Acute Appendicitis Presenting with Escherichia coli Bacteremia without Perforation in a Healthy Male / 감염과화학요법

Acute appendicitis is the most frequent cause of acute abdomen. However, bacteremia in patient with acute appendicitis is rare. A 34-year-old male patient presenting with fever and abdominal discomfort for two days showed leukocytosis, elevated C-reactive protein and erythrocyte sedimentation rate. Gram-negative rods were cultured in blood and empirical ceftriaxone was injected intravenously. On abdominal CT, wall enhanced and distended retrocecal appendix was recognized. Appendectomy was performed, which revealed suppurative inflammation without perforation. We report a case of acute appendicitis without perforation associated with Escherichia coli sepsis and atypical clinical manifestations in a healthy male.

Infection Rate of Chlamydia pneumoniae in Patients with Chronic Cough / 결핵및호흡기질환

BACKGROUND: Persistent cough has recently been found to be associated with Chlamydia pneumoniae infection. We aimed to investigate the infection rate of C. pneumonia in adult patients with chronic cough. METHODS: We recruited 68 patients with persistent cough lasting in excess of 3 weeks, who visited Kangdong Sacred Heart Hospital from January 2005 to August 2005. On the first visit, chest and paranasal sinuses radiography, skin prick test of common allergens, and induced sputum samples for C. pneumoniae were performed in all of patients. Further evaluation for diagnosis included a methacholine provocation test and eosinophil counts in induced sputum. RESULTS: The most common cause of chronic cough was upper airway cough syndrome (UACS) (26.5%), followed by eosinophilic bronchitis (20.6%) and cough variant asthma (16.2%). Idiopathic chronic cough was the cause in 33.8% of patients. The mean duration of cough was 11.7 months. C. pneumoniae was isolated by polymerase chain reaction (PCR) from one patient who had upper respiratory air way syndrome. CONCLUSION: Chlamydia pneumoniae appears to have a minor role as a cause of chronic cough in patients.

A Case of Providencia rettgeri Sepsis in a Patient with Cervical Cord Injury / 감염과화학요법

Providencia rettgeri is a member of Enterobacteriacea that is known to cause urinary tract infection (UTI), septicemia, and wound infections, especially in immunocompromised patients and in those with indwelling urinary catheters. We experienced a case of UTI sepsis by Providencia rettgeri in a patient with spinal cord injury. The patient had only high fever without urinary symptoms or signs after high dose intravenous methylprednisolone. The laboratory results showed leukocytosis (21,900/microL, segmented neutrophils 91.1%) and pyuria. Cefepime was given empirically and it was switched to oral trimethoprim-sulfamethoxazole because P. rettgeri was identified from blood and urine culture which was susceptible to TMP-SMX. The patient was improved clinically but P. rettgeri was not eradicated microbiologically. To the best of our knowledge, this is the first case report on sepsis caused by Providencia rettgeri in Korea.

Prevalence of IgG anti-HAV in patients with chronic hepatitis B and in the general healthy population in Korea / 대한간학회지

BACKGROUND/AIMS: Few studies have investigated hepatitis A virus (HAV) seroepidemiology in Koreans with chronic liver disease (CLD). This study compared the prevalence of IgG anti-HAV between the general healthy population and patients with hepatitis B virus-related CLD (HBV-CLD), with the aim of identifying predictors of HAV prior exposure. METHODS: In total, 1,319 patients were recruited between June 2008 and April 2010. All patients were tested for IgG anti-HAV, hepatitis B surface antigen (HBsAg), and antibodies to hepatitis C virus. The patients were divided into the general healthy population group and the HBV-CLD group based on the presence of HBsAg. The seroprevalence of IgG anti-HAV was compared between these two groups. RESULTS: The age-standardized seroprevalence rates of IgG anti-HAV in the general healthy population and patients with HBV-CLD were 52.5% and 49.1%, respectively. The age-stratified IgG anti-HAV seroprevalence rates for ages or =60 years were 14.3%, 11.2%, 45.5%, 90.5%, 97.6% and 98.3%, respectively, in the general healthy population, and 0%, 9.8%, 46.3%, 91.1%, 97.7%, and 100% in the HBV-CLD group. In multivariate analysis, age ( or =60 years: OR=1060.5, 95% CI=142.233-7907.964, P<0.001) and advanced status of HBV-CLD (OR=19.180, 95% CI=4.550-80.856, P<0.001) were independent predictors of HAV prior exposure. CONCLUSIONS: The seroprevalence of IgG anti-HAV did not differ significantly between the general-healthy-population and HBV-CLD groups. An HAV vaccination strategy might be warranted in people younger than 35 years, especially in patients with HBV-CLD.