Publications (20)45.41 Total impact
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Article: Evaluation of the Cobas TaqMan MTB real-time PCR assay for direct detection of Mycobacterium tuberculosis in respiratory specimens.
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ABSTRACT: Cobas TaqMan MTB assay is a real-time polymerase chain reaction (qPCR) kit in rapid detection of Mycobacterium tuberculosis (MTB) from clinical specimens. There are, however, limited studies validating its performance. We performed a prospective study in two hospitals in Taiwan including 586 respiratory specimens. By using culture as the reference method, the sensitivity and specificity of Cobas TaqMan MTB assay were 82.7 % and 96.5 %, respectively. The sensitivity of Cobas TaqMan MTB assay in acid-fast stain negative respiratory specimens was only 34.9 %. Five specimens from five patients were positive for MTB by the Cobas TaqMan MTB assay but were negative for MTB by conventional culture methods. A diagnosis of pulmonary tuberculosis was made based on clinical and radiological findings as well as response to anti-tuberculosis treatment in all these five patients. Addition of data from these five specimens with discrepant results (PCR vs. culture) from patients with symptoms clinically compatible with tuberculosis increased the sensitivity of Cobas TaqMan MTB assay to 83.1 %. The Cobas TaqMan MTB assay is a rapid identification tool with a high degree of specificity for the direct detection of MTB in respiratory specimens. The sensitivity for detecting acid-fast smear-negative respiratory specimens, however, was low.Journal of Medical Microbiology 05/2013; · 2.50 Impact Factor -
Article: Outcome Correlation of Smear-positivity for Acid-fast Bacilli on the Fifth Month of Treatment in Non-Multidrug Resistant Tuberculosis.
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ABSTRACT: ABSTRACT BACKGROUND: Sputum samples from patients with non-multidrug-resistant (non-MDR) pulmonary tuberculosis (TB) may remain smear-positive for acid-fast bacilli (AFB) on the 5th month of anti-TB treatment. However, its significance remains unknown. METHODS: From January 2004 to April 2009, there were 5403 patients with culture-confirmed pulmonary TB from in four hospitals in Taiwan. Among them, 116 (2.2%) non-MDR-TB patients whose sputum samples were smear-positive by concentration smear method on the 5th month of treatment were evaluated. RESULTS: Sputum culture yielded Mycobacterium tuberculosis in 10 patients (8.6%, MTB group), non-tuberculous mycobacteria in 23 (19.8%, NTM group), and no-growth in the remaining 83 (71.6%, no-growth group). The relapse rate (22%) was higher in the MTB group (p=0.01). Four predictors, smear grading ≥3+ on the 5th month ["S"] (OR:10.73, 2.67-43.17), no sputum culture conversion on the 2nd month ["C"] (OR:7.16, 1.45-35.44), lack of Directly Observed Therapy ["O"] (OR:6.40, 1.54-26.56), and no radiographic improvement on the 5th month ["R"] (OR:4.18, 1.02-17.10), were associated with viable M. tuberculosis (MTB group). An integrated "SCOR" index of 1 point for each positive factor had the best discriminatory power for predicting culture results on the 5th month. If the "SCOR" index was 0, all smear-positive sputum was culture-negative for M. tuberculosis. CONCLUSIONS: Positive sputum smears by a concentrated smear method on the 5th month of treatment in non-MDR TB patients, especially those with a low "SCOR" index, may be due to non-viable bacilli and NTM. Careful review of the quality of patient supervision, bacteriologic data, and chest radiography is crucial.Chest 01/2013; · 5.25 Impact Factor -
Article: Association of Mycobacterium tuberculosis genotypes and clinical and epidemiological features - a multi-center study in Taiwan.
