Necrotizing fasciitis is a rapidly progressing soft-tissue infection that affects the subcutaneous fascia and dermis, and characteristically spares the underlying muscle. Most cases represent a synergistic or mixed bacterial infection of aerobes and anaerobes. A variety of etiologies have been reported. Herein, two cases of necrotizing fasciitis of the right thigh secondary to perforated appendicitis, an extremely rare complication, are reported. Both cases recovered following aggressive surgical and medical therapies. The delay in diagnosis and radical surgical excision are frequent and significant contributory factors in the high reported mortality rate. A high index of suspicion, followed by prompt surgical intervention with broad-spectrum antibiotic therapy, seems to be the most important prognostic factor in these difficult cases.
Appendicitis* ; Bacterial Infections ; Dermis ; Diagnosis ; Fascia ; Fasciitis, Necrotizing* ; Mortality ; Thigh

Advances in the antimicrobials lower the mortality rate in most infectious diseases. But bacterial infections of the CNS is still one of the life-threatening infections. Untreated acute bacterial meningitis is fatal in 70% to 100% of patients. With appropriate antibacterial therapy, the case-fatality rate had been greatly reduced with death occurring principally in the very young the very old, or those with potentially lethal underlying diseases. Early recognition and antimicrobial therapy is mostly desirable. The causes of acute bacterial meningitis vary with age and the clinical setting under which the infection occurs. Empirical antibiotic treatment was started immediately on suspicion of the bacterial meningitis prior to etiologic diagnosis. The most effective and least toxic bactericidal drugs should be selected on the basis of known or predicted susceptibility of the bacterial cause of the disease. After the identification of the specific organism and determination of susceptibilities, effective antimicrobial was administered parenterally at maximum dose. The third-generation cephalosporins(cefotaxime, ceftriaxone, and ceftzidime) offer new advantages in the treatment of meningitis because they are active at the CSF concentraions obtainable. Newer antimicrobials(monobactam and newer quinolones) with improved access and an appropriately focused spectrum for CNS infections will become available.
Bacterial Infections* ; Ceftriaxone ; Central Nervous System* ; Communicable Diseases ; Diagnosis ; Humans ; Meningitis ; Meningitis, Bacterial ; Mortality

Phlegmonous gastritis is a rare disorder caused by suppurative bacterial infection of the gastric wall. The mortality rate remains extremely high and the gastrectomy has been thought to be an effective form of treatment. We report a case of acute phlegmonous gastritis developed in a patient with advanced alcoholic liver cirrhosis, and recovered with early endoscopic diagnosis and antibiotics alone.
Anti-Bacterial Agents* ; Bacterial Infections ; Cellulitis* ; Diagnosis ; Gastrectomy ; Gastritis* ; Humans ; Liver Cirrhosis, Alcoholic ; Mortality

The hemophagocytic syndrome is a disorder caused by systemic proliferation of benign histiocytes with avid phagocytosis of blood cells. Although this is an established disease entity, early clinical diagnosis is often difficult. The disease is known to be rare. The clinical and laboratory characteristics of 33 patients with the infection-associated hemophagocytic syndrome were reviewed which included previously reported 31 cases from the literature, and 2 recent cases presented in this study. The patients were 22 males and 11 females with a mean age of 20.8 years(range 1 to 69 years). Ten patients were associated with viral infection and seven with bacterial infection. The infection usually occurs in patients with preexisting immunological abnormalities, but in this study underlying illness was found in only 8 out of the 33 cases. The overall mortality rate was 63.6%, which is a higher percentage than in other countries. Since the clinical course can be fulminant, accurate diagnosis and effective treatment are needed.
Bacterial Infections ; Blood Cells ; Diagnosis ; Female ; Histiocytes ; Humans ; Lymphohistiocytosis, Hemophagocytic* ; Male ; Mortality ; Phagocytosis

