1
|
Chung MH, Kang JS, Lee JS. Tick-Borne Rickettsiosis and Tsutsugamushi Disease Recorded in 313. Infect Chemother 2024; 56:56.e17. [PMID: 38686644 DOI: 10.3947/ic.2023.0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/21/2024] [Indexed: 05/02/2024] Open
Abstract
Tsutsugamushi disease was first described in China by Hong Ge in 313. In his book Zhouhou Beiji Fang, three eschar-associated febrile diseases were described: Shashidu, Zhongxidu, and Shegongdu. Shashidu was identified as being identical to tsutsugamushi disease in Japan: it occurred in riverside areas, exhibited an eschar, and was transmitted by tiny red "sand lice". The nature of Zhongxidu remains unknown, but we propose that it is another type of Orientia tsutsugamushi infection: it occurred in mountainous areas, an eschar was observed, and the causative vector was not identified. Moreover, Zhongxidu would have predated Shashidu by five centuries; thus, the first documentation of tsutsugamushi disease would date back 2.2 millennia. O. tsutsugamushi infection without eschar has not been identified in ancient Chinese literature and may be included in Shanghan. Several ancient Chinese books describe that Shegongdu occurs following a Shegong bite. Shegong is described as a bug resembling a cockroach or cicada with a crossbow-like structure, possibly the hypostome and unfolded palps of tick, in its mouth. Thus, Shegong refers to an engorged tick and Shegongdu is a tick-borne rickettsiosis. However, due to a lack of entomological knowledge, these findings have not been recognized for the past 1.7 millennia.
Collapse
Affiliation(s)
| | - Jae-Seung Kang
- Department of Microbiology, Inha University School of Medicine, Incheon, Korea
| | - Jin-Soo Lee
- Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea.
| |
Collapse
|
2
|
Chung MH, Lee JS, Im JH. Antibiotic Combination Therapy for Severe Scrub Typhus: Is It Necessary? Infect Chemother 2023; 55:179-184. [PMID: 37407239 DOI: 10.3947/ic.2023.0055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/16/2023] [Indexed: 07/07/2023] Open
Abstract
Scrub typhus can be adequately treated with doxycycline or azithromycin unless it is treated too late. Such cases present as severe scrub typhus, and their treatment remains a challenging problem. In this article, we briefly review the literature on the treatment of scrub typhus and the limitations of the combination of doxycycline and azithromycin. Several options are suggested for further study in the treatment of severe scrub typhus (such as encephalitis, myocarditis, and pneumonia), including dose escalation of doxycycline, the adjuvant use of steroids, the selective use of beta-lactam antibiotics, and the use of tigecycline.
Collapse
Affiliation(s)
| | - Jin-Soo Lee
- Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Jae Hyoung Im
- Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea.
| |
Collapse
|
3
|
Im JH, Nahm CH, Je YS, Lee JS, Baek JH, Kwon HY, Chung MH, Jang JH, Kim JS, Lim JH, Park MH. The effect of Epstein-Barr virus viremia on the progression to severe COVID-19. Medicine (Baltimore) 2022; 101:e29027. [PMID: 35550458 PMCID: PMC9276369 DOI: 10.1097/md.0000000000029027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/15/2022] [Indexed: 01/04/2023] Open
Abstract
Epstein-Barr virus (EBV) is frequently reactivated by coronavirus 2019 (COVID-19), and a high incidence of EBV viremia has been reported in patients with severe COVID-19. However, the impact of EBV viremia on progression to severe COVID-19 is unclear. Therefore, we conducted a study to evaluate the effect of EBV on COVID-19 progression.We investigated EBV viremia at the time of admission in COVID-19 patients hospitalized between February 1, 2020, and April 11, 2021. A cross-sectional study was performed to compare the severity of COVID-19 according to the presence or absence of EBV viremia. However, since it is difficult to analyze the influence of EBV viremia on COVID-19 progression with cross-sectional studies, a retrospective cohort study, limited to patients with mild COVID-19, was additionally conducted to observe progression to severe COVID-19 according to the presence or absence of EBV viremia.Two hundred sixty-nine COVID-19 patients were tested for EBV viremia. In a cross-sectional study that included patients with both mild and severe COVID-19, the EBV viremia group had more severe pneumonia than the EBV-negative group. However, in the cohort study limited to mild cases (N = 213), EBV viremia was not associated with COVID-19 progression.COVID-19 severity may affect EBV viremia; however, there was no evidence that EBV viremia was a factor in exacerbating pneumonia in patients with mild COVID-19.
Collapse
Affiliation(s)
- Jae Hyoung Im
- Division of Infectious Diseases, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - Chung Hyun Nahm
- Department of Laboratory Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - Young Soo Je
- Department of Laboratory Medicine, Seoul Clinical Laboratories (SCL), Yongin, Republic of Korea
| | - Jin-Soo Lee
- Division of Infectious Diseases, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - Ji Hyeon Baek
- Division of Infectious Diseases, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - Hea Yoon Kwon
- Division of Infectious Diseases, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - Moon-Hyun Chung
- Department of Internal Medicine, Seogwipo Medical Center, Jeju-do, Republic of Korea
| | - Ji-Hun Jang
- Department of Hospital Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - Jung Soo Kim
- Division of Critical Care Medicine, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - Jun Hyeok Lim
- Division of Pulmonology, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea
| | - Mi Hwa Park
- Division of Pulmonology, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea
| |
Collapse
|
4
|
Chung MH, Lee JS, Kang JS. Buerger’s Disease May be a Chronic Rickettsial Infection with Superimposed Thrombosis: Literature Review and Efficacy of Doxycycline in Three Patients. Infect Chemother 2022; 54:20-58. [PMID: 35384418 PMCID: PMC8987189 DOI: 10.3947/ic.2021.0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/26/2022] [Indexed: 12/03/2022] Open
Abstract
Buerger’s disease (BD) is a chronic inflammatory vasculitis of unknown etiology. The infectious etiology of BD was proposed by Buerger in 1914. Furthermore, there are scattered reports insisting that BD may be related to rickettsial infection, first asserted by Goodman since 1916, followed by Giroud and other French investigators from the 1940s through the 1960s, Nicolau in the 1960s, Bartolo (1980s), and Fazeli (2010s). However, their causal relationship has hardly been accepted because rickettsial infections are known to be acute febrile, vector-borne illnesses, whereas BD is a chronic afebrile illness. In this article we review the relevant literature on the chronic nature of Rickettsia and Orientia infections and on the rickettsial etiology of BD. Excellent initial responses to doxycycline in three patients with BD are briefly described. Based on these findings, we hypothesize that BD patients acquired a rickettsial infection far before the onset of BD. Over years, the infected area expands to become a segment of the infected vessel. Subsequently, thrombus develops on the luminal surface of the infected endothelial cells, which produces the vascular obstructive manifestations of BD. Collectively, it is postulated that BD is a chronic infection with a member of the family Rickettsiaceae with superimposed thrombosis.
Collapse
Affiliation(s)
- Moon-Hyun Chung
- Division of Infectious Diseases, Department of Internal Medicine, Seogwipo Medical Center, Jeju, Korea
| | - Jin-Soo Lee
- Division of Infectious Diseases, Department of Internal Medicine; Inha University, Incheon, Korea
| | - Jae-Seung Kang
- Department of Microbiology, Inha University, Incheon, Korea
| |
Collapse
|
5
|
Im JH, Lee JS, Chung MH, Kwon HY, Lee MJ, Baek JH. Effect of a serum lactate monitoring recommendation policy on patients treated with linezolid. Medicine (Baltimore) 2021; 100:e23790. [PMID: 33429740 PMCID: PMC7793345 DOI: 10.1097/md.0000000000023790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 11/14/2020] [Indexed: 01/05/2023] Open
Abstract
Lactic acidosis is one of the most fatal adverse effects of linezolid, an antibiotic used to treat serious infections caused by antibiotic-resistant bacteria. However, the measures to prevent lactic acidosis have not been well established.We performed a retrospective study to analyze the impact of applying a serum lactate monitoring recommendation policy in patients treated with linezolid.Since September 2011, we have recommended inpatient monitoring of serum lactate levels in patients treated with linezolid at our hospital. Patients were divided into two groups according to whether they were seen during the non-recommendation or recommendation periods. The frequency of serum lactate monitoring, linezolid-induced lactatemia, lactic acidosis, critical illness, and death were compared between the two periods.After September 2011, adherence to the recommendation to monitor serum lactate increased from 6.1% to 60.1%. No difference was observed in the incidence of linezolid-induced lactatemia and lactic acidosis between the two periods. However, there was a significant difference in the incidence of linezolid-induced critical illness between the non-recommendation and recommendation periods (3 vs 0 cases, P = .044).In patients treated with linezolid, serum lactate monitoring led to early detection of lactatemia, thus enabling rapid rescue. We recommend regular monitoring of serum lactate in all patients treated with linezolid.
Collapse
Affiliation(s)
- Jae Hyoung Im
- Division of Infectious Diseases, Department of Internal Medicine, Inha University college of Medicine, Incheon
| | - Jin-Soo Lee
- Division of Infectious Diseases, Department of Internal Medicine, Inha University college of Medicine, Incheon
| | - Moon-Hyun Chung
- Department of Internal Medicine, Seigui-po Medical Center, Jeju-do
| | - Hea Yoon Kwon
- Division of Infectious Diseases, Department of Internal Medicine, Inha University college of Medicine, Incheon
| | - Man-Jong Lee
- Division of Critical Care Medicine, Department of Hospital Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - Ji Hyeon Baek
- Division of Infectious Diseases, Department of Internal Medicine, Inha University college of Medicine, Incheon
| |
Collapse
|
6
|
Im JH, Chung MH, Lee HJ, Kwon HY, Baek JH, Jang JH, Lee JS. Splenic infarction and infectious diseases in Korea. BMC Infect Dis 2020; 20:915. [PMID: 33267828 PMCID: PMC7708890 DOI: 10.1186/s12879-020-05645-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/22/2020] [Indexed: 01/20/2023] Open
Abstract
Background The spleen contains immune cells and exhibits a pattern of infarction different from other organs; as such, splenic infarction (SI) may provide important clues to infection. However, the nature of the relationship between SI and infectious disease(s) is not well understood. Accordingly, this retrospective study investigated the relationship between SI and infection. Methods Hospital records of patients with SI, who visited Inha University Hospital (Incheon, Republic of Korea) between January 2008 and December 2018, were reviewed. Patient data regarding clinical presentation, causative pathogens, risk factors, and radiological findings were collected and analyzed. Results Of 353 patients with SI, 101 with infectious conditions were enrolled in this study, and their data were analyzed to identify associations between SI and infection. Ten patients were diagnosed with infective endocarditis (IE), and 26 exhibited bacteremia without IE. Twenty-seven patients experienced systemic infection due to miscellaneous causes (negative result on conventional automated blood culture), including the following intracellular organisms: parasites (malaria [n = 12], babesiosis [n = 1]); bacteria (scrub typhus [n = 5]); viruses (Epstein–Barr [n = 1], cytomegalovirus [n = 1]); and unidentified pathogen[s] (n = 7). Splenomegaly was more common among patients with miscellaneous systemic infection; infarction involving other organs was rare. Thirty-eight patients had localized infections (e.g., respiratory, intra-abdominal, or skin and soft tissue infection), and most (35 of 38) had other risk factors for SI. Conclusions In this study, various infectious conditions were found to be associated with SI, and intracellular organisms were the most common causative pathogens. Further studies are needed to examine other possible etiologies and the underlying pathophysiological mechanisms.