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ABSTRACT: Genotypes of Mycobacterium tuberculosis (MTB) are related to the geographic origin of the patients and population migration. The relationship between genotypes of MTB and clinical presentations has mainly focused on transmission of multi-drug resistant MTB strain in population. This study aimed to investigate the molecular epidemiology and dynamic change of MTB genotypes in Taiwan, and their association with clinical presentation among patients with pulmonary tuberculosis. A multi-center, two-year study which enrolled 516 patients with 516 MTB isolates was conducted, including: (1) 254 isolates from northern Taiwan; (2) 38 isolates from mid-western Taiwan; (3) 211 isolates from southern Taiwan; and (4) 13 isolates from the east coast of Taiwan. The isolates were genotyped with spoligotyping and standardized 12-loci-MIRU-VNTR method. The results showed Beijing/Beijing-like family was the major genotype of MTB in the northern (58%), eastern (53%), and southern (33%) regions. The second most widely spread lineage were the EAI-Manila (20% in the west and south) and Haarlem family (13-27% in the south, west, and east). According to the cluster analysis of 12-MIRU-VNTR genotypes, there were differences in distribution of MTB genotype between the northern and southern regions, and a temporal relationship between isolation year and 12-MIRU-VNTR genotype especially in loci 26 and 39 might exist. Furthermore, some patients with cavity lesions on chest films were associated with a cluster of Beijing family MTB strains, which can be defined by cluster analysis of 12-MIRU-VNTR genotype. However, the results of 12-loci-MIRU-VNTR genotyping in a longitudinal study should be interpreted with caution due to its short term instability. Further investigations of different molecular methodologies are necessary.Infection, genetics and evolution: journal of molecular epidemiology and evolutionary genetics in infectious diseases 01/2012; 12(1):28-37. · 3.22 Impact Factor -
Article: Pleural empyema secondary to rupture of amoebic liver abscess.
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ABSTRACT: Amoebiasis is a worldwide parasitic infection although it is more prevalent in the subtropical and tropical countries. Extraintestinal amoebic infections currently have been reported in increased numbers of male homosexuals and immunocompromised patients. Here, we present an interesting case of a 27-year-old homosexual man with pleural empyema secondary to rupture of amoebic liver abscess. Using chest tube and percutaneous liver abscess drainage, the patient was treated with metronidazole followed by iodoquinol. His general condition improved dramatically. After one-year of follow-up, there was no evidence of relapse on plain chest radiography and abdominal CT scan.Internal Medicine 01/2012; 51(5):471-4. · 0.94 Impact Factor -
Article: Effective interventions and decline of antituberculosis drug resistance in Eastern Taiwan, 2004-2008.
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ABSTRACT: The Taiwan health authority recently launched several tuberculosis (TB) control interventions, which may have an impact on the epidemic of drug-resistant TB. We conducted a population-based antituberculosis drug resistance surveillance program in Eastern Taiwan to measure the proportions of notified TB patients with anti-TB drug resistance and the trend from 2004 to 2008. All culture-positive TB patients were enrolled. Drug susceptibility testing results of the first isolate of each TB patient in each treatment course were analyzed. In total, 2688 patients were included, of which 2176 (81.0%) were new TB cases and 512 (19.0%) were previously treated cases. Among the 2176 new TB cases, 97 (4.5%) were retreated after the first episode of TB treatment within the study period. The proportion of new patients with any resistance, isoniazid resistance but not multidrug-resistant TB (resistant to at least isoniazid and rifampin, MDR-TB), and MDR-TB was 16.4%, 7.5%, and 4.0%, respectively, and that among previously treated cases was 30.9%, 7.9%, and 17.6%, respectively. The combined proportion of any resistance decreased from 23.3% in 2004 to 14.3% in 2008, and that of MDR-TB from 11.5% to 2.4%. The proportion of TB patients with drug-resistant TB in Eastern Taiwan remains substantial. However, an effective TB control program has successfully driven the proportion of drug resistance among TB patients downward.PLoS ONE 01/2012; 7(2):e31531. · 4.09 Impact Factor -
Article: Pilot study of twice-weekly therapy for pulmonary tuberculosis in Taiwan.
