[Show abstract][Hide abstract] ABSTRACT: Recently, serotype K1 Klebsiella pneumoniae has been a major agent of an invasive syndrome characterized by liver abscess and its metastatic infection. Extrahepatic infection and its characteristics in patients with renal abscess caused by K. pneumoniae are poorly understood, and few cases of central nervous system infection have been reported. This is a report of 80-year-old woman with uncontrolled type 2 diabetes mellitus with renal abscess caused by serotype K1 K. pneumoniae, complicated with ventriculitis despite of appropriate use of antibiotics. Physicians need to be aware of possibility of metastatic infection in patients with serotype K1 K. pneumoniae infection, if they develop neurologic symptom and focus of infection is still present.
[Show abstract][Hide abstract] ABSTRACT: Incidence of nontuberculous mycobacterium (NTM) pulmonary disease is increasing with the wider recognition and development of diagnostic technology. Mycobacterium kansasii is the second most common pathogen of NTM pulmonary disease in human immunodeficiency virus (HIV)-infected patients. However in Korea, the incidence of M. kansasii pulmonary disease is relatively low, and there has been no report of M. kansasii pulmonary disease with bronchial involvement in HIV patients, to the best of our knowledge. We report a case of M. kansasii pulmonary disease presenting with endobronchial lesions in an HIV-infected patient complaining of chronic cough with bilateral enlargements of hilar lymph nodes on chest X-ray.
Tuberculosis and Respiratory Diseases 10/2013; 75(4):157-160. DOI:10.4046/trd.2013.75.4.157
[Show abstract][Hide abstract] ABSTRACT: A 62-year-old diabetic female was admitted to the hospital with fever and pain in both legs. Computed tomography scans of the abdomen revealed necrotizing fasciitis of the right thigh extending into the abdominal wall, and abscesses on the right psoas muscle. Magnetic resonance imaging showed increased T2 signal intensity along the peroneus muscle and fascia of the lower left leg. The patient received antibiotics and underwent debridement of the infected and necrotic tissue. Intra-abdominal abscesses were drained. Blood and pus cultures showed growth of Klebsiella pneumoniae, as had been suspected due to string test results showing hypermucoviscosity. Free-skin grafts were performed to repair tissue loss and the patient was subsequently discharged 82 days after admission. This represents the first reported case of necrotizing fasciitis and psoas muscle abscess caused by a hypervirulent strain of K. pneumoniae in Korea.
[Show abstract][Hide abstract] ABSTRACT: A 35-year-old man with known coccidioidal meningitis developed a severe headache and vomiting during routine treatment. Hydrocephalus was visible on brain imaging, and CSF study revealed pleocytosis, lowering of glucose, and increased intracranial pressure. Dexamethasone and mannitol was used for intracranial pressure control. Intrathecal amphotericin B administration and switching to itraconazole resulted in gradual improvement of symptoms. After 4 months of discontinuing amphotericin B intrathecal administration, the patient developed severe headaches with vomiting, diplopia and tandem gait. Coccidioidal meningitis aggravation was suspected based on brain MRI and CSF studies. Ventriculo-peritoneal shunt insertion was performed for intracranial pressure control and the combined therapy of intrathecal amphotericin B administration and fluconazole was maintained. This combined regimen kept the meningitis stable for 1 month.
[Show abstract][Hide abstract] ABSTRACT: The tuberculin skin test for diagnosing latent tuberculosis (TB) has some limitations for HIV-infected patients, especially in BCG vaccinated countries. The objective of this study was to identify the incidence rate of new TB cases among HIV-infected patients in an intermediate TB-endemic area and to examine its correlation with the ELISPOT assay. We prospectively followed up 124 patients with HIV-1 infection to monitor development of active TB disease after performing an ELISPOT assay (T-SPOT. TB test, Oxford Immunotec, Ltd., Abingdon, UK). A total of 120 patients were followed for a median of 947 days; four patients with active TB at enrollment were excluded. Eleven patients developed active TB during 238 person-years, giving a high incidence rate of 4621/100,000 person-years. Patients with positive ELISPOT responses had a higher TB incidence rate than those with negative ELISPOT responses; however this was not statistically significant [20% (6/30) vs. 6.02% (5/83), p=0.052]. A Cox regression analysis showed that the independent risk factors associated with progression of TB were low CD4(+) T cell counts, previous history of TB treatment, and positive ELISPOT results. Advanced HIV-infected patients who showed a positive TB ELISPOT assay had a higher rate of progression to TB in the intermediate TB-endemic area.