Collapse
Affiliation(s)
- Jae Hyoung Im
- Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon, 22212, Republic of Korea
| | - Moon-Hyun Chung
- Department of Internal Medicine, Seogwipo Medical Center, Jeju-do, Republic of Korea
| | - Hye-Jin Lee
- Translation Research Center, Inha University School of Medicine, Incheon, Republic of Korea
| | - Hea Yoon Kwon
- Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon, 22212, Republic of Korea
| | - Ji Hyeon Baek
- Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon, 22212, Republic of Korea
| | - Ji-Hun Jang
- Department of Hospital Medicine, Inha University School of Medicine, Incheon, 22212, Republic of Korea.
| | - Jin-Soo Lee
- Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon, 22212, Republic of Korea.
| |
Collapse
|
7
|
Im JH, Kim TS, Chung MH, Baek JH, Kwon HY, Lee JS. Current Status and a Perspective of Mosquito-Borne Diseases in the Republic of Korea. Vector Borne Zoonotic Dis 2020; 21:69-77. [PMID: 33136531 DOI: 10.1089/vbz.2019.2588] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background: Mosquito-borne diseases in the Republic of Korea have a unique epidemiology due to the rapid improvement in hygiene and economic status, occurrence of four distinct seasons, and separation from North Korea owing to the political situation. Therefore, we aimed to analyze and review the epidemiology of mosquito-borne diseases in Korea. Methods: The incidence and geographical distribution of malaria, Japanese encephalitis (JE), Zika virus infection, chikungunya fever, and dengue fever were investigated using data from the Korean Centers for Disease Control and Prevention. Lymphatic filariasis and West Nile fever, which have rarely been reported in Korea, have also been discussed in this literature review. Results and Conclusions: Malaria disappeared from Korea in 1979, but since its re-emergence in 1993 there has been constant occurrence with local transmission. In Korea, vivax malaria is the only prevailing disease, and the clinically problematic chloroquine resistance has not been reported. The incidence of JE has greatly reduced since the introduction of the national vaccination program for children in 1985. However, the incidence of JE has been increasing recently, especially in adults >40 years of age. Filariasis, which was previously endemic to Jeju Island and the southern coastal area, has not been reported since 2002. Although there are numerous imported cases with increasing overseas travel, there are still no indigenous cases of Zika, chikungunya, and dengue fever reported in Korea. The West Nile virus was isolated from migratory birds, but there has been only one imported human case to date.
Collapse
Affiliation(s)
- Jae Hyoung Im
- Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - Tong-Soo Kim
- Department of Tropical Medicine and Parasitology, Inha University School of Medicine, Incheon, Republic of Korea
| | - Moon-Hyun Chung
- Department of Internal Medicine, Seogwipo Medical Center, Jeju, Republic of Korea
| | - Ji Hyeon Baek
- Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - Hea Yoon Kwon
- Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - Jin-Soo Lee
- Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| |
Collapse
|
8
|
Im JH, Je YS, Baek J, Chung MH, Kwon HY, Lee JS. Nutritional status of patients with COVID-19. Int J Infect Dis 2020; 100:390-393. [PMID: 32795605 PMCID: PMC7418699 DOI: 10.1016/j.ijid.2020.08.018] [Citation(s) in RCA: 159] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/03/2020] [Accepted: 08/07/2020] [Indexed: 12/12/2022] Open
Abstract
The relationship between immunity and nutrition is well known and its role in coronavirus disease 2019 (COVID-19) is also being paid great attention. However, the nutritional status of COVID-19 patients is unknown. Vitamin B1, B6, B12, vitamin D (25-hydroxyvitamin D), folate, selenium, and zinc levels were measured in 50 hospitalized patients with COVID-19. Overall, 76% of the patients were vitamin D deficient and 42% were selenium deficient. No significant increase in the incidence of deficiency was found for vitamins B1, B6, and B12, folate, and zinc in patients with COVID-19. The COVID-19 group showed significantly lower vitamin D values than the healthy control group (150 people, matched by age/sex). Severe vitamin D deficiency (based on a cut-off of ≤10 ng/dl) was found in 24.0% of the patients in the COVID-19 group and 7.3% in the control group. Among 12 patients with respiratory distress, 11 (91.7%) were deficient in at least one nutrient. However, patients without respiratory distress showed a deficiency in 30/38 cases (78.9%; p = 0.425). These results suggest that a deficiency of vitamin D or selenium may decrease the immune defenses against COVID-19 and cause progression to severe disease. However, more precise and large-scale studies are needed.
Collapse
Affiliation(s)
- Jae Hyoung Im
- Division of Infectious Diseases, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - Young Soo Je
- Department of Laboratory Medicine, Seoul Clinical Laboratories (SCL), Yongin, South Korea
| | - Jihyeon Baek
- Division of Infectious Diseases, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - Moon-Hyun Chung
- The Korean Society of Infectious Diseases, Republic of Korea
| | - Hea Yoon Kwon
- Division of Infectious Diseases, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea.
| | - Jin-Soo Lee
- Division of Infectious Diseases, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea.
| |
Collapse
|
9
|
Abstract
INTRODUCTION Chryseobacterium arthrosphaerae is a gram-negative bacteria, known for its intrinsic multidrug resistance, which can lead to treatment difficulties. PATIENT CONCERNS A 56-year-old male had an indwelling external ventricular drainage catheter for 6 months and had been frequently treated with antibiotics for nosocomial infections. He showed cerebrospinal fluid pleocytosis and an abrupt fever during hospitalization. DIAGNOSIS He was diagnosed as a ventriculitis caused by Chryseobacterium arthrosphaerae (C arthrosphaerae). INTERVENTION Initially, we used ciprofloxacin as the backbone in combination with minocycline (and rifampin). However, fever and pleocytosis persisted, and improvement was slow. We then switched the minocycline and rifampin regiment to trimethoprim/sulfamethoxazole. Following this switch of antibiotics, the patient's pleocytosis rapidly improved, allowing the replacement of his external ventricular drainage catheters. C arthrospharae was no longer growing in cerebrospinal fluid and he was recovered from ventriculitis. OUTCOMES The patient remains alive without any incidence of C arthrosphaerae recurrence. CONCLUSION We propose trimethoprim/sulfamethoxazole alone or in combination with ciprofloxacin to be good candidates for the treatment of ventriculitis by C arthrosphaerae.
Collapse
Affiliation(s)
- Jae Hyoung Im
- Division of Infectious diseases, Department of Internal Medicine
| | | | | | | | - Young Kyoung Park
- Translation Research Center, Inha University College of Medicine, Incheon
| | - Hea Yoon Kwon
- Division of Infectious diseases, Department of Internal Medicine
| | - Moon-Hyun Chung
- Department of Internal Medicine, Seogwipo Medical Center, Jeju, Republic of Korea
| | - Ji Hyeon Baek
- Division of Infectious diseases, Department of Internal Medicine
| | - Jin-Soo Lee
- Division of Infectious diseases, Department of Internal Medicine
| |
Collapse
|
10
|
Im JH, Choi SJ, Chung MH, Lee SY, Park YK, Kwon HY, Baek JH, Lee JS. A case of Henoch-Schönlein purpura associated with scrub typhus. BMC Infect Dis 2020; 20:286. [PMID: 32303196 PMCID: PMC7165380 DOI: 10.1186/s12879-020-05001-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 03/29/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Henoch-Schönlein purpura (HSP) may be caused by several allergens. However, to date, HSP caused by Orientia tsutsugamushi has not been reported. Here, we report an unusual rash with features of HSP caused by Orientia tsutsugamushi. CASE PRESENTATION A man visited a tertiary hospital with bilateral symmetrical purpura and fever. He presented with an eschar in the left popliteal fossa and proteinuria. He was diagnosed with tsutsugamushi disease by indirect fluorescent antibody and positive polymerase chain reaction tests. Purpura biopsy demonstrated a feature of leukocytoclastic vasculitis and IgA deposition in dermal vessels, indicative of HSP. CONCLUSIONS When examining patients with unique rashes, such as in this case, we suggest investigating out-door activities and evidence of mite bites. Furthermore, differential diagnosis of tsutsugamushi disease should be considered when necessary.
Collapse
Affiliation(s)
- Jae Hyoung Im
- Division of Infectious Diseases, Department of Internal Medicine, Inha University College of Medicine, 7-206, Shinheung-Dong, Jung-Gu, Incheon, 22332 Republic of Korea
| | - Suk Jin Choi
- Department of Pathology, Inha University College of Medicine, Incheon, Republic of Korea
| | - Moon-Hyun Chung
- Department of Internal Medicine, Seogwipo Medical Center, Jeju, Jeju-do Republic of Korea
| | - Seung Yun Lee
- Division of Rheumatology,Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - Young Kyoung Park
- Translation Research Center, Inha University College of Medicine, Incheon, Republic of Korea
| | - Hea Yoon Kwon
- Division of Infectious Diseases, Department of Internal Medicine, Inha University College of Medicine, 7-206, Shinheung-Dong, Jung-Gu, Incheon, 22332 Republic of Korea
| | - Ji Hyeon Baek
- Division of Infectious Diseases, Department of Internal Medicine, Inha University College of Medicine, 7-206, Shinheung-Dong, Jung-Gu, Incheon, 22332 Republic of Korea
| | - Jin-Soo Lee
- Division of Infectious Diseases, Department of Internal Medicine, Inha University College of Medicine, 7-206, Shinheung-Dong, Jung-Gu, Incheon, 22332 Republic of Korea
| |
Collapse
|
11
|
Im JH, Chung MH, Durey A, Kwon HY, Lee JS, Lee MJ, Baek JH. Splenic Infarction in Plasmodium vivax Infection in South Korea. Am J Trop Med Hyg 2020; 101:803-805. [PMID: 31436158 DOI: 10.4269/ajtmh.19-0101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Splenic infarction caused by malaria can be fatal, but its incidence and clinical presentation are not well-known. Thus, we investigated the prevalence and characteristics of splenic complications in patients with vivax malaria from 2005 to 2017 in a university hospital. Among 273 patients who were diagnosed with Plasmodium vivax infection by blood smear, 92 underwent abdominal computed tomography or ultrasonography. Twelve patients had splenic infarction. All patients with splenic infarction recovered after treatment with antimalarial drugs, without surgery and intervention. Although anemia and prolonged fever may be risk factors for splenic infarction, the incidence of these events was insufficient for a detailed analysis.
Collapse
Affiliation(s)
- Jae Hyoung Im
- Department of Infectious Disease, Inha University School of Medicine, Incheon, Republic of Korea
| | - Moon-Hyun Chung
- Department of Infectious Disease, Jeju University Hospital, Jeju, Republic of Korea
| | - Areum Durey
- Department of Emergency Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - Hea Yoon Kwon
- Department of Infectious Disease, Inha University School of Medicine, Incheon, Republic of Korea
| | - Jin-Soo Lee
- Department of Infectious Disease, Inha University School of Medicine, Incheon, Republic of Korea
| | - Man-Jong Lee
- Division of Critical Care Medicine, Department of Hospital Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - Ji Hyeon Baek
- Department of Infectious Disease, Inha University School of Medicine, Incheon, Republic of Korea
| |
Collapse
|
12
|
Im JH, Woo H, Ha BM, Lee JS, Chung MH, Jung J. Effectiveness of a single dose of the quadrivalent meningococcal conjugate vaccine, MenACWY-CRM, in the Korean Armed Forces. Vaccine 2020; 38:730-732. [PMID: 31787413 DOI: 10.1016/j.vaccine.2019.11.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 11/03/2019] [Accepted: 11/11/2019] [Indexed: 11/26/2022]
Abstract
Conjugate vaccines are widely used to overcome the disadvantages of polysaccharide vaccines in the prevention of meningococcal disease. However, limited studies have examined the clinical effectiveness of single-dose meningococcal quadrivalent conjugate vaccines in adults. We assessed the effectiveness of the meningococcal vaccination program in the Republic of Korea Armed Forces, since 2013. Following vaccination program implementation, meningococcal disease cases decreased from 0.52/100,000 to 0.06/100,000 and the number of deaths declined from four to zero. Two meningococcal cases that developed post-implementation were identified as serotype B and X. The effectiveness of single-dose conjugate vaccination in recruits, expressed as the incidence rate ratio, was 0.88 during a 19-23-month observation period. These results indicate that meningococcal infections can be prevented by single-dose administration of the quadrivalent conjugate vaccine in at-risk groups, such as soldiers, travelers, and students in dormitories. Continuous investigation is needed to determine serogroup change, including B serogroups.