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ABSTRACT: Taiwan has never implemented supervised intermittent chemotherapy for pulmonary tuberculosis, and its application and results are unknown. The purpose of this study was to evaluate the efficacy and feasibility of a 62-dose, four-drug, 6-month, twice-weekly regimen administered by directly observed therapy for the treatment of pulmonary tuberculosis. From January 2004 through December 2006, a total of 116 patients with suspected or confirmed pulmonary tuberculosis were enrolled. Thirty-two of these patients were excluded from the analysis because of drug resistance, negative culture, self withdrawal and drug reactions. Isoniazid, rifampin, pyrazinamide, and ethambutol were administered daily for 2 weeks, followed by twice weekly at a higher dose for 6 weeks. Thereafter, isoniazid, ethambutol and rifampin were administered twice weekly for 18 weeks. Treatment was directly observed by nurses or outreach workers. Of the 84 evaluable patients, 75 [89.3%, 95% confidence interval (CI): 80.6s-95.0%] patients were considered as successfully treated, three (3.6%, 95% CI: 0.7-10.1%) transferred out, five (6.0%, 95% CI: 2.0-13.3%) were unsuccessful and one (1.2%, 95% CI: 0.03-6.5%) died. Five patients were treatment failure (6.0%, 95% CI: 2.0-13.3%). Three patients had recurrences of pulmonary tuberculosis, and the recurrences were 4, 6 and 15 months after the completion of therapy. Sixpatients (5.2%) had severe adverse drug reactions and had their regimen modified. Prior to this study, intermittent therapy has not been attempted in Taiwan. This four-drug mostly twice-weeldy pulmonary tuberculosis treatment regimen is efficacious and relatively nontoxic, with a higher treatment success rate and a lower death rate. It considerably simplifies treatment and facilitates the execution of directly observed therapy. The reasons for the relatively high failure rate require further studies.Journal of the Formosan Medical Association 07/2011; 110(7):438-45. · 1.13 Impact Factor -
Article: Is it appropriate to routinely use a nucleic acid amplification test for the diagnosis of tuberculosis?
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ABSTRACT: The purpose of this study was to compare the usefulness of the nucleic acid amplification (NAA) test against conventional tests under normal laboratory operational conditions. The NAA test was performed on the first sputum specimen of all patients. Liquid media culture, solid media culture, and Ziehl-Neelsen stain for an acid-fast bacilli (AFB) smear were performed on three sputum specimens. The results were calculated using the gold standard of either the culture results or the clinical diagnosis. Of the 593 patients tested, 151 (25.5%) were diagnosed with pulmonary tuberculosis. The sensitivity of the first specimen only was 64% for the NAA test, 54% for the AFB smear, 77% for BACTEC MGIT 960 culture, 40% for Lowestain-Jensen (LJ) culture, and 25% for 7H11 culture. The sensitivity when using all three specimens increased to 63% for AFB smear, 87% for BACTEC MGIT 960 culture, 51% for LJ culture, and 40% for 7H11 culture. The specificity was 100% for all culture tests, 99% for the AFB smear, and 99.5% for NAA test. The mean turnaround time was 1.34 days for NAA, 0.59 days for AFB smear, 11 days for BACTEC MGIT 960 culture, 23 days for LJ culture, and 20 days for 7H11 culture. We conclude that the sensitivity of NAA is still far from ideal, and the test is not cost effective. Thus, the COBAS AMPLICOR PCR system is not suitable for routine use in microbiology laboratories.The Kaohsiung journal of medical sciences 04/2011; 27(4):138-43. · 0.61 Impact Factor -
Article: Initial presentations predict mortality in pulmonary tuberculosis patients--a prospective observational study.