BACKGROUND: Bacterial infections in diabetic patients are an important cause of increased morbidity and mortality. It has been reported that bacterial infections in diabetics showed more impaired PMN functions such as reduced PMN respiratory burst and decreased microbicidal activity in inflammed tissues. Also, apoptosis(programmed cell death) is postulated to be a key mechanism for neutrophil elimination. It is very important that PMN apoptosis keeps the balance from an area of inflammation. Actuallly, as little was known about PMN apoptosis and respiratory burst in diabetes, we investigated PMN apoptosis and hydrogen peroxide production after endotoxin exposure. METHODS: Peripheral venous blood samples were collected by routine venipuncture from healthy volunteers and diabetics to harvest neutrophils. We respectively measured the PMN apoptosis, the production of hydrogen peroxide, and the cell viability. RESULTS: Normal neutrophils showed a tendency to decreased apoptosis after endotoxin treatment. In patients with diabetes, PMN apoptosis was significantly decreased compared with healthy controls. In addition, the LPS-induced neutrophils in diabetics demonstrated more decreased apoptosis. However, the production of hydrogen peroxide was not different between groups. CONCLUSION: These observations suggest that the decreased PMN apoptosis in diabetics with endotoxin exposure may also affect the increased susceptibility and severity of infections.
Apoptosis* ; Bacterial Infections ; Cell Survival ; Healthy Volunteers ; Humans ; Hydrogen Peroxide ; Inflammation ; Mortality ; Neutrophils* ; Phlebotomy ; Respiratory Burst

Nephrotic syndrome is a common chronic disease in childhood. Patients with nephrotic syndrome are at an increased risk of bacterial infections due to immunological changes secondary to proteinuria. Primary bacterial peritonitis is one of the most serious and common infectious complications. The rate of peritonitis is 2-6% and overwhelming infection still carries a mortality rate of 1.5%. We experienced a rare case of nephrotic syndrome complicated with severe peritonitis and peritoneal empyema in a 10-year old girl after 2 months of medical neglect by parents. Here we emphasize the importance of early detection and treatment of peritoneal infection in nephrotic syndrome.
Bacterial Infections ; Child ; Chronic Disease ; Empyema* ; Female ; Humans ; Mortality ; Nephrotic Syndrome* ; Parents ; Peritonitis ; Proteinuria

Urinary tract infections constitute a large clinical problems that particularly affect catheter indwelling patients, causing morbidity and mortality. To investigate 1) the rate of infection by duration of catheter indwelling in patients of several kinds of disease, 2) the kinds of colonized bacteria and the similarity or difference of the bacterial species cultured in the urine and catheter of same patient, and 3) the comparison of sensitivity to antibiotics of cultured bacteria of both material, bacterial culture and antibiotic sensitivity test were done from urine and proximal tip of catheters in 31 catheter indwelling patients who had been administered, sometimes intermittently, various antibiotics. The rate of bacterial infection increased markedly with the lengthening of catheter indwelling period in urine and catheter cultures, 22.2% and 33.3% at 1 week, both 50% at 2-3 weeks, 78.6% and 85.7% at 4 weeks respectively The results of bacterial culture from both material were same in 27 (87.1%) patients. The gram negative bacteria composed of 41 (89.1%) species in cultured bacteria. The three frequent species were 16 (34.8%) Escherichia coli, 9 (19.6%) Klebsiella pneumonia, and 6 (13.0%) Morganella morgagni. The overall sensitivity of urine cultured bacteria to tested antibiotics showed minor difference from that of catheter, susceptible in 70.4%, and 73.8%, resistant in 28. 6%, and 24.6%, respectively. Almost all of the patients indwelling catheter longer than 4 weeks had bacterial infection or colonization in urine and proximal catheter-tip in spite of preventive administration of antibiotics. The urine culture only may be enough instead of culturing both the urine and proximal catheter-tip in long-term catheterized patients. Routine antibacterial drug administration should be taken into consideration not to be overused in long-term catheter indwelling patients.
Anti-Bacterial Agents ; Bacteria ; Bacterial Infections ; Catheters* ; Catheters, Indwelling ; Colon ; Escherichia coli ; Gram-Negative Bacteria ; Humans ; Klebsiella ; Morganella ; Mortality ; Pneumonia ; Urinary Tract Infections

