Arcanobacterium haemolyticum is a cause of chronic skin ulcers in diabetic patients and respiratory infection, especially pharyngitis in healthy person. Less frequently, it is a cause of osteomyelitis, meningitis, pneumonia, abscess, endocarditis and sepsis. We isolated A. haemolyticum from 5 patients including foot or back ulceration in 3 diabetic patients, wound on calcaneus in a chronic osteomyelitis patient and peritonsillar abscess in a pharyngitis patient. A. haemolyticum is usually isolated with other microorganisms and coryneform bacilli which are often considered to be nonpathogenic normal flora or contaminants in wound infections. The correct diagnosis of this microorganism is important for proper treatment and prevention of serious infections.
Abscess ; Arcanobacterium* ; Calcaneus ; Diagnosis ; Endocarditis ; Foot ; Humans ; Meningitis ; Osteomyelitis ; Peritonsillar Abscess* ; Pharyngitis ; Pneumonia ; Sepsis ; Skin Ulcer* ; Ulcer ; Wound Infection ; Wounds and Injuries

Sweet's syndrome is a rare disorder presenting with painful erythematous plaques or nodules of the skin with fever, leukocytosis, arthralgia and conjunctivitis.Sweet's syndrome occurs in association with malignant tumors in 10~20% of cases. Eighty five percent of the malignant tumors are hematologic malignancies, acute myelogenous leukemia being most common. Sweet's syndrome occurring in a patient with solid tumor is rare and pulmonary involvement of Sweet's syndrome occurring in a patient with a solid tumor has not been reported in world literature so far. We report a case of Sweet's syndrome presenting with pulmonary nodules in a patient with hepatocellular carcinoma.
Arthralgia ; Carcinoma, Hepatocellular ; Fever ; Hematologic Neoplasms ; Humans ; Leukemia, Myeloid, Acute ; Leukocytosis ; Skin ; Sweet Syndrome*

BACKGROUND AND OBJECTIVES: Some patients with Kawasaki disease (KD) develop large coronary aneurysms and subsequent coronary stenosis or obstruction, leading to ischemic heart disease. This study examined the long-term outcomes of patients with KD complicated by large coronary aneurysms. SUBJECTS AND METHODS: The medical records of 71 patients (53 men and 18 women) diagnosed with large coronary aneurysms (diameter ≥6 mm) between December 1986 and December 2013 were retrospectively reviewed from our institutional database. RESULTS: The mean age at onset was 4.6±3.3 years, and the mean follow-up duration was 12.5±6.9 years. Maximum coronary artery internal diameter ranged from 6.1 to 25 mm. Giant coronary aneurysms occurred in 48 patients and coronary aneurysms 6-8 mm in diameter developed in 23 patients. Coronary stenosis and/or complete occlusion occurred in 30 patients (42.3%). Catheter and/or surgical interventions (mean: 1.5 interventions, range: 1-5 interventions) were performed in 20 patients (28.2%), 9 months to 18 years after KD onset, resulting in 33.7% cumulative coronary intervention rates at 20 years after onset. There were no differences in cumulative coronary intervention rates between two coronary aneurysm groups (6-8 mm vs. ≥8 mm). Myocardial infarction occurred in 7 patients with a giant aneurysm and there was one death. CONCLUSIONS: Long-term survival of patients with KD complicated by large coronary aneurysm was good even though 28.2% of patients underwent multiple catheter or surgical interventions. Careful follow-up is also necessary in KD patients with coronary aneurysms 6-8 mm in diameter, such as those with giant aneurysms.
Age of Onset ; Aneurysm ; Catheters ; Coronary Aneurysm* ; Coronary Stenosis ; Coronary Vessels ; Follow-Up Studies ; Humans ; Male ; Medical Records ; Mucocutaneous Lymph Node Syndrome* ; Myocardial Infarction ; Myocardial Ischemia ; Prognosis* ; Retrospective Studies