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ABSTRACT: Despite effective anti-TB treatments, tuberculosis remains a serious threat to public health and is associated with high mortality. Old age and multiple co-morbidities are known risk factors for death. The association of clinical presentations with mortality in pulmonary tuberculosis patients remains an issue of controversy. This prospective observational study enrolled newly diagnosed, culture-proven pulmonary tuberculosis patients from five medical centers and one regional hospital, which were referral hospitals of TB patients. Radiographic findings and clinical symptoms were determined at the time of diagnosis. Patients who died for any reason during the course of anti-TB treatment were defined as mortality cases and death that occurred within 30 days of initiating treatment was defined as early mortality. Clinical factors associated with overall mortality and early mortality were investigated. A total of 992 patients were enrolled and 195 (19.7%) died. Nearly one-third (62/195, 31.8%) of the deaths occurred before or within 30 days of treatment initiation. Older age (RR = 1.04, 95%CI: 1.03-1.05), malignancy (RR = 2.42, 95%CI: 1.77-3.31), renal insufficiency (RR = 1.77, 95%CI: 1.12-2.80), presence of chronic cough (RR = 0.63, 95%CI: 0.47-0.84), fever (RR = 1.45, 95%CI: 1.09-1.94), and anorexia (RR = 1.49, 95%CI: 1.07-2.06) were independently associated with overall mortality. Kaplan-Meier survival analysis demonstrated significantly higher mortality in patients present with fever (p<0.001), anorexia (p = 0.005), and without chronic cough (p<0.001). Among patients of mortality, those with respiratory symptoms of chronic cough (RR = 0.56, 95%CI: 0.33-0.98) and dyspnea (HR = 0.51, 95%CI: 0.27-0.98) were less likely to experience early mortality. The radiological features were comparable between survivors and non-survivors. In addition to demographic characteristics, clinical presentations including the presence of fever, anorexia, and the absence of chronic cough, were also independent predictors for on-treatment mortality in pulmonary tuberculosis patients.PLoS ONE 01/2011; 6(9):e23715. · 4.09 Impact Factor -
Article: Seroprevalence and severity of 2009 pandemic influenza A H1N1 in Taiwan.
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ABSTRACT: This study is to determine the seroprevalence of the pandemic influenza A H1N1 virus (pH1N1) in Taiwan before and after the 2009 pandemic, and to estimate the relative severity of pH1N1 infections among different age groups. A total of 1544 and 1558 random serum samples were collected from the general population in Taiwan in 2007 and 2010, respectively. Seropositivity was defined by a hemagglutination inhibition titer to pH1N1 (A/Taiwan/126/09) ≥1:40. The seropositivity rate of pH1N1 among the unvaccinated subjects and national surveillance data were used to compare the proportion of infections that led to severe diseases and fatalities among different age groups. The overall seroprevalence of pH1N1 was 0.91% (95% confidence interval [CI] 0.43-1.38) in 2007 and significantly increased to 29.9% (95% CI 27.6-32.2) in 2010 (p<0.0001), with the peak attack rate (55.4%) in 10-17 year-old adolescents, the lowest in elderly ≥65 years (14.1%). The overall attack rates were 20.6% (188/912) in unvaccinated subjects. Among the unvaccinated but infected populations, the estimated attack rates of severe cases per 100,000 infections were significantly higher in children aged 0-5 years (54.9 cases, odds ratio [OR] 4.23, 95% CI 3.04-5.90) and elderly ≥ 65 years (22.4 cases, OR 2.76, 95% CI 1.99-3.83) compared to adolescents aged 10-17 years (13.0 cases). The overall case-fatality rate was 0.98 per 100,000 infections without a significant difference in different age groups. Pre-existing immunity against pH1N1 was rarely identified in Taiwanese at any age in 2007. Young children and elderly--the two most lower seroprotection groups showed the greatest vulnerability to clinical severity after the pH1N1 infections. These results imply that both age groups should have higher priority for immunization in the coming flu season.PLoS ONE 01/2011; 6(9):e24440. · 4.09 Impact Factor -
Article: Pleural plaque related to asbestos mining in Taiwan.
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ABSTRACT: A 78-year-old woman complained of twisting-like pain in her left lower chest. During physical examination, friction rubbing was noted in both lungs. Chest radiography showed extensive bilateral pleural calcification. High-resolution computed tomography confirmed the presence of bilateral calcified pleural plaques. The patient had worked at a Japanese asbestos factory in Taiwan for 1 year when she was 16 years old. Her job involved picking out asbestos fibers from crushed asbestos minerals, but no protective equipment was used at that time. This is believed to be the first reported case of asbestos-related disease in Taiwan that resulted from asbestos mining. We also summarize the history of domestic asbestos mining, importation of asbestos, and trends in asbestos use in Taiwan.Journal of the Formosan Medical Association 12/2010; 109(12):928-33. · 1.13 Impact Factor -
Article: An outbreak of human metapneumovirus infection in hospitalized psychiatric adult patients in Taiwan.
