BACKGROUND: Cancer therapy-related infections due to neutropenia is a well known problem in cancer treatment. Leukemia increases the risk furthermore because of its nature of bone marrow involvement. Therefore knowledge of the aspects of infections in neutropenic leukemic patients are important in preventing morbidity and mortality. METHODS: This study was conducted by reviewing clinical records of 69 cases of 49 leukemic patients who had neutropenic fever during 1996~2001. Each case was reviewed and analyzed in terms of clinical status & treatment, laboratory results, origins of fever and pathogens (if origin was infectious), final outcome and prognostic factors. RESULTS: Of 69 cases of 49 leukemic patients with neutropenic fever, mortalilty was 29%. Microbiologically defined infection (MDI) was 45% and clinically defined infection (CDI) was 30.4%, which meant a increase in MDIs compared with the previous study. Major focuses of fever were lung, blood and catheter-related, which were similar to those of 1988~1995. The major pathogens were gram negative bacilli (43.2%), followed by gram positive cocci (29.7%), but the proportion of gram positive pathogens had increased. Age, usage of selective gut decontamination and colony-stimulating factors (CSFs), and the presence of bone marrow recovery were related to prognosis by univariate analysis. Multivariate logistic regression analysis revealed that the bone marrow recovery was the only significantly related to patient's outcome, which was the same as the previous study (P<0.001). CONCLUSION: Proportions of pathogens in febrile neutropenic patients were similar with the previous study, but gram positive infections are increasing recently. Bone marrow recovery was the only significant prognostic factor in these patients. And, the benefits of selective gut decontamination or CSF usage is still questionable.
Bone Marrow ; Colony-Stimulating Factors ; Decontamination ; Fever* ; Gram-Positive Cocci ; Humans ; Leukemia ; Logistic Models ; Lung ; Mortality ; Neutropenia ; Prognosis

BACKGROUND: The Epstein-Barr virus (EBV) is a human DNA herpesvirus that causes worldwide spread. Primary infection of EBV in early childhood is often subclinical, and more than 90% of children older than five years of ages are seropositive for EBV in Korea. Two types of EBV have been described which differ in their geographical distributions and associated diseases. Variable diseases including many malignancies are associated with EBV infections. And the pathogenesis of EBV associated diseases are very complicated. To study EBV typing in EBV associated diseases could be the first step to find out the pathogenesis of EBV associated diseases, and to confirm the altered reactivation and typing of EBV under various disease conditions may be indirectly helpful to understand the pathogenesis of EBV associated diseases. In this aspect, we performed this study. METHODS: The study group included 90 children (age range 1 to 15 years) with febrile illness and malignancies who had serologic evidence of previous EBV infection. Sixty-two cases of the study group had febrile illness and 28 cases had malignancies. Febrile illness groups were classified into bacterial infection, non-bacterial infection and Kawasaki disease. The control group included 62 healthy children in the range of 5 to 15 years of age. Mouth washing samples were taken and two types, EBV A and B were identified by using one-step PCR. B95-8 cells (type A) and Jijoye cells (type B) were used as positive controls, and K-562 cells was used as a negative control. RESULTS: The results were as follows; Eleven (17.7%) of the 62 healthy children had EBV DNA in throat washings : of these, 8 (72.7%) were shedding type A virus, and 3 (27.3%) type B. EBV was detected in 12 (57%) of the 21 patients with bacterial infection : 7 (58.3%) had A type, 2 (16.7%) B type, and 3 (25%) both types. 23 (79.3%) of the 29 patient with non-bacterial infection had EBV DNA in throat washing: of these, 15 (65.2%) had A type, 4 (17.4%) B type, and 4 (17.4%) both types. Two (16.7%) of the 12 patients with Kawasaki disease had EBV DNA in throat washing; all of them were type A. EBV was detected in 15 of the 28 children with malignancies : 11 (73.3%) had only type A, 2 (13.3%) type B, and 2 (13.3%) both types. Overall, the seropositive rate of study group was significantly higher than that of control group. But, there was no significant difference in seropositive rate between febrile illness and malignancies. Both the seropositive rates in the bacterial infection and non-bacterial infection groups were significantly higher than that of Kawasaki disease group (respectively P<0.001, P<0.001). CONCLUSION: We have the facts and suggestions as followings; We reconfirm that type A EBV is highly dominant and no mixed infection in Korean healthy children. The EBV excretion rate in children with febrile illness or malignancies was about 3-fold higher than that in healthy children, and coinfection with type A and B was seen in both study group. These results suggest that EBV reactivation may be increased in the status of immunologic alteration, induced by diseases. By contrast, EBV reactivation may not be found in certain acute febrile illness like Kawasaki disease, in which immunologic alteration to reactivate EBV is not induced. We think that this study may provide the basis to figure out the pathogenesis of EBV associated diseases. But, The outcome of this study is incomplete and indirect to understand the host immune responses to EBV and pathognomic role according to EBV types. So, further large scaled studies of EBV subtyping using variable methods will be needed to investigate the pathogenesis of EBV associated diseases.
Bacterial Infections ; Child* ; Coinfection ; DNA ; Epstein-Barr Virus Infections ; Herpesvirus 4, Human* ; Humans ; Korea ; Mouth ; Mucocutaneous Lymph Node Syndrome ; Pharynx ; Polymerase Chain Reaction

