Multiple intracerebral space-occupying lesions (SOL) demonstrated by computed tomography (CT), magnetic resonance imaging (MRI), and radionuclide brain scanning or cerebral arteriography often present a diagnostic enigma. The differential diagnosis between brain abscess and brain tumor is occasionally difficult to determine on the basis of imaging studies and clinical judgement, especially in the case of brain SOL with mainly cystic or necrotic component. Elderly patients with a history suggestive of hidden malignancy and the above radiological features are usually presumptively diagnosed as having multiple cerebral metastases. We experienced a case of multiple brain abscess which was confirmed by diagnostic surgery, in a 67- year old male who showed clinical and radiological findings of mimicking cystic brain metastases with undetermined primary focus. Even with long-term therapy with antibiotics and supportive care, the patient suffered from massive ventriculitis and subsequently died.
Aged ; Angiography ; Anti-Bacterial Agents ; Brain Abscess* ; Brain Neoplasms ; Brain* ; Diagnosis, Differential ; Humans ; Magnetic Resonance Imaging ; Male ; Neoplasm Metastasis*

BACKGROUND: Typhoid can be diagnosed with certainly only by the isolation of Salmonella Typhi from the blood, urine, feces, or other body fluids. The Widal reaction has been one of the most important diagnostic tests for typhoid and is still widely used in many developing countries. METHODS: The Widal test was done in 50 nontyphoidal febrile patients, and 50 patients with proven typhoid in Chonbuk area. we compare this result with that of last 10 years. RESULTS: By rapid slide method S. typhi O titer of 1:160 or more was seen in 58% and S. typhi H titer of 1:320 or more was seen in 12% of patients with bacteriologically proven typhoid fever. CONCLUSION: O titer was similar to the result of past 10 years. A false positive test was found in 40% of patients with nontyphoidal febrile patients in whom Widal test must therefore be interpreted with caution.
Body Fluids ; Developing Countries ; Diagnosis* ; Diagnostic Tests, Routine ; Feces ; Humans ; Jeollabuk-do ; Salmonella typhi ; Typhoid Fever*

BACKGROUND: There are increasing reports of hepatic abscess cause by K. pneumoniae, especially in Asia and its more frequent occurrence in diabetes mellitus but the reason remains unclear. This study was conducted to clarify the different clinical presentations between patients with K. pneumoniae (KP group) and those with non-K. pneumoniae (non-KP group) hepatic abscess. METHODS: A retrospective clinical survey was done from April 1997 to February 2001. The medical records of 20 adults with culture-confirmed pyogenic liver abscess who had attended Chonbuk National University hospital were reviewed. RESULTS: Hepatic abscess caused by K. pneumoniae accounted for 10 (50%) of 20 patients with pyogenic liver abscesses. Compared to KP group, non-KP group showed higher proportions of polymicrobial infections (50% vs 20%) including E. coli, Proteus sp., Enterobacter sp., Citrobacter sp., P. aeruginosa, viridans streptococcus, Enterococcus, and Bacteroides sp.. Although, the clinical presentations of the two groups were similar, but KP group showed higher association with diabetes mellitus, lower hepatobiliary diseases, and larger abscess formation than non-KP group. CONCLUSION: K. pneumoniae was one of the most important causative organism in pyogenic liver abscess. Clinical findings were similar between K. pneumoniae heatic abscess and non-K. pneumoniae-induced abscess, though, K. pneumoniae-induced hepatic abscess was more frequently associated with diabetes mellitus and single large abscess.
Abscess ; Adult ; Asia ; Bacteroides ; Citrobacter ; Coinfection ; Diabetes Mellitus ; Enterobacter ; Enterococcus ; Humans ; Jeollabuk-do ; Klebsiella pneumoniae* ; Klebsiella* ; Liver Abscess ; Liver Abscess, Pyogenic* ; Medical Records ; Pneumonia* ; Proteus ; Retrospective Studies ; Streptococcus