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ABSTRACT: Human metapneumovirus (hMPV) is a paramyxovirus that is associated with respiratory tract infection (RTI) mostly in children, but these outbreaks have rarely been reported in adults. We encountered an outbreak of this disease involving 10 adults in a psychiatric ward in eastern Taiwan. The nasopharyngeal swab specimens from 13 patients with symptoms of RTI were obtained and analyzed. The RT-PCR tests were negative to influenza virus A/B, adenovirus, RSV, parainfluenza virus, coronavirus, Nipah virus and Legionella. The antigen tests were negative to Legionella, Chlamydia, and Mycoplasma. Blood culture was negative in all except patient no. 1, who was found positive for coagulase-negative staphylococci. The hMPV was identified in 10 of 13 adults (77%), but negative for the other virus. Cough was present in all (100%), fever in 90%, and X-ray evidence of pneumonia in 7 patients. One patient died of respiratory failure. We report this outbreak in a mental hospital to alert the medical profession that this unusual infection of hMPV can occur as an outbreak in an adult setting and is an occupational hazard for healthcare personnel.Scandinavian Journal of Infectious Diseases 04/2009; 41(5):363-7. · 1.72 Impact Factor -
Article: High resolution chest CT in patients with pulmonary tuberculosis: characteristic findings before and after antituberculous therapy.
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ABSTRACT: The purpose of this study was (a) to describe HRCT findings for pulmonary tuberculosis before and after treatment, and (b) to evaluate the possible use of HRCT to assess disease activity. We prospectively studied 52 patients with newly diagnosed pulmonary tuberculosis that was proven bacteriologically. HRCT scans were performed before and after treatment. Micronodules, nodules, tree-in-bud appearance, consolidation, and cavities were the most common HRCT findings seen in active pulmonary tuberculosis. The disappearance of tree-in-bud appearance, pleural effusion and the presence of fibrotic change appear to be indications of the effectiveness of treatment. HRCT can differentiate old fibrotic lesions from newly active tuberculous lesions. HRCT may be helpful in the diagnosis of pulmonary tuberculosis and may be useful in the assessment of the efficacy of anti-tuberculous treatment.European Journal of Radiology 08/2008; 67(1):100-4. · 2.61 Impact Factor -
Article: Nosocomial transmission of tuberculosis in two hospitals for mentally handicapped patients.
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ABSTRACT: An unexpected significant increase in the number of tuberculosis (TB) cases in one hospital for mentally handicapped patients in eastern Taiwan was observed in early 2002. An active screening program was performed to identify undetected TB cases and to investigate nosocomial transmission of TB in two hospitals for mentally handicapped patients in eastern Taiwan. Active chest X-ray (CXR) screening followed by passive symptom screening were used to identify patients with pulmonary TB over 2 years in hospital A and B. IS 6110 restriction fragment length polymorphism and spacer oligonucleotide typing (spoligotyping) profiles of the isolates, clinical record of each case, TB control policies of the two hospitals, and risk factors of nosocomial transmission were analyzed. A total of 94.8% (2298/2423) inmates in hospital A and 96.3% (1902/1975) inmates in hospital B were screened by CXR at the beginning of 2002. During the 2-year study period, TB was diagnosed by sputum cultures for 30 patients in hospital A (notified disease rate = 619 per 100,000 population per year) and eight patients in hospital B (notified disease rate = 203 per 100,000 population per year). Seventeen patients (56.7%) in hospital A had six cluster pattern strains, and none did in hospital B, which highlighted the importance of immediate expert consultation and thorough isolation of TB suspects. This is the first study to prove that thorough isolation by referring patients to general hospital as soon as possible could decrease nosocomial transmission of TB in hospitals for mentally handicapped patients. Routine CXR screening at admission and maintaining a high alert for TB in daily practice are essential.Journal of the Formosan Medical Association 01/2008; 106(12):999-1006. · 1.13 Impact Factor -
Article: Transmission of Mycobacterium tuberculosis in a family proved by genotyping.
