BACKGROUND: Avoparcin, cross-resistance with vancomycin, was added as feed-additive since 1970s and was prohibited in 1997 in Korea. After avoparcin was banned we examined prevalence and genetic relatedness of VRE in enterococci isolated from livestock and humans. MATERIALS AND METHODS: Using enrichment broth and 6 microgram/mL vancomycin-containing enterococcosel selective agar, vancomycin-resistant enterococci (VRE) were isolated from fecal sample of 255 pigs of 8 farms, 431 chickens of 9 farms, and 328 humans (Food industry employee and Institution cafeteria employee) of 5 public health centers, and 100 raw chicken meats from April to June 2003. Antimicrobial susceptibility was examined by disk diffusion and minimum inhibitory concentrations (MICs), and E-test. Species identification and genotyping were done by multiplex PCR method. Pulsed-field gel electrophoresis (PFGE) of vanA-type VRE isolates was performed by CHEF-Mapper system. RESULTS: 19 isolates from 255 pigs, 122 isolates from 431 chickens, 19 isolates from 100 raw chicken meat, and 7 isolates from 328 humans were resistant to vancomycin. Of the 167 VRE isolates, vanA gene was detected in 141 isolates; 1 isolate (0.4%) in pigs, 121 isolates (28.1%) in chickens, 18 isolates (18.0%) in raw chicken meat, and 1 isolate (0.3%) in humans. Resistant rates of streptomycin, tetracycline, and erythromycin were over 60% in vanA-type E. faecium isolated from poultry. PFGE analysis resulted in two major patterns, F and P types. Also PFGE pattern of 1 VRE from human was identical to that of 1 VRE from poultry. CONCLUSION: Despite the high prevalence of vanA-type VRE in poultry farms, VRE isolation rate in human was relatively low. This result suggests that the possibility of VRE transmission from poultry to human is low but that possibility may be not ruled out. In PFGE analysis showing 51.5% identical in 2 PFGE patterns, the dissemination of VRE isolates in poultry may be transmitted vertically and horizontally.
Agar ; Chickens ; Diffusion ; Electrophoresis, Gel, Pulsed-Field ; Enterococcus faecium ; Erythromycin ; Humans* ; Korea* ; Livestock* ; Meat ; Microbial Sensitivity Tests ; Multiplex Polymerase Chain Reaction ; Poultry ; Prevalence* ; Public Health ; Streptomycin ; Swine ; Tetracycline ; Vancomycin

BACKGROUND: Procalcitonin (PCT) is a new marker of severe systemic bacterial infection. PCT consists of fragments katacalcin and calcitonin, which are precursors of calcitonin in thyroid. The source and role of PCT in pathogenesis of sepsis remains clarified. This study was focused on which subsets of peripheral blood mononuclear cells (PBMC) can induce PCT when they are stimulated with endotoxin or phorbol myristate acetate (PMA), and how the PCT production is controlled. MATERIALS AND METHODS: PBMC were isolated and incubated overnight in each media containing 1 ug/mL lipopolysaccharide (LPS), or 5 ng/mL PMA. Intracellular PCT was detected using fluorescein isothiocyanate (FITC) labeled anti-katacalcin antibody (Ab). Monocytes and lymphocytes were identified by phycoerythrin-conjugated CD14 Ab and CyChrome-conjugated CD3 Ab, respectively. Ten micrograms of soluble TNF receptor (sTNFR) were pretreated in PBMC 1 hr prior to adding the stimuli. Then, PBMC were analyzed using a flow cytometer. RESULTS: LPS increased intracellular PCT from 10.0 % to 27.2% in CD14-positive monocytes from healthy donors, but PMA induced more PCT production from 10.0% to 40.8%. (one representative, n=8). For CD3-p ositive lymphocytes, LPS did not stimulate PCT, but PMA increased PCT production by 2.35 fold (P<0.05, n=8). In the PBMC from the same donor, sTNFR highly decreased LPS-stimulated PCT (control 10.0%, LPS 27.2%, sTNFR 12.3%), but it did not significantly affect PMA-stimulated PCT. For sepsis patients, PMA stimulated more PCT than LPS did and PCT was more expressed compared with healthy donors. CONCLUSION: The PCT was produced in both monocytes and lymphocytes. PMA stimulated more PCT production than LPS did. The LPS-induced PCT production is partly mediated through TNF-alpha production.
Bacterial Infections ; Calcitonin ; Fluorescein ; Humans* ; Lymphocytes ; Monocytes ; Receptors, Tumor Necrosis Factor ; Sepsis ; Tetradecanoylphorbol Acetate ; Thyroid Gland ; Tissue Donors ; Tumor Necrosis Factor-alpha