AIDS research and human retroviruses 02/2012; 28(9):1038-43. DOI:10.1089/AID.2011.0360 · 2.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The actual trends in antibiotic use in Korea are difficult to determine because antibiotic usage, which is not covered by insurance or not consumed in all hospitals in Korea, cannot be calculated accurately. Therefore, this study estimated the antibiotic usage indirectly from the data available in the 'Annual Products of Medicine,' which is published by the Korean Pharmaceutical Manufacturers Association.
[Show abstract][Hide abstract] ABSTRACT: The incidence of invasive fungal infections has been increased worldwide along with the increasing population at high risk for fungal infection. However, no data is available for the current status of usage of antifungal agents in Korea. We described the usage of antifungal agents including second-generation triazole and echinocandins that have been recently introduced. Data from Health Insurance Review and Assessment Service were analyzed. Estimated total DDDs (daily defined doses)/1,000 patient-day of parenteral antifungal agents were 187.6 in 2008 and 143.2 in 2007 and annual rates of increase was 20% to 30% since 2004. Indeed, increased percentage of newer agents were observed. Changes of the treatment guidelines and the regulations for insurance coverage are considered to influence the trend of antifungal usage.
[Show abstract][Hide abstract] ABSTRACT: Pneumocystis carinii pneumonia (PCP), now known as Pneumocystis jirovecii, is a fungal pathogen that causes opportunistic disease, especially pneumonia, in immunocompromised patients. The patients can have a spectrum of illnesses ranging from asymptomatic to fulminant respiratory failure. Here we report two cases with pneumocystis pneumonia after liver transplantation who presented with different clinical features. One patient developed acute respiratory failure requiring mechanical ventilation and expired due to PCP and a superimposed bacterial infection. The other patient was asymptomatic and discovered by regular X-ray check-up. He was successfully treated with trimethoprim/sulfamethoxazole. As shown by our cases, PCP presents with broad clinical manifestations and leads to various clinical courses in liver transplant recipients. Thus, Pneumocystis jirovecii has to be considered a potential pathogen of pneumonia in liver transplant recipients regardless of severity, especially one who is not on prophylactic medications. We consider prophylaxis of PCP in liver transplant recipients in our center.
[Show abstract][Hide abstract] ABSTRACT: Bacteremia is a major infectious complication associated with mortality in liver transplant recipients. The causative organisms and clinical courses differ between medical centers due to variations in regional bacterial epidemiology and posttransplant care. Further, living donors in Korea contribute to 83% of liver transplants, and individualized data are required to improve survival rates.
We retrospectively analyzed 104 subjects who had undergone living-donor liver transplant from 2005 to 2007.
Among the 144 consecutive living-donor liver transplant recipients, 24% (34/144) developed bacteremia, 32% (46/144) developed non-bacteremic infections, and 44% (64/144) did not develop any infectious complications. Forty episodes of bacteremia occurred in 34 recipients. The major sources of bacteremia were intravascular catheter (30%; 12/40), biliary tract (30%; 12/40), and abdomen (22.5%; 9/40). Gram-positive cocci were more common (57.5%; 23/40) than Gram-negative rods (32.5 %; 13/40) and fungi (10%; 4/40). The data revealed that the following factors were significantly different between the bacteremia, non-bacteremic infection, and no infection groups: age (p = 0.024), posttransplant hemodialysis (p = 0.002), ICU stay (p = 0.012), posttransplant hospitalization (p < 0.0001), and duration of catheterization (p < 0.0001). The risk factors for bacteremia were older than 55 years (odds ratio, 6.1; p = 0.003), catheterization for more than 22 days (odds ratio, 4.0; p = 0.009), UNOS class IIA (odds ratio, 6.6; p = 0.039), and posttransplant hemodialysis (odds ratio, 23.1; p = 0.001). One-year survival rates in the bacteremic, non-bacteremic infection, and no infection groups were 73.2%, 91.3%, and 93.5%, respectively.
Early catheter removal and preservation of renal function should focus for improving survival after transplant.
Yonsei medical journal 02/2009; 50(1):112-21. DOI:10.3349/ymj.2009.50.1.112 · 1.29 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We investigated the occurrence and mechanism of amikacin resistance and its association with various beta-lactamase genes in Pseudomonas aeruginosa isolates.
Of the total 250 consecutive, non-duplicated isolates of P. aeruginosa, 55 isolates showed amikacin resistance. PCR amplification of genes for aminoglycoside (AG)-modifying enzymes [aac(3)-I, aac(3)-II/VI, aac(3)-III/IV, aac(6')-I, aac(6')-II, ant(2'')-I, ant(4')-II and aph(3')-VI], 16S rRNA methylases (rmtA, rmtB, rmtC and armA) and class 1 integrons was performed. In addition, we analysed the association of AG resistance genes with various beta-lactamase genes.