As a result of the enlarging pool of unvaccinated children and young adults, there has been an increase in measles in our countries. In these situation, it has been reported that measles associated pneumoinia is easily complicated with fatal respiratory failure, especially in immunocompromised patients. Herein we report the case of lethal measles pneumonia after allogenic hematopoietic stem cell transplantation in adults proven by autopsy. Recently, one case of measles was encountered in a 39-year-old female patients after allogenic bone marrow transplanted case (chronic myelogenous leukemia), who progressed into interstitial pneumonia pattern, despite treatment including antibiotics, immunoglobulin. The patient died of giant cell pneumonia compatible with that of measles which was comfirmed in the section of necropsy lung specimen.
Adult ; Anti-Bacterial Agents ; Autopsy ; Bone Marrow ; Bone Marrow Transplantation ; Child ; Female ; Giant Cells ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Humans ; Immunocompromised Host ; Immunoglobulins ; Lung ; Lung Diseases, Interstitial ; Measles* ; Pneumonia* ; Respiratory Insufficiency ; Young Adult

We experienced a case of Plasmodium falciparum gametocytemia successfully treated with primaquine in a twenty seven-years old woman. The patient had been admitted due to general malaise after diagosis and treatment of P. falciparum at Tanzania one month ago. On microscopic examination, P. falciparum gametocytemia was seen and treated with mefloquine for one week but gametocytemia was not disappeared. After primaquine treatment for two weeks, she was successfully treated.
Female ; Humans ; Mefloquine ; Plasmodium falciparum* ; Plasmodium* ; Primaquine* ; Tanzania

Skeletal cryptococcosis is an uncommon infection. Cryptococcus is a common cause of meningitis and infects 7~10% of patients with AIDS. As well as AIDS, the infection may be seen in association with leukemia, lymphoma, Hodgkin's disease, sarcoidosis, tuberculosis and diabetes, also in patients on steroid medication. But there is no case report of skeletal cryptococcosis following allogeneic hematopoietic stem cell transplantation. A 40-year-old woman was admitted to the hospital because of low back pain. She had chronic myelogenous leukemia for 2 years and underwent allogeneic hematopoietic stem cell transplantation 8 months ago. She have been treated with steroid and cyclosporine orally because of chronic graft versus host disease. On examination she was afebrile and had posterior lower lumbar tenderness. But, she had no reduced strength of low extremities. Open biopsy was underwent. Histology demonstrated budding, round-to-oval, refractile yeast-like organisms within debris. The results of a lumbar puncture were unremarkable and cerebrospinal fluid culture failed to grow bacteria and yeast. The patient was treated with amphotericin B (1 gram) and AmBisome (2.8 gram) over 6 weeks. Three months after cessation of therapy, the patient was doing well.
Adult ; Amphotericin B ; Bacteria ; Biopsy ; Bone Marrow Transplantation ; Cerebrospinal Fluid ; Cryptococcosis ; Cryptococcus ; Cyclosporine ; Extremities ; Female ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Hodgkin Disease ; Humans ; Leukemia ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Low Back Pain ; Meningitis ; Sarcoidosis ; Spinal Puncture ; Spondylitis* ; Tuberculosis ; Yeasts

BACKGROUND: We previously reported that activity of iron-uptake systems (IUS) influenced on the growth of Staphylococcus aureus in laboratory medium and body fluids according to the iron and oxygen concentrations, which they are closely related each other in several microbial metabolism. In the present study, we tried to investigate the profiles of cell wall proteins of S. aureus according to the change of iron and oxygen concentrations. METHODS: SR-1 strain, whose IUS are defective, was isolated from the standard strain ATCC 6538 by repeated exposure against streptonigrin. These two strains were cultured under the aerobic, microaerobic and anaerobic conditions in the iron-sufficient BHI and iron-depleted BHI, respectively. Cell wall proteins were visualized by Coomassie staining after SDS-PAGE. RESULTS: Cell wall proteins of the both strains were expressed more than under the aerobic condition than under the anaerobic condition in the iron-sufficient medium as well as in the iron-deficient medium. However, expression of cell wall proteins of SR-1 strain was markedly inhibited compared to that of parental ATCC 6538 strain, especially in the iron-deficient medium. Among the proteins more expressed under the aerobic culture condition in the iron-deficient medium, about 88, 55, 39, 36, 35 and 33 kDa of proteins were iron-repressible and oxygen-inducible, and corresponded to the iron-repressible proteins which other researchers reported. CONCLUSION: Expression of cell wall proteins of S. aureus was affected by simultaneous and respective change of iron and oxygen concentrations. Activity of IUS influenced more on the expression of cell wall proteins of S. aureus in the iron-deficient environment than in the iron-sufficient environment. These results suggest the possibility that the iron-repressible and oxygen-inducible proteins mimic those (antigens) found commonly in clinical infections.
Body Fluids ; Cell Wall* ; Electrophoresis, Polyacrylamide Gel ; Humans ; Iron* ; Metabolism ; Oxygen* ; Parents ; Staphylococcus aureus* ; Staphylococcus* ; Streptonigrin

