Salmonella are motile, gram-negative, non-spore-forming members of the family Enterobacteriaceae. Among nontyphoid Salmonella serotypes, Salmonella choleraesuis shows a high predilection to cause systemic infections in humans. Thoracic infection is a rare complication of Salmonella infection. So far, most of reported cases of empyema caused by Salmonella spp. have involved immunocompromised patients. Herein, as we had experienced one case of thoracic empyema due to Salmonella choleraesuis related thymoma, we report it with review of literature.
Empyema ; Empyema, Pleural* ; Enterobacteriaceae ; Humans ; Immunocompromised Host ; Salmonella Infections ; Salmonella* ; Thymoma

Salmonella enterica serovar Typhi infection is widely prevalent in developing countries; its treatment has been complicated by the emergence of resistance to antimicrobial agents. Fluoroquinolones are orally administered antimicrobials effective against typhoid fever, including that caused by the multidrug-resistant S. Typhi. They are relatively inexpensive and more convenient to administer com pared to third-generation cephalosporins; hence, they constitute the drugs of choice for the treatment of typhoid fever in developing countries. In Asian countries, however, resistance to nalidixic acid-a prototype of quinolone antibiotics-diminishes the value of fluoroquinolones with regard to the treatment of typhoid fever. We experienced a case of nalidixic acid-resistant S. Typhi infection imported from Pakistan that was clinically refractory to ciprofloxacin treatment. A 31-year-old male presented with a fever of 14 days' duration after returning from his native Pakistan. Oral ciprofloxacin was empirically administered for three days without any beneficial effect. His illness, however, improved after the administration of ceftriaxone for three days. Blood culture revealed the presence of S. Typhi that was resistant to nalidixic acid (minimal inhibitory concentration > or =32 microgram/mL) but susceptible to ciprofloxacin (minimal inhibitory concentration=1.0 microgram/mL) in vitro.
Adult ; Anti-Infective Agents ; Asian Continental Ancestry Group ; Ceftriaxone ; Cephalosporins ; Ciprofloxacin* ; Developing Countries ; Fever ; Fluoroquinolones ; Humans ; Male ; Nalidixic Acid ; Pakistan ; Salmonella typhi ; Typhoid Fever*

BACKGROUND: We wanted to evaluate the immunomodulatory effect of three antifungal agents, amphotericin B (AmB), micafungin (MF), itraconazole (ITZ), in the aspect of cytokine production and expression of nuclear factor-kappaB (NF-kappaB) in the Aspergillus fumigatus conidia treated-RAW264.7 cells, a murine alveolar macrophage cell line. MATERIALS AND METHODS: We evaluated cytotoxic effect of antifungal agents using commercial cell proliferation assay. Tumor necrosis factor (TNF)-alpha and interleukin (IL)-10 production according to stimulation (control, A. fumigatus conidia only, conidia + antifungal drug, conidia + antifungal drug + G(M)-CSF) was evaluated and compared each using commercial ELISA method. NF-kappaB activation was evaluated by western blot analysis. RESULTS: AmB, MF, ITZ showed dose-dependent cytotoxic effect on the tested cells. Stimulation of cells by A. fumigatus conidia induced TNF-alpha production. Pretreatment of AmB at concentration not affecting cellular survival did not change the production of TNF-alpha compared to conidia treated cells, but pretreament of MF or ITZ showed reduced amount of TNF-alpha production compared to conidia treated cells. AmB also showed synergistic effect on TNF-alpha production when simultaneously treated with GM-CSF. IL-10 production was markedly increased when the cells were treated with AmB with conidia. MF and ITZ induced less increase of IL-10 production than AmB. AmB also showed synergistic effect on the production of IL-10 when treated with GM-CSF simultaneously. A. fumigatus conidia enhanced expression of NF-kappaB. The degree of NF-kappaB expression was associated with the amount of TNF-alpha and IL-10 produced. CONCLUSION: The antifungal agents we used in this experiment showed that decreased TNF-alpha production and increased IL-10 production from the RAW264.7 cells stimulated by A. fumigatus conidia after pretreatment of antifungal agents. But more studies, such as the association between immunomodulatory effect, antifungal activity and difference of signal pathway of cellular activation according to drugs should be performed.
Amphotericin B ; Antifungal Agents* ; Aspergillus fumigatus* ; Aspergillus* ; Blotting, Western ; Cell Line ; Cell Proliferation ; Cytokines* ; Enzyme-Linked Immunosorbent Assay ; Granulocyte-Macrophage Colony-Stimulating Factor ; Immunomodulation ; Interleukin-10 ; Interleukins ; Itraconazole ; Macrophages* ; Macrophages, Alveolar ; NF-kappa B ; Signal Transduction ; Spores, Fungal* ; Tumor Necrosis Factor-alpha