BACKGROUND: Increasing numbers of resistant and multidrug resistant (MDR) isolates of Pseudomonas aeruginosa have become a worldwide problem. This report provides the trend of antimicrobial resistance, the proportions of MDR and metallo-beta-lactamase-producing isolates among clinical isolates of P. aeruginosa in Korea. MATERIALS AND METHODS: Clinical isolates of P. aeruginosa were collected from two representative reference laboratories during 2002-2004. Clinical information regarding specimens and type of hospital for isolates was investigated. Antimicrobial susceptibility against 11 antibiotics was tested by disk diffusion according to NCCLS criteria. MDR was assessed as resistance to > or =3 of the core drugs (ceftazidime, ciprofloxacin, gentamicin, imipenem and piperacillin). PCR assays and sequencing for detection of blaVIM-2 and blaIMP-1 gene were carried out. RESULTS: Of 1,748 P. aeruginosa isolates, 179 isolates were collected from primary care hospitals and 1,569 isolates were recovered from outpatients and inpatients in secondary care hospitals. From 2002 to 2004, rates of resistance to ceftazidime and imipenem increased from 10% to 12.3% and from 14.8% to 15.9%, respectively. Rates of resistance to amikacin (from 26.2% to 31.0%) and ciprofloxacin (from 35.6% to 46.2%) increased annually. In the period 2002-2004, decreasing of susceptibility to meropenem (from 83.4% to 76.8%) was observed, but meropenem was the most potent agent against P. aeruginosa isolates studied. During the 3-year period, MDR P. aeruginosa accounted for 26.4-33.5% of clinical isolates and the most common MDR phenotype was concurrent resistance to piperacillin, gentamicin and ciprofloxacin. The prevalence of VIM-2-producing isolates obviously increased from 1.7% in 2002 to 6.3% in 2004. CONCLUSIONS: These results suggested that MDR P. aeruginosa was already prevalent in one third of clinical isolates and VIM-2-producing P. aeruginosa isolates disseminated in non-tertiary care hospitals in Korea.
Amikacin ; Anti-Bacterial Agents ; Ceftazidime ; Ciprofloxacin ; Diffusion ; Drug Resistance, Multiple ; Gentamicins ; Humans ; Imipenem ; Inpatients ; Korea* ; Outpatients ; Phenotype ; Piperacillin ; Polymerase Chain Reaction ; Prevalence ; Primary Health Care ; Pseudomonas aeruginosa* ; Pseudomonas* ; Secondary Care

Granulicatella adiacens was first described as nutritionally variant streptococci, and named as Streptococcus adjacens and Abiotrophia adiacens. Granulicatella species are flora of oral cavity, upper respiratory, urogenital, and gastrointestinal tracts, and are normal often isolated from patients with infective endocarditis. G. adiacens endocarditis is associated with high mortality, but the species hardly grow in the ordinary growth media. We report a case of septicemia caused by G. adiacens in a 52-year-old woman with liver cirrhosis and chronic renal failure.
Abiotrophia ; Endocarditis ; Female ; Gastrointestinal Tract ; Humans ; Kidney Failure, Chronic ; Liver Cirrhosis ; Middle Aged ; Mortality ; Mouth ; Sepsis* ; Streptococcus

We have encountered a rare case of symmetrical peripheral gangrene complicating Escherichia coli sepsis in a 47-years-old male. He was successfully treated with antibiotics, anticoagulants, and vasodilator. To our knowledge, this is the first report on symmetrical peripheral gangrene complicating E. coli sepsis in Korea.
Anti-Bacterial Agents ; Anticoagulants ; Escherichia coli* ; Escherichia* ; Gangrene* ; Humans ; Korea ; Male ; Sepsis*