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ABSTRACT: Molecular genetic methods have been applied in various epidemiologic studies including investigations of disease acquisition by contact. This report describes the use of various molecular genetic methods in tracing possible household transmission of tuberculosis by contact. Four Mycobacterium tuberculosis strains, each from four members of a family, were first isolated and identified in the clinical laboratory of the Chest Hospital and were submitted to the National Reference Laboratory of Mycobacteriology for further confirmation and genotyping. In this study, IS6110 restriction fragment length polymorphism (RFLP), spacer oligonucleotide typing (spoligotyping) and mycobacterial interspersed repetitive units-variable number tandem repeats (MIRU-VNTR), and rpoB gene sequencing were used for genotyping. All four strains were found to have identical spoligotypes, MIRU-VNTR patterns, and similar IS6110 RFLP profiles. The results of the drug susceptibility test and of rpoB sequencing showed that all four strains were rifampicin resistant. Household transmission through close contact was thus proved by genotyping. We conclude that all four family members were infected with the same lineage of M. tuberculosis.Journal of the Formosan Medical Association 11/2007; 106(10):808-14. · 1.13 Impact Factor -
Article: Treatment outcome of pulmonary tuberculosis in eastern Taiwan - experience at a medical center.
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ABSTRACT: The World Health Organization (WHO) has proposed that treatment outcome is an important indicator of tuberculosis control. This study investigated the outcome of tuberculosis treatment at a medical center in eastern Taiwan. A total of 166 pulmonary tuberculosis patients notified by Tzu Chi Hospital in 2002 were included in this study. Treatment outcome data were collected at the local level and categorized according to WHO recommendations as cured, treatment completed, failed, died, defaulted, or transferred. Outcomes of the 166 patients, as reported by the National Tuberculosis Program were obtained from the Taiwan Center for Disease Control (Taiwan CDC) for comparison. Of the 166 patients, outcome was classified as cured in 46 (27.7%), treatment completed in 73 (44.0%), died in 27 (16.3%), treatment failed in five (3.0%), and defaulted in 15 (9.0%). Males were more likely to die or to default than females, and the elderly were more likely to die than younger patients. Patients with comorbidities were significantly more likely to die than patients without (p = 0.025). Patients with a history of tuberculosis were more likely to default (p = 0.050). Smear-positive patients were more likely to fail, and patients without cavitation on chest radiograph were more likely to have successful treatment. Outcomes of 26 (15.7%) cases in this cohort were unavailable (18 cases) or inaccurate (8 cases) on the Taiwan CDC website. The unsatisfactory outcome of pulmonary tuberculosis treatment in this medical center in eastern Taiwan highlights the importance of implementing directly observed treatment short course strategy. Improvement in the quality of data reported by the National Tuberculosis Program is urgently needed.Journal of the Formosan Medical Association 02/2007; 106(1):25-30. · 1.13 Impact Factor -
Article: Pulmonary manifestation in neurofibromatosis type 1.
Internal Medicine 02/2007; 46(8):527-8. · 0.94 Impact Factor -
Article: Revisit of 1997 TNM staging system--survival analysis of 1112 lung cancer patients in Taiwan.
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ABSTRACT: There is neither a nation-wide nor a large-scale, multi-institutional lung cancer database available for stage-by-stage survival analysis in Taiwan at present. Using the data element provided by the International Association for the Study of Lung Cancer, the Taiwan Lung Cancer Society initiated a project to include native lung cancer patients into a global database. A total of 1112 Taiwan lung cancer patients treated in 7 medical centers were enrolled. In small cell lung cancer, patients with ipsilateral pleural effusion had a survival between those with locoregional disease alone and those with distant metastasis; however, the difference was not statistically significant (P = 0.204). In non-small cell lung cancer, tumor size had significant survival influence for patients as a whole (P < 0.001) but it did not support the further division of stage IA according to tumor size (P = 0.122). The survival was compatible in stage IIIB and IV patients and therefore, the survival impact of pleural effusion cannot be determined. In patients with pIIIA-N2 disease, those who had station 8 nodal metastasis had inferior survival (P = 0.020) and station 5 superior survival (P = 0.010). In patients with distant metastasis, bone, liver, or distant lymph node metastasis predicted an inferior survival (all P values < 0.05). The present study provides for comparison in this area a stage-by-stage reference for the survival of lung cancer patients. Some factors other than current TNM descriptors need to be further investigated in constructing the next version of the staging system.Japanese Journal of Clinical Oncology 01/2007; 37(1):9-15. · 1.78 Impact Factor -
Article: Association of NRAMP 1 gene polymorphism with susceptibility to tuberculosis in Taiwanese aboriginals.