Collapse
Affiliation(s)
- Jae Hyoung Im
- Division of Infectious Disease, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea.
| | - Hyeongtaek Woo
- Department of Preventive Medicine, Armed Force Medical Command, Seongnam, Republic of Korea.
| | - Beom Man Ha
- Department of Preventive Medicine, Armed Force Medical Command, Seongnam, Republic of Korea.
| | - Jin-Soo Lee
- Division of Infectious Disease, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea.
| | - Moon-Hyun Chung
- Department of Internal Medicine, Seogwipo Medical Center, Jeju, Republic of Korea.
| | - Jaehun Jung
- Department of Preventive Medicine, Gachon University College of Medicine, Incheon, Republic of Korea.
| |
Collapse
|
13
|
Abstract
A comprehensive understanding of the geographic distribution of the tick-borne encephalitis virus (TBEV) complex is necessary due to increasing transboundary movement and cross-reactivity of serological tests. This review was conducted to identify the geographic distribution of the TBEV complex, including TBE virus, Alkhurma haemorrhagic fever virus, Kyasanur forest disease virus, louping-ill virus, Omsk haemorrhagic fever virus, and Powassan virus. Published reports were identified using PubMed, EMBASE, and the Cochrane library. In addition to TBEV complex case-related studies, seroprevalence studies were also retrieved to assess the risk of TBEV complex infection. Among 1406 search results, 314 articles met the inclusion criteria. The following countries, which are known to TBEV epidemic region, had conducted national surveillance studies: Austria, China, Czech, Denmark, Estonia, Finland, Germany, Hungary, Italy, Latvia, Norway, Poland, Romania, Russia, Switzerland, Sweden, Slovenia, and Slovakia. There were also studies/reports on human TBEV infection from Belarus, Bulgaria, Croatia, France, Japan, Kyrgyzstan, Netherland, and Turkey. Seroprevalence studies were found in some areas far from the TBEV belt, specifically Malaysia, Comoros, Djibouti, and Kenya. Kyasanur forest disease virus was reported in southwestern India and Yunnan of China, the Powassan virus in the United States, Canada, and east Siberia, Alkhurma haemorrhagic fever virus in Saudi Arabia and east Egypt, and Louping-ill virus in the United Kingdom, Ireland, and east Siberia. In some areas, the distribution of the TBEV complex overlaps with that of other viruses, and caution is recommended during serologic diagnosis. The geographic distribution of the TBEV complex appears to be wide and overlap of the TBE virus complex with other viruses was observed in some areas. Knowledge of the geographical distribution of the TBEV complex could help avoid cross-reactivity during the serologic diagnosis of these viruses. Surveillance studies can implement effective control measures according to the distribution pattern of these viruses.
Collapse
Affiliation(s)
- Jae Hyoung Im
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - Ji-Hyeon Baek
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - Areum Durey
- Department of Emergency Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - Hea Yoon Kwon
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - Moon-Hyun Chung
- Department of Internal Medicine, Seogwipo Medical Center, Jeju-do, Republic of Korea
| | - Jin-Soo Lee
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| |
Collapse
|
14
|
Chung MH, Kang JS. Erythematous Patch in Tsutsugamushi Disease – An Atypical Form of Eschar. Infect Chemother 2020; 52:403-406. [PMID: 32468739 PMCID: PMC7533208 DOI: 10.3947/ic.2020.52.3.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 05/11/2020] [Indexed: 11/24/2022] Open
Abstract
Tsutsugamushi disease is caused by the bacterium, Orientia tsutsugamushi and transmitted by chigger mites. In addition to the typical dark eschar, various forms of the eschar, including papules and vesicles, develop at chigger bite sites. Macular lesions were reported only in a human inoculation study; the inoculation lesions relapsed as erythematous macules or erythema-based papules concomitant with fever relapse. Herein, we report an erythematous patch as an inoculation lesion in two patients with tsutsugamushi disease, which, additionally, displayed a central small circle of 1 mm in diameter, possibly a chigger bite site, and desquamation around the circle during doxycycline therapy.
Collapse
Affiliation(s)
- Moon-Hyun Chung
- Department of Internal Medicine, Seogwipo Medical Center, Seogwipo, Korea
| | - Jae-Seung Kang
- Department of Microbiology, Inha University, Incheon, Korea
| |
Collapse
|
15
|
Abstract
Introduction: Antinuclear antibody (ANA) tests are widely used for the diagnosis of autoimmune diseases, but ANAs are also commonly found in patients with various infections. This retrospective study aimed to investigate the relationship between infections and ANA status.Methods: Patients that visited the Department of Infectious Diseases at Inha University Hospital between January 2007 and July 2018 were investigated. We analysed their ANA test results and reviewed rheumatic and infectious diagnoses of patients with positive ANA findings.Results: Of the 9,320 patients during the study period, 1,111 underwent ANA testing and 110 tested positive. Seven of the 110 patients were previously diagnosed with ANA-positive disease, and 21 were diagnosed with autoimmune disease during the present study. Of the remaining 82 patients, 43 were confirmed with infectious disease. The most common pathogen was Mycobacterium tuberculosis (n = 10), followed by Treponema pallidum (n = 5), Orientia tsutsugamushi (n = 5), Escherichia coli (n = 5), Bartonella henselae (n = 3), and human immunodeficiency virus (n = 3). Of the 39 patients without a confirmed pathogen, 7 were seropositive for O. tsutsugamushi, B. henselae, or Rickettsia spp. Patients were observed at an average of 24 weeks in our hospital. One patient developed systemic lupus erythematosus after being diagnosed with Epstein-Barr virus-induced infectious mononucleosis, and another patient developed adult-onset Still's disease after being diagnosed with scrub typhus.Conclusion: This study showed that various relationships exist between infections and rheumatic diseases. In particular, several patients with a positive ANA test result were found to have intracellular infections such as mycobacterial infections, syphilis, or scrub typhus.
Collapse
Affiliation(s)
- Jae Hyoung Im
- Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - Moon-Hyun Chung
- Department of Internal Medicine, Seigui-po Medical Center, Jeju-Do, Republic of Korea
| | - Young Kyoung Park
- Translation Research Center, Inha University School of Medicine, Incheon, Republic of Korea
| | - Hea Yoon Kwon
- Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - Ji Hyeon Baek
- Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - Seung Yun Lee
- Department of Rheumatology, Inha University Hospital, Incheon, Republic of Korea
| | - Jin-Soo Lee
- Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| |
Collapse
|
16
|
Im JH, Chung MH, Durey A, Lee JS, Kim TS, Kwon HY, Baek JH. Subcapsular Splenic Hemorrhage in Vivax Malaria. Korean J Parasitol 2019; 57:405-409. [PMID: 31533407 PMCID: PMC6753294 DOI: 10.3347/kjp.2019.57.4.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 08/05/2019] [Indexed: 11/30/2022]
Abstract
In malaria, splenic rupture is a serious complication potentially leading to death. Subcapsular hemorrhage of spleen is thought to be an impending sign of splenic rupture; however, the characteristics of subcapsular hemorrhage are not well known. We report 3 cases of subcapsular hemorrhage of the spleen in vivax malaria, with varying degrees of severity. Case 1 showed subcapsular hemorrhage without splenic rupture, was treated by antimalarial drug without any procedure. The healing process of the patient's spleen was monitored through 6 computed tomography follow-up examinations, over 118 days. Case 2 presented subcapsular hemorrhage with splenic rupture, treated only with an antimalarial drug. Case 3 showed subcapsular hemorrhage with splenic rupture and hypotension, treated using splenic artery embolization. They all recovered from subcapsular hemorrhage without any other complications. These 3 cases reveal the process of subcapsular hemorrhage leading to rupture and a potentially fatal outcome. The treatment plan of subcapsular hemorrhage should be determined carefully considering the vital signs, changes in hemoglobin, and bleeding tendency.
Collapse
Affiliation(s)
- Jae Hyoung Im
- Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon 22332, Korea
| | - Moon-Hyun Chung
- Department of Internal Medicine, Seogwipo Medical Center, Jeju 63585, Korea
| | - Areum Durey
- Department of Emergency Medicine, Inha University School of Medicine, Incheon 22332, Korea
| | - Jin-Soo Lee
- Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon 22332, Korea
| | - Tong-Soo Kim
- Department of Tropical Medicine, Inha University School of Medicine, Incheon 22332, Korea
| | - Hea Yoon Kwon
- Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon 22332, Korea
| | - Ji Hyeon Baek
- Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon 22332, Korea
| |
Collapse
|
17
|
Abstract
Objective: This study assessed the construct validity of the Menopause Rating Scale (MRS) in Indonesia. Methods: The study included 240 women aged over 45 years in Indonesia. The MRS measures psychological, somatic-vegetative, and urogenital symptoms using 11 items obtained from participants' daily symptom records. The intraclass correlation coefficient (ICC) and Cronbach's alpha coefficient were measured to examine the test-retest reliability and internal consistency reliability. The test-retest reliability was evaluated by an extra 30 participants twice at 2-week intervals. For construct validity, exploratory factor analysis (EFA) was employed to assess factor structure and confirmatory factor analysis (CFA) was used to evaluate the structural model fit of the MRS. Results: The ICC for the test-retest reliability ranged between 0.90 and 0.95. The Cronbach alpha coefficients in the somatic-vegetative, psychological, and urogenital dimensions were 0.92, 0.93, and 0.95, respectively. The Kaiser-Meyer-Olkin value was 0.96, and the Bartlett's test of sphericity was statistically significant and adequate for EFA. CFA was tested using the second-order model with three first-order factors and yielded an excellent model fit. Conclusion: Results indicated that the brief questionnaire of the MRS possesses acceptable construct validity for evaluating menopause symptoms in Indonesian women.
Collapse
Affiliation(s)
- H Dwi Susanti
- School of Nursing, College of Nursing, Taipei Medical University , Taipei , Taiwan
| | - P C Chang
- School of Nursing, College of Nursing, Taipei Medical University , Taipei , Taiwan
| | - M H Chung
- School of Nursing, College of Nursing, Taipei Medical University , Taipei , Taiwan.,Department of Nursing, Shuang Ho Hospital, Taipei Medical University , New Taipei City , Taiwan
| |
Collapse
|
18
|
Kwon HY, Park YK, Lee SM, Baek JH, Kang JS, Chung MH, Kim EJ, Lee JS. Characterization of Clinical Isolates of Bartonella henselae Strains, South Korea. Emerg Infect Dis 2019; 24:912-915. [PMID: 29664377 PMCID: PMC5938757 DOI: 10.3201/eid2405.171497] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Bartonella henselae, a gram-negative bacterium, is a common causative agent of zoonotic infections. We report 5 culture-proven cases of B. henselae infection in South Korea. By alignment of the 16S rRNA sequences and multilocus sequencing typing analysis, we identified all isolates as B. henselae Houston-1 strain, which belongs to sequence type 1.
Collapse
|
19
|
Abstract
BACKGROUND Bites with tick-borne pathogens can cause various bacterial, viral, or parasitic diseases in humans. Tick-transmitted diseases are known as contributing factors to the increasing incidence and burden of diseases. The present article investigated the epidemiology of tick-borne diseases in South Korea. METHODS The incidence and distribution of common tick-borne diseases in Korea (Lyme disease, Q fever, and severe fever with thrombocytopenia syndrome [SFTS]) were investigated and analyzed, using data from the Korea Centers for Disease Control and Prevention (KCDC) infectious disease reporting system. A literature review was compiled on the current status of uncommon tick-borne diseases (Rickettsia, anaplasmosis, ehrlichiosis, bartonellosis, tularemia, tick-borne encephalitis, and babesiosis). RESULTS AND CONCLUSIONS In South Korea, SFTS is an emerging disease, showing a rapid increase in reports since 2012, with high mortality. Likewise, reports of Lyme disease and Q fever cases have also been rapidly increasing during 2012-2017, although caution should be taken when interpreting these results, considering the likely influence of increased physician awareness and reporting of these diseases. Other tick-borne diseases reported in South Korea included spotted fever group rickettsiae, anaplasmosis, ehrlichiosis, tularemia, Bartonella, and babesiosis. Evidences on human infection with tick-borne encephalitis virus and Crimean-Congo hemorrhagic fever were recently unavailable, but both need constant monitoring.