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is the major pathogen of nosocomial infections. There are many reports that MRSA nasal cariers play a major role in the transmission of MRSA. We studied to assess the nasal carriage rates, therapeutic effects of nasal carriers and control of MRSA outbreak in a tertiary, acute and educational hospital. METHODS: From 1990 to 1997, eight MRSA epidemics were detected and investigated for outbreak control. We surveyed the MRSA colonization of anterior nares and hands of health care workers (HCW). MRSA was identified by staphylococcal broth, mannitol-salt- agar, Muller-Hinton-oxacillin agar. To identify the permanent carriers in the HCWs, the nasal swab was done weekly for 3 weeks. Two percent povidone iodine ointment or 2% mupirocin ointment was applied topically to treat the permanent MRSA nasal carriers. RESULTS: Of eight MRSA outbreaks, five epidemics occurred in the intensive care unit, all of them occurred in surgical departments and five of them occurred in winter seasons. For eight MRSA outbreaks, 351 HCWs were surveyed. The rates of transient carriers was 10.8% (38/351) and the rates of that were 9.0% (10/111) in medical doctors (MD), 12.5% (24/192) in registered nurses (RN) and 11.4% (4/35) in aid nurses (P=0.470). The rate of permanent carrier in doctors was 1.8%, and that in RNs was 3.7% (P=0.490). After topical therapy with 2% povidone iodine ointment or 2% mupirocin ointment for permanent carriers, MRSA was not identified for 2 months follow up. CONCLUSION: In MRSA epidemics, the rate of the transient carrier rate of MRSA in HCWs was 10.8% and the rate of the permanent carrier was 2.6%. The difference of carrier rates in HCWs was not significant statistically. The therapy for the permanent nasal carriers in HCWs with two percent povidone iodine ointment or 2% mupirocin ointment was very effective. And MRSA outbreaks were ended and controlled for 6months follow up.
Agar ; Colon ; Cross Infection ; Delivery of Health Care* ; Disease Outbreaks ; Follow-Up Studies ; Hand ; Intensive Care Units ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Mupirocin ; Povidone-Iodine ; Seasons

BACKGROUND: The frequency of nosocomial bloodstream infections by Candida species has risen dramatically in the past two decades, and a noticeable shift in the species of Candida causing bloodstream infection toward non-albicans species has occurred. Also, the isolation frequency of Candida species are influenced by patient type, nation and region, study period, and investigators. The aim of this study is to investigate the isolation rates and antifungal susceptibility of Candida species isolated from blood cultures at Wonju Christian Hospital during the recent four years (1997~2000). METHODS: For one-hundred twenty-seven isolates of Candida species from blood cultures, we analyzed the isolation frequency by year, age/sex, and department. Identification of yeasts was done by germ tube test and ATB ID 32 C kit. Antifungal susceptibilities to flucytosine, amphotericin B, nystatin, miconazole, econazole, and ketoconazole were determined by ATB FUNGUS. RESULTS: The isolation rates of Candida species in decreasing order were C. albicans (44.9%), C. parapsilosis (21.3%), C. glabrata (14.2%), and C. tropicalis (9.5%). The isolation rates of Candida species by year were as follows; C. albicans decreased from 61.5% in 1997 to 33.3% in 2000; C. tropicalis decreased from 23.1% in 1997 to 5.0% in 2000; C. parapsilosis increased from 0% in 1997 to 30.8% in 2000; and C. glabrata increased from 7.7% in 1997 to 18.0% in 2000. Of 127 Candida species, all but one isolates were susceptible to amphotericin B. CONCLUSION: This data showed that the candidemia by C. albicans and C. tropicalis are decreasing trend, and candidemia by C. parapsilosis and C. glabrata are increasing trend in recent four years.
Amphotericin B ; Candida* ; Candidemia ; Econazole ; Flucytosine ; Fungi ; Gangwon-do ; Humans ; Ketoconazole ; Miconazole ; Nystatin ; Research Personnel ; Yeasts

BACKGROUND: Vancomycin-resistant enterococci (VRE) were first recovered from clinical isolates in Korea in 1992, and the incidence has been steadily increasing. Alternatives to vancomycin are few because VRE are frequently resistant to commonly used antimicrobial agents. The present study was designed to assess the in-vitro activity of fosfomycin to clinical isolates of VRE. METHODS: For 199 VRE isolates from 1995 to 2000, and 91 enterococcal isolates that were consecutively isolated during the January of 2001 at Wonju Christian Hospital, fosfomycin (200 microgram) disk diffusion test was done by NCCLS method. The number of enterococcal isolates tested for fosfomycin were as follows:58 E. faecalis (42 vancomycin susceptible isolates, 16 vancomycin resistant isolates, and 1 vancomycin intermediate resistance isolate); 210 E. faecium (185 vancomycin resistant and 25 vancomycin susceptible isolates); 15 E. gallinarum, and 6 E. casseliflavus isolates. RESULTS: Among the VRE isolates, the resistance rates of fosfomycin according to enterococcal species were 6.3% in E. faecalis, 4.9% in E. faecium, 0% in E. casseliflavus, and 16.7% in E. gallinarum. CONCLUSION: Fosfomycin could be a potentially useful drug for the treatment of infections caused by VRE.
Anti-Infective Agents ; Diffusion ; Enterococcus faecalis ; Enterococcus faecium ; Fosfomycin* ; Gangwon-do ; Incidence ; Korea ; Vancomycin*

