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Chan JFW, Tse H, To KKW, Li IWS, Tang BSF, Cheng VCC, Yuen KY. Q fever: underdiagnosed in Hong Kong? Hong Kong Med J 2010; 16:56-58. [PMID: 20124575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
We report the first imported case of chronic Q fever with multi-organ involvement seen in Hong Kong. Although the disease is found worldwide, its chronic form is very rare in our locality. Familiarity with the clinical presentation, useful diagnostic tools, and appropriate treatment is necessary for the prevention of the serious morbidity and mortality associated with chronic Q fever. To the best of our knowledge, this article represents the first comprehensive review to compare the local experience with Q fever with international data, and establishes a management approach for this unusual infectious disease while suggesting possible explanations for its exceptionally low incidence in this locality.
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Affiliation(s)
- J F W Chan
- Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong.
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Tang BSF, Chan KH, Cheng VCC, Yuen KY. Comparative host gene transcription by microarray analysis early after infection of the Huh7 cell line by SARS coronavirus and human coronavirus 229E. Hong Kong Med J 2009; 15 Suppl 9:23-26. [PMID: 20393221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
During the early stages of infection, SARS-CoV produces more severe perturbation of host cell gene expression in a human epithelial cell line of liver origin than the HCoV-229E.
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Affiliation(s)
- B S F Tang
- Department of Microbiology, The University of Hong Kong, Queen Mary Hospital Compound, Pokfulam Road, Hong Kong SAR, China.
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Cheng VCC, Li IWS, Wu AKL, Tang BSF, Ng KHL, To KKW, Tse H, Que TL, Ho PL, Yuen KY. Effect of antibiotics on the bacterial load of meticillin-resistant Staphylococcus aureus colonisation in anterior nares. J Hosp Infect 2008; 70:27-34. [PMID: 18632184 DOI: 10.1016/j.jhin.2008.05.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2008] [Accepted: 05/09/2008] [Indexed: 10/21/2022]
Abstract
Prevalence of hospital-acquired meticillin-resistant Staphylococcus aureus (MRSA) infection or colonisation has been associated with antimicrobial consumption. The impact of antibiotic treatment on nasal colonisation is unknown. We conducted a three-month prospective study of 116 patients with extranasal MRSA infection or colonisation, whose nasal MRSA bacterial loads were determined during and after various antibiotic courses over a period of three weeks. Environmental swabs were also taken from the near patient environment. Concomitant nasal MRSA carriage was observed in 76.7% of extranasal MRSA-colonised or -infected patients. The median nasal MRSA bacterial load increased significantly from 2.78 (range 0-6.15) to 5.30 (range 2.90-8.41) log(10) cfu per swab (cfu/swab) (P<0.001) over 21 days during beta-lactam therapy. It also increased from 0 (range 0-4.00) to 4.30 (range 0-7.46) log(10)cfu/swab (P=0.039) over 14 days during fluoroquinolone therapy. Median bacterial loads were significantly higher for beta-lactam- and fluoroquinolone-treated patients on day 7 [4.78, range 0-7.30], day 14 [4.30, range 0-7.60] and day 21 [5.30, range 2.90-8.41] than controls not receiving antibiotics (P<0.05). These loads then decreased by 2-5log(10)cfu/swab 2 weeks after discontinuation of antibiotics. The environment of patients receiving beta-lactam agents (relative risk: 3.55; 95% confidence interval: 1.30-9.62; P=0.018) or fluoroquinolones (4.32; 1.52-12.31; P=0.008) demonstrated more MRSA contamination than the environment around control patients (0.79; 0.67-0.93; P=0.002). Patients on beta-lactam or fluoroquinolone therapy have increased incidence of MRSA colonisation and higher nasal bacterial loads, and appear to spread their MRSA into the near patient environment.
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Affiliation(s)
- V C C Cheng
- Department of Microbiology, Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong SAR, China
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Ng KHL, Wu AKL, Cheng VCC, Tang BSF, Chan CY, Yung CY, Luk SH, Lee TW, Chow L, Yuen KY. Pulmonary artery thrombosis in a patient with severe acute respiratory syndrome. Postgrad Med J 2005; 81:e3. [PMID: 15937197 PMCID: PMC1743280 DOI: 10.1136/pgmj.2004.030049] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Severe acute respiratory syndrome (SARS) is an emerging infectious disease with both pulmonary and extra-pulmonary manifestations. Although coagulation abnormalities are common in these patients, clinically overt thromboembolic events are rarely reported. This report describes the first case of pulmonary artery thrombosis in a patient with laboratory confirmed SARS.
