group A Streptococcal Pharyngitis / 대한임상미생물학회지

Background@#Pharyngitis is one of the most common conditions encountered in primary health care facilities. Accurate differentiation of group A streptococcus (GAS) infection from viral infection is difficult. The STANDARD F Strep A Ag FIA (SD BIOSENSOR, Korea) is a rapid antigen detection test (RADT) that has been recently developed for diagnosing GAS pharyngitis. In this study, we evaluated the diagnostic performance of the STANDARD F Strep A Ag FIA and compared the results between the RADT and conventional throat culture. @*Methods@#Throat swab samples were obtained from a total of 372 children presenting pharyngitis symptoms in five pediatric clinics in Changwon, Korea from July 2018 to October 2019. A comparative study between STANDARD F Strep A Ag FIA and Sofia Strep A FIA (Quidel, USA) was performed. Two throat swabs were taken simultaneously from each patient for RADT. The third throat swab was stored in a transport tube containing Stuart's transport medium for culture. Performance and kappa index of STANDARD F Strep A Ag FIA were evaluated. @*Results@#GAS infection was detected in 29.3% (109/372) patients, using the STANDARD F Strep A Ag FIA. The sensitivity, specificity, positive predictive value, and negative predictive value were 95.0%, 95.2%, 88.1%, and 98.1%, respectively. The STANDARD F Strep A Ag FIA showed an excellent concordance rate of 96.5% and a kappa value of 0.89 compared to Sofia Strep A FIA. @*Conclusion@#The STANDARD F Strep A Ag FIA demonstrated an excellent performance along with Sofia Strep A FIA for the diagnosis of GAS pharyngitis.

Comparison and Recommendation of Diagnostic Tools for Bacterial Pharyngitis at Primary Care Clinics

There are more than 10 million visits to primary care clinics annually due to pharyngitis or tonsillitis. The antibiotic prescription rate for these patients is more than 50%. An optimal diagnosis is necessary to avoid antibiotic misuse or overuse. Here, we compared the benefits and pitfalls of three currently available laboratory methods, such as throat culture, rapid antigen detection test (RADT), and molecular tests. We also reviewed the current American and Korean guidelines for bacterial pharyngitis. Although throat culture is regarded as a gold standard, it requires high technical expertise and culture facilities. In addition, the turn-around time (TAT) is 1 day-2 days causing possible inadequate prescription as well as the inconvenience of a second clinical visit to check results. The RADT does not require culture facilities and the TAT is noticeably short (5-10 min). The initial low sensitivity of the RADT has been improved these days. Though molecular tests are the most advanced, there remains a lack of clinical data. Therefore, we recommend judicious use of the RADT for diagnosing bacterial pharyngitis as well as effective antibiotic prescriptions at primary care clinics.

Comparison and Recommendation of Diagnostic Tools for Bacterial Pharyngitis at Primary Care Clinics

There are more than 10 million visits to primary care clinics annually due to pharyngitis or tonsillitis. The antibiotic prescription rate for these patients is more than 50%. An optimal diagnosis is necessary to avoid antibiotic misuse or overuse. Here, we compared the benefits and pitfalls of three currently available laboratory methods, such as throat culture, rapid antigen detection test (RADT), and molecular tests. We also reviewed the current American and Korean guidelines for bacterial pharyngitis. Although throat culture is regarded as a gold standard, it requires high technical expertise and culture facilities. In addition, the turn-around time (TAT) is 1 day-2 days causing possible inadequate prescription as well as the inconvenience of a second clinical visit to check results. The RADT does not require culture facilities and the TAT is noticeably short (5-10 min). The initial low sensitivity of the RADT has been improved these days. Though molecular tests are the most advanced, there remains a lack of clinical data. Therefore, we recommend judicious use of the RADT for diagnosing bacterial pharyngitis as well as effective antibiotic prescriptions at primary care clinics.

Miller-Dieker Syndrome with der(17)t(12;17)(q24.33;p13.3)pat Presenting with a Potential Risk of Mis-identification as a de novo Submicroscopic Deletion of 17p13.3 / 대한진단검사의학회지

