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Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 04/2013; · 0.99 Impact Factor
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Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 03/2013; · 0.99 Impact Factor
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Journal of the Formosan Medical Association 02/2013; 112(2):61-3. · 1.13 Impact Factor
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ABSTRACT: Although previously rare, catheter-related bloodstream infection caused by rapidly growing mycobacteria is now increasingly encountered, especially among cancer patients who have catheters implanted for chemotherapy treatments. A 73-year-old female patient with acute myeloid leukemia (AML) had Mycobacterium abscessus bacteremia with manifestations of multiple skin nodules, pneumonia, and mediastinal lymphadenopathy 4 months after the implantation of a peripherally inserted central catheter (PICC) for the delivery of chemotherapy. The catheter-related M. abscessus bacteremia was confirmed by positive blood cultures of specimens drawn from a PICC line and a peripheral vein. She defervesced with the administration of meropenem, amikacin, levofloxacin, clarithromycin, and by the removal of PICC. Her fever subsided for 3 months with the disappearance of skin and lung lesions; however, she died of AML relapse. Bacteremia and skin infection caused by M. abscessus can be detected by culture and pathological examinations and should be considered in leukemia patients with a PICC. With appropriate laboratory diagnosis, M. abscessus bacteremia with disseminated infections can improve with catheter removal and combination antimicrobial therapy.
The Kaohsiung journal of medical sciences 01/2013; 29(1):50-4. · 0.61 Impact Factor
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Chung-Hao Huang,
Li-Li Kuo,
Kuender D Yang,
Po-Shan Lin,
Po-Liang Lu,
Chien-Chou Lin,
Ko Chang,
Tun-Chieh Chen,
Wei-Ru Lin, Chun-Yu Lin,
Yen-Hsu Chen,
Ho-Sheng Wu
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ABSTRACT: BACKGROUND/PURPOSE: In 2008, the Dengue NS1 Ag STRIP (Bio-Rad Laboratories, Marnes-la-Coquette, France) was introduced to routine dengue diagnostics in Taiwan, in addition to real-time reverse-transcription polymerase chain reaction (PCR), virus isolation, and capture immunoglobulin (Ig)M/IgG enzyme-linked immunosorbent assay (ELISA). This study aimed to evaluate the benefit of this assay and factors influencing the results of these diagnostic tests. METHODS: Retrospectively, the authors enrolled laboratory-confirmed adult dengue patients from July 2008 to January 2012 in a tertiary hospital. The sensitivities of each test alone and in combination were analyzed by the duration of illness (early stage: day 0-day 3 and late stage: day 4-day 8). The factors influencing sensitivity of the Dengue NS1 Ag STRIP were examined. RESULTS: There were 392 patients enrolled. The overall sensitivity of the Dengue NS1 Ag STRIP was 68.37% and PCR was 71.94%. With the assistance of the Dengue NS1 Ag STRIP, a diagnosis was made in 10.97% of patients without the need for second convalescent samples, and 4.34% more cases were detected. Independent factors for reduced Dengue NS1 Ag STRIP sensitivity were dengue virus (DENV) IgG seropositivity and a sample taken after the fifth day of illness. At the early stage, the PCR and the Dengue NS1 Ag STRIP combination had the highest sensitivity rate than other combinations. At the late stage, a combination of the Dengue NS1 Ag STRIP and capture IgM/IgG ELISA had better sensitivity rates. PCR and capture IgM/IgG ELISA in combination had sensitivity above 90% through the course of illness. CONCLUSION: Dengue NS1 Ag STRIP is a useful tool for early dengue diagnosis. Its use can increase the diagnostic sensitivity and decrease the need of convalescent samples. Seeking treatment late (days postonset > 4) and DENV IgG seropositivity independently decrease the sensitivity of the Dengue NS1 Ag STRIP.
Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 10/2012; · 0.99 Impact Factor
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Ya-Ting Chang, Chun-Yu Lin,
Po-Liang Lu,
Chung-Chih Lai,
Tun-Chieh Chen,
Chi-Yu Chen,
Deng-Chyang Wu,
Tzu-Pin Wang,
Chiu-Mei Lin,
Wei-Ru Lin,
Yen-Hsu Chen
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ABSTRACT: BACKGROUND AND PURPOSE: Stenotrophomonas maltophilia has been recognized as an important nosocomial pathogen, but few reports have discussed S. maltophilia infection in the community settings. This study aimed to reveal characteristics of patients with community-onset S. maltophilia bloodstream infection (SMBSI), to specify the subgroup of healthcare-associated (HCA) infection in the community-onset group and to compare them with hospital-acquired (HA) SMBSI patients. MATERIALS AND METHODS: Medical charts of adult patients with SMBSI presenting to a medical center in southern Taiwan from May 2008 to October 2011 were reviewed and analyzed retrospectively. RESULTS: Among 153 patients, we observed a high percentage (38.6%) of SMBSI to be community onset. Among community-onset SMBSI, 45.8% were community-acquired (CA) and 54.2% were HCA. The crude mortality rates were 11.1%, 18.8%, and 60.6% in the CA, HCA, and HA groups, respectively. Structural/mechanical abnormalities were observed in 32.7% of all cases, and 60% of those were related to malignancy. Independent risk factors for mortality in community-onset SMBSI were liver cirrhosis, liver metastasis, and a high Pitt bacteremia score, whereas structural/mechanical abnormalities and a high Pitt bacteremia score related to increased mortality in HA SMBSI. CONCLUSION: Community-onset S. maltophilia infection deserves attention. Patients with community-onset SMBSI have reduced disease severity and lower mortality rate when compared to HA SMBSI. Underlying structural/mechanical abnormalities, especially those caused by malignancies, are common in SMBSI cases and should be investigated when bacteremia occurs.
Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 10/2012; · 0.99 Impact Factor
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ABSTRACT: A 56-year-old male had periodic fever for 5 years and suffered from auditory hallucination and hearing impairment for 3 years. Xerostomia, xerophthalmia, elevated anti-SSA/Ro tilter, positive Schirmer's test, and lymphocyte infiltrate of mucoserous gland in lip biopsy of this case confirmed the diagnosis of primary Sjogren's syndrome (pSS). We review literature for fever and neuropsychiatric involvement in pSS case series. Though fever is present in 6-41 % pSS cases, periodic fever has not been reported. Auditory hallucination was rare in cases with pSS. The literature review alerts clinicians that fever and neurological manifestations were not uncommon in pSS cases.
Clinical Rheumatology 07/2012; 31(10):1517-9. · 2.00 Impact Factor
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Ko Chang,
Yen-Hsu Chen,
Nan-Yao Lee,
Hsin-Chun Lee, Chun-Yu Lin,
Jih-Jin Tsai,
Po-Liang Lu,
Tun-Chieh Chen,
Hsiao-Chen Hsieh,
Wei-Ru Lin,
Ping-Chang Lai,
Chia-Ming Chang,
Chi-Jung Wu,
Chung-Hsu Lai,
Wen-Chien Ko
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ABSTRACT: Clinical information regarding murine typhus in Taiwan is limited. In this study, 81 cases of serologically documented murine typhus during 1992-2009 at four referral hospitals in southern Taiwan were analyzed. There was a significant correlation between average environmental temperature and case numbers of murine typhus (r = 0.747, P = 0.005). Acute hepatitis was found in 67% of cases, and hyperbilirubinemia (serum total bilirubin ≥ 23.9 μmol/L) was found in 38%. The intervals between the initiation of appropriate therapy to defervescence were longer in patients with hyperbilirubinemia than those without hyperbilirubinemia (6.1 versus 4.1 days; P = 0.015). Nine (11.1%) showed development of severe illnesses such as acute respiratory distress syndrome (2 patients), aseptic meningitis (3), and acute renal failure (4). Only one died of acute respiratory distress syndrome. Cases of murine typhus were often found during the summer and had acute febrile hepatitis. Those patients with hyperbilirubinemia tended to have a delayed recovery even with appropriate therapy.
