Bacillus species are aerobic, gram-positive, spore forming rods that are widely distributed in soil, dust, stream, and other environmental sources and are regarded as natural organism. But certain species of the genus Bacillus, most notably B.cereus, which is associated with food-borne illness, occasionally have been implicated in the occurrence of fatal illness and complication in a compromised host. We roport a case of pneumonia and bacteremia caused by B.cereus in an 81 year-old man, who had no obvious immunologic compromise. The condition was treated with combination of roxithromycin and gentamicin.
Bacillus cereus* ; Bacillus* ; Bacteremia ; Dust ; Gentamicins ; Pneumonia* ; Rivers ; Roxithromycin ; Soil ; Spores

Pseudomembranous colitis, although uncommon, is an important complication of antibiotics that is related to a variety of deleterious effects on the gastrointestinal tract. Rifampicin is one of the 1st line agents in the treatment of tuberculosis and a large number of patients are exposed to its potential adverse effects. We report upon a patient that had diarrhea due to pseudomembranous colitis after receiving antitubeculous medication, and which was probably caused by rifampicin. A 77-year-old man was admitted with diarrhea of three weeks duration. One month previously, he suffered from left pleuritic chest pain and left pleural effusion was noticed at chest X-ray. One week prior to the onset of diarrhea, he was started on empirically isoniazid, rifampicin, ethambutol and pyrazynamide as antituberculous medication. On admission, he complained of diarrhea, left pleuritic chest pain, dyspnea and sputum. On physical examination, breathing sound was decreased in the left lower lung field and bowel sound increased. Pleural biopsy revealed chronic granulomatous infalmmation, which was compatible with tuberculosis. Sigmoidoscopy showed whitish to yellowish pseudomembrane with intervening normal mucosa, and his stool was positive for C.difficle toxin. He was diagnosed as pseudomembranous colitis and treated with oral metronidazole and vancomycin. The diarrhea did not recur after reinstitution of the anti-tuberculous medication without rifampicin. In patients with severe diarrhea receining anti-tuberculous medication, rifampicin induced pseudomembranous colitis should be excluded.
Aged ; Anti-Bacterial Agents ; Biopsy ; Chest Pain ; Clostridium difficile ; Diarrhea ; Dyspnea ; Enterocolitis, Pseudomembranous* ; Ethambutol ; Gastrointestinal Tract ; Humans ; Isoniazid ; Lung ; Metronidazole ; Mucous Membrane ; Physical Examination ; Pleural Effusion ; Respiratory Sounds ; Rifampin* ; Sigmoidoscopy ; Sputum ; Thorax ; Tuberculosis ; Vancomycin

BACKGROUND: Hemoptysis is a common clinical symptom responsible for 11% of admission to the hospital chest service. In KOREA pulmonary tuberculosis is still the most common cause of hemoptysis and the incidence of hemoptysis due to neoplasia has increased. Bronchoscopy and high resonance CT are essential for diagnosis of the cause of hemoptysis. We studied the causes, diagnostic tools and treatment treatment of hemoptysis. METHODS: We conducted a retrospective analysis of clinical profiles, radiologic and bronchoscopy findings and treatments of hemoptysis for 220 patients who were admitted to our hospital with hemoptysis between 1994 and 1998. RESULTS: The mean age at diagnosis was 49.3 years and male to female ratio was 2.1:1. The main causes were active pulmonay pulmonary tuberculosis in 72 cases(32.7%), inactive pulmonary tuberculosis with sequlae in 69 cases(31.4%) lung cancer in 43 cases(19.5%), bronchiectasis in 10 cases(4.5%), and chronicbronchitis in 10 cases(4.5%). The mean amount of hemoptysis for 24hrs was 120cc. The mean duration of bleeding was 25 days. The number of cases with a past history of pulmonary tuberculosis were 128 cases, in which 24 were relapsed tuberculosis cases, 25 chronic tuberculosis cases, 69 inactive tuberculosis cases, and 10 lung cancer cases. High resonance CT was the most useful method for structural etiologic evaluation of hemoptysis developed in patients with inactive tuberculosis, bronchiectasis and aspergilloma. sputum study and bronchofiberscopy were the confirmative diagnostic tools for active pulmonary tuberculosis and lung cancer. The treatments of hemoptysis medical in 152 cases(71.7%), bronchial artery embolization in 39 cases(17.8%), and operation in 9 cases(4.0%). The mean following up duration was 22.4 months. The overall outcomes of hemoptysis were controlled in 77 cases (43.5%), rebleeding in 100 cases (56.5%) and expired in 9 cases (4.0%). The outcomes of hemoptysis in pulmonary tuberculosis were controlled in 21.6%, rebleeding in 78.4%, and expire in 14.7%. CONCLUSION: The most common cause of hemoptysis was related with pulmonary tuberculosis. HRCT was an important diagnostic tool in AFB smear negative active pulmonary tuberculosis and inactive tuberculosis with sequelae. Early, proper management of pulmonary tuberculosis is important for prevention of hemoptysis in Korea.
Bronchial Arteries ; Bronchiectasis ; Bronchoscopy ; Diagnosis ; Female ; Hemoptysis* ; Hemorrhage ; Humans ; Incidence ; Korea ; Lung Diseases* ; Lung Neoplasms ; Lung* ; Male ; Retrospective Studies ; Sputum ; Thorax ; Tuberculosis ; Tuberculosis, Pulmonary