BACKGROUND: Recent predictions of catastrophic epidemic surge of HIV infection in East Asia concern experts and governmental organizations. As in many other areas, countries in East Asia show diversities in their HIV epidemics, both geographically and temporally. However, they have similar regional, cultural and racial characteristics which allow them to have certain common factors. Having a clear picture of the current extent and feature of HIV/AIDS in this region is a very difficult task largely due to the fast pacing of expending epidemic and difficulty in data-sharing among countries in the region. Hence, we decided to study the epidemiologic feature of HIV/AIDS in East Asia through East Asia Network on HIV (EAN-HIV). MATERIALS AND METHODS: The epidemiological patterns of HIV/AIDS in East Asian countries were investigated by collecting data through EAN-HIV. RESULTS: The HIV/AIDS epidemic in East Asia started relatively late at mid 1980s. Since then, the number of newly infected HIV/AIDS cases has been steadily increasing with stiffer escalation in recent years. In China and Taiwan, IDU plays an important part in the swiftly growing HIV epidemics; however, in other regions like Korea, Japan, and Hong Kong, MSM (men who have sex with men) seems to be more of a problem. The major subtypes of HIV in East Asia are subtype B, C, and CRF01_AE, and rapidly evolving circulating recombinant forms (CRF) between subtypes such as CRF07_BC give dynamic change to the current status. CONCLUSION: The incidence of HIV/AIDS is rapidly increasing in East Asia. The epidemic pattern has undergone dynamic changes over time. China seems to be the leading source of HIV/AIDS epidemic in East Asia due to its large population and rapidly growing epidemics.
Asian Continental Ancestry Group ; China ; Epidemiology* ; Far East* ; HIV ; HIV Infections ; Hong Kong ; Humans ; Incidence ; Japan ; Korea ; Taiwan

BACKGROUND: CD14 is the receptor for lipopolysaccharides and heat shock protein (HSP), which has been suggested being associated with increased risk of coronary artery disease (CAD). We investigated whether the response to infectious agents or HSP is different according to CD14 polymorphism in Koreans. MATERIALS AND METHODS: Antibody titers to Helicobacter pylori, Chlamydia pneumoniae, and human HSP60 (hHSP60) were measured in 48 patients with stable CAD and in 41 healthy controls by ELISA. CD14 genotype was determined by PCR and high-sensitivity C-reactive protein (hs-CRP) was measured. RESULTS: Seropositivity to C. pneumoniae and H. pylori, and antibody titer to hHSP60 were not significantly associated with the presence of CAD. CD14 genotype distribution was 31 TT (35%), 43 CT (48%), and 15 CC (17%). To compare the response to the infectious organism and hHSP60, we divided study population into 3 groups; CAD patients with non-TT genotype (group I, n=30), CAD patients with TT genotype (group II, n=18), and normal controls (group III, n=41). Seropositivity to C. pneumoniae and H. pylori, and antibody titer to hHSP60 were not significantly different among 3 groups. Though hs-CRP level was significantly different among 3 groups, post-Hoc analysis showed that hs-CRP level was not significantly different between group I and group II (group I: 1.6[1.1-3.5] mg/L and group II: 0.35[0.1-2.0] mg/L). Conclusions:This study suggests that the inflammatory responses to infectious organisms and HSP do not differ according to the CD14 genotype in Koreans.
C-Reactive Protein ; Chlamydophila pneumoniae ; Coronary Artery Disease* ; Coronary Vessels* ; Enzyme-Linked Immunosorbent Assay ; Genotype ; Heat-Shock Proteins* ; Helicobacter pylori ; Hot Temperature* ; Humans ; Lipopolysaccharides ; Pneumonia ; Polymerase Chain Reaction