Collapse
Affiliation(s)
- Jae Hyoung Im
- 1 Department of Internal Medicine and Inha University School of Medicine, Incheon, Republic of Korea
| | - JiHyeon Baek
- 1 Department of Internal Medicine and Inha University School of Medicine, Incheon, Republic of Korea
| | - Areum Durey
- 2 Department of Emergency Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - Hea Yoon Kwon
- 1 Department of Internal Medicine and Inha University School of Medicine, Incheon, Republic of Korea
| | - Moon-Hyun Chung
- 3 Department of Internal Medicine, Jeju University Hospital, Jeju, Republic of Korea
| | - Jin-Soo Lee
- 1 Department of Internal Medicine and Inha University School of Medicine, Incheon, Republic of Korea
| |
Collapse
|
20
|
Im JH, Huh K, Yoon CG, Woo H, Lee JS, Chung MH, Klein TA, Jung J. Malaria control and chemoprophylaxis policy in the Republic of Korea Armed Forces for the previous 20 years (1997-2016). Malar J 2018; 17:295. [PMID: 30111314 PMCID: PMC6094909 DOI: 10.1186/s12936-018-2449-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 08/07/2018] [Indexed: 11/10/2022] Open
Abstract
Background Vivax malaria reemerged along the Demilitarized Zone (DMZ), Republic of Korea (ROK), in 1993. While it was hypothesized that vivax malaria would spread throughout the peninsula, nearly all cases were due to exposure near the DMZ. To reduce spillover of vivax malaria to the civilian community, the ROK Ministry of National Defense (MND) initiated malaria prevention policies including a large-scale chemoprophylaxis programme in malaria high-risk areas in 1997. The present study investigated the overall changes in the incidence of malaria among ROK soldiers and the mass chemoprophylaxis program from 1997 to 2016. Results Peak numbers of vivax malaria were reported in 2000, with most cases reported near the DMZ, before declining to the current levels. To combat the rapid increase in the number of malaria cases and its expansion throughout the ROK, the MND implemented mosquito control and personal protection programmes. The MND also implemented a large-scale vivax malaria chemoprophylaxis programme using hydroxychloroquine (400 mg weekly) in 1997, and primaquine (15 mg × 14 days) as terminal chemoprophylaxis in 2001. Additionally, an improved medical system enabled the rapid detection and treatment of malaria to reduce morbidity and decrease transmission of malaria from humans to mosquitoes. Following the full implementation of these programmes, the incidence of vivax malaria declined in both ROK Armed Forces and civilian populations. Subsequently, several changes in the ROK Armed Forces chemoprophylaxis programme were implemented, including the reduction of the period of hydroxychloroquine prophylaxis by 2 months (2008) and other changes in the chemoprophylaxis policy, e.g., only ROK Armed Forces personnel in moderate risk groups received terminal primaquine chemoprophylaxis (2011), and in 2016, the discontinuation of terminal primaquine chemoprophylaxis in moderate-risk area. Conclusions The resurgence of vivax malaria in the ROK Armed Forces personnel near the DMZ was successfully suppressed through the implementation of a mass malaria chemoprophylaxis programme initiated by the MND in 1997, as well as several other factors that may have contributed to the reduction of malaria transmission since 2000. Given the current malaria situation in the ROK and North Korea, it is necessary to reevaluate the ROK Armed Forces and civilian malaria control policies. Electronic supplementary material The online version of this article (10.1186/s12936-018-2449-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Jae Hyoung Im
- Department of Internal Medicine, Armed Forces Daejeon Hospital, Daejeon, Republic of Korea.,Department of Infectious Diseases, INHA University Hospital, Incheon, Republic of Korea
| | - Kyungmin Huh
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chang-Gyo Yoon
- Department of Preventive Medicine, Armed Force Medical Command, Seongnam, Republic of Korea
| | - Hyeongtaek Woo
- Department of Preventive Medicine, Armed Force Medical Command, Seongnam, Republic of Korea
| | - Jin-Soo Lee
- Department of Infectious Diseases, INHA University Hospital, Incheon, Republic of Korea
| | - Moon-Hyun Chung
- Department of Internal Medicine, Jeju University Hospital, Jeju, Republic of Korea
| | - Terry A Klein
- Force Health Protection & Preventive Medicine, Medical Activity-Korea/65th Medical Brigade, Unit 15281, Apo, AP, 96251, USA
| | - Jaehun Jung
- Department of Preventive Medicine, Armed Force Medical Command, Seongnam, Republic of Korea. .,Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
21
|
Im JH, Kwon HY, Baek J, Durey A, Lee SM, Park YK, Kang JS, Chung MH, Lee JS. Serologic Study of Bartonella henselae in Patients with Acute Undifferentiated Febrile Illness in Korea. Vector Borne Zoonotic Dis 2018; 18:291-296. [PMID: 29630475 DOI: 10.1089/vbz.2017.2170] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Bartonella infection is an emerging cause of acute febrile illness; however, its significance has not been thoroughly investigated. We studied the antibody specific to Bartonella henselae in patients with various febrile diseases in Korea. MATERIALS AND METHODS A total of 177 patients with acute febrile illness who were managed at the Inha University Hospital from February 2012 to January 2013 were evaluated with an in-house immunofluorescent antibody test to detect B. henselae immunoglobulin G (IgG) antibody. The clinical features of the patients included fever of undetermined origin (n = 88 patients), lymphadenopathy (n = 28), febrile rash (n = 17), respiratory infection (n = 12), aseptic meningitis (n = 7), intra-abdominal infection (n = 5), arthritis (n = 4), and other conditions (n = 16). We reviewed the medical records of these patients and collected demographic data, clinical features, and their histories of animal exposure. RESULTS Among the 177 patients with acute febrile illness, 23.7% (42/177) had elevated levels of IgG antibodies to B. henselae (≥1:160). Of these seropositive patients, 32.4% (12/37) had contact with animals and had developed arthralgia (29.5%), headache (25%), or lymphadenopathy (15.9%). Seven (16.7%) of the 42 patients had higher IgG titers (≥1:640). Among them, four patients presented fourfold increase/decrease of IgG in convalescent serum. According to the clinical diagnosis, the antibody positivity rates were as follows: 24/88 with undifferentiated fever, 8/28 with lymphadenopathy, 4/17 with febrile rash, 2/12 with respiratory infection, 2/7 with aseptic meningitis, and 2/16 with other illnesses. CONCLUSIONS There was high prevalence of B. henselae in patients with undifferentiated fever in Korea, for which further research is needed.
Collapse
Affiliation(s)
- Jae Hyoung Im
- 1 Department of Internal Medicine, Inha University School of Medicine , Incheon, Republic of Korea
| | - Hae Yoon Kwon
- 1 Department of Internal Medicine, Inha University School of Medicine , Incheon, Republic of Korea
| | - JiHyeon Baek
- 1 Department of Internal Medicine, Inha University School of Medicine , Incheon, Republic of Korea
| | - Areum Durey
- 2 Department of Emergency Medicine, Inha University School of Medicine , Incheon, Republic of Korea
| | - Sun Myoung Lee
- 3 Translation Research Center, Inha University School of Medicine , Incheon, Republic of Korea
| | - Young Kyung Park
- 3 Translation Research Center, Inha University School of Medicine , Incheon, Republic of Korea
| | - Jae-Seung Kang
- 4 Department of Microbiology, Inha University School of Medicine , Incheon, Republic of Korea
| | - Moon-Hyun Chung
- 5 Department of Internal Medicine, Jeju University Hospital , Jeju, Jeju-do, Republic of Korea
| | - Jin-Soo Lee
- 1 Department of Internal Medicine, Inha University School of Medicine , Incheon, Republic of Korea
| |
Collapse
|
22
|
Abstract
Background Although severe malaria by Plasmodium vivax has been increasingly reported, there are marked variations in the type and rate of the complications by geographic area. This is possibly because of the presence of concurrent falciparum malaria or bacteraemia, and of differences in underlying immune status among the infected subjects. Furthermore, published studies on P. vivax in temperate regions are limited. The present study investigated severe vivax malaria in Korea, where only vivax malaria occurs. Hence, other compounding factors are rare. Additionally, most of the patients are possibly non-immune to this malarial disease. Methods Adults with vivax malaria observed in one 860-bed university hospital from January 2006 to December 2012 were retrospectively evaluated. Seventeen patients who had travelled overseas within 6 months before the presentation of malaria were excluded. Severe vivax malaria was diagnosed according to World Health Organization criteria. Other complications were also investigated. Results Two-hundred and ten patients were enrolled, of which 88 (41.9%) were treated as inpatients and the remainder as outpatients. Eleven patients were treated in an intensive care unit; among them, five patients received mechanical ventilation, and one needed extracorporeal membrane oxygenation therapy (ECMO) additionally. Severe vivax malaria was identified in 44 patients (21.0%), and the most common severe complication was pulmonary manifestation (40/188, 21.9%), which was followed by cerebral malaria (5/210, 2.4%), shock (4/210, 1.9%), spontaneous bleeding (3/210, 1.4%), metabolic acidosis (3/210, 3.5%) and acute kidney injury (2/210, 1.0%). Unusual complications, such as splenic infarction (ten patients) and retinal haemorrhage (two patients) were sometimes observed. There were no deaths, but the case involving ECMO was potentially fatal. Conclusions Plasmodium vivax infection can be severe to be fatal and is frequently associated with various complications in non-immune adults. The frequency of each complication seems to differ from other countries. Hence, further investigation is needed to elucidate the causes and mechanisms responsible for these differences. Electronic supplementary material The online version of this article (doi:10.1186/s12936-017-1684-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Jae Hyoung Im
- Department of Internal Medicine, Inha University School of Medicine, Incheon, 400-711, South Korea.
| | - Hea Yoon Kwon
- Department of Internal Medicine, Inha University School of Medicine, Incheon, 400-711, South Korea
| | - JiHyeon Baek
- Department of Internal Medicine, Inha University School of Medicine, Incheon, 400-711, South Korea
| | - Seong Wook Park
- Department of Internal Medicine, Inha University School of Medicine, Incheon, 400-711, South Korea
| | - Areum Durey
- Department of Emergency Medicine, Incheon, 400-711, South Korea
| | - Kyung Hee Lee
- Department of Radiology, Inha University School of Medicine, 7-206, Shinheung-Dong, Jung-Gu, Incheon, 400-711, South Korea
| | - Moon-Hyun Chung
- Department of Internal Medicine, Jeju University Hospital, Jeju, South Korea
| | - Jin-Soo Lee
- Department of Internal Medicine, Inha University School of Medicine, Incheon, 400-711, South Korea.
| |
Collapse
|
23
|
Liu AY, Lohman-Payne B, Chung MH, Kiarie J, Kinuthia J, Slyker J, Richardson B, Lehman D, Farquhar C, John-Stewart G. Maternal plasma and breastmilk viral loads are associated with HIV-1-specific cellular immune responses among HIV-1-exposed, uninfected infants in Kenya. Clin Exp Immunol 2015; 180:509-19. [PMID: 25652232 DOI: 10.1111/cei.12599] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2015] [Indexed: 11/28/2022] Open
Abstract
Infants exposed to maternal HIV-1 provide an opportunity to assess correlates of HIV-1-specific interferon (IFN)-γ responses and may be informative in the development of HIV-1 vaccines. HIV-1-infected women with CD4 counts 200-500 cells/mm(3) were randomized to short-course zidovudine/nevirapine (ZDV/NVP) or highly active anti-retroviral therapy (HAART) between 2003 and 2005. Maternal plasma and breastmilk HIV-1 RNA and DNA were quantified during the first 6-12 months postpartum. HIV-1 gag peptide-stimulated enzyme-linked immunospot (ELISPOT) assays were conducted in HIV-1-exposed, uninfected infants (EU), and correlates were determined using regression and generalized estimating equations. Among 47 EU infants, 21 (45%) had ≥1 positive ELISPOT result during follow-up. Infants had a median response magnitude of 177 HIV-1-specific spot-forming units (SFU)/106 peripheral blood mononuclear cells (PBMC) [interquartile range (IQR)=117-287] directed against 2 (IQR = 1-3) gag peptide pools. The prevalence and magnitude of responses did not differ by maternal anti-retroviral (ARV) randomization arm. Maternal plasma HIV-1 RNA levels during pregnancy (P=0.009) and breastmilk HIV-1 DNA levels at 1 month (P=0.02) were associated with a higher magnitude of infant HIV-1-specific ELISPOT responses at 1 month postpartum. During follow-up, concurrent breastmilk HIV-1 RNA and DNA (cell-free virus and cell-associated virus, respectively) each were associated positively with magnitude of infant HIV-1-specific responses (P=0.01). Our data demonstrate the importance of antigenic exposure on the induction of infant HIV-1-specific cellular immune responses in the absence of infection.