BACKGROUND: When pediatric patients with normal renal function were given the recommended keep-up amount of aminoglicocide for the use, they showed a better clinical symptom not indicating the poisonous without checking serum concentrations. We studied this subject against the patients who used Netimilcin in order to know if the blood creatinine significantly increases in a clinic and if it reaches the maximum and minimum concentrations without adjusting the amount and the symptom of infection and the result get better. METHODS: We picked the maximum concentration of drugstuffs 30 minutes after injection and its minimum just prior to the next injection within 24~32 hours with a vein injection of 2 mg/kg/dose Netilmicin with the 8 hours difference against 16 patients at the age between 3 months and 14 years. We measured the blood creatinine at the beginning of the treatment and at the closing, and we decided the medicine serum concentration with TDX system and we counted the result of Pharmaco-kinetic parameter with Simkin PC clinical Database system. To check the patients' result of better clinical conditions, leukocyte values and the temperature were measured 72 hours after the treatment. The analysis of statistics was performed with the use of paired t-test. RESULTS: The average age of 16 patients shows 3.5+/-3.2, average weight 15.2+/-8.5 kg, the leukocyte value first 14.9+/-6.6X10X10X10/mm3, and 72 hours after the treatment it shows 6.6+/-1.9X10X10X10/mm3, average temperature fell from 37.7+/-1 celsius into 36.3+/-0.4 celsius. The average drug amount taken in case of patients showed 2.06+/-0.4, the average treatment period was 7.6+/-2.3 days, the maximum serum concentration shows 5.5+/-1.1 mg/mL, the minimum concentration shows 0.5+/-0.3 mg/mL. The average blood creatinine was first 0.52+/-0.19 mg/mL, and at closing 0.46+/-0.11 mg/dL (P=0.209). The minimum concentration didn't show more than 2 mcg/mL, the blood creatinine didn't increase showing 0.5 mg/mL(P=0.201). CONCLUSION: At the result of checking the medicine concentration of Netilmicin in pediatric patients in our clinic, there is no detecting the betterment of the clinical symptom owing to the decrease of the values of leukocyte. There was no necessity to adjust the amount of medicine from the beginning to the end as there was no sign of change of blood creatinine. In view of this result, we can understand that we don't need the regular examination of the medicine concentration about the aminoglicocide from Korean pediatric patients with normal renal function.
Creatinine ; Humans ; Leukocytes ; Netilmicin* ; Pediatrics ; Veins

BACKGROUND: Since 1997, the annual case occurrence of vivax malaria in the Republic of Korea have exceeded 1,000 cases since 1997. The military is thought to be an important source of the current outbreak. We collected various informations about malaria cases (soldiers, veterans and civilians) which occurred in 2000, and analyzed the characteristics of the current outbreak. METHODS: Informations about malaria cases of soldiers, veterans and civilians, including name, age, sex, day of onset, region, etc., were collected through the National Institute of Health. RESULTS: Out of total 4,141 cases, 1,288 (31.1%) occurred in the military, 1,273 (30.7%) occurred among the veterans, and 1,580 (38.2%) occurred among civilians. The monthly case occurrence reached its peak in early August. Areas such as Cheolwon, Yeoncheon and Paju showed the highest prevalence. CONCLUSION: It is considered that the current malaria outbreak has escaped from the exponential growth phase, however, more attention should be paid to prevent further spreading of malaria infection.
Humans ; Malaria ; Malaria, Vivax* ; Military Personnel ; Prevalence ; Republic of Korea* ; United Nations ; Veterans