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Affiliation(s)
- K H L Ng
- Department of Pathology, Tuen Mun Hospital, Hospital Authority, Hong Kong Special Administrative Region, China
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Hung IFN, Wu AKL, Cheng VCC, Tang BSF, To KW, Yeung CK, Woo PCY, Lau SKP, Cheung BMY, Yuen KY. Fatal Interaction between Clarithromycin and Colchicine in Patients with Renal Insufficiency: A Retrospective Study. Clin Infect Dis 2005; 41:291-300. [PMID: 16007523 DOI: 10.1086/431592] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2005] [Accepted: 03/16/2005] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Clarithromycin is frequently used to treat community-acquired pneumonia in elderly persons. Like erythromycin, it may interact with other drugs by interfering with metabolism by cytochrome P450 enzymes and with the P-glycoprotein transporter system. Colchicine, used for treatment of acute gout and for prophylaxis, may cause bone marrow toxicity. It is metabolized by CYP3A4 and is transported by P-glycoprotein. Initial case reports suggested potentially fatal interactions between clarithromycin and colchicine. METHODS A retrospective study was conducted with 116 patients who were prescribed clarithromycin and colchicine during the same clinical admission. Case-control comparisons were made between patients who received concomitant therapy with the 2 drugs and patients who received sequential therapy. We assessed the clinical presentations and outcomes of the 2 patient groups and analyzed the risk factors associated with fatal outcomes. RESULTS Nine (10.2%) of the 88 patients who received the 2 drugs concomitantly died. Only 1 (3.6%) of the 28 patients who received the drugs sequentially died. Multivariate analysis of the 88 patients who received concomitant therapy showed that longer overlapped therapy (relative risk [RR], 2.16; 95% confidence interval [CI], 1.41-3.31; P< or =.01), the presence of baseline renal impairment (RR, 9.1; 95% CI, 1.75-47.06; P<.001), and the development of pancytopenia (RR, 23.4; 95% CI, 4.48-122.7; P<.001) were independently associated with death. CONCLUSIONS Clarithromycin increases the risk of fatal colchicine toxicity, especially for patients with renal insufficiency. Since there are other drugs for treatment of pneumonia and gout, these 2 drugs should not be coprescribed, because of the risk of fatality.
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Affiliation(s)
- I F N Hung
- Research Center of Infection and Immunology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
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Abstract
BACKGROUND Owing to problems in accurate species identification of the diverse genus clostridium, the epidemiology and pathogenicity of many species are not fully understood. Moreover, previous studies on clostridium bacteraemia have been limited and relied only on phenotypic species identification. AIMS To characterise the epidemiology, disease spectrum, and outcome of clostridium bacteraemia using 16S ribosomal RNA (rRNA) gene sequencing. METHOD During a four year period (1998-2001), all cases of clostridium bacteraemia were prospectively studied and all "non-perfringens" clostridium isolates identified to the species level by 16S rRNA gene sequencing. RESULTS Fifty one blood culture isolates were identified as Clostridium perfringens and 17 belonged to 11 other clostridium species. The first case of C disporicum infection and two cases of clostridium bacteraemia in children with intussusception were also described. Of the 68 clostridium isolates from 68 different patients, 38 were associated with clinically relevant bacteraemia. The gastrointestinal and hepatobiliary tracts were common sites of both underlying disease and portal of entry in these patients. Clostridium perfringens accounted for 79% of all clinically relevant bacteraemia, with the remainder caused by a diversity of species. The attributable mortality rate of clinically relevant clostridium bacteraemia was 29%. Younger age and underlying gastrointestinal/hepatobiliary tract disease were associated with mortality (p < 0.05). CONCLUSIONS Patients with clinically relevant clostridium bacteraemia should be investigated for the presence of underlying disease processes in the gastrointestinal or hepatobiliary tracts. 16S rRNA gene analysis will continue to be useful in further understanding the pathogenicity of various clostridium species.