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ABSTRACT: The human homologue of mice natural-resistance-associated macrophage protein 1 (Nramp 1) gene, NRAMP 1, has been reported to play a role in susceptibility to tuberculosis in humans. The aboriginal population in Taiwan has a five-fold higher prevalence of tuberculosis than people of Han ethnicity. Whether genetic factors such as NRAMP 1 polymorphism play a role in the prevalence of tuberculosis in Taiwanese aboriginals should be clarified. NRAMP 1 polymorphism was studied using a case-control design of patients with tuberculosis, including subjects of Han (Hans) and aboriginal ethnicity in Hualien, eastern Taiwan. The polymorphisms of NRAMP 1 at loci INT4, D543N, 77-385C/T, 3-UTR (CAAA) deletion and 5-(CA)n microsatellite markers were assessed by polymerase chain reaction on tissue DNA isolated from 105 aborigines and 110 Hans with tuberculosis. Comparable numbers of ethnically-matched controls were studied simultaneously. Two NRAMP 1 polymorphisms, INT4 and 5-(CA)n, were significantly associated with susceptibility to tuberculosis in aboriginals (p = 0.0070 and p = 0.0031, respectively). However, no association was detected at the five loci of NRAMP 1 polymorphisms among Hans (p > 0.08). Genetic variation in NRAMP 1 may affect susceptibility to and increase risk for tuberculosis in Taiwanese aboriginals. Although environmental factors play an important role in tuberculosis infection, genetic factors such as NRAMP 1 polymorphism may also contribute to the high prevalence of tuberculosis in Taiwanese aboriginals.Journal of the Formosan Medical Association 06/2006; 105(5):363-9. · 1.13 Impact Factor -
Article: Acute respiratory distress syndrome associated with rabies: a case report.
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ABSTRACT: Acute respiratory distress syndrome (ARDS) is the first potentially lethal complication in rabies virus infection, although its occurrence is rare. We report on a fatal case of rabies virus infection in a 45-year-old woman from Hu-Nan Province, China. The neurologic signs of limb numbness and water phobia occurred from 61 days after the dog bite; the clinical course was progressive, with the most severe clinical manifestations being fever, encephalitis, and ARDS. The woman expired 12 days after admission to the hospital. An autopsy proved rabies encephalitis, mainly involving the medulla oblongata, the thalamus, part of the pons, the cerebellum, and the hippocampus. The lung pathologic examination revealed the organizing phase of ARDS with diffuse alveolar damage, hyaline membrane formation, type II alveolar cell hyperplasia accompanied by proliferation of fibroblasts and infiltration of mononuclear cells into the interstitial space. Immunohistochemistry stain and reverse transcription-polymerase chain reaction for rabies virus failed to demonstrate the organism in the lung tissue. Strong expression of inducible nitric oxide synthase (iNOS) was detected in the alveolar macrophages. An immunologic mechanism with iNOS expression in the absence of direct invasion of the organism may participate in the pathogenesis of ARDS associated with rabies.The Kaohsiung journal of medical sciences 03/2006; 22(2):94-8. · 0.61 Impact Factor -
Article: SARS-associated coronavirus infection in teenagers.
Emerging infectious diseases 03/2004; 10(2):382-3. · 6.17 Impact Factor
Top co-authors
Top Journals
Institutions
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2007–2011
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Buddhist Tzu Chi General Hospital
Taipei, Taipei, Taiwan
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2009
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Kaohsiung Armed Forces General Hospital
Kaohsiung, Kaohsiung, Taiwan
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