BACKGROUND: Pneumocytitis cainii pneumonia (PCP) can occur in immunocompromised hosts especially such as AIDS or cancer patients. Although recent research had focused on PCP in AIDS patients, few studies have described the clinical presentations of PCP in recipients of stem cell transplantation (SCT). We evaluated the clinical manifestations of PCP in SCT patients admitted at St. Mary's hospital, Seoul, Korea. METHODS: The medical records of 17 PCP patients undergoing SCT between Feb. 1998 and Feb. 2000 were reviewed. The diagnosis of PCP was confirmed through the demonstration of Pneumocystis carinii via either cytology of brochoalveolar lavage (BAL) or histological technique of lung biopsy. CMV disease and CMV infection were confirmed by BAL culture and antigenemia respectively. RESULTS: Seventeen patients were all recipients of allogeneic SCT and 7 of 17 patients were performed non-sibling SCT. Patients presented with symptoms including brief period (4~23 days) of fever (76%), dyspnea (70%), cough (64%), and signs such as rale (58.8%). Sixteen patients (94%) had been receiving immunosuppressive agent such as cyclosporine A (64%) or FK506 (35%) without PCP prophylaxis. Eleven patients (64%) were treated with corticosteroid with mean dose of 16 mg/day prednisolone and mean duration of 4.6 months after post-SCT period. Twelve patients were co-infected with CMV. Another co-infected microorganisms were Pseudomonas aeruginosa, Mycobacterium tuberculosis, herpes simplex virus, parainfluenza virus. Average duration of treatment with trimethoprim-sulfamethoxazole (TMP/SMX) was 21+/-9 days. Four patients died, and three of them were related with PCP. CONCLUSION: PCP developed frequently in patients who were taking immunosuppressive drug due to graft versus host disease or were not taking TMP/SMX prophylaxis. High risk patients showing fever, cough, or dyspnea should be considered to take early bronchoscopic intervention for detection of PCP. When treat for PCP, it also be considered to the possibility of co- infection such as CMV.
Biopsy ; Cough ; Cyclosporine ; Cytomegalovirus ; Diagnosis ; Dyspnea ; Fever ; Graft vs Host Disease ; Histological Techniques ; Humans ; Immunocompromised Host ; Korea ; Lung ; Medical Records ; Mycobacterium tuberculosis ; Paramyxoviridae Infections ; Pneumocystis carinii* ; Pneumocystis* ; Pneumonia ; Pneumonia, Pneumocystis* ; Prednisolone ; Pseudomonas aeruginosa ; Respiratory Sounds ; Seoul ; Simplexvirus ; Stem Cell Transplantation* ; Stem Cells* ; Tacrolimus ; Therapeutic Irrigation ; Trimethoprim, Sulfamethoxazole Drug Combination

BACKGROUND: The diagnosis of malaria has been usually made using microscopic examination of Wright stained thin blood films in Korean army. This method is labor-intensive, time consuming and requires the microscopic expertise. Therefore, the alternative techniques, rapid diagnostic test, have been sought for use in Korean army. We performed a comparison of the OptiMAL test with GENEDIA Malaria (P. vivax) Ab Rapid I, II to assess its sensitivity and specificity of Plasmodium vivax malaria. METHODS: Blood specimen were collected from 51 patients who were presented and initially diagnosed for P. vivax by the microscopy of blood smears and from 30 control patients without malaria infection at the Capital Armed Forces General Hospital (CAFGH) between October 2000 and February 2001. Among the 51 patients, we also collected 24 samples from 24 patients at 2 or 3 days after therapy. The OptiMAL test and GENEDIA Malaria (P. vivax) Ab Rapid I, II were performed according to the manufacturer's instructions on all samples respectively. RESULTS: Compared with the blood film, sensitivities and specificities of the OptiMAL test, GENEDIA Malaria (P. vivax) Ab Rapid I and GENEDIA Malaria (P. vivax) Ab Rapid II were 94.1~100% (29/29), 80.4~83.3%, 96.1~96.7% respectively. One case was interpreted as 'undetermined' by OptiMAL test. In 24 patients during therapy, the sensitivities of the OptiMAL test, GENEDIA Malaria (P. vivax) Ab Rapid I and GENEDIA Malaria (P. vivax) Ab Rapid II on 8 specimens with mean 120/microliter parasitemia and 16 specimens with negative parasitemia were 75~43.8%, 87.5~81.3%, 100~100% respectively. CONCLUSION: Our data demonstrated that the sensitivity and specificity of the GENEDIA Malaria (P. vivax) Ab Rapid I were not satisfactory, but the sensitivity and specificity of the OptiMAL test and GENEDIA Malaria (P. vivax) Ab Rapid II were relatively high and useful diagnostic tests for diagnosis of P. vivax in areas like the militaries where laboratory facilities are poor or non-existent.
Arm ; Diagnosis* ; Diagnostic Tests, Routine ; Hospitals, General ; Humans ; Malaria* ; Malaria, Vivax ; Microscopy ; Military Personnel* ; Parasitemia ; Plasmodium vivax* ; Plasmodium* ; Sensitivity and Specificity