The hemorrhagic fever with renal syndrome (HFRS) is an acute febrile infectious disease with clinical characteristics of fever, bleeding tendency, gastrointestinal symptoms and renal failure. It has been known that most patients with hemorrhagic fever with renal syndrome were spontaneously recovered without any significant complication. However, there are several complications of HFRS such as chronic renal failure, bleeding, hypopituitarism, pyelonephritis, and acute pancreatitis. Rarely, cardiac complications were reported. The cardiac complications include severe bradycardia, hypertension, atrial dilatation, atrial hemorrhage, atrial fibrillation, complete atrioventicular block, atrioventricular junctional tachycardia, heart failure and myocarditis. However, there was no previous report about hemorrhagic fever with renal syndrome accompanied by acute pericarditis with pericardial effusion. We experienced a patient with hemorrhagic fever with renal syndrome complicated by acute pericarditis and pericardial effusion. A 28 year-old woman visited this hospital with complaints of fever, chill and epigastric pain. She was diagnosed as hemorrhagic fever with renal syndrome by serologic test and clinical manifestations. Pericardial effusion was observed on transthoraic echocardiography. She recovered with conservative treatment. Therefore, we report this case with brief review of related articles.
Adult ; Atrial Fibrillation ; Bradycardia ; Communicable Diseases ; Dilatation ; Echocardiography ; Female ; Fever* ; Hantaan virus ; Heart Failure ; Hemorrhage ; Hemorrhagic Fever with Renal Syndrome ; Humans ; Hypertension ; Hypopituitarism ; Kidney Failure, Chronic ; Myocarditis ; Pancreatitis ; Pericardial Effusion* ; Pericarditis* ; Pyelonephritis ; Renal Insufficiency ; Serologic Tests ; Tachycardia

Plasmodium vivax malaria, which used to be endemic in the past, re-emerged in 1993 and the number of cases has increased annually. Though there has been no proven endemic drug-resistant malaria case reported, widespread use of anti-malarial chemoprophylaxis for the military personnel could cause emergence of resistance. We herein report a case of tertian malaria, which recurred three times despite the standard chloroquine-primaquine therapy. The patient is 40-year-old male, lives in Dongducheon city, Gyeonggy province, and has never been abroad. He visited hospital in September 2000, because of fever. His blood smear revealed ring forms and trophozoites of P. vivax. He took hydroxychloroquine for 3 days and primaquine for 14 days. His symptoms disappeared then. After 7 months he got fever for 2 days and his blood smear revealed schizonts of P. vivax. He took the same medicines and got well next day. Fever recurred 4 month later, and trophozoites were observed on the blood smear. Hydroxychloroquine and primaquine were prescribed in the same way and fever disappeared. Forty three days later, he had fever and positive blood smear of P. vivax trophozoite. Fever disappeared on the day drug was administered and no malaria was detected in follow up smear of 7 and 14 days. He was free of fever in follow up at 3 months later.
Adult ; Chemoprevention ; Chloroquine ; Fever ; Follow-Up Studies ; Gyeonggi-do ; Humans ; Hydroxychloroquine ; Malaria* ; Malaria, Vivax ; Male ; Military Personnel ; Plasmodium vivax ; Primaquine ; Recurrence ; Schizonts ; Trophozoites

Scrub typhus, which is caused by Orientia tsutsugamushi, is systemic illness that causes generalized vasculitis. The central nervous system (CNS) is the most crucial target in scrub typhus as in other rickettsial disease. A 54-year-old woman, who was receiving doxycycline under the diagnosis of scrub typhus, developed rapidly progressive neurologic symptoms. During the treatment, abnormal mental function, abnormal lateral gaze, paralysis in upper extremities and dysphasia occurred in the patient. To investigate CNS involvement in the patients, CSF profile (cell count and levels of protein and glucose) and brain radiologic image (brain CT, brain MRI) were concurrently examined. And ampicillin and high-dose steroid were empirically added to her treatment with doxycycline. With use of high-dose steroid, the initial neurologic symptoms such as restlessness and irritability and other disorders like abnormal lateral gaze and paralysis in upper extremities were recovered. And also any other neurologic sequelae did not appear. We could observe the clinical improvements of abnormal neurologic symptoms and signs after use of high-dose steroid in the Orientia tsutsugamushi infected patients. A further intensive study about the steroid therapy in Orientia tsutusgamushi infected patients with focal neurologic symptoms is required.
Ampicillin ; Aphasia ; Brain ; Central Nervous System ; Diagnosis ; Doxycycline ; Female ; Humans ; Middle Aged ; Neurologic Manifestations* ; Orientia tsutsugamushi ; Paralysis ; Psychomotor Agitation ; Scrub Typhus* ; Upper Extremity ; Vasculitis