In Korea, the amikacin resistance rate in P. aeruginosa was high (22%), and it varied among provinces (3.8% to 40%). Four types of AG-modifying enzyme genes [aph(3')-VI, ant(2'')-I, aac(6')-I and aac(3)-II/VI] were found in 48 isolates. Thirty-six strains harboured two or more types of enzymes, of which a combination of aph(3')-VI and ant(2'')-I was the most frequent (24/36 isolates, 66.7%). None harboured aac(3)-I, aac(3)-III/IV, aac(6')-II, ant(4')-II, rmtA, rmtB, rmtC or armA. Forty-two isolates co-harboured beta-lactamase genes (mostly bla(OXA-10)). A class 1 integron was detected in all but one, and all the ant(2'')-I and 26/29 bla(OXA-10) were found in it. In contrast, aph(3')-VI was not found to be associated with the class 1 integron. Considering the possibility of co-selection and dissemination, constant monitoring of resistance evolution is necessary.
[Show abstract][Hide abstract] ABSTRACT: Scrub typhus may cause complications such as pneumonia, meningoencephalitis, liver failure, and renal failure, although most of patients with scrub typhus are treated with appropriate antibiotics. Scrub typhus has varying degree of disease severity, from mild to fatal, therefore, early recognition of the clinical parameters representing the severity of the disease is a very important factor for effective treatment.
Infection and Chemotherapy 01/2008; 40(1). DOI:10.3947/ic.2008.40.1.40
[Show abstract][Hide abstract] ABSTRACT: Background: Several studies showed that 18F-FDG PET/CT was valuable in the diagnosis of malignant diseases. But only limited studies have evaluated its usefulness in the FUO patients. We have examinated the diagnostic value of 18F-FDG PET/CT as a investigation in FUO patients and analysed the predictors which 18F-FDG PET/CT were helpful potentially to the diagnosis.
Methods: From January 2005 through April 2007, the patients who met the definition criteria of classical FUO were reviewed retrospectively in Kangnam St. Mary’s Hospital of Korea.
Results: In 29 patients, 18F-FDG PET/CT was performed as FUO study. Twenty-three (79.3 %) of the 29 18F-FDG PET/CT showed abnormal findings, and eighteen scans (62 % of the total scan or 78.2 % of the abnormal scan) were considered helpful clinically. The causes of FUO detected by 18F-FDG PET/CT include malignancy(62.1%), infection (10.3%), and multisytemic disease(10.3%). C-reactive protein and LDH were significant predictors for value of 18F-FDG PET/CT (p value=0.006, 0.02).
Conclusion: 18F-FDG PET/CT is a useful imaging investigation for FUO patients whose laboratory findings showed raised CRP and LDH especially.
Infectious Diseases Society of America 2007 Annual Meeting; 10/2007
[Show abstract][Hide abstract] ABSTRACT: Trichosporon asahii is an emerging mycosis characterized by high mortality rate in immunologically compromised patients. Only a few cases have been reported in immunocompetent subjects. We report a 46-yr-old man who had been healthy and who presented with septic shock and purpura fulminans caused by Trichosporon asahii. He responded well to antifungal therapy with amphotericin B and voriconazole.
Annals of clinical and laboratory science 02/2007; 37(4):366-9. · 0.91 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The incidence of opportunistic infection has decreased since the introduction of highly active antiretroviral therapy, so lymphoma is now far and away the most lethal complication of acquired immunodeficiency syndrome. We have experienced four cases of NHL in AIDS patients. The first patient was a 37 year old male who presented with left sided hemiplegia due to CNS lymphoma. The second patient was a 40 year old male who was admitted because of jaundice; he was diagnosed as having lymphoma that exclusively involved the liver. The third patient was a 38-year-old male who presented with palpable mass in the left cervical region, which was diagnosed as lymphoma. Above three cases were confirmed as diffuse large B cell lymphoma. The fourth patient presented with a protruding swollen chest wall mass on the right side of his chest, this was determined pathologically to be the Burkitt's type. The latter case is the first report of NHL involving the chest wall musculature in a Korean AIDS patient.
The Korean Journal of Internal Medicine 01/2007; 21(4):266-74. DOI:10.3904/kjim.2006.21.4.266 · 1.43 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Recently, resistance to extended-spectrum cephalosporins due to acquired beta-lactamases has been reported in Pseudomonas aeruginosa. The aim of this study was to investigate the prevalence of Ambler class A and D beta-lactamases and their extended-spectrum derivatives and antimicrobial susceptibilities of P. aeruginosa isolated from various parts of Korea.