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Affiliation(s)
- P C Y Woo
- Department of Microbiology, University Pathology Building, Queen Mary Hospital, Pokfulam Road, Hong Kong, China
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Cheng VCC, Hung IFN, Wu AKL, Tang BSF, Chu CM, Yuen KY. Lymphocyte surge as a marker for immunorestitution disease due to Pneumocystis jiroveci pneumonia in HIV-negative immunosuppressed hosts. Eur J Clin Microbiol Infect Dis 2004; 23:512-4. [PMID: 15141339 DOI: 10.1007/s10096-004-1140-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- V C C Cheng
- Division of Infectious Diseases, Centre of Infection, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
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Cheng VCC, Yam WC, Hung IFN, Woo PCY, Lau SKP, Tang BSF, Yuen KY. Clinical evaluation of the polymerase chain reaction for the rapid diagnosis of tuberculosis. J Clin Pathol 2004; 57:281-5. [PMID: 14990600 PMCID: PMC1770227 DOI: 10.1136/jcp.2003.012658] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS Use of the polymerase chain reaction for the detection of Mycobacterium tuberculosis (TB PCR) as a basis for making clinical decisions on the initiation of antituberculosis treatment was studied. METHODS A retrospective study involving a cohort of 155 patients being investigated for tuberculosis in an infectious disease consultation service was undertaken. TB PCR was performed on pulmonary and extrapulmonary specimens from these patients. The sensitivity of TB PCR was analysed. RESULTS Of the 155 patients, 144 fitted the clinical diagnosis of tuberculosis, and 112 of them were culture positive for M tuberculosis. Sixty (58.3%) patients with clinical features suggestive of tuberculosis received antituberculosis treatment based on positive TB PCR alone. Of 224 clinical specimens (138 pulmonary and 86 extrapulmonary) sent for TB PCR, 148 (99 pulmonary and 49 extrapulmonary) were positive in 117 patients. Of the 690 clinical specimens sent for culture, 279 were positive for M tuberculosis in 112 patients. The diagnostic sensitivity of TB PCR was 75.9% (85 of 112) and 81.3% (117 of 144) in patients with culture confirmed and clinically diagnosed tuberculosis, respectively. Using culture as the gold standard, the overall sensitivity of TB PCR was 78.3%, and for pulmonary and extrapulmonary specimens it was 82.3% and 72.0%, respectively. CONCLUSIONS TB PCR is a rapid and reliable test in the diagnosis and management of tuberculosis.
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Affiliation(s)
- V C C Cheng
- Division of Infectious Diseases, Centre of Infection, The University of Hong Kong, University Pathology Building, Queen Mary Hospital, Hong Kong ROC
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Cheng VCC, Hung IFN, Tang BSF, Chu CM, Wong MML, Chan KH, Wu AKL, Tse DMW, Chan KS, Zheng BJ, Peiris JSM, Sung JJY, Yuen KY. Viral replication in the nasopharynx is associated with diarrhea in patients with severe acute respiratory syndrome. Clin Infect Dis 2004; 38:467-75. [PMID: 14765337 PMCID: PMC7107995 DOI: 10.1086/382681] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2003] [Accepted: 01/09/2004] [Indexed: 12/15/2022] Open
Abstract
The role of severe acute respiratory syndrome (SARS) coronavirus as an enteric pathogen was investigated in a cohort of 142 patients with SARS who were treated with a standard treatment protocol. Data from daily hematological, biochemical, radiological, and microbiological investigations were prospectively collected, and the correlation of these findings with diarrhea was retrospectively analyzed. Sixty-nine patients (48.6%) developed diarrhea at a mean (± standard deviation [SD]) of 7.6 ± 2.6 days after the onset of symptoms. The diarrhea was most severe at a mean (±SD) of 8.8 ± 2.4 days after onset, with a maximum frequency of 24 episodes per day (median, 5 episodes; range, 3–24 episodes). A higher mean virus load in nasopharyngeal specimens obtained on day 10 after the onset of symptoms was significantly associated with the occurrence of diarrhea (3.1 log10 vs. 1.8 log10 copies/mL; P = .01) and mortality (6.2 vs. 1.7 log10 copies/mL; P < .01). However, diarrhea was not associated with mortality. The lung and the gastrointestinal tract may react differently to SARS coronavirus infection. Additional investigation of the role of SARS coronavirus in the pathogenesis of diarrhea in patients with SARS should be conducted.