No abstract available.
Bacteremia* ; Staphylococcus aureus* ; Staphylococcus*

OBJECTIVE: Trichomonas vaginalis is the common cause of sexually transmitted diseases. The present study was performed to find the possibility of other transmission mode of T. vaginalis than sexual transmission. METHODS: Survivals of trophozoites suspended in various environmental conditions were measured by haemocytometer after trypan blue staining. Also, drying time of vaginal secretion exposed at different temperatures such as 4 degrees C, 26 degrees C, 30 degrees C were observed. RESULTS: The survival rates of T. vaginalis decreased as the temperatures of tap water increased. The survival rates of trophozoites were less than 10% at 30 min-exposure at 4d degrees C or 15 min-exposure at 26 degrees C water. Hot water above 45 degrees C killed trichomonads in 5 minutes or so. T. vaginalis soaked in water from swimming pool and in cleaning solution deceased in about 5 minutes. When trophozoites were put into urines of six healthy person, the survival rates of T. vaginalis showed less than 10% after 24 hr exposure except KT4. The survival rates of trichomonads were changed according to individual urine on examined day, and isolate of T. vaginalis. The vaginal secretion was put on slide glass and leave alone until complete drying in 4degrees C refrigerator, 26 degrees C and 30 degrees C incubator. For drying of vaginal secretion, it took 70 minutes, 44 minutes and 26 minutes in 4 degrees C refrigerator, 26 degrees C and 30 degrees C incubators, respectively. The survival of trichomonads showed no change until complete dryness of vaginal secretion. T. vaginalis immersed in tap water for 5 minutes, was divided into two or many fragments. Some trichomonads were partially or completely destructed. CONCLUSION: From above results, it is supposed that transmission of T. vaginalis by contaminated fomites such as toilet stool, toilet seats is possible although this type of transmission may not occur frequently.
Fomites ; Glass ; Humans ; Incubators ; Sexually Transmitted Diseases ; Survival Rate ; Swimming Pools ; Trichomonas vaginalis* ; Trichomonas* ; Trophozoites ; Trypan Blue ; Water

BACKGROUND: Staphylococcus aureus remains one of the most frequently encountered bacterial pathogens and is responsible for a variety of mild to life- threatening infections. There is a substantial body of evidence that individuals who are asymptomatic nasal carriers of S. aureus are at increased risk of developing serious staphylococcal infections. Approximately 20% to 30% of health care workers at any given time are also nasal carriers of S. aureus. A subset of these may spread the organism to patients by direct contact transmission. CHROMagar Staph aureus (CSA) is a new chromogenic medium for identification of S. aureus on the basis of colony pigmentation. METHODS: The abilities of CSA, thermostable nuclease (DNase), and mannitol salt agar (MSA) to identify S. aureus isolates (n=70) and discriminate between S. aureus and coagluase-negative staphylococci (CoNS; n=8) were compared. RESULTS: CSA proved to be more sensitive and specific than DNase and MSA, allowing a reliable, simple, and rapid method for the identification of S. aureus isolates. All CoNS encountered in this study could be easily differentiated from S. aureus on the medium. The supplementation with 4 microgram/mL of oxacillin allowed simple identification of methicillin resistance in hospital acquired S. aureus strains which show multiple drug resistance profiles. CONCLUSION: CSA proved to be simple and reliable method for the identification of nasal carriers of S. aureus of health care workers.
Agar ; Delivery of Health Care ; Deoxyribonucleases ; Drug Resistance, Multiple ; Humans ; Mannitol ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Micrococcal Nuclease ; Oxacillin ; Pigmentation ; Staphylococcal Infections ; Staphylococcus aureus