BACKGROUND: Many studies have shown that pulmonary function differs widely among race, age and geographical residency. By virtue of the improvement of nutrition and environment, the elderly population in Korea is markedly increasing and so are the ages of patients complaining respiratory symptoms. However, we do not have our own data on the pulmonary functional reserve of elderly persons in Korea. We evaluate the deterioration of pulmonary functional reserve and standardize the predictive values of pulmonary function in the elderly population. METHOD: Pulmonary function tests were conducted in 100 men and 100 women over the age of 65. We analyzed changes of FVC and FEV1 according to age and height by linear regression. We compared our new multiple linear regression equation with other equations currently used in Korea. RESULTS: In men, the mean age was 71.5±5.2(mean±SD) years and the mean height was 163.6±6.2cm. The mean FVC was 3.42±0.49ℓ and the mean FEV1, 2.72±0.40ℓ. In women, the mean age was 72.0±5.1 years and the mean height was 149.1±5.9cm. The mean FVC was 2.22±0.42ℓ and the mean FEV1, 1.83±0.34ℓ. Multiple linear regression equation using age and height as an independent factors was as follows : FVC(ℓ)=1.857-0.0356×age(year)+0.02157×height(cm) (p<0.01, R2=0.279), FEV1(ℓ)=1.340-0.02698×age(year)+0.02021×height(cm) (p<0.01, R20.255) in men, FVC(ℓ)=-0.09765-0.03332×age(year)+0.03164×height(cm) (p<0.01, R2=0.435), FEV1(ℓ)=-0.169-0.02469×age(year)+0.02539×height(cm) (p<0.01, R2=0.41) in women. CONCLUSION: We established prediction regressions for pulmonary functional tests in the elderly Korean population. We also confirmed that currently adopted equations do not exactly anticipate the expected pulmonary functional reserve in the aged person over 65 years old. We suggest that our new equations from this study should be applied to interpret the pulmonary function tests in the elderly population in Korea.
Aged* ; Aging* ; Continental Population Groups ; Female ; Humans ; Internship and Residency ; Korea ; Linear Models ; Male ; Respiratory Function Tests* ; Virtues

BACKGROUND: Moxifloxacin is a newly developed drug which is more potent and safe compared to previous fluoroquinolones. This drug effectively eradicates organisms such as beta-lactamase-producing or other resistant bacteria. Moxifloxacin is known to be effective in treating respiratory infections such as Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Chlamydia pneumoniae, Legionella spp. and Mycoplasma pneumoniae. METHODS: In a multicenter, randomized, open, comparative study, the efficacy and safety of oral moxifloxacin taken 400 mg once a day and clarithromycin taken 500 mg twice daily for 7 days were compared for the treatment of Korean patients with acute exacerbations of chronic bronchitis. RESULTS: A total of 170 patients were enrolled, and they were divided into two groups:87 in the moxifloxacin group and 83 in the clarithromycin group. Of those enrolled, 76 (35 for bacteriologic efficacy) in the moxifloxacin group and 77 (31 for bacteriologic efficacy) in the clarithromycin group were included in the efficacy analysis. All were included in the safety analysis. Clinical success was noted in 70 (92.1%) of 76 moxifloxacin-treated patients and 71 (92.2%) of 77 clarithromycin-treated patients. Bacteriologic success rate seemed to be higher in moxifloxacin group (73.5%) than in clarithromycin group (54.8%), but statistically insignificant (p=0.098). Drug susceptibility among organisms initially isolated was higher in moxifloxacin group on Streptococcus pneumoniae, Pseudomonas aeruginosa, Klebsiella pneumoniae(p<0.001). Adverse events were reported by 12.8% of 86 patients receiving moxifloxacin and 21.7% of 83 patients receiveing clarithromycin. Headache (4.7% vs 4.8%, moxiflosacin group vs clarithromycin group, respectively) and indigestion (2.3% vs 6.0%, moxifloxacin group vs clarithromycin group, respectively) were the most frequent side effects in the two groups. CONCLUSION: This study demonstrated that for the treatment of acute exacerbations of chronic bronchitis a 7-days course of moxifloxacin 400 mg od was clinically equivalent and microbiologically superior to clarithromycin 500 mg bid.
Bacteria ; Bronchitis, Chronic* ; Chlamydophila pneumoniae ; Clarithromycin* ; Dyspepsia ; Fluoroquinolones ; Haemophilus influenzae ; Headache ; Humans ; Klebsiella ; Legionella ; Moraxella (Branhamella) catarrhalis ; Mycoplasma pneumoniae ; Pneumonia, Mycoplasma ; Pseudomonas aeruginosa ; Respiratory Tract Infections ; Streptococcus pneumoniae