The American journal of tropical medicine and hygiene 07/2012; 87(1):141-7. · 2.59 Impact Factor
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Shang-Yi Lin,
Po-Liang Lu,
Kun-Bow Tsai, Chun-Yu Lin,
Wei-Ru Lin,
Tun-Chieh Chen,
Ya-Ting Chang,
Chung-Hao Huang,
Chi-Yu Chen,
Chung-Chih Lai,
Yen-Hsu Chen
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ABSTRACT: Mucormycosis is an invasive fungal infection associated with a high mortality rate, especially in immunocompromised hosts. Mucormycosis rarely occurs in cirrhotic patients. Here, we report a case of mucormycosis with underlying liver cirrhosis and diabetes mellitus. The patient suffered from maxillary sinusitis and osteomyelitis, and the infection was successfully treated with antifungal agents, surgical debridement, and hyperbaric oxygen therapy. The antifungal treatments used were liposomal amphotericin B, itraconazole, and posaconazole. Although our patient had liver cirrhosis (Child-Pugh classification B), no hepatic decompensation was developed during the treatment course of posaconazole. This is the first report of the safe and effective use of posaconazole for the treatment of mucormycosis in a cirrhotic patient.
Mycopathologia 06/2012; · 1.65 Impact Factor
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ABSTRACT: Proteus mirabilis is a common pathogen responsible for complicated urinary tract infections (UTIs) that sometimes causes bacteremia. Most cases of P. mirabilis bacteremia originate from a UTI; however, the risk factors for bacteremia and mortality rates from P. mirabilis UTI have not been determined.
A retrospective, case-control study was performed between May 2008 and November 2010 to identify the risk factors and markers for P. mirabilis bacteremic UTI. Each subject in the case group (all patients were diagnosed with P. mirabilis bacteremia from a urinary tract source) was matched by age and gender to two subjects in the control group (patients diagnosed with P. mirabilis UTI but with negative blood culture results). Clinical presentation and laboratory data were analyzed to determine the risk factors and markers of P. mirabilis bacteremic UTI.
Sixty-seven bacteremic UTIs and 124 nonbacteremic UTIs were included in this study. Community-acquired infection (p=0.017), hydronephrosis (p=0.017), band neutrophils accounting for >10% of the white blood cell count (p=0.001), hyperthermia or hypothermia (p=0.047), and a serum C-reactive protein concentration >100mg/L (p=0.002) were identified as independent risk factors for P. mirabilis bacteremic UTI. Seventeen patients died in hospital, including 11 in the bacteremic group and 6 in the nonbacteremic group. The bacteremic group had a higher mortality rate (p=0.016). Bacteremic UTI (p=0.049), shock (p=0.014), and a low body mass index (BMI) <18 kg/m(2) (p=0.033) were identified as independent risk factors for mortality.
Because bacteremic P. mirabilis UTIs are associated with higher mortality, clinicians should carefully manage cases that present with the risk factors for bacteremia, including community-acquired infection, hydronephrosis, band neutrophils accounting for >10% of the white blood cell count, hyperthermia or hypothermia, and a high level of C-reactive protein.
Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 05/2012; 45(3):228-36. · 0.99 Impact Factor
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ABSTRACT: Scrub typhus is widely distributed across the Asia-Pacific region, Taiwan included. The clinical manifestations and complications of scrub typhus vary and the illness ranges in severity from mild to fatal. The etiology of facial nerve palsy varies and infectious agents have been associated with this condition. Rickettsiae species have, however, rarely been reported as the causative agents. We report the case of a 49-year-old man who had fever, malaise, headache, oligouria and tea-colored urine. Bilateral pneumonitis, acute renal failure, acalculous cholecystitis and aseptic meningitis were diagnosed after a series of examinations. The patient recovered after doxycycline treatment but he developed bilateral facial palsy during the convalescent phase, which improved after the administration of a steroid. The diagnosis of infection with Orientia tsutsugamushi was confirmed by the Taiwan Center of Disease Control and the tests for Leptospira, Rickettsia typhi and Coxiella burnetii were all negative. This case indicates that scrub typhus needs to be included in the differential diagnoses of cases of bilateral and simultaneous facial nerve palsy, particularly in areas where the disease is endemic.