Miller-Dieker syndrome involves a severe type of lissencephaly, which is caused by defects in the lissencephaly gene (LIS1). We report the case of a female infant with der(17)t(12;17)(q24.33;p13.3)pat caused by an unbalanced segregation of the parental balanced translocation of 17p with other chromosomes. The proband presented with facial dysmorphism, arthrogryposis, and intrauterine growth retardation. Most cases of Miller-Dieker syndrome have a de novo deletion involving 17p13.3. When Miller-Dieker syndrome is caused by an unbalanced translocation, mild-to-severe phenotypes occur according to the extension of the involved partner chromosome. However, a pure partial monosomy derived from a paternal balanced translocation is relatively rare. In this case, the submicroscopic cryptic deletion in the proband was initially elucidated by FISH, and karyotype analysis did not reveal additional chromosome abnormalities such as translocation. However, a family history of recurrent pregnancy abnormalities strongly suggested familial translocation. Sequential G-banding and FISH analysis of the father's chromosomes showed that the segment of 17p13.3-->pter was attached to the 12qter. Thus, we report a case that showed resemblance to the findings in cases of a nearly pure 17p deletion, derived from t(12;17), and delineated by whole genome array comparative genomic hybridization (CGH). If such cases are incorrectly diagnosed as Miller-Dieker syndrome caused by de novo 17p13.3 deletion, the resultant improper genetic counseling may make it difficult to exactly predict the potential risk of recurrent lissencephaly for successive pregnancies.

Clinical Relevance of Elevated Levels of Serum Soluble Interleukin-2 Receptor alpha (sIL-2Ralpha) in Patients with Non-Hodgkin's Lymphoma / 대한진단검사의학회지

Levels of soluble interleukin-2 receptor alpha (sIL-2Ralpha) are known to increase in the sera of patients with certain malignancies, including malignant lymphoma. This study aimed to assess the clinical significance of the sIL-2Ralpha level in non-Hodgkin's lymphoma (NHL). We used ELISA to measure the sIL-2Ralpha levels in 48 newly diagnosed and untreated patients with NHL and evaluated the correlation between the sIL-2Ralpha levels and clinical characteristics and the International Prognostic Index (IPI). We monitored serum sIL-2Ralpha in 7 patients to compare the changes in their clinical progress with these levels. High levels of serum sIL-2Ralpha (> or =2,000 U/mL) correlated well with parameters defining the high risk group according to the IPI, i.e., high tumor burden at diagnosis (stage III+IV) and lactate dehydrogenase > or =472 U/L. The levels were also associated with B symptoms, bone marrow involvement, and poor response to therapy. The sIL-2Ralpha level decreased during complete remission and was elevated during disease progression or relapse. A high level of sIL-2Ralpha was significantly associated with a low survival rate. These results suggest that serum sIL-2Ralpha might be useful as a biomarker for evaluating the prognosis of patients with NHL at the time of diagnosis and during therapy. A well-controlled, large-scale study is needed to clarify the clinical significance of sIL-2Ralpha in specific groups of NHL.

Maintenance of Recurred Focal Segmental Glomerulosclerosis of Transplanted Kidney for More Than 9 Months by Performing Plasmapheresis / 대한수혈학회지

Focal segmental glomerulosclerosis (FSGS) is thought to be caused by FSGS permeability factor (FSGF) in the plasma, and this plasma FSGF might be responsible for FSGS recurrence after transplantation. Therefore, to reduce the FSGF in plasma, plasmapheresis (PE) is usually used to treat recurred FSGS. We report here on the PE treatment of 33-year-old women who had recurrence of FSGS after transplantation. After recurrence, she was treated by intensive PE for 1 month and she achieved complete remission. But because the proteinuria was increased when we stopped PE, we regularly continued PE for 28 month with the patient in a state of partial remission. To the best of our knowledge, this is the second report on treating recurred FSGS with intensive PE and this is the first report for long term maintenance with performing regular PE.

Study for Efficient Blood Management Using Evaluation the Blood Wastage Statements in Pusan University Hospital / 대한수혈학회지

BACKGROUND: Efforts to reduce the wastage of blood components are necessary because of the shortage of blood components. To find ways of reducing the blood component wastage, we monitored the trends and reasons for wastage and we analyzed this data. METHODS: We have investigated and analyzed the amount and reasons for wastage from 2003 to 2005 by reviewing the wastage statements, and the information on these wastage statements was classified according to several aspects. Ouestions about the reasons for wastage and the methods for reducing such wastage were created and these were widely distributed to the doctors and nurses working at Pusan University Hospital. The results of the survey were analyzed. RESULTS: The wastage rates of blood component from 2003 to 2005 had a tendency to slightly decline: 1.49% in 2003, 1.26% in 2004 and 1.23% in 2005. The most frequent reason for wastage was the improvement in the patient's condition and the second most frequent reason was death of the patient. The favorite answers for the question about the most likely reason for wastage were related to different aspects of medicine, and also to the improvement in the patient's condition (52.6%) and the death of patient (22.6%) for the aspect of blood management, the most frequent answers were overcharge (43.3%) and delay of blood returning (17.7%). The analysis of the pattern of wastage showed that only 5 departments were responsible for 71.5%~78.1% of the wastage. CONCLUSION: Systematic and active management of the transfusion process, along with intensive cooperation of clinicians, is needed to prevent a considerable amount of blood component wastage.