BACKGROUND: Pleural eosinophilia is rare and commonly considered to be an indicator of good prognosis. The diagnostic significance of eosinophilic pleural effusions remains controversial despite a century of observation and discussion. This study was conducted to assess the prevalence of eosinophilia in 446 consecutive samples of pleural fluid, to review the cause of eosinophilic pleural effusion and to determine whether the presence of eosinophils increases the likehood of benign conditions. METHOD: A retrospective analysis was performed upon patients that underwent first thoracentesis due to pleural effusion between January 1999 and December 1999. RESULTS: Eosinophilic pleural effusions were identified in 24 of the 446 patients (5.4%). Malignancy, parapneumonic effusion and tuberculosis were determined the major causes of pleural effusion (80.6%). Malignancy was diagnosed as frequently in eosinophilic effusions as in non-eosinophilic effusions (54.2% vs 50.5%, p=0.725). No difference was found in the prevalence of eosinophilic and non-eosinophilic effusion according to the etiology. The mean blood eosinophil ratio in patients with eosinophilic pleural effusion was 5.4% and no significant correlation existed between the blood and pleural eosinophilic count. CONCLUSION: Pleural eosinophilia is not helpful for differentiating benign and malignant etiology and is not related with blood eosinophilia or repeated tapping.
Eosinophilia ; Eosinophils* ; Humans ; Pleural Effusion* ; Prevalence ; Prognosis ; Retrospective Studies ; Tuberculosis

Exogenous lipoid pneumonia (ELP) is an uncommon condition resulting from aspiration or inhalation of vegetable, animal or mineral oil. It results in foreign body type inflammatory reaction of the lung and can show various clinical presentations from asymptomatic incidental finding to severe pneumonia leading to acute respiratory failure. Although many cases have been reported, severe ELP requiring steroid or whole lung lavage for treatment is rare. We report a case of 51-year old man with esophageal cancer who developed severe ELP following ingestion of large dose shark oil (Squalene) and successfully treated with prednisolone.
Animals ; Bronchoalveolar Lavage ; Eating* ; Esophageal Neoplasms ; Foreign Bodies ; Humans ; Incidental Findings ; Inhalation ; Lung ; Middle Aged ; Mineral Oil ; Pneumonia* ; Prednisolone ; Respiratory Insufficiency ; Sharks ; Squalene* ; Vegetables

BACKGROUND: Acinetobacter baumannii is an important pathogen associated with nosocomial infections in intensive care units, and is responsible for nosocomial pneumonia, UTI, bacteremia, etc. The main concern is that this pathogen is often resistant to many antimicrobial agents, particularly to carbapenem. This study compared the clinical those of ICU admitted patients with the carbapenem resistant A. baumannii isolated from the sputum with characteristics of patients with carbapenem sensitive A. baumannii. METHODS: A total of 49 patients with A. baumannii from a sputum culture who were admitted to the ICU from January to December 2003 were enrolled in this study. This study evaluated the demographic variables, mortality, APACHE II score, comorbidity, antibiotics used, hospital and ICU stay, Clinical Pulmonary Infection Score, and mechanical ventilation. A retrospective analysis was made by a review of the patients' medical records. RESULTS: Carbapenem sensitive and resistant A. baumannii was isolated from 23 patients and 26 patients respectively. Univariate analysis revealed renal disease, the use of carbapenem and aminoglycoside to be statistically significant factors for carbapenem resistance. Multivariate analysis revealed carbapenem use(p=0.024; OR, 8.17; CI 1.32 to 50.68) to be positively associated with carbapenem resistance, and aminoglycoside use(p=0.026; OR, 0.18; CI, 0.04 to 0.82) to be negatively associated with carbapenem resistance. There was no significant difference in mortality between the carbapenem sensitive and resistant group(30 vs 42%. P=0.39). CONCLUSION: The occurrence of carbapenem resistant A. baumannii is positively associated with carbapenem use and negatively associated with aminoglycoside use. Carbapenem resistance in the sputum culture did not affect the mortality rate.
Acinetobacter baumannii* ; Acinetobacter* ; Anti-Bacterial Agents ; Anti-Infective Agents ; APACHE ; Bacteremia ; Comorbidity ; Cross Infection ; Drug Resistance ; Drug Resistance, Bacterial ; Humans ; Intensive Care Units* ; Critical Care* ; Medical Records ; Mortality ; Multivariate Analysis ; Pneumonia ; Respiration, Artificial ; Retrospective Studies ; Sputum*