The Kaohsiung journal of medical sciences 12/2011; 27(12):573-6. · 0.61 Impact Factor
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ABSTRACT: Peptostreptococcus sp., which are normal flora of human mucocutaneous surfaces, can be recovered in mixed infections involving the skin, soft tissue, respiratory tract, gastrointestinal tract and genitourinary tract. Peptostreptococci are rarely reported to be the cause of infective endocarditis. Because of their fastidiousness, peptostreptococci are difficult to isolate and are often overlooked. The authors report a case of Peptostreptococcus infective endocarditis of a native mitral valve complicated by splenic infarction. The authors also review the literature to identify features of infective endocarditis caused by Peptostreptococcus anaerobius.
The American Journal of the Medical Sciences 06/2011; 342(2):174-6. · 1.39 Impact Factor
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ABSTRACT: We investigated the impacts of introducing an expedited acid-fast bacilli (AFB) smear laboratory procedure and an automatic, real-time laboratory notification system by short message with mobile phones on delays in prompt isolation of patients with pulmonary tuberculosis (TB).
We analyzed the data for all patients with active pulmonary tuberculosis at a hospital in Kaohsiung, Taiwan, a 1,600-bed medical center, during baseline (January 2004 to February 2005) and intervention (July 2005 to August 2006) phases.
A total of 96 and 127 patients with AFB-positive TB was reported during the baseline and intervention phases, respectively. There were significant decreases in health care system delays (ie, laboratory delays: reception of sputum to reporting, P < .001; response delays: reporting to patient isolation, P = .045; and interval from admission to patient isolation, P < .001) during the intervention phase. Significantly fewer nurses were exposed to each patient with active pulmonary TB during the intervention phase (P = .039).
Implementation of expedited AFB smear laboratory procedures and an automatic, real-time laboratory mobile notification system significantly decreased delays in the diagnosis and isolation of patients with active TB.
American journal of infection control 06/2011; 39(5):426-30. · 3.01 Impact Factor
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ABSTRACT: Extensively drug-resistant Acinetobacter baumannii (XDRAb) emerges as an important pathogen of health care-associated infections and outbreaks worldwide. During January and February 2006, there was a hospital-wide outbreak of XDRAb at a medical center in Taiwan. Without limiting the usage of carbapenems or the closure of any ward, this outbreak was effectively controlled. We investigated the molecular epidemiology and reported the infection control experiences. XDRAb is defined as A baumannii that is resistant to multiple antibiotics but susceptible to tigecycline and polymyxin B. During the outbreak, the clinical and environmental XDRAb isolates were collected and studied by antimicrobial susceptibility testing, pulsed-field gel electrophoresis, and polymerase chain reaction for Verona integron-encoded metallo-beta-lactamases, imipenemases, and oxacillinases (OXA). Our measures to control the outbreak included private room isolation of patients until there were three successive negative cultures, reinforcement of contact precautions, daily environmental cleansing with room-dedicated cleaning tools and sodium hypochlorite, and careful auditing of adherence. During the outbreak, 32 clinical XDRAb isolates came from 13 patients who were hospitalized in four intensive care units and three wards. Most (7 of 13, 53.8%) cases were associated with a surgical intensive care unit. The results from pulsed-field gel electrophoresis study indicated that all isolates were of one genotype. All 32 isolates harbored ISAba1-bla(OxA-51-like) and bla(OxA-72) genes. After this outbreak till August 2010, further incidences of XDRAb were sporadic cases of XDRAb with different clones and did not reach the level of outbreak. To our knowledge, this is the first reported hospital-wide outbreak caused by OXA-72 carbapenemase-producing A baumannii in the Asia-Pacific region, with successful and sustained control. Although the source or vehicle of the outbreak was not identified, our results suggest that a hospital-wide outbreak can be successfully managed with strict infection control measures, and that the limitation of the use of carbapenems and closure of wards may not be necessary.