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Affiliation(s)
- V. C. C. Cheng
- Centre of Infection, Queen Mary Hospital, The University of Hong Kong, China
| | - I. F. N. Hung
- Centre of Infection, Queen Mary Hospital, The University of Hong Kong, China
| | - B. S. F. Tang
- Centre of Infection, Queen Mary Hospital, The University of Hong Kong, China
| | - C. M. Chu
- Department of Medicine, United Christian Hospital, China
| | - M. M. L. Wong
- Department of Medicine and Geriatrics, Caritas Medical Centre, China
| | - K. H. Chan
- Centre of Infection, Queen Mary Hospital, The University of Hong Kong, China
| | - A. K. L. Wu
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - D. M. W. Tse
- Department of Medicine and Geriatrics, Caritas Medical Centre, China
| | - K. S. Chan
- Department of Medicine, United Christian Hospital, China
| | - B. J. Zheng
- Centre of Infection, Queen Mary Hospital, The University of Hong Kong, China
| | - J. S. M. Peiris
- Centre of Infection, Queen Mary Hospital, The University of Hong Kong, China
| | - J. J. Y. Sung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - K. Y. Yuen
- Centre of Infection, Queen Mary Hospital, The University of Hong Kong, China
- Reprints or correspondence: Prof. K. Y. Yuen, Centre of Infection, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, China ()
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Peiris JSM, Chu CM, Cheng VCC, Chan KS, Hung IFN, Poon LLM, Law KI, Tang BSF, Hon TYW, Chan CS, Chan KH, Ng JSC, Zheng BJ, Ng WL, Lai RWM, Guan Y, Yuen KY. Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Lancet 2003; 361:1767-72. [PMID: 12781535 PMCID: PMC7112410 DOI: 10.1016/s0140-6736(03)13412-5] [Citation(s) in RCA: 1750] [Impact Index Per Article: 83.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND We investigated the temporal progression of the clinical, radiological, and virological changes in a community outbreak of severe acute respiratory syndrome (SARS). METHODS We followed up 75 patients for 3 weeks managed with a standard treatment protocol of ribavirin and corticosteroids, and assessed the pattern of clinical disease, viral load, risk factors for poor clinical outcome, and the usefulness of virological diagnostic methods. FINDINGS Fever and pneumonia initially improved but 64 (85%) patients developed recurrent fever after a mean of 8.9 (SD 3.1) days, 55 (73%) had watery diarrhoea after 7.5 (2.3) days, 60 (80%) had radiological worsening after 7.4 (2.2) days, and respiratory symptoms worsened in 34 (45%) after 8.6 (3.0) days. In 34 (45%) patients, improvement of initial pulmonary lesions was associated with appearance of new radiological lesions at other sites. Nine (12%) patients developed spontaneous pneumomediastinum and 15 (20%) developed acute respiratory distress syndrome (ARDS) in week 3. Quantitative reverse-transcriptase (RT) PCR of nasopharyngeal aspirates in 14 patients (four with ARDS) showed peak viral load at day 10, and at day 15 a load lower than at admission. Age and chronic hepatitis B virus infection treated with lamivudine were independent significant risk factors for progression to ARDS (p=0.001). SARS-associated coronavirus in faeces was seen on RT-PCR in 65 (97%) of 67 patients at day 14. The mean time to seroconversion was 20 days. INTERPRETATION The consistent clinical progression, shifting radiological infiltrates, and an inverted V viral-load profile suggest that worsening in week 2 is unrelated to uncontrolled viral replication but may be related to immunopathological damage.
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Affiliation(s)
- JSM Peiris
- Departments of Microbiology and Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - CM Chu
- Department of Medicine, Intensive Care, Radiology, and Pathology, United Christian Hospital, Hong Kong
| | - VCC Cheng
- Departments of Microbiology and Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - KS Chan
- Department of Medicine, Intensive Care, Radiology, and Pathology, United Christian Hospital, Hong Kong
| | - IFN Hung
- Departments of Microbiology and Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - LLM Poon
- Departments of Microbiology and Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - KI Law
- Department of Medicine, Intensive Care, Radiology, and Pathology, United Christian Hospital, Hong Kong
| | - BSF Tang
- Departments of Microbiology and Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - TYW Hon
- Department of Medicine, Intensive Care, Radiology, and Pathology, United Christian Hospital, Hong Kong
| | - CS Chan
- Department of Medicine, Intensive Care, Radiology, and Pathology, United Christian Hospital, Hong Kong
| | - KH Chan
- Departments of Microbiology and Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - JSC Ng
- Department of Medicine, Intensive Care, Radiology, and Pathology, United Christian Hospital, Hong Kong
| | - BJ Zheng
- Departments of Microbiology and Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - WL Ng
- Department of Medicine, Intensive Care, Radiology, and Pathology, United Christian Hospital, Hong Kong
| | - RWM Lai
- Department of Medicine, Intensive Care, Radiology, and Pathology, United Christian Hospital, Hong Kong
| | - Y Guan
- Departments of Microbiology and Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - KY Yuen
- Departments of Microbiology and Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Region, China
- Correspondence to: Prof K Y Yuen, Department of Microbiology, University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong, Special Administrative Region, China
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