BACKGROUND: Acute pyelonephritis in women is one of the most common infections within the community; some patients also suffer from related bacteremia and renal abscess. The predominant pathogen in acute pyelonephritis is Escherichia coli and the changes in antimicrobial resistance over time is a very important factor in the choice of effective and economic antibiotics. MATERIALS AND METHODS: We investigated clinical features and antibiotic sensitivities of 577 organisms isolated from the urine cultures of 577 patients, admitted to Catholic University St Vincent's Hospital for community-acquired acute pyelonephritis from January 2001 to December 2006. We analyzed the patterns of antimicrobial resistance of urinary isolates and the clinical courses of the patients. RESULTS: Patients demographics revealed a mean age of 51, (age:16 to 91), with bacteremic patients representing 30.8% of patients and renal abscess patients representing 5.9% of the group. Sixteen (4.2%) of 382 in the pyelonephritis group and five (3.1%) of 161 in the bacteremia group revealed clinical manifestations of therapeutic failure such as persistent fever and pyuria. The mean time to defervescence was 44.6 h for the pyelonephritis group, 76.4 h for the bacteremia group and 91.2 h for the renal abscess group. Among the 577 isolates, 554 isolates were E. coli, 10 were K. pneumoniae, three were S. saprophyticus, three were Proteus mirabilis. two were K. oxytoca, and two were Enterobacter aerogenes. Among 554 E. coli, the rates of susceptibility to ampicillin was 38.3%; to sulfamethoxazole 62.1%; to gentamicin 81.3%; to ciprofloxacin 86.3%; to cefuroxime 97.3%; to amikacin 98.7%; to cefotaxime 99.5%. CONCLUSION: In hospitalized patients, initial intravenous treatment with an aminoglycoside or a second -generation cephalosporin, and then switch to oral first, second-cephalosporin, amoxicillin and sulfamethoxazole is recommended. In vitro resistance to fluoroquinolones appears to be increasing, and therefore close monitoring of antibiotic susceptibility patterns in isolates of urinary tract infections and the use of fluoroquinolone-sparing agents are required.
Abscess ; Amikacin ; Amoxicillin ; Ampicillin ; Anti-Bacterial Agents ; Bacteremia ; Cefotaxime ; Cefuroxime ; Ciprofloxacin ; Demography ; Enterobacter aerogenes ; Escherichia coli ; Female ; Fever ; Fluoroquinolones ; Gentamicins ; Humans ; Pneumonia ; Proteus mirabilis ; Pyelonephritis* ; Pyuria ; Sulfamethoxazole ; Urinary Tract Infections