A total of 252 consecutive, non-duplicate isolates of P. aeruginosa were studied for the presence of class A or D beta-lactamase. Antibiotic susceptibility tests and PCR amplification of genes encoding class A (bla(PSE-1), bla(PER-1), bla(VEB-1), bla(TEM), bla(SHV), bla(CTX-M) and bla(GES-1)) and class D beta-lactamases (bla(OXA-groupI), bla(OXA-groupII) and bla(OXA-groupIII)) were performed. For PCR-positive isolates, isoelectric focusing (IEF) analysis, sequencing and pulsed-field gel electrophoresis (PFGE) were performed.
In 64 (25.4%) isolates, structural genes for PSE-1 (6.3%), OXA-10 (13.1%), OXA-4 (4.3%), OXA-30 (2.0%), OXA-2 (2.3%) and OXA-17 (0.4%) were found; their distribution varied between provinces. None harboured bla(PER-1), bla(VEB-1), bla(TEM), bla(SHV), bla(CTX-M) and bla(GES-1). The cross-class resistance rates to other antibiotics was significantly higher in class A and D beta-lactamase producers than in non-producers (P < 0.001 for aminoglycosides, ciprofloxacin and meropenem).
OXA-type beta-lactamases are widespread, but their extended-spectrum derivatives are rare among P. aeruginosa in Korea. To our knowledge, this is the first report of OXA-17, an extended-spectrum derivative of OXA-10, outside the Middle East. In addition, combined resistance to ticarcillin and aminoglycosides was a useful indicator for P. aeruginosa producing PSE- or OXA-type beta-lactamases in this study.
[Show abstract][Hide abstract] ABSTRACT: To examine the molecular mechanisms involved in the beta-lactam resistance of multidrug-resistant Proteus mirabilis isolates that showed an unusual synergy between imipenem and ceftazidime in a Korean hospital.
Over an 11 month period, a total of 12 P. mirabilis isolates showing resistance to ampicillin, gentamicin, ceftazidime, cefotaxime, cefuroxime, cefalothin, cefepime, piperacillin, trimethoprim/sulfamethoxazole and ciprofloxacin, were recovered from the sputum and urine specimens of nine patients who were hospitalized in the neurosurgery ward. The extended-spectrum beta-lactamases were screened with a double disc synergy test using ceftazidime, cefotaxime, aztreonam, cefepime and clavulanate. The ESBL types were determined by PCR using specific primers for bla(TEM-1), bla(SHV-1), bla(CTX-M-1), bla(CTX-M-2), bla(CTX-M-8), bla(CTX-M-9), bla(PER-1), bla(GES-1), bla(VEB-1), bla(OXA-10) and bla(OXA-13) followed by sequencing. All the isolates underwent molecular typing by PFGE. The transferability was examined by conjugation.
All the isolates showed a marked synergy between the extended-spectrum cephalosporins and clavulanate together with an unusual synergy between cefoxitin and the cephalosporins (cefalothin, cefuroxime, ceftazidime, cefotaxime) and between imipenem, and ceftazidime and cefotaxime. Isoelectric focusing of the crude bacterial extracts showed a beta-lactamase band with a pI value of 5.4, which was inhibited by clavulanate. PCR and sequencing identified the gene to be bla(VEB-1). In addition, the aadB gene was detected, conferring aminoglycoside resistance. The resistance was not transferred by conjugation. The outbreak was of a clonal origin as shown by PFGE demonstrating an identical banding pattern. This is the first report of VEB-1-producing Enterobacteriaceae in Korea.
[Show abstract][Hide abstract] ABSTRACT: To identify the metallo-beta-lactamases (MBLs) prevalent in Korea, a total of 130 clinical isolates of Pseudomonas aeruginosa and Acinetobacter baumannii (99 P. aeruginosa and 31 A. baumannii) with a reduced susceptibility to imipenem (IPM) and/or ceftazidime (CAZ) was subjected to PCR analyses with primers specific to bla(IMP-1), bla(VIM-1), and bla(VIM-2). In addition, inhibitor-potentiated disk diffusion methods (IPD) using two kinds of substrate-inhibitor combinations (ceftazidime-2-mercaptopropionic acid (2MPA) and imipenem-EDTA) were investigated. Thirty-three isolates (29 P. aeruginosa and 4 A. baumannii) carried bla(VIM-2) and two P. aeruginosa isolates harbored bla(IMP-1). The enterobacterial repetitive intergenic consensus PCR (ERIC-PCR) pattern revealed that many of the VIM-2-producing P. aeruginosa isolates were clonally related, whereas the A. baumannii isolates were diverse. The inhibitor-potentiated disk diffusion test using imipenem-EDTA was highly sensitive and specific for detecting the VIM-2 producer. These results suggest that VIM-2 is an important MBL in P. aeruginosa and A. baumannii in the Korean hospital of this study and that the IMP-1-producing P. aeruginosa has also emerged. Screening for MBLs and strict infection control for these isolates will contribute to prevent further spread of resistance.