We conducted this study to compare clinical features, outcomes, and clinical implication of antimicrobial resistance in Klebsiella pneumoniae bacteremia acquired as community vs. nosocomial infection. A total of 377 patients with K. pneumoniae bacteremia (191 community-acquired and 186 nosocomial) were retrospectively analyzed. Neoplastic diseases (hematologic malignancy and solid tumor, 56%) were the most commonly associated conditions in patients with nosocomial bacteremia, whereas chronic liver disease (35%) and diabetes mellitus (20%) were the most commonly associated conditions in patients with community-acquired bacteremia. Bacteremic liver abscess occurred almost exclusively in patients with community-acquired infection. The overall 30-day mortality was 24% (91/377), and the mortality of nosocomial bacteremia was significantly higher than that of community-acquired bacteremia (32% vs. 16%, p<0.001). Of all community-acquired and nosocomial isolates, 4% and 33%, respectively, were extended-spectrum cephalosporin (ESC)-resistant, and 4% and 21%, respectively, were ciprofloxacin (CIP)-resistant. In nosocomial infections, prior uses of ESC and CIP were found to be independent risk factors for ESC and CIP resistance, respectively. Significant differences were identified between community-acquired and nosocomial K. pneumoniae bacteremia, and the mortality of nosocomial infections was more than twice than that of community-acquired infections. Antimicrobial resistance was a widespread nosocomial problem and also identified in community-acquired infections.
Treatment Outcome ; Risk Factors ; Retrospective Studies ; Middle Aged ; Male ; *Klebsiella pneumoniae ; Klebsiella Infections/*drug therapy ; Humans ; Female ; Drug Resistance, Bacterial ; Cross Infection/*drug therapy/mortality ; Community-Acquired Infections/*drug therapy/mortality ; Ciprofloxacin/therapeutic use ; Cephalosporins/therapeutic use ; Bacteremia/*drug therapy/mortality ; Aged, 80 and over ; Aged ; Adult ; Adolescent ; APACHE

BACKGROUND: We compared vaccinia virus shedding from the vaccine inoculation site (vaccination lesion) and two sites of a dressing covering the vaccination site; the outer surface of the semipermeable dressing (outer surface) and the inner surface of the semipermeable dressing, that is, the surface of a folded gauze under the semipermeable membrane (gauze surface) MATERIAL AND METHODS: Subjects were recruited from the volunteers who participated in a clinical trial of the efficacy of a 1:10 dilution of Lancy-Vaxina? (Berna Biotech, Switzerland), and were seen every 2-3 days (days 6, 8, 10, 13, and 15 after smallpox vaccination) for scheduled dressing changes. Swab specimens were obtained from the vaccination lesion, the outer surface, and the gauze surface. Quantitative viral culture assays for these specimens were done. RESULTS: Vaccinia virus was recovered from 126 (81%) of the 156 vaccination lesion samples collected from the 40 participants. A high virus titer was recovered from the vaccination lesion (geometric mean titer (log10)=3.91 on day 8). Of the 39 swab samples obtained from the gauze surface of the gauze, 16 (41%) were positive for virus. An intermediate titer was recovered from the gauze surface (geometric mean titer (log10)=0.91 on day 8). Of the 133 swab samples obtained from the outer surface, only one (0.8%) was positive for vaccinia. No virus was recovered from the outer surface on day 8. CONCLUSION: Our findings suggest that the addition of a semipermeable dressing to the folded gauze further reduces viral shedding and therefore increases protection.
Bandages* ; Membranes ; Smallpox* ; Vaccination* ; Vaccinia virus* ; Vaccinia* ; Viral Load ; Virus Shedding ; Volunteers