BACKGROUND: Carbapenem-resistant Acinetobacter spp. are being isolated with increasing frequency from clinical sources. This study was designed to determine the resistance mechanism to carbapenems of Acinetobacter spp. isolates from patients of a tertiary care hospital in Busan, Korea. METHODS: Nonduplicated clinical isolates of Acinetobacter spp. resistant to carbapenems were collected during the period of 2000-2001 in Kosin Medical Center, Busan, Korea. Antimicrobial susceptibilities were tested by disk diffusion method. Carbapenem-resistant Acinetobacter spp. isolates were examined for metallo-beta-lactamase-production by modified Hodge and EDTA-disk synergy tests. For the detection of blaIMP-1 and blaVIM-2 genes, polymerase chain reactions (PCR) were performed, and the DNA sequences of amplified products were determined by using dideoxy- chain termination method. RESULTS: Among 21 clinical isolates of Acinetobacter spp. intermediate or resistant to carbapenems, 17 isolates showed positive reactions in modified Hodge and EDTA-disk synergy tests. Nine isolates showed positive reaction in PCR for the detection of blaIMP-1 genes, and 8 isolates showed positive reaction in PCR for the detection of blaVIM-2 genes. Sequencing of amplified products showed that they were blaIMP-1 or blaVIM-2 genes. CONCLUSION: Acinetobacter spp. isolates with carbapenem-resistance are not uncommon in Kosin Medical Center, and most of the carbapenem-resistant isolates acquired resistance by production of IMP-1 or VIM-2 metallo-beta-lactamases. The spread of metallo-beta-lactamase genes could compromise the future usefulness of carbapenem for the treatment of gram-negative bacilli infections.
Acinetobacter* ; Base Sequence ; Busan ; Carbapenems ; Diffusion ; Genotype* ; Humans ; Korea ; Polymerase Chain Reaction ; Tertiary Healthcare

BACKGROUND: Acute pyelonephritis in women can be treated with trimethoprim-sulfamethoxazole (SXT), fluoroquinolone, aminoglycosides, second- and third- generation cephalosporins. The purpose of this study is to provide basic informations for the choice of the most effectve and economic first-line antibiotics among several agents to clinicians, who manage community- acquired acute pyelonephritis. METHODS: We investigated antibiotic sensitivities of 130 organisms isolated from urine culture of 165 patients, who admitted to Catholic University St. Vincent's Hospital due to community-acquired acute pyelonephritis from February 2001 to November 2002. All those patients had more than 105 cfu/mL on urine culture and we analyzed the usage of antibiotics and clinical course in those patients. RESULTS: Among 130 isolates, 120 isolates were E. coli, 6 K. pneumoniae, 1 K. oxytoca, 1 Enterobacter aerogenes and 2 Proteus mirabilis. Among 120 E. coli, the rates of resistance were 59.2% to piperacillin, 58.3% to cephalothin, 36.7% to sulfamethoxazole, 19.2 % to gentamicin, and 7.5% to ciprofloxacin in order. For 120 E. coli isolates, 100%, 99.2%, 99.2%, 99.2%, and 97.5% were susceptible to imipenem, cefotaxime, cefuroxime, amikacin, and piperacillin/tazobactam, respectively. Among 165 patients, 130 patients who had positive urine or blood culture, were divided into three groups according to the first-line antibiotics administered on the day of admission. Gentamicin (5 mg/kg q 24h) were infused to 90 patients, and 9 (10%) of 90 patients revealed clinical manifestations of therapeutic failure such as persistent fever and pyuria in group I. Cefuroxime were administered to 36 patients in group II and all 36 patients revealed evidences of clinical success such as defervescence and absence of pyuria. Intravenous antibiotics changed to oral administration of the first-, second-cephalosporin, and trimethoprim- sulfamethoxazole in all patients except one patient, who received oral fluoroquinolone according to the results of antibiotic sensitivities. CONCLUSION: Cefuroxime, amikacin, and the third- generation cephalosporins showed excellent antibacterial activity against isolated organisms from women with acute pyelonephritis in this study, and gentamicin could be used as initial empiric regimen with careful monitoring of clinical response and antibiotic sensitivities of isolated microorganisms. These findings would be useful informations to physicians, who are trying to use low-priced antibiotics with narrow spectrum antibacterial activity, sparing more expensive and broad spectrum antibiotics in managing urinary tract infections.
Administration, Oral ; Amikacin ; Aminoglycosides ; Anti-Bacterial Agents* ; Cefotaxime ; Cefuroxime ; Cephalosporins ; Cephalothin ; Ciprofloxacin ; Enterobacter aerogenes ; Female ; Fever ; Gentamicins ; Humans ; Imipenem ; Piperacillin ; Pneumonia ; Proteus mirabilis ; Pyelonephritis* ; Pyuria ; Sulfamethoxazole ; Trimethoprim, Sulfamethoxazole Drug Combination ; Urinary Tract Infections