BACKGROUND: Cough may be a consequence of bronchial hyperresponsiveness or inflammation. Empirical treatment is important in this context because it difficult to verify the obvious cause of cough using laboratory tests, Corticosteroid has a nonspecific anti-inflammatory effect, and can be used for cough management. However, its response rate has not yet been fully elucidated. This study investigated the short-term effects of inhaled corticosteroid on chronic cough METHODS: Patients with chronic cough with a normal chest radiograph and a pulmonary function test were enrolled. Cases with a prior respiratory infection within 8 weeks, a history of bronchial asthma, objective wheezing on examination, subjective symptoms of gastroesophageal reflux or taking an ACE inhibitor were excluded. On the first visit, a methacholine bronchial provocation test, spontaneous sputum eosinophil count performed twice and a paranasal sinus radiograph were checked, and the patients were treated with budesonide turbuhaler 800 microgram/day for ten days. The primary outcome measure was a decrease in the cough score after treatment. RESULTS: Sixty nine chronic coughers were finally analyzed. The final diagnoses by the routine tests were as follows: bronchial asthma 13.0%, eosinophilic bronchitis 18.8%, paranasal sinusitis 23.2% and non-diagnostic cases 53.6%. The following responses to the inhaled corticosteroid were observed: definite responders, 76.8%, possible responders, 2.9% and non-responders, 20.3%. The response rate was not affected by the final diagnosis even in the non-diagnostic cases. There were minimal adverse drug related effects during the empirical treatment. CONCLUSION: Routine objective tests such as methacholine provocation, sputum eosinophil count and simple radiographs were notare not suitable for diagnosing chronic cough Therefore, empirical treatment is important. Short term inhaled corticosteroid is effective and can guide a further treatment plan for chronic cough.
Asthma ; Bronchial Provocation Tests ; Bronchitis ; Budesonide ; Cough* ; Diagnosis ; Eosinophils ; Gastroesophageal Reflux ; Humans ; Inflammation ; Methacholine Chloride ; Outcome Assessment (Health Care) ; Radiography, Thoracic ; Respiratory Function Tests ; Respiratory Sounds ; Sinusitis ; Sputum

BACKGROUND: A spirometric reference equation was recently developed for the general population in Korea. The applicability of the new Korean equation to clinical practice was examined by comparing it with the Morris equation, which is one of the most popular reference equations used for interpreting the spirometric patterns and for grading the disease severity in Korea. METHODS: Spirometry was performed on 926 men and 694 women, aged 20 years or older, in November 2004 at the Asan Medical Center, Seoul, Korea. The subjects' age, gender, height, weight, and spirometric values (FEV1 [forced expiratory volume in one second], FVC [forced vital capacity], and FEV1/FVC) were obtained. The spirometric patterns and disease severity were evaluated using both equations, and the results of the Korean equation were compared with the Morris equation. The spirometric patterns were defined as normal, restrictive, obstructive, and undetermined according to the level of FEV1/FVC and FVC. The disease severity was defined according to the level of FEV1 level for subjects with an airflow limitation, and according to the FVC level for those subjects without an airflow limitation. RESULTS: Spirometric patterns were differently interpreted in 22.5% (208/926) of the men and 24.8% (172/694) of the women after the application of the Korean equation compared with the Morris equation. Of the subjects with airflow limitation, disease severity was differently graded in 30.2% (114/378) of the men and 39.4% (37/94) of the women after the application of the Korean equation. Of the subjects without airflow limitation, disease severity was differently graded in 27.9% (153/548) of the men and 30.2% (181/600) of the women after the application of the Korean equation. CONCLUSION: Achange in the reference equation for spirometry could have an effect on the interpretation of spirometric patterns and on the grading of disease severity.
Chungcheongnam-do ; Female ; Humans ; Korea ; Male ; Seoul ; Spirometry