Collapse
Affiliation(s)
- A Y Liu
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - B Lohman-Payne
- Department of Medicine, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - M H Chung
- Department of Epidemiology, University of Washington, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
| | - J Kiarie
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - J Kinuthia
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - J Slyker
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - B Richardson
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Paediatrics, University of Nairobi, Nairobi, Kenya.,Departments of Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - D Lehman
- Departments of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - C Farquhar
- Department of Epidemiology, University of Washington, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
| | - G John-Stewart
- Department of Epidemiology, University of Washington, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
| |
Collapse
|
24
|
Kim Y, Wie SH, Kim J, Ki M, Cho YK, Lim SK, Lee JS, Kwon KT, Lee H, Cheong HJ, Ryu SY, Chung MH, Pai H. 1043Fluoroquinolone Resistance in Community-acquired Acute Pyelonephritis: Clinical Characteristics, Risk Factors and Clinical Response according to Fluoroquinolone MIC of Uropathogens. Open Forum Infect Dis 2014. [PMCID: PMC5782122 DOI: 10.1093/ofid/ofu052.751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Yeonjae Kim
- Infectious Disease, College of Medicine Hanyang University, seoul, South Korea
| | - Seong-Heon Wie
- St. Vincent Hospital Catholic University, Suwon, South Korea
| | - Jieun Kim
- Division of Infectious Diseases, Hanyang University Hospital, Seoul, South Korea
| | - Moran Ki
- Department of Preventive Medicine, Eulji University School of Medicine, Daejeon, South Korea
| | - Yong Kyun Cho
- Department of Infectious Disease, Gachon University Gil Hospital, Incheon, South Korea
| | | | - Jin Seo Lee
- Department of Internal Medicine, Division of Infectious Disease, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Ki Tae Kwon
- Internal Medicine, Daegu Fatima Hospital, Daegu, South Korea
| | - Hyuck Lee
- Dong-A University Hospital, Busan, South Korea
| | | | | | | | - Hyunjoo Pai
- Division of Infectious Diseases, Department of Internal Medicine, Hanyang University Hospital, Seoul, South Korea
| |
Collapse
|
25
|
Im JH, Baek JH, Lee JS, Chung MH, Lee SM, Kang JS. A case series of possibly recrudescent Orientia tsutsugamushi infection presenting as pneumonia. Jpn J Infect Dis 2014; 67:122-6. [PMID: 24647257 DOI: 10.7883/yoken.67.122] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Orientia tsutsugamushi remains latent in humans after scrub typhus. Pneumonia occurs as a complication of scrub typhus in the late-phase disease. However, pneumonia may also occur as a presenting manifestation of O. tsutsugamushi infection. We reviewed the cases of 3 patients with atypical pneumonia who presented at our hospital and were later confirmed to have O. tsutsugamushi infection by serology, nested polymerase chain reaction (PCR), and cell culture. All patients were young adults with no history of scrub typhus, and none claimed to have recently been exposed to areas where scrub typhus is endemic. Two cases occurred in non-outbreak seasons. Furthermore, eschar was not observed. Pneumonia was documented within 4 days after fever onset. The immunoglobulin (Ig) G antibody titers against O. tsutsugamushi were higher than the IgM titers, although the serologic test results were less helpful in the diagnosis. Nested PCR and cell culture of blood specimens confirmed the diagnosis of O. tsutsugamushi infection. These findings suggest that pneumonia can occur as a result of recrudescence of latent O. tsutsugamushi infection.
Collapse
Affiliation(s)
- Jae-Hyoung Im
- Department of Internal Medicine, Inha University School of Medicine
| | | | | | | | | | | |
Collapse
|
26
|
Lee HJ, Chung MH, Kim WJ, Hong YJ, Choi KM, Lee J, Oh CE, Welsch JA, Kim KH, Hong KB, Dagnew AF, Bock H, Dull PM, Odrljin T. Immunogenicity and safety of a novel quadrivalent meningococcal conjugate vaccine (MenACWY-CRM) in healthy Korean adolescents and adults. Int J Infect Dis 2014; 28:204-10. [DOI: 10.1016/j.ijid.2014.06.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 06/02/2014] [Accepted: 06/09/2014] [Indexed: 11/29/2022] Open
|
27
|
Lee OH, Baek JH, Lee JS, Chung MH, Lee SM, Kang JS. In vitro Antagonism between Cefotaxime and Anti-Rickettsial Antibiotics against Orientia tsutsugamushi. Infect Chemother 2014; 46:189-93. [PMID: 25298908 PMCID: PMC4189142 DOI: 10.3947/ic.2014.46.3.189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Revised: 06/18/2014] [Accepted: 06/18/2014] [Indexed: 11/24/2022] Open
Abstract
We have investigated the in vitro antimicrobial effects of antibiotic combinations against Orientia tsutsugamushi, the causative agent of scrub typhus. ECV304 cells were infected with the Boryong strain of O. tsutsugamushi and incubated in a medium containing doxycycline (4 µg/mL), azithromycin (0.5 µg/mL), rifampin (4 µg/mL), ciprofloxacin (25 µg/mL), gentamicin (5 µg/mL), cefotaxime (2 µg/mL), or combinations of these agents for 7 days, after which immunofluorescent staining for O. tsutsugamushi was performed. The percentages of infective foci in cultures containing antibiotics compared to those in cultures without antibiotics were 6.2% for doxycycline, 9.6% for azithromycin, 8.8% for rifampin, 96.6% for cefotaxime, 29.7% for doxycycline plus cefotaxime, 23.6% for azithromycin plus cefotaxime, and 41.4% for rifampin plus cefotaxime. These findings show an in vitro antagonism between anti-rickettsial agents and cefotaxime against O. tsutsugamushi. These results suggest that the efficacy of antibiotic combinations involving cefotaxime for the treatment of patients with scrub typhus, particularly those with severe pneumonia, needs to be investigated.
Collapse
Affiliation(s)
- Oh Hyun Lee
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Ji Hyeon Baek
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Jin-Soo Lee
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Moon-Hyun Chung
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Sun Myoung Lee
- Translation Research Center, Inha University School of Medicine, Incheon, Korea
| | - Jae-Seung Kang
- Department of Microbiology, Inha University School of Medicine, Incheon, Korea
| |
Collapse
|
28
|
Son D, Chung MH. In vitro Synergism between Chloroquine and Antibiotics against Orientia tsutsugamushi. Infect Chemother 2014; 46:182-8. [PMID: 25298907 PMCID: PMC4189136 DOI: 10.3947/ic.2014.46.3.182] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 09/12/2014] [Accepted: 09/12/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND To investigate whether chloroquine enhances the effect of antibiotics against Orientia tsutsugamushi, the causative organism of scrub typhus, we compared the effect of antibiotics in combination with chloroquine with the effect of antibiotics alone in vitro. MATERIALS AND METHODS The Boryong or AFSC-4 strain was inoculated into ECV304 cells, and incubated in medium containing doxycycline (4 µg/mL), rifampin (4 µg/mL), azithromycin (0.5 µg/mL), chloroquine (1 µg/mL), and each of these antibiotics in combination with chloroquine for 7 d. Immunofluorescence (IF) staining for O. tsutsugamushi was performed 4 hr and 7 d after inoculation of the bacteria, and IF-positive foci were enumerated. RESULTS Chloroquine inhibited the growth of O. tsutsugamushi by 15.5%. In combination with chloroquine, the antimicrobial effects increased by 4.4% for doxycycline (a 92.9% reduction of bacterial numbers for doxycycline versus a 97.3% reduction for doxycycline plus chloroquine), 4.6% for rifampin (90.0% versus 94.6%), and 8.3% for azithromycin (86.9% versus 95.2%). The antimicrobial effect of the antibiotics alone was significantly different compared to the combined effect of antibiotics and chloroquine (Wilcoxon signed-rank test, P = 0.001). CONCLUSIONS The combined use of chloroquine with an antibiotic for the treatment of O. tsutsugamushi infections may be useful for increasing the efficacy of the antibiotics.
Collapse
Affiliation(s)
- Dongwook Son
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Moon-Hyun Chung
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| |
Collapse
|
29
|
Seo MR, Kim SJ, Kim Y, Kim J, Choi TY, Kang JO, Wie SH, Ki M, Cho YK, Lim SK, Lee JS, Kwon KT, Lee H, Cheong HJ, Park DW, Ryu SY, Chung MH, Pai H. Susceptibility of Escherichia coli from community-acquired urinary tract infection to fosfomycin, nitrofurantoin, and temocillin in Korea. J Korean Med Sci 2014; 29:1178-81. [PMID: 25120333 PMCID: PMC4129215 DOI: 10.3346/jkms.2014.29.8.1178] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 05/14/2014] [Indexed: 11/22/2022] Open
Abstract
With increase of multi-drug resistant Escherichia coli in community-acquired urinary tract infections (CA-UTI), other treatment option with a therapeutic efficacy and a low antibiotic selective pressure is necessary. In this study, we evaluated in vitro susceptibility of E. coli isolates from CA-UTI to fosfomycin (FM), nitrofurantoin (NI), temocillin (TMO) as well as trimethoprim-sulfamethoxazole (SMX), ciprofloxacin (CIP) and cefepime (FEP). The minimal inhibitory concentrations were determined by E-test or agar dilution method according to the Clinical and Laboratory Standards Institute guidelines, using 346 E. coli collected in 12 Korean hospitals from March 2010 to February 2011. FM, NI and TMO showed an excellent susceptibility profile; FM 100% (346/346), TMO 96.8% (335/346), and NI 99.4% (344/346). Conversely, resistance rates of CIP and SMX were 22% (76/346) and 29.2% (101/349), respectively. FEP still retained an activity of 98.5%. In Korea, NI and TMO in addition to FM are a good therapeutic option for uncomplicated CA-UTI, especially for lower UTI.