BACKGROUND: The principal acute febrile diseases reported in autumn, Korea, have been hemorrhagic fever with renal syndrome (HFRS), scrub typhus, murine METHODS: To evaluate the seroepidemiologic patterns of acute febrile illness in Korea, sera were collected from 5330 patients from 1994 to 1995, and examined for antibodies against Hantaan virus, Orientia tsutsuga-mushi, Rickettsia typhi, and Borrelia burgdorf eri by indirect immunofluorescent antibody technique(IFA) and by macroscopic agglutination test for Leptosp ira intero-gans. RESULTS: Of 640 seropositive cases against O. tsutsu-gamushi, 60% were female; age group of the seventh decade occupied 30%; 89% were reported during October and November. By IFA test, the seropositive rate of murine typhus was 3.5% (187/5330) with high incidence rate (44%) in the period from October to December, and males in their forties and fifties were mostly affected. Cases seropositive for leptospirosis consisted 1% of 5330 acute febrile illness cases. Of 55 seropositive cases, 71% were male; 71% were in their sixties; 78% occurred during the period from August to October. Hantavirus seropositive rate was 12.2% (649/5330) with a high incidence rate (70%) in the period from October to January and males in the thirties were mostly infected. No seropositive case of Lyme disease was present. CONCLUSION: The above results indicate that hantavirus, O. tsutsugamushi, R. typhi, and L. interogans were the main causative agents of acute febrile diseases during autumn season in Korea.
Agglutination Tests ; Antibodies ; Borrelia ; Female ; Hantaan virus ; Hantavirus ; Hemorrhagic Fever with Renal Syndrome ; Humans ; Incidence ; Korea* ; Leptospirosis ; Lyme Disease ; Male ; Rickettsia typhi ; Scrub Typhus ; Seasons ; Typhus, Endemic Flea-Borne

BACKGROUND: Typhoid fever is diagnosed by culture or serological study. The confirmative diagnosis of typhoid fever is made by culture of the causative orga-nism usually from body fluids. Serological test is a supportive diagnostic tool, which is useful for early dia-gnosis. In Severance Hospital, Vi-indirect fluorescent antibody test(Vi-IFAT) using the Vi-antigen of Salmo-nella typhi has been used in the diagnosis of typhoid fever since 1989. We investigated the test results from the past 7 years, in order to clarify the sensitivity and specificity of Vi-IFAT. METHODS: A retrospective study was done on pa-tients whose chief complaint was fever and who were tested using Vi-IFAT in the Severance Hospital from 1989 to 1996. The positive value for Vi-IFAT was de- fined as 1:64 or higher. RESULTS: The sensitivity and specificity of Vi-IFAT for typhoid fever was 94.4% and 95.1%, respectively. The positive and negative predictive values were 85.7% and 98.2% respectively. Positive rates of Vi-IFAT after fever onset increased with time and 68% were positive before the first week. From the first to the second week, 89.5% were positive and after the second week, 100% were positive. CONCLUSION: Vi-IFAT is not only a valuable sero-logic test for the diagnosis of typhoid fever, but also useful in the early diagnosis of the disease.
Body Fluids ; Diagnosis* ; Early Diagnosis ; Fever ; Retrospective Studies ; Sensitivity and Specificity* ; Serologic Tests ; Typhoid Fever*