Infections due to antibiotic-resistant bacteria, especially gram-negative bacteria, are a common cause of child mortality in Papua New Guinea. Antibiotic-resistant bacteria include the enteric gram-negative bacilli, especially Escherichia coli, Klebsiella and Enterobacter, and Haemophilus influenzae type b, a major respiratory tract pathogen and cause of meningitis. Among these bacteria there is now high-level resistance to standard antibiotics, including chloramphenicol, amoxycillin and cotrimoxazole. Reasons behind the increase in antibiotic-resistant bacterial infections are the widespread unregulated use of antibiotics and the very large burden of bacterial infections. Risk factors for development of resistant enteric gram-negative infections include village births, prolonged hospital stay, kwashiorkor in adopted children and previous treatment with broad-spectrum antibiotics. Cost-effective strategies to combat these pathogens will need to be broad and must focus on reducing the use of antibiotics for trivial illnesses, reducing the need to use antibiotics and reducing the risk factors for resistant bacterial sepsis. There must be stricter regulation of commercial pharmacies, education of health workers on how to avoid inappropriate antibiotic prescribing, a focus on the prevention of pneumonia by immunization with new vaccines, improvements in the quality and uptake of formal maternal care services and public health measures within villages. In addition there is a need for better surveillance for antibiotic-resistant bacteria within hospitals; this will require substantial improvements in laboratory facilities and carefully planned research collaboration. A national committee should be established to advise on these matters and coordinate interventions.
Bacterial Infections - mortality ; Bacterial Infections - prevention & ; control ; Community Health Workers ; Cross Infection - epidemiology ; Drug Resistance, Microbial ; Health Education ; Infant, Newborn ; Papua New Guinea - epidemiology

PURPOSE: Streptococcus pyogenes is an important cause of invasive diseases in children. We aimed to describe the clinical characteristics of invasive infections due to S. pyogenes in children in Korea. METHODS: A retrospective study of children under 18 years of age with invasive infections due to S. pyogenes at Seoul National University Children's Hospital between March 1992 and December 2012, and Seoul National University Bundang Hospital between March 2003 and December 2012 was conducted. Demographic factors, clinical characteristics, laboratory findings, treatment, mortality and morbidity of all patients were reviewed. RESULTS: A total of 30 among 36 cases identified as invasive disease due to S. pyogenes were available for review. There was a predominance for male subjects (male:female=2.75:1). The median age was 50 months (range 12 days to 15 years) and 53.3% were under 5 years of age. Skin and soft tissue infections (9/30, 30.0%), bacteremia without identified focus (4/30, 13.3%) and bone and joint infections (6/30, 20.0%) were the most frequent clinical presentations. Streptococcal toxic shock syndrome (3/30, 10.0%) pulmonary, abdomen and central nervous system infections (2/30, 6.7%) were also seen. There was a peak in number of patients in year 2012 (9/30, 30.0%). There were no cases of mortality. Erythromycin and clindamycin resistance rates were low by 3.8% and 7.5%, respectively. CONCLUSION: We studied the clinical presentations of invasive infections due to S. pyogenes during the past 20 years in Korean children. The findings of this study help us understand the characteristics of the disease, enhancing early recognition and prompting adequate antibiotic therapy which is important in reducing morbidity and mortality.
Abdomen ; Bacteremia ; Bacterial Infections ; Central Nervous System Infections ; Child* ; Clindamycin ; Demography ; Erythromycin ; Humans ; Joints ; Korea ; Male ; Mortality ; Retrospective Studies ; Seoul ; Shock, Septic ; Skin ; Soft Tissue Infections ; Streptococcus pyogenes*

The aim of this paper was to provide an overview of mortality and disease prevalence related to occupational diseases among agricultural workers in Korea. We evaluated the age-standardized mortality rates and the prevalence of chronic diseases and compared them with those of other populations using death registration data from 2004 through 2008 and the 2005 Korean National Health and Nutrition Examination Survey. In addition, we conducted a literature review on published articles examining the health status of farmers in Korea. Agricultural workers have a significantly higher mortality of cancer, tuberculosis, chronic respiratory diseases, liver diseases, suicide, motor and non-motor vehicle accidents. Compared to other populations, farmers have higher prevalence rates of arthritis and intervertebral disc disorders. The literature review revealed a number of work-related diseases among farmers, such as musculoskeletal diseases, pesticide poisoning, infections, and respiratory and neurologic diseases. Korean farmers demonstrate a distinct pattern of mortality and disease prevalence compared to other populations. Although lifestyle factors remain important contributors to those deaths and diseases, our study suggests that occupation is a major determinant as well. Intensive programs such as surveillance systems, therefore, should be developed in order to identify and prevent work-related diseases among agricultural workers in Korea.
Agricultural Workers' Diseases/*epidemiology/mortality ; Bacterial Infections/epidemiology/mortality ; Humans ; Life Style ; Musculoskeletal Diseases/epidemiology/mortality ; Mycoses/epidemiology/mortality ; Neoplasms/epidemiology/mortality ; Prevalence ; Republic of Korea/epidemiology ; Risk Factors ; Virus Diseases/epidemiology/mortality