Candida is the most common etiologic agent causing endogenous endophthalmitis resulting due to hematogenous spread from a remote primary focus. Risk factors for the infection include intravenous drug use, hyperalimentation, surgery, malignancy, diabetes, neutropenia, and the use of broad- spectrum antibiotics and immunosuppressive agents, especially corticosteroids. The outcome of candida endophthalmitis is disappointing. One main problem in the management of this infection is that early diagnosis is difficult. Thus, treatment may be delayed and this which often leads to a poor outcome. Candida endophthalmitis, particularly candida guilliermondii endophthalmitis, is extremely rare, although it is becoming more common as the number of chronically debilitated patients and the use of invasive procedures increase. It is an ophthalmologic emergency and commonly takes a tragic course. Therefore, early suspicion and aggressive management are imperative to prevent visual loss. The authors report a case of candida endophthalmitis caused by Candida guilliermondii in a 65-year-old man with mixed gastrointestinal stromal tumor(GIST) and stomach adenocarcinoma.
Adenocarcinoma* ; Adrenal Cortex Hormones ; Aged ; Anti-Bacterial Agents ; Candida* ; Early Diagnosis ; Emergencies ; Endophthalmitis* ; Gastrointestinal Stromal Tumors* ; Humans ; Immunosuppressive Agents ; Neutropenia ; Risk Factors ; Stomach*

Thrombocytopenia is a common event in the course of human immunodef-iciency virus (HIV) infection. The maior cause of HIV virus related thrombocytopenia is idiopathic thrombocytopenic purpura (ITP). Treatment options for HIV related ITP are steroids, immunoglobulin, other immunosuppressive agents, and splenectomy. In addition, Antiretroviral agents are reported as effective treatment options in the setting of HIV-associated ITP, by enhancing CD4+ T cell counts, and reducing HIV viral loads. We report a case of HIV related ITP treated with prednisone, immunoglobulin, and highly active antiretroviral therapy (HAART).
Anti-Retroviral Agents ; Antiretroviral Therapy, Highly Active ; Cell Count ; HIV* ; Humans ; Humans* ; Immunoglobulins ; Immunosuppressive Agents ; Prednisone ; Purpura, Thrombocytopenic, Idiopathic* ; Splenectomy ; Steroids ; Thrombocytopenia ; Viral Load

Cryptococcus neoformans is an organism that mainly causes opportunistic infection in immunocompromised patients. It can also cause various infections in immunocompetent patients, but cryptococcal lymphadenitis is rare. We have experienced a case of cryptococcal lymphadenitis in an immunocompetent adult patient who presented with cervical lymphadenopathy and fever that did not subside for 3 weeks. Neck and chest CT scan showed multiple lymph node enlargements with central low density and peripheral enhancement on both hilar, mediastinal, and right supraclavicular areas. Cryptococcus lymphadenitis was diagnosed by tissue biopsy, PAS and GMS stain, and culture. This case emphasizes that when an immunocompetent patient presents with lymphadenopathy, cryptococcal lymphadenitis should always be considered in the differential diagnosis.
Adult* ; Biopsy ; Cryptococcus ; Cryptococcus neoformans ; Diagnosis, Differential ; Fever ; Humans ; Immunocompromised Host ; Lymph Nodes ; Lymphadenitis* ; Lymphatic Diseases ; Neck ; Opportunistic Infections ; Tomography, X-Ray Computed

Pellagra is a disease caused by a deficiency of niacin. It is usually found among chronic alcoholics in Korea. Dermatitis, dementia and diarrhea are characteristic symptoms of pellagra. Vibrio sepsis is due to a virulent, gram-negative rod infection caused by Vibrio vulnificus. It is generally acquired in coastal areas near warm water. Underlying disease and initial clinical presentations of pellagra are very similar to that of vibrio sepsis. Herein, we report a case of pellagra that initially mimicked vibrio sepsis.
Alcoholics ; Dementia ; Dermatitis ; Diarrhea ; Humans ; Korea ; Niacin ; Pellagra ; Sepsis ; Vibrio ; Vibrio vulnificus

Community-associated methicillin resistant Staphylococcus aureus (CA-MRSA) with Panton-Valentine leukocidin (PVL) genes have recently emerged worldwide, but infections due to PVL carrying CA-MRSA strains have never been reported in Korea. We report a case of extensive perianal abscess due to PVL+ CA-MRSA in a 76-year-old Korean female patient, of which genetic background was very close to USA300. It belonged to staphylococcal cassette chromosome mec element (SCCmec) type IV, ST8 of multilocus sequence typing (MLST), type 1 spa type, and accessory gene regulator locus (agr) group I. Comprehensive literature reviews from the Far East showed molecular characteristics were diverse and PVL genes were infrequently found than in western countries.
Abscess ; Aged ; Bacterial Toxins ; Exotoxins ; Far East ; Female ; Humans ; Korea ; Leukocidins ; Lifting ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Multilocus Sequence Typing ; Staphylococcus aureus