BACKGROUND: Upper respiratory infections (URIs) are the most common infections in developed countries and are the major reasons for the consumption of medicines including antibiotics. In Korea, antibiotics and glucocorticoids were dispensed by pharmacies without prescriptions before July 2000, when the dispensation of antibiotics without doctor's prescriptions was prohibited. The objective of this study is to investigate the rate of antibiotic dispensation by pharmacies for the treatment of common cold and to identify the dispensing pattern for URI management in 2005, i.e., 5 years after the establishment of the prohibition policy. MATERIALS AND METHODS: In August 2005, medical students visited 90 drugstores in three cities (Seoul, Chonan, and Chunchun) and received medications for the treatment of illnesses that simulate the common cold, i.e., rhinorrhea and nasal stuffiness that had lasted for one day and were not accompanied by fever. The components of the dispensed medicines were identified by pharmacists at a university hospital. RESULTS: All the components of the dispensed medicines were identifiable in 85 cases (94.4%), and the mean number of medicines was 1.36 (S.D.+/-0.724); no difference was observed among the three cities. The antibiotics ampicillin and chloramphenicol were identified in two pharmacies in Seoul and Chunchun, respectively. Glucocorticoids were not dispensed in any case, and a nonsteroidal antiinflammatory drug was dispensed in only one case. Compound medicines are increasingly used as cold remedies; the components of the most frequently dispensed medicine were acetaminophen, chlorpheniramine, and pseudoephedrine. Herbal medicines were also frequently included in cold remedies (38.9%); licorice (30%) and ginger (26%) were the two most frequently used medicinal herbs. CONCLUSION: There was a marked decrease in the dispensation of antimicrobials, glucocorticoids, and nonsteroidal antiinflammatory drugs without doctor's prescriptions. Chloramphenicol continued to be dispensed as a URI medication. Increased use of compound and herbal medicines as cold remedies suggests a need for the evaluation of the additional benefits of herbal medicines, their adverse effects, and the drug interactions between herbal and conventional medicines.
Acetaminophen ; Ampicillin ; Anti-Bacterial Agents ; Chloramphenicol ; Chlorpheniramine ; Chungcheongnam-do ; Common Cold* ; Developed Countries ; Drug Interactions ; Fever ; Gangwon-do ; Ginger ; Glucocorticoids ; Glycyrrhiza ; Herbal Medicine ; Humans ; Korea ; Pharmacies* ; Pharmacists ; Plants, Medicinal ; Prescriptions ; Pseudoephedrine ; Respiratory Tract Infections ; Seoul ; Students, Medical

We have submitted and published the above paper in Infection and Chemotherapy this October 2006. After the publication, we noticed that identical case was already reported in other journal (The Korean Journal of Laboratory Medicine 2005;25(6):421-424). We hereby regret to have to retract the paper.
Drug Therapy* ; Humans ; Liver* ; Publications ; Scedosporium*

Plasmodium vivax is a typically seen infectious disease in Korea. The incidence of Plasmodium vivax malaria has been increasing in recent year despite of worldwide attempts at control. Fever, anemia, thrombocytopenia, and splenomegaly are the most common manifestations seen in Korean patient with P. vivax. Cardiac involvement is thought to be a very rare complication of malaria infection. Cardiac complication seems to be limited to acute infection with Plasmodium falcifarum. However we have experienced cardiac complication such as pericardial effusion, and complete AV block by Plasmodium vivax. Physicians should consider cardiac involvement in patient who present hypotension, fever and arrhythmia in malaria endemic area.
Anemia ; Arrhythmias, Cardiac* ; Atrioventricular Block ; Communicable Diseases ; Fever ; Humans ; Hypotension ; Incidence ; Korea ; Malaria ; Malaria, Vivax ; Pericardial Effusion* ; Plasmodium vivax* ; Plasmodium* ; Splenomegaly ; Thrombocytopenia

Leptospirosis is an acute febrile illness that is endemic in many tropical areas and considered the most common zoonosis worldwide. It is caused by the spirochete Leptospira interrogans. The clinical manifestations may be extremely variable, ranging from flu-like symptoms with mild constitutional complains like fever, headache, myalgias, and gastrointestinal complaints to a severe presentation with the complete Weil's syndrome and sometimes with acute respiratory distress syndrome (ARDS). In Korea, the more common clinical finding is pulmonary manifestation such as cough, hemoptysis and dyspnea. Respiratory failure is an uncommon complication of leptospirosis and is due to severe pulmonary hemorrhage and/or acute respiratory distress syndrome (ARDS). A 67-year-old farmer was referred to the hospital with a history of fever, dyspnea, and confusion. She was found to have severe arterial hypoxemia but, denied blood-tinged sputum. Radiography showed widespread infiltrations over both lung fields, and hemodynamic features were consistent with ARDS. The patient recovered completely without mechanical ventilation.
Aged ; Anoxia ; Cough ; Dyspnea ; Fever ; Headache ; Hemodynamics ; Hemoptysis* ; Hemorrhage ; Humans ; Korea ; Leptospira interrogans ; Leptospirosis* ; Lung ; Myalgia ; Radiography ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult* ; Respiratory Insufficiency ; Spirochaetales ; Sputum