Collapse
Affiliation(s)
- Mi-Ran Seo
- Division of Infectious Diseases, Department of Internal Medicine, Hanyang University, Seoul, Korea
| | - Seong-Jong Kim
- Division of Infectious Diseases, Department of Internal Medicine, Hanyang University, Seoul, Korea
| | - Yeonjae Kim
- Division of Infectious Diseases, Department of Internal Medicine, Hanyang University, Seoul, Korea
| | - Jieun Kim
- Division of Infectious Diseases, Department of Internal Medicine, Hanyang University, Seoul, Korea
| | - Tae Yeal Choi
- Department of Laboratory Medicine, Hanyang University, Seoul, Korea
| | - Jung Oak Kang
- Department of Clinical Microbiology, Hanyang University, Guri, Korea
| | - Seong-Heon Wie
- Department of Internal Medicine, St. Vincent's Hospital, School of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Moran Ki
- Department of Preventive Medicine, Eulji University School of Medicine, Daejeon, Korea
| | - Young Kyun Cho
- Department of Internal Medicine, Gil Hospital, Gacheon University, Incheon, Korea
| | - Seung-Kwan Lim
- Department of Internal Medicine, Ajou University Hospital, Suwon, Korea
| | - Jin Seo Lee
- Department of Internal Medicine, Hallym University, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Ki Tae Kwon
- Department of Internal Medicine, Daegu Patima Hospital, Daegu, Korea
| | - Hyuck Lee
- Department of Internal Medicine, Dong-A University Hospital, Busan, Korea
| | - Hee Jin Cheong
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Dae Won Park
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Seong Yeol Ryu
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Moon-Hyun Chung
- Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Hyunjoo Pai
- Division of Infectious Diseases, Department of Internal Medicine, Hanyang University, Seoul, Korea
| |
Collapse
|
30
|
Kim Y, Wie SH, Chang UI, Kim J, Ki M, Cho YK, Lim SK, Lee JS, Kwon KT, Lee H, Cheong HJ, Park DW, Ryu SY, Chung MH, Pai H. Comparison of the clinical characteristics of diabetic and non-diabetic women with community-acquired acute pyelonephritis: a multicenter study. J Infect 2014; 69:244-51. [PMID: 24854421 DOI: 10.1016/j.jinf.2014.05.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 03/13/2014] [Accepted: 05/08/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Purpose of this study was to compare clinical characteristics and treatment outcomes in diabetic and non-diabetic women with community-acquired APN (CA-APN). METHODS We prospectively collected and analyzed clinical data of women with CA-APN who attended 11 hospitals in South Korea from March 2010 to February 2012. RESULTS Of a total of 775 patients, 246 (31.7%) were diabetic and 529 (68.3%) non-diabetic. Fewer of the diabetic patients had flank pain (27.6% vs. 37.2% P = 0.009), symptoms of lower urinary tract infection (57.3% vs. 69.6% P = 0.001) and costovertebral angle tenderness (54.9% vs. 72.2% P < 0.001). However, more of them had C-reactive protein ≥20 mg/dL (40.7% vs. 27.4% P < 0.001), azotemia (29.3% vs. 13.4% P < 0.001) and bacteremia (53.7% vs. 38.2% P < 0.001). Final clinical failure rates and deaths did not differ between the two groups: 6.9% vs. 4.5%, P = 0.169; 2.0% vs. 1.7%, P = 0.747. However, hospitalization was longer in the diabetics than the non-diabetics (median 9.0 days vs. 7.0 days, P < 0.001). In logistic regression, diabetes was independently associated with longer hospitalization (OR 1.7, CI 1.1-2.7, P = 0.011), together with nausea/vomiting, history of admission within 1 year, bacteremia, azotemia, and dementia, as well as extended-spectrum β-lactamase (ESBL)-positivity and fluoroquinolone resistance of uropathogens. CONCLUSIONS CA-APN patients with diabetes have more severe disease manifestations and require longer hospitalization than non-diabetic patients although their clinical findings are less clear than those of non-diabetic patients.
Collapse
Affiliation(s)
- Yeonjae Kim
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, South Korea
| | - Seong-Heon Wie
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - U-Im Chang
- Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Jieun Kim
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, South Korea
| | - Moran Ki
- College of Medicine, Department of Preventive Medicine, Eulji University School of Medicine, Daejeon, South Korea
| | | | | | - Jin Seo Lee
- Hallym University Kangdong Sacred Heart Hospital, Seoul, South Korea
| | | | - Hyuck Lee
- Dong-A University Hospital, Busan, South Korea
| | | | - Dae Won Park
- Korea University Ansan Hospital, Ansan, South Korea
| | | | | | - Hyunjoo Pai
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, South Korea.
| |
Collapse
|
31
|
Nah SY, Im JH, Yeo JY, Baek JH, Kim CW, Nam MS, Lee HK, Chung MH, Lee JS. Therapeutic drug concentrations of teicoplanin in clinical settings. Infect Chemother 2014; 46:35-41. [PMID: 24693468 PMCID: PMC3970309 DOI: 10.3947/ic.2014.46.1.35] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 02/12/2014] [Accepted: 03/06/2014] [Indexed: 12/20/2022] Open
Abstract
Background Teicoplanin is a glycopeptide antibiotic that is widely used in clinical practice for the treatment of infections caused by drug-resistant Gram-positive bacteria. The aim of this study was to analyze plasma teicoplanin concentrations to determine the percentage of patients in whom therapeutic concentrations of teicoplanin were achieved in clinical practice. Materials and Methods The plasma teicoplanin concentrations of hospitalized patients receiving treatment at a teaching hospital were retrospectively analyzed. The target level was defined as a plasma teicoplanin concentration of 10 mg/L or greater, since this was generally regarded as the lower limit of the optimal concentration range required for the effective treatment of a majority of infections. Results Patients with sub-optimal (< 10 mg/L) plasma teicoplanin concentrations constituted nearly half of the total study population. The majority of these patients received the recommended loading dose, which were three 400 mg doses administered every 12 hours. Sub-group analysis showed a trend that the group receiving loading dose was more likely to reach the optimal teicoplanin concentration. Conclusions The data revealed that a significant proportion of patients in clinical practice achieved only sub-optimal teicoplanin concentrations, which emphasizes the importance of the mandatory use of loading dose and routine therapeutic drug monitoring. Treatment reassessment and simulation of individual dose regimens may also be necessary to achieve optimal drug concentrations.
Collapse
Affiliation(s)
- So-Yun Nah
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Jae Hyoung Im
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Jin Yeob Yeo
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Ji-Hyeon Baek
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Cheol-Woo Kim
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea. ; Inha University Hospital Clinical Trial Center, Incheon, Korea
| | - Moon-Seok Nam
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea. ; Inha University Hospital Clinical Trial Center, Incheon, Korea
| | - Hye-Kyung Lee
- Department of Pharmacy, Inha University Hospital, Incheon, Korea
| | - Moon-Hyun Chung
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Jin-Soo Lee
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| |
Collapse
|
32
|
Abstract
We performed an in vitro cell culture experiment to ascertain whether rifampin exhibits bactericidal effects against Orientia tsutsugamushi, the causative agent of scrub typhus. ECV304 cells were infected with the Boryong or AFSC-4 strain of O. tsutsugamushi and then, the cultures were maintained in media with increasing concentrations of rifampin, azithromycin, doxycycline, or chloramphenicol for 4 days. On day 5, the media were replaced with fresh antibiotic-free medium and the cultures were maintained until day 28. On days 5, 13, and 28, immunofluorescence (IF) staining of O. tsutsugamushi was performed. IF staining on days 13 and 28 revealed increasing numbers of IF-positive foci in all cultures, even in cultures initially exposed to the highest concentration of rifampin (80 µg/mL), azithromycin (80 µg/mL), doxycycline (20 µg/mL), or chloramphenicol (100 µg/mL). The present study reveals that rifampin has no bactericidal effect against O. tsutsugamushi as observed for azithromycin, doxycycline, and chloramphenicol. A subpopulation of the bacteria that are not killed by high concentrations of the antibiotics may explain the persistence of O. tsutsugamushi in humans even after complete recovery from scrub typhus with antibiotic therapy.
Collapse
Affiliation(s)
- Jae-Hyoung Im
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Ji Hyeon Baek
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Jin-Soo Lee
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Moon-Hyun Chung
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Sun Myoung Lee
- Translation Research Center, Inha University School of Medicine, Incheon, Korea
| | - Jae-Seung Kang
- Department of Microbiology, Inha University School of Medicine, Incheon, Korea
| |
Collapse
|
33
|
Kim MS, Baek JH, Lee JS, Chung MH, Lee SM, Kang JS. High In Vitro Infectivity of a Doxycycline-Insensitive Strain of Orientia tsutsugamushi. Infect Chemother 2013; 45:431-4. [PMID: 24475357 PMCID: PMC3902816 DOI: 10.3947/ic.2013.45.4.431] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 08/11/2013] [Accepted: 08/14/2013] [Indexed: 11/24/2022] Open
Abstract
We compared the infectivity and growth rates of 12 strains of Orientia tsutsugamushi in a cell culture system. ECV304 cells were infected with O. tsutsugamushi strains for 4 hr, and the culture was maintained for 72 hr. Immunofluorescence (IF) staining was performed at 4, 24, 48, and 72 hr after inoculation (hpi), and IF-positive foci were enumerated. The AFSC-4 strain, which is known to be insensitive to doxycycline, showed higher numbers of IF-positive foci than the other 11 strains at 4, 24, 48, and 72 hpi, which may explain its apparent insensitivity to antibiotics.
Collapse
Affiliation(s)
- Min Su Kim
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Ji Hyeon Baek
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Jin-Soo Lee
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Moon-Hyun Chung
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Sun Myoung Lee
- Translation Research Center, Inha University School of Medicine, Incheon, Korea
| | - Jae-Seung Kang
- Department of Microbiology, Inha University School of Medicine, Incheon, Korea
| |
Collapse
|
34
|
Im JH, Baek JH, Lee HJ, Lee JS, Chung MH, Kim M, Lee SM, Kang JS. First Case of Bartonella henselae Bacteremia in Korea. Infect Chemother 2013; 45:446-50. [PMID: 24475360 PMCID: PMC3902810 DOI: 10.3947/ic.2013.45.4.446] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 05/24/2013] [Accepted: 05/27/2013] [Indexed: 11/24/2022] Open
Abstract
Bartonella henselae causes cat-scratch disease, bacteremia, and various focal infections. Despite the worldwide occurrence of B. henselae infections, reports in humans are rare in Korea. The clinical manifestation of all 5 previously reported cases was lymphadenopathy. Herein, we report a case of bacteremia in a woman who presented with prolonged fever. B. henselae was isolated from a blood specimen by cell culture. Conventional polymerase chain reaction amplification and sequencing of the 16S-23S rRNA intergenic space region confirmed the isolate to be B. henselae. The patient had no underlying immunocompromising conditions and no recent exposure to animals. She was successfully managed with a combination of doxycycline and hydroxychloroquine.
Collapse
Affiliation(s)
- Jae-Hyoung Im
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Ji Hyeon Baek
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Hyun-Jung Lee
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Jin-Soo Lee
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Moon-Hyun Chung
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Mijeong Kim
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Sun Myoung Lee
- Translation Research Center, Inha University School of Medicine, Incheon, Korea
| | - Jae-Seung Kang
- Department of Microbiology, Inha University School of Medicine, Incheon, Korea
| |
Collapse
|
35
|
Lee HJ, Baek JH, Chae MH, Joo H, Lee JS, Chung MH, Park YK, Kim JT. A case of vivax malaria complicated by adult respiratory distress syndrome and successful management with extracorporeal membrane oxygenation. Korean J Parasitol 2013; 51:551-5. [PMID: 24327781 PMCID: PMC3857503 DOI: 10.3347/kjp.2013.51.5.551] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 07/15/2013] [Accepted: 08/21/2013] [Indexed: 11/23/2022]
Abstract
Complicated malaria is mainly caused by Plasmodium falciparum, but, increasingly, Plasmodium vivax is also being reported as a cause. Since the reemergence of indigenous vivax malaria in 1993, cases of severe malaria have been steadily reported in Korea. Herein, we report a case of vivax malaria complicated by adult respiratory distress syndrome (ARDS) that was successfully managed with extracorporeal membrane oxygenation (ECMO). A 59-year-old man presented at our hospital with fever and abdominal pain, which had persisted for 10 days. On admission, the patient had impaired consciousness, shock, hypoxia and haziness in both lungs, jaundice, thrombocytopenia and disseminated intravascular coagulation, metabolic acidosis, and acute kidney injury. A peripheral blood smear and a rapid diagnostic test verified P. vivax mono-infection. Ten hours after admission, hypoxia became more severe, despite providing maximal ventilatory support. The administration of antimalarial agents, ECMO, and continuous venovenous hemofiltration resulted in an improvement of his vital signs and laboratory findings. He was discharged from the hospital 7 weeks later, without any sequelae.