BACKGROUND: Beta-hemolytic streptococci (BHS) are frequently isolated pathogens in the clinical microbiology laboratory, and the isolation frequency of each serogroup of BHS are influenced by patient type, nation and region, study period, and investigators. The aim of this study is to investigate the isolation rates and distribution of BHS by serogroup at Wonju area during the recent periods. METHODS: Isolation rates of BHS isolated from 1997 to 2000 at Wonju Christian Hospital were investigated. The distribution of each serogroup of BHS according to the types of clinical specimens was also studied. Serogroups A, B, C, F, and G were determined by latex agglutination test (Murex Streptex kit). RESULTS: Of 627 BHS isolated during the study periods, 16.3% were group A, 49.3% were group B, 5.1% were group C, 4.3% were group F, 21.0% were group G, and 4.0% were nongroupable. Isolation rates of BHS by specimen type were as follows:wound/pus was 44.4%; cervix, urine, and respiratory specimen ranged from 10% to 20%; blood was 4.0%; body fluid was 2.9%; and cerebrospinal fluid was 0.5%. The prevalent isolation sites by serogroup were:group A, wound/ pus (78.4%); group B, cervix (32.7%), urine (28.5%), and wound/pus (26.2%); group C and G, wound/pus and respiratory specimen; and group F, wound/pus and urine. From blood, group B streptococci (44.0%) were the most frequent isolate. CONCLUSIONS: Half of BHS isolated from clinical specimens were group B streptococci in this study, which reflects the increasing trend of group B streptococcal infections during the recent years at Wonju area.
Body Fluids ; Cerebrospinal Fluid ; Cervix Uteri ; Female ; Gangwon-do* ; Humans ; Latex Fixation Tests ; Research Personnel ; Streptococcal Infections ; Suppuration ; Tertiary Healthcare*

BACKGROUND: Patients receiving bone marrow transplantation (BMT) are highly susceptible to infection. This study aims to analyze the frequencies, types and distributions of the organisms causing infectious complications following BMT. METHODS: We retrospectively analyzed infectious complications of 76 bone marrow transplant patients treated at Chonnam National University Hospital during the period 1992~1999. RESULTS: The patient group consisted of 52 allogeneic and 24 autologous recipients. In the allogeneic recipient group, the majority of the patients were diagnosed with acute myelogenous leukemia (37%) and in the autologous group, non-Hodgkin's lymphoma (58 %). Sixty-five of 76 recipients (85.5%) had a total of 118 infectious complications. Out of the 52 allogeneic and 24 autologous recipients, 87 and 31 infectious complications occurred, respectively. Clinically defined infections were reported in 88 cases, microbiologically defined infections in 20 cases, and unexplained fever in 10 cases. Seventy-two infections occurred within the first 30 days following transplant, 17 cases between days 30 and 100, and 29 cases after the 100th day. Infection of the oral cavity occurred in 25.9% of the subjects, pneumonia in 24.1% and skin and soft tissue infection in 19.4%. Oral mucositis was the most common type of infection within the first 30 days following transplant, pneumonia between days 30 and 100, and skin and soft tissue infection after the 100th day. The causative organisms for bacteremia were gram- positive organisms in four of the cases and gram-negative organisms in six of the cases. Similarly, the causative organisms for pneumonia were cytomegalovirus in 5 cases, Pneumocystis carinii in 1 case, methicillin- resistant Staphylococcus aureus in 1 case, and M. tuberculosis in 2 cases. The most common cause of death was acute respiratory distress syndrome due to pneumonia (11 cases). CONCLUSION: Infection is a major complication in patients undergoing BMT. Infection occurred most commonly within the first 30 days following transplant, with oral mucositis and pneumonia being the most common types of infection. Antimicrobial prophylaxis with improved strategies should be utilized in order to prevent infection during post-BMT immunohematopoietic recovery.
Bacteremia ; Bone Marrow Transplantation ; Bone Marrow* ; Cause of Death ; Cytomegalovirus ; Fever ; Humans ; Jeollanam-do ; Leukemia, Myeloid, Acute ; Lymphoma, Non-Hodgkin ; Mouth ; Pneumocystis carinii ; Pneumonia ; Respiratory Distress Syndrome, Adult ; Retrospective Studies ; Skin ; Soft Tissue Infections ; Staphylococcus aureus ; Stomatitis ; Transplantation* ; Tuberculosis