The Kaohsiung journal of medical sciences 06/2011; 27(6):207-14. · 0.61 Impact Factor
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ABSTRACT: Bacterial contamination of platelet (PLT) products is one of the most serious complications of transfusion. Culturing PLT components may detect the presence of bacteria, thus reducing the risk of a septic result after transfusion. Streptococcus bovis has previously been reported as a contaminating microorganism in PLT products. Here we report an asymptomatic donor diagnosed with occult colon malignancy after positive isolation of S. bovis from his apheresis PLTs (APs). We also review previous cases.
The PLT donor was a 50-year-old man with more than 150 prior plateletpheresis or whole blood donations. Bacterial culture of his AP components yielded two positive results: group D Streptococcus was isolated in July 2008 and S. bovis was reported in April 2010. The donor received further testing, and colonofibroscopic examination revealed colonic neoplasm. Pathologic examination of the biopsied tissue led to a diagnosis of invasive adenocarcinoma. He underwent a left hemicolectomy in July 2010. Examination of the resection specimen confirmed adenocarcinoma, Stage III with regional lymph node metastatic adenocarcinoma.
Donated AP products positive for S. bovis should not be presumed to be due to contamination during collection. This bacteremia originating from donor factors needs to be carefully evaluated. Colonofibroscopic examination is recommended for these donors to detect colonic malignancy as early as possible.
Transfusion 03/2011; 51(9):2023-7. · 3.22 Impact Factor
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ABSTRACT: With the increasing experience of tigecycline usage, its ecological impact on microorganisms raises concerns but remains unknown. We aimed to analyze the difference in microorganisms isolated before, during, and after tigecycline usage and their susceptibility to antimicrobial agents.
Between July 2008 and August 2009, 66 patients who received tigecycline monotherapy for more than 2 days at a Taiwan medical center were enrolled. Antimicrobial susceptibility testing was performed by broth microdilution method with VITEK-2 system and was analyzed according to the Clinical and Laboratory Standards Institute guidelines, except for tigecycline. We followed USA Food and Drug Administration criteria for interpretation of susceptibility to tigecycline.
The median duration of tigecycline monotherapy was 13.4 days. After tigecycline treatment, the isolation frequency of Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus, Escherichia coli, and Klebsiella pneumoniae decreased, but that of Pseudomonas aeruginosa, Proteus sp, and Stenotrophomonas maltophilia did not change. A baumannii and P aeruginosa were the two most common pathogens when tigecycline was administered. The tigecycline susceptibility rate of A baumannii isolates decreased after the administration of tigecycline.
The most common pathogens isolated in patients receiving tigecycline were A baumannii and P aeruginosa. Tigecycline usage decreased the isolation frequency of A baumannii, methicillin-resistant S aureus, E coli, and K pneumoniae. Exposure to tigecycline may be associated with a decreased susceptibility rate of A baumannii for tigecycline.
Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 01/2011; 44(5):352-7. · 0.99 Impact Factor
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Hui-Min Wang,
Chung-Yi Chen,
Hsi-An Chen,
Wan-Chun Huang,
Wei-Ru Lin,
Tun-Chieh Chen, Chun-Yu Lin,
Hsin-Ju Chien,
Po-Liang Lu,
Chiu-Mei Lin,
Yen-Hsu Chen
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ABSTRACT: Extensively drug-resistant Acinetobacter baumannii (XDRAB) is a growing and serious nosocomial infection worldwide, such that developing new agents against it is critical. The antimicrobial activities of the rhizomes from Zingiber officinale, known as ginger, have not been proven in clinical bacterial isolates with extensive drug-resistance. This study aimed to investigate the effects of four known components of ginger, [6]-dehydrogingerdione, [10]-gingerol, [6]-shogaol and [6]-gingerol, against clinical XDRAB. All these compounds showed antibacterial effects against XDRAB. Combined with tetracycline, they showed good resistance modifying effects to modulate tetracycline resistance. Using the 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical scavenging method, these four ginger compounds demonstrated antioxidant properties, which were inhibited by MnO₂, an oxidant without antibacterial effects. After the antioxidant property was blocked, their antimicrobial effects were abolished significantly. These results indicate that ginger compounds have antioxidant effects that partially contribute to their antimicrobial activity and are candidates for use in the treatment of infections with XDRAB.