Collapse
Affiliation(s)
- Hyun-Jung Lee
- Department of Internal Medicine, Inha University School of Medicine, Incheon 400-712, Korea
| | | | | | | | | | | | | | | |
Collapse
|
36
|
|
37
|
Ngomoa RS, Njoroge J, Thiga J, McGrath C, Chung MH, Attwa M, Yatich N. P4.034 Effects of Partner Disclosure on Clinical Outcomes Among HIV Infected Adult Initiating ART. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
38
|
Joo K, Hyun IY, Baek JH, Chung MH, Lee JS. Detection of an Infected N-butyl-2-cyanoacrylate Plug by F-18 FDG PET/CT Scan in a Patient Who Received Endoscopic Intervention for Gastric Variceal Bleeding. Infect Chemother 2013; 45:230-3. [PMID: 24265972 PMCID: PMC3780960 DOI: 10.3947/ic.2013.45.2.230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 05/15/2013] [Accepted: 05/20/2013] [Indexed: 11/24/2022] Open
Abstract
Injection of N-butyl-2-cyanoacrylate has been used successfully for treatment of gastric variceal bleeding. Bacteremia after injection of N-butyl-2-cyanoacrylate is well known, however, the method for diagnosis of infected endovascular injected material has remained uncertain. This is the first case reporting use of F-18 FDG PET/CT in detection of the source of infection after control of endoscopic bleeding with N-butyl-2-cyanoacrylate.
Collapse
Affiliation(s)
- Kowoon Joo
- Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | | | | | | | | |
Collapse
|
39
|
Chung MH, Kuo EY, Wu CM, Chen KT, Lin HJ. Cerebral “eThrombosis”: Cerebral Venous Sinus Thrombosis Associated with Prolonged Sitting in Front of a Computer. HONG KONG J EMERG ME 2013. [DOI: 10.1177/102490791302000207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Venous thromboembolism caused by prolonged sitting during air travel has been recognised as economy-class syndrome for more than 30 years. Since 2003, the term “eThrombosis” has been proposed to describe the 21st Century variant of venous thromboembolism associated with immobilisation. We reported a case of cerebral venous sinus thrombosis presenting with severe headache after a prolonged period of sitting for over 12 hours in front of a computer for recreational purpose. We described this case as cerebral “eThrombosis”. Considering the widespread use of computers for many purposes including working, recreation and communications in the present digital era, we would like to put forward that prolonged immobilisation associated with computer use is a possible provoking risk factor of cerebral venous sinus thrombosis.
Collapse
Affiliation(s)
| | | | | | - KT Chen
- Taipei Medical University, Department of Emergency Medicine, Taipei, Taiwan
| | - HJ Lin
- Southern Tainan University of Technology, Department of Biotechnology, Tainan, Taiwan
| |
Collapse
|
40
|
Joo K, Park W, Chung MH, Lim MJ, Jung KH, Heo Y, Kwon SR. Extensive thrombosis in a patient with familial Mediterranean fever, despite hyperimmunoglobulin D state in serum. [corrected]. J Korean Med Sci 2013; 28:328-30. [PMID: 23400211 PMCID: PMC3565148 DOI: 10.3346/jkms.2013.28.2.328] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 11/19/2012] [Indexed: 11/25/2022] Open
Abstract
Familial Mediterranean fever (FMF) is an autosomal recessive disease characterized by recurrent episodes of fever accompanied by peritonitis, pleuritis, arthritis, or erysipelas-like erythema. It is known to occur mainly among Mediterranean and Middle Eastern populations such as non-Ashkenazi Jews, Arabs, Turks, and Armenians. FMF is not familiar to clinicians beyond this area and diagnosing FMF can be challenging. We report a 22-yr old boy who presented with fever, arthalgia and abdominal pain. He had a history of recurrent episodes of fever associated with arthalgia which would subside spontaneously or by antipyretics. Autosomal recessive periodic fever syndromes were suspected. Immunoglobulin D (IgD) level in the serum was elevated and DNA analysis showed complex mutations (p.Glu148Gln, p.Pro369Ser, p.Arg408Gln) in the MEFV gene. 3D angio computed tomography showed total thrombosis of splenic vein with partial thrombosis of proximal superior mesenteric vein, main portal vein and intrahepatic both portal vein. This is a case of FMF associated with multiple venous thrombosis and elevated IgD level. When thrombosis is associated with elevated IgD, FMF should be suspected. This is the first adult case reported in Korea.
Collapse
Affiliation(s)
- Kowoon Joo
- Division of Rheumatology, Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Won Park
- Division of Rheumatology, Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Moon-Hyun Chung
- Division of Infectious Disease, Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Mie-Jin Lim
- Division of Rheumatology, Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Kyong Hee Jung
- Division of Rheumatology, Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Yoonseok Heo
- Department of General Surgery, Inha University Hospital, Incheon, Korea
| | - Seong-Ryul Kwon
- Division of Rheumatology, Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| |
Collapse
|
41
|
De Vuyst H, Mugo NR, Chung MH, McKenzie KP, Nyongesa-Malava E, Tenet V, Njoroge JW, Sakr SR, Meijer CM, Snijders PJF, Rana FS, Franceschi S. Prevalence and determinants of human papillomavirus infection and cervical lesions in HIV-positive women in Kenya. Br J Cancer 2012; 107:1624-30. [PMID: 23033006 PMCID: PMC3493776 DOI: 10.1038/bjc.2012.441] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: We assessed the association of human papillomavirus (HPV) infection and cervical intraepithelial neoplasia (CIN) with various characteristics, CD4 count and use of combination antiretroviral therapy (cART) among HIV-positive women. Methods: Cross-sectional study of 498 HIV-positive women who underwent HPV PCR-based testing, cytology, and systematic cervical biopsy. Results: In all, 68.7% of women were HPV-positive, 52.6% had high-risk (hr) HPV, and 40.2% multiple type infections. High-risk human papillomavirus-positivity did not vary significantly by age but it was negatively associated with education level. The most frequent types in 113 CIN2/3 were HPV16 (26.5%), HPV35 (19.5%), and HPV58 (12.4%). CD4 count was negatively associated with prevalence of hrHPV (P<0.001) and CIN2/3 among non-users of cART (P=0.013). Combination antiretroviral therapies users (⩾2 year) had lower hrHPV prevalence (prevalence ratio (PR) vs non-users=0.77, 95% confidence interval (CI): 0.61–0.96) and multiple infections (PR=0.68, 95% CI: 0.53–0.88), but not fewer CIN2/3. The positive predictive value of hrHPV-positivity for CIN2/3 increased from 28.9% at age <35 years to 53.3% in ⩾45 years. Conclusion: The burden of hrHPV and CIN2/3 was high and it was related to immunosuppression level. Combination antiretroviral therapies ( ⩾2 year) use had a favourable effect on hrHPV prevalence but cART in our population may have been started too late to prevent CIN2/3.
Collapse
Affiliation(s)
- H De Vuyst
- International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, Lyon, France.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Durey A, Bae SM, Lee HJ, Nah SY, Kim M, Baek JH, Kang YH, Chung MH, Lee JS. Carriage rates and serogroups of Neisseria meningitidis among freshmen in a University dormitory in Korea. Yonsei Med J 2012; 53:742-7. [PMID: 22665340 PMCID: PMC3381497 DOI: 10.3349/ymj.2012.53.4.742] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Neisseria meningitidis is a leading cause of bacterial meningitis in young adults. University students, especially those living in dormitories, have been known to be at increased risk of meningococcal disease. We performed a longitudinal study to determine the carriage rates of N. meningitidis and the changes thereof. MATERIALS AND METHODS We recruited Inha University freshmen who were, at that time, admitted to a student dormitory. A pharyngeal swab was taken from all participant who were also asked to complete a questionnaire. This was repeated four weeks later. RESULTS A total of 136 students were enrolled at the first culture. After four weeks, 128 students were enrolled, including 106 re-participants. The overall carriage rates changed from 11.8% to 14.1%. In analysis of the 106 re-participants, "visiting to pubs" was associated with carriage of N. meningitis for both the first (p=0.047) and second cultures (p=0.026). Serogroup C was found to be the most frequent serogroup (5 isolates), while 3 isolates were found from serogroup B. The most prevalent PorA types were P1.22,14-6 (4 isolates) and P1.19,15 (3 isolates). The DNA sequences of PorA VR2 were changed in 2 students during prolonged carriage. CONCLUSION The meningococcal carriage rate among first year university students who resided in a dormitory did not significantly increase over 4-week interval between cultures, which is markedly different from those reported in Western studies. Close social contact appeared to be related with carriage. Our data also revealed diversity in PorA types, suggesting the possibility of rapid mutation of the PorA gene during the 4-week interval.
Collapse
Affiliation(s)
- Areum Durey
- Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Song-Mee Bae
- Division of Bacterial Respiratory Infections, Centers for Infectious Diseases, National Institute of Health, Korea Centers for Disease Control and Prevention, Seoul, Korea
| | - Hye-Jin Lee
- Department of Infection Control Service, Inha University Hospital, Incheon, Korea
| | - So-Yun Nah
- Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Mijeong Kim
- Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Ji Hyeon Baek
- Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Yeon-Ho Kang
- Division of Bacterial Respiratory Infections, Centers for Infectious Diseases, National Institute of Health, Korea Centers for Disease Control and Prevention, Seoul, Korea
| | - Moon-Hyun Chung
- Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Jin-Soo Lee
- Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| |
Collapse
|
43
|
Shin J, Kim J, Wie SH, Cho YK, Lim SK, Shin SY, Yeom JS, Lee JS, Kweon KT, Lee H, Cheong HJ, Park SH, Park DW, Ryu SY, Chung MH, Yoo S, Pai H. Fluoroquinolone resistance in uncomplicated acute pyelonephritis: epidemiology and clinical impact. Microb Drug Resist 2012; 18:169-75. [PMID: 22400491 DOI: 10.1089/mdr.2011.0139] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The objectives of this study were to investigate antibiotic resistance in urinary pathogens from Korean patients with uncomplicated acute pyelonephritis (UAPN), and to determine the effect of fluoroquinolone (FQ) resistance on clinical outcome in those patients with UAPN initially treated with FQ. Clinical and microbiologic data for all the APN patients attending 14 hospitals in South Korea in 2008 were collected retrospectively. Urinary pathogens were identified in 719 cases, and Escherichia coli was the most common pathogen (661/719, 91.9%). Antibiotic susceptibilities to several E. coli antibiotics were as follows: ciprofloxacin, 84.1%; trimethoprim-sulfamethoxazola (TMP-SMX), 67.2%; and extended-spectrum beta-lactamase-negative, 92.4%. FQ was the most frequent antibiotic prescribed for UAPN (45.3% intravenously and 53.9% by mouth). We compared clinical outcomes and hospital days in patients with FQ-resistant (32) and FQ-sensitive E. coli (173) who received FQ as initial empirical therapy. Clinical cure was higher in the FQ-sensitive group (78% vs. 91%, p=0.027), and hospital days were longer in the FQ-resistant group (9.6±5.5 days vs. 7±3.5 days, p=0.001). In conclusion, FQ-sensitivity of E. coli from UAPN was 84.1%. FQ treatment of UAPN caused by FQ-resistant E. coli has a lower cure rate and involves longer hospital stay than FQ treatment of cases caused by FQ-sensitive E. coli.