BACKGROUND: Although massive use of live attenuated mumps virus vaccines successfully reduced the incidence of mumps virus infection worldwide, mumps outbreaks have not been completely eliminated, even in vaccinated populations. In recent years, the incidence of mumps has been remarkably increased in Korea. This study was designed to evaluate the recent seroprevalence rate of mumps IgG among children in Kyonggi province at 1996 and 1999. METHODS: Study population included students from 8 elementary schools in Kyonggi province. Serum samples were collected twice at 1996 and 1999 and tested for mumps-specific antibody by enzyme-linked immunosorbent assay (ELISA). We also conducted a questionnaire survey on the parents and collected the records including history of vaccination and mumps infection. RESULTS: The seropositive rates against mumps were 89.47% and 89.74% at 1996 and 1999, respectively, and they were not significantly different when compared to age, sex, and region. Although the first vaccination rates were 92.17% and 92.25% at 1996 and 1999, respectively, the second vaccination rates were only 37.89% and 38.03% at 1996 and 1999, respectively. Infection rate showed no significant difference between vaccinated groups and nonvaccinated groups. Seropositive rate of infected group was higher than that of noninfected group but it was not significantly different between the vaccinated and the nonvaccinated. CONCLUSIONS: This study showed the seropositive rate and vaccination against mumps in children. There were no significant relationships between vaccination and infection. Therefore, it seems likely that the vaccination is not fully protective against mumps infection. This study will be helpful for the establishment of guideline for prevention and treatment of mumps in Korea.
Child* ; Disease Outbreaks ; Enzyme-Linked Immunosorbent Assay ; Gyeonggi-do* ; Humans ; Immunoglobulin G* ; Incidence ; Korea ; Mumps virus ; Mumps* ; Parents ; Seroepidemiologic Studies ; Vaccination ; Vaccines ; Surveys and Questionnaires

BACKGROUND: With the improvement of sanitary conditions, epidemiologic features and relative frequency of serogroups of salmonella have changed in developed countries. Also there are increasing reports on occurrence of multidrug-resistant salmonella infections. To investigate such changes in Korean children, we retrospectively evaluated epidemiologic features of salmonellosis and antibiotic resistance pattern. METHODS: Medical records of patients, whose blood or stool culture yielded Salmonella sp. were reviewed. Then serogroup, monthly occurrence, clinical syndromes, and antibiotic resistance were evaluated. RESULTS: During the period from January 1986 to December 1995, 166 cases of salmonellosis had been admitted to the Seoul National University Children's Hospital. Group B salmonella was most frequently isolated (48.8%), followed by non-typhoidal group D, group C, and Salmonella typhi. S. typhi was frequently isolated from blood, in contrast with other serogroups from stool. The isolation of S. typhi has been decreasing, while that of non-typhoidal group D and group B has been increasing in the nineties. Forty-two percent were isolated from July to September. Group B was responsible for 54% of the gastroenteritis cases. Among the cases presenting with fever without a primary focus, S. typhi was isolated from blood in 16 cases and group B from blood or stool in 10 cases. Sixty- eight percent of gastroenteritis occurred in children of 2 years or below in age, while most cases of enteric fever occurred in school-age children. Group D strains including S. typhi were susceptible to most antibiotics, such as ampicillin, trimethoprim-sulfamethoxazole, chloramphenicol, ciprofloxacin, and ceftriaxone, but more than half of group B strains were resistant to ampicillin and chloramphenicol. CONCLUSION: The occurrence of typhoid fever has been decreasing markedly, but salmonella gastroenteritis by group B and non-typhoidal group D has been increasing in the nineties. Resistance to the primary antibiotics used for the treatment of salmonellosis was observed in the group B strains.
Ampicillin ; Anti-Bacterial Agents ; Ceftriaxone ; Child* ; Chloramphenicol ; Ciprofloxacin ; Developed Countries ; Drug Resistance, Microbial ; Fever ; Gastroenteritis ; Humans ; Medical Records ; Retrospective Studies ; Salmonella ; Salmonella Infections* ; Salmonella typhi ; Seoul ; Trimethoprim, Sulfamethoxazole Drug Combination ; Typhoid Fever