Phytotherapy Research 12/2010; 24(12):1825-30. · 2.09 Impact Factor
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ABSTRACT: Current guidelines for treating community-acquired pneumonia recommend the use of fluoroquinolones for high-risk patients. Previous studies have reported controversial results as to whether fluoroquinolones are associated with delayed diagnosis and treatment of pulmonary tuberculosis (TB) and the development of fluoroquinolone-resistant Mycobacterium tuberculosis. We performed a systematic review and meta-analysis to clarify these issues.
The following databases were searched through September 30, 2010: PubMed, EMBASE, CINAHL, Cochrane Library, Web of Science, BIOSIS Previews, and the ACP Journal Club. We considered studies that addressed the issues of delay in diagnosis and treatment of TB and the development of resistance.
Nine eligible studies (four for delays and five for resistance issues) were included in the meta-analysis from the 770 articles originally identified in the database search. The mean duration of delayed diagnosis and treatment of pulmonary TB in the fluoroquinolone prescription group was 19.03 days, significantly longer than that in the non-fluoroquinolone group (95% confidence interval (CI) 10.87 to 27.18, p<0.001). The pooled odds ratio of developing a fluoroquinolone-resistant M. tuberculosis strain was 2.70 (95% CI 1.30 to 5.60, p=0.008). No significant heterogeneity was found among studies in the meta-analysis.
Empirical fluoroquinolone prescriptions for pneumonia are associated with longer delays in diagnosis and treatment of pulmonary TB and a higher risk of developing fluoroquinolone-resistant M. tuberculosis.
International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases 12/2010; 15(3):e211-6. · 2.17 Impact Factor
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ABSTRACT: Healthcare system delays in the diagnosis of tuberculosis can increase the risk of its nosocomial transmission. We aimed to determine whether different physicians' specialties and experience influenced this diagnostic delay.
We retrospectively reviewed the cases of 167 patients with smear-positive pulmonary tuberculosis who were hospitalized from September, 2004, to August, 2006, for 5 components of healthcare system delays according to the World Health Organization definitions and analyzed the impact of physicians' specialties and their experience (annual number of patients treated for tuberculosis) on these delays.
The median suspicion delay was significantly longer for patients in surgical departments than those in medical departments (4 days versus 1 day, P = 0.001) and for patients treated by nontuberculosis specialists than those treated by tuberculosis specialists (including pulmonologists, infectious diseases specialists and thoracic surgeons; 3 days versus 1 day, P < 0.001). Both were independent factors related to suspicion delay examined by multivariate analysis. The annual number of tuberculosis patients in each department had a significant negative correlation with suspicion delay (r = -0.303, P < 0.001).
Patients treated by surgeons and nontuberculosis specialists who were inexperienced in treating tuberculosis experienced a longer suspicion delay. Enhancing knowledge about tuberculosis among all physicians in the hospital, encouraging staff to consult tuberculosis specialists to confirm a diagnosis and implementing early alarm systems are crucial to improving the correct diagnosis of tuberculosis and to reducing delays in treatment.
The American Journal of the Medical Sciences 11/2010; 340(5):367-72. · 1.39 Impact Factor
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ABSTRACT: Myocarditis is defined clinically as inflammation of the heart muscle, which can be caused by infectious agents, toxins or immunologic reactions. Most recognized cases of acute myocarditis are secondary to cardiotropic viral infections. Escherichia coli rarely cause myocarditis. The authors report a 25-year-old woman with E coli-induced acute pyelonephritis and septic shock that was complicated with acute myocarditis. Her symptoms mimicked acute myocardial infarction. The authors discuss the possible mechanism of bacterial sepsis-induced myocarditis.
The American Journal of the Medical Sciences 10/2010; 340(4):332-4. · 1.39 Impact Factor