Collapse
Affiliation(s)
- Jaehyun Shin
- Department of Medicine, Rochester General Hospital , Rochester, New York, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Abstract
We investigated the persistence of viable Orientia tsutsugamushi in patients who had recovered from scrub typhus. Blood specimens were available from six patients with scrub typhus who were at 1 to 18 months after the onset of the illness. The EDTA-treated blood specimens were inoculated into ECV304 cells, and cultures were maintained for 7 months. Sequencing of the 56-kDa type-specific antigen gene of O. tsutsugamushi was performed to ascertain the homology of isolates. O. tsutsugamushi was isolated from all six patients, and nucleotide sequences of isolates serially collected from each patient were identical in all five patients in whom nucleotide sequences were compared. One patient relapsed 2 days after completion of antibiotic therapy; two patients complained of weakness for 1 to 2.5 months after the illness; one patient underwent coronary angioplasty 6 months later; and one patient suffered from a transient ischemic attack 8 months later. This finding suggests that O. tsutsugamushi causes chronic latent infection, which may be associated with certain clinical illnesses, preceded by scrub typhus. Antibiotic therapy abates the symptoms of scrub typhus, but does not eradicate O. tsutsugamushi from the human body.
Collapse
Affiliation(s)
- Moon-Hyun Chung
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Jin-Soo Lee
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Ji-hyeon Baek
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Mijeong Kim
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Jae-Seung Kang
- Department of Microbiology, Inha University School of Medicine, Incheon, Korea
| |
Collapse
|
45
|
Kim B, Kim J, Wie SH, Park SH, Cho YK, Lim SK, Shin SY, Yum JS, Lee JS, Kweon KT, Lee H, Cheong HJ, Park DW, Ryu SY, Chung MH, Pai H. Is it Acceptable to Select Antibiotics for the Treatment of Community-acquired Acute Cystitis Based on the Antibiotics Susceptibility Results for Uropathogens from Community-acquired Acute Pyelonephritis in Korea? Infect Chemother 2012. [DOI: 10.3947/ic.2012.44.4.269] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Bongyoung Kim
- Department of Internal Medicine, Hanyang University, College of Medicine, Seoul, Korea
| | - Jieun Kim
- Department of Internal Medicine, Hanyang University, College of Medicine, Seoul, Korea
| | - Seong-heon Wie
- Department of Internal Medicine, Catholic University, College of Medicine, Seoul, Korea
| | - Sun Hee Park
- Department of Internal Medicine, Catholic University, College of Medicine, Seoul, Korea
| | - Young Kyun Cho
- Department of Internal Medicine, Gacheon University, College of Medicine, Gacheon, Korea
| | - Seung-Kwan Lim
- Department of Internal Medicine, Ajou University, College of Medicine, Suwon, Korea
| | - Sang Yop Shin
- Department of Internal Medicine, Jeju University, College of Medicine, Jeju, Korea
| | - Joon Sup Yum
- Department of Internal Medicine, Sungkyunkwan University, College of Medicine, Seoul, Korea
| | - Jin Seo Lee
- Department of Internal Medicine, Hallym University, College of Medicine, Seoul, Korea
| | - Ki Tae Kweon
- Department of Infectious disease, Patima Hospital, Daegu, Korea
| | - Hyuck Lee
- Department of Internal Medicine, Donga University, College of Medicine, Daegu, Korea
| | - Hee Jin Cheong
- Department of Internal Medicine, Korea University, College of Medicine, Seoul, Korea
| | - Dae Won Park
- Department of Internal Medicine, Korea University, College of Medicine, Seoul, Korea
| | - Seong Yeol Ryu
- Department of Internal Medicine, Gyemyeong University, College of Medicine, Daegu, Korea
| | - Moon-Hyun Chung
- Department of Internal Medicine, Inha University, College of Medicine, Incheon, Korea
| | - Hyunjoo Pai
- Department of Internal Medicine, Hanyang University, College of Medicine, Seoul, Korea
| |
Collapse
|
46
|
Kim SH, Choi EM, Chang CH, Kim HK, Chung MH, Choi YR. Comparison of the effect-site concentrations of remifentanil for Streamlined Liner of the Pharynx Airway (SLIPA) versus laryngeal mask airway SoftSealTM insertion during target-controlled infusion of propofol. Anaesth Intensive Care 2011; 39:611-7. [PMID: 21823378 DOI: 10.1177/0310057x1103900412] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study was designed to determine the optimal dose of remifentanil required for the successful insertion of Streamlined Liner of the Pharynx Airway (SLIPA) and to compare it to that required for laryngeal mask airway (LMA) insertion in patients receiving a propofol infusion at a standard effect-site concentration. Fifty-eight patients scheduled to undergo general anaesthesia were randomly assigned to either the SLIPA (n = 29) or LMA (n = 29) group. All patients were premedicated with midazolam 0.05 mg x kg(-1) and glycopyrrolate 0.004 mg x kg(-1) intramuscularly. After the administration of lignocaine 1 mg x kg(-1) intravenously, a propofol infusion was started at an effect-site concentration of 3.5 microg x ml(-1) with a remifentanil infusion without a neuromuscular blocking agent. The remifentanil dose was determined by the modified up-and-down method starting in each group at 4 ng x ml(-1). Six minutes after induction, the airway device was inserted. Airway device insertion was classified as 'success' or 'failure' based on patient response. From the isotonic regression analysis and bootstrap distribution, the EC50 of remifentanil for SLIPA and LMA were 0.93 ng x ml(-1) (95% confidence interval [CI] 0.81 to 1.50 ng x ml(-1) and 1.36 ng x ml(-1) (95% CI 1.19 to 2.06 ng x ml(-1)) respectively, and the EC95 for SLIPA and LMA insertions were 1.90 ng x ml(-1) (95% CI 1.39 to 1.95) and 2.43 ng x ml(-1) (95% CI 1.80 to 2.46 ng x ml(-1)) respectively. Using the 83% CIs from the bootstrap distribution, EC50 for SLIPA was significantly less than that of LMA (0.83 to 1.23 vs 1.26 to 2.00, respectively) (P < 0.05). These findings suggest that the insertion of SLIPA needs about a 32% lower depth of anaesthesia than LMA insertion.
Collapse
Affiliation(s)
- S H Kim
- Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | | | | | | | | | | |
Collapse
|
47
|
Nah SY, Chung MH, Park JE, Durey A, Kim M, Lee JS. Infective endocarditis caused by methicillin-resistant Staphylococcus aureus in a young woman after ear piercing: a case report. J Med Case Rep 2011; 5:336. [PMID: 21806817 PMCID: PMC3163215 DOI: 10.1186/1752-1947-5-336] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 08/01/2011] [Indexed: 11/25/2022] Open
Abstract
Introduction Ear piercing is a common practice among Korean adolescents and young women and usually is performed by nonmedical personnel, sometimes under suboptimal hygienic conditions. Consequently, ear piercing has been associated with various infectious complications, including fatal infective endocarditis. We report a case of infective endocarditis that was caused by community-associated methicillin-resistant Staphylococcus aureus after ear piercing and that was accompanied by a noticeable facial rash. Case presentation A 29-year-old Korean woman underwent ear piercing six days before hospitalization. On admission, she had fever, erythematous maculopapular rashes on her face, signs of generalized emboli, vegetation in her mitral valve, and methicillin-resistant S. aureus bacteremia. On the basis of the blood culture results, she was treated with vancomycin in combination with gentamicin. On day six of hospitalization, a rupture of the papillary muscle of her mitral valve developed, and emergency cardiac surgery replacing her mitral valve with a prosthetic valve was performed. After eight weeks of antibiotic therapy, she was treated successfully and discharged without significant sequelae. Conclusions Numerable cases of body piercing-related infective endocarditis have been reported, and since ear piercing is commonplace nowadays, the importance of risk recognition cannot be overemphasized. In our report, a patient developed infective endocarditis that was caused by methicillin-resistant S. aureus after ear piercing and that was accompanied by an interesting feature, namely facial rash.
Collapse
Affiliation(s)
- So-Yun Nah
- Department of Internal Medicine (Infectious Diseases), Inha University Hospital, Incheon City, Joong-gu, Sinheung-dong 3, Republic of Korea.
| | | | | | | | | | | |
Collapse
|
48
|
Song JY, Cheong HJ, Woo HJ, Wie SH, Lee JS, Chung MH, Kim YR, Jung SI, Park KH, Kim TH, Uh ST, Kim WJ. Immunogenicity and safety of trivalent inactivated influenza vaccine: a randomized, double-blind, multi-center, phase 3 clinical trial in a vaccine-limited country. J Korean Med Sci 2011; 26:191-5. [PMID: 21286008 PMCID: PMC3031001 DOI: 10.3346/jkms.2011.26.2.191] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 12/06/2010] [Indexed: 12/03/2022] Open
Abstract
Influenza vaccines are the primary method for controlling influenza and its complications. This study was conducted as a phase 3, randomized, double-blind, controlled, multi-center trial at seven university hospitals to evaluate the immunogenicity and safety of an inactivated, split, trivalent influenza vaccine (GC501, Green Cross Corporation, Yongin, Korea), which was newly manufactured in Korea in 2008. Between September 21 and 26, a total of 329 healthy subjects were recruited for the immunogenicity analysis, while 976 subjects were enrolled for the safety analysis. The GC501 vaccine met both FDA and EMEA criteria with ≥ 80% of subjects achieving post-vaccination titers ≥ 40 for all three subtypes, even in the elderly. The vaccine was well tolerated with only mild systemic and local adverse events. In summary, GC501 showed excellent immunogenicity and a good safety profile in both young adults and the elderly. The licensure of GC501 might be an important basis in preparation for the future influenza pandemic.
Collapse
Affiliation(s)
- Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hee Jin Cheong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Heung Jeong Woo
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Seong-Heon Wie
- Division of Infectious Diseases, Department of Internal Medicine, The Catholic University of Korea, School of Medicne, St. Vincent's Hospital, Suwon, Korea
| | - Jin-Soo Lee
- Division of Infectious Diseases, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Moon-Hyun Chung
- Division of Infectious Diseases, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Yang Ree Kim
- Division of Infectious Diseases, Department of Internal Medicine, The Catholic University of Korea, School of Medicne, Uijeongbu St. Mary's Hospital, Uijeongbu, Korea
| | - Sook In Jung
- Division of Infectious Diseases, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Kyung-Hwa Park
- Division of Infectious Diseases, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Tae Hyong Kim
- Division of Infectious Diseases, Department of Internal Medicine, SoonChunHyang University Hospital, Seoul, Korea
| | - Soo-Taek Uh
- Division of Respiratory and Allergy Medicine, Department of Internal Medicine, SoonChunHyang University Hospital, Seoul, Korea
| | - Woo Joo Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| |
Collapse
|
49
|
Nah SY, Hong JT, Im JH, Lee JH, Durey A, Kim M, Lee HJ, Park SK, Chung MH, Baek JH, Lee JS. Variations in Number of Hospitalized Patients with Cardiopulmonary Diseases Associated with 2009 H1N1 Pandemic Influenza in a Tertiary Teaching Hospital - Comparison with Seasonal Influenza. Infect Chemother 2011. [DOI: 10.3947/ic.2011.43.5.390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- So-Yun Nah
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Ji Taek Hong
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Jae Hyoung Im
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Jung Hwan Lee
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Areum Durey
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Mijeong Kim
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Hye-Jin Lee
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Shin-Ku Park
- Department of Occupational Medicine, Inha University School of Medicine, Incheon, Korea
| | - Moon-Hyun Chung
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Ji Hyeon Baek
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Jin-Soo Lee
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| |
Collapse
|
50
|
Abstract
Retinal hemorrhage is a frequently observed sign in Plasmodium falciparum infection. In Plasmodium vivax infection, however, retinal hemorrhage is very rare; only five cases have been reported in the literature. In this case report, we review the literature and the case of 52-year-old man who had retinal hemorrhages in P. vivax infection. We analyzed the structural characteristics of the lesions using fluorescein angiography and spectral-domain optical coherence tomography. Physicians should be aware of the possibility of retinal hemorrhage in malaria patients, even those with P. vivax infection, and should consider a diagnosis of malaria in a patient with unexplained retinal hemorrhage and fever.
Collapse
Affiliation(s)
- Ji Hwan Lee
- Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea.
| | | | | | | |
Collapse
|