BACKGROUND: To identify specific risk factors for Pseudomonas aeruginosa and evaluate the relationship between the mortality rate and P. aeruginosa bacteraemia in bloodstream infections, we compared the clinical features and outcomes of patients with P. aeruginosa bacteremia with the patients with Klebsiella pneumoniae or Enterobacter bacteremia. MATERIALS AND METHODS: A total of 190 patients with P. aeruginosa bacteremia were identified from January 1998 to December 2002 and included in this retrospective analysis. During the same period, 377 patients with K. pneumoniae bacteremia and 183 patients with Enterobacter bacteremia were identified and compared with those with P. aeruginosa bacteremia. RESULTS: Factors associated with P. aeruginosa bacteremia in the multivariate analysis included pneumonia, soft tissue infection, nosocomial acquisition, neutropenia, and prior invasive procedure (All P<0.05). The 30-day mortality rate was 37.9% (72/190) in patients with P. aeruginosa bacteremia, 24.1% (91/377) in those with K. pneumoniae, and 25.7% (47/183) in those with Enterobacter bacteremia (P<0.001). However, in the analysis including patients who had received appropriate initial antimicrobial therapy (n=552), the mortality rate of P. aeruginosa bacteremia was not significantly higher than that of non-pseudomonas bacteremia (28.6% [18/63] vs. 22.5% [110/489]; P=0.282). Inappropriate initial antimicrobial therapy was found to be one of the significant independent predictors of mortality. P. aeruginosa bacteremia as a risk factor for mortality did not reach statistical significance (OR, 1.30; 95% CI, 0.73-2.32; P=0.371), after adjusting for underlying illness and adequacy of antimicrobial therapy. CONCLUSION: An initial empirical antimicrobial coverage of P. aeruginosa should be seriously considered in patients with pneumonia, soft tissue infection, neutropenia, and prior invasive procedure, when gram-negative sepsis was suspected in nosocomial infection.
Bacteremia* ; Cross Infection ; Enterobacter* ; Gram-Negative Bacterial Infections ; Humans ; Klebsiella pneumoniae* ; Klebsiella* ; Mortality ; Multivariate Analysis ; Neutropenia ; Pneumonia ; Pseudomonas aeruginosa* ; Pseudomonas* ; Retrospective Studies ; Risk Factors ; Sepsis ; Soft Tissue Infections ; Treatment Outcome

BACKGROUND: This study was conducted to evaluate risk factors for infection and treatment outcome of bloodstream infection due to extended spectrum beta-lactamases(ESBL)-producing K. pneumoniae. METHODS: ESBL production was evaluated by NCCLS guidelines and/or double-disk synergy test in K. pneumoniae blood isolates stored from January, 1998 to April, 2002. Sixty patients with bloodstream infection due to ESBL-producing K. pneumoniae (case patients) were compared with 159 matched control patients with bloodstream infection of non-ESBL-producing K. pneumoniae. Retrospective case-control study was performed. RESULTS: There were no significant differences in age, sex, APACHE II score, and the primary site of infection between the case and control groups. In multivariate analysis, significant independent risk factors associated with bloodstream infection due to ESBL-producing K. pneumoniae were urinary catheterization, invasive procedure within previous 72 hours, and the number of antibiotics administered within previous 30 days. In clinical response at 72 hours after initial antibiotic treatment, complete response rate was higher in the controls (13.3% vs. 40.3%, respectively, P<0.001), however, treatment failure rate was higher in the cases (33.3% vs. 11.9%, respectively, P<0.001). Overall 7- day mortality rates in the cases and the controls were was 20% (12/60) and 15.7% (25/159) (P= 0.451), respectively, and overall 30-day mortality rates were 30% (18/60) and 24.5% (39/159), respectively (P=0.410). When the patients with bloodstream infection of ESBL-producing organism were evaluated and the patients who received inadequate definitive antibiotic treatment were excluded, delayed effective antibiotic treatment was found to be not associated with higher mortality. CONCLUSION: In patients infected with ESBL-producing K. pneumoniae bacteremia, clinical response rate at 72 hours after antimicrobial therapy was lower, but the increase of mortality rate was not significant. Delayed effective antibiotic treatment was not associated with higher mortality, when definitive appropriate antibiotic treatment was prescribed.
Anti-Bacterial Agents ; APACHE ; Bacteremia ; beta-Lactamases* ; Case-Control Studies ; Humans ; Klebsiella pneumoniae* ; Klebsiella* ; Mortality ; Multivariate Analysis ; Pneumonia ; Retrospective Studies ; Risk Factors* ; Treatment Failure ; Treatment Outcome* ; Urinary Catheterization ; Urinary Catheters

BACKGROUND: We compared vaccinia virus shedding from the vaccine inoculation site (vaccination lesion) and two sites of a dressing covering the vaccination site; the outer surface of the semipermeable dressing (outer surface) and the inner surface of the semipermeable dressing, that is, the surface of a folded gauze under the semipermeable membrane (gauze surface) MATERIAL AND METHODS: Subjects were recruited from the volunteers who participated in a clinical trial of the efficacy of a 1:10 dilution of Lancy-Vaxina? (Berna Biotech, Switzerland), and were seen every 2-3 days (days 6, 8, 10, 13, and 15 after smallpox vaccination) for scheduled dressing changes. Swab specimens were obtained from the vaccination lesion, the outer surface, and the gauze surface. Quantitative viral culture assays for these specimens were done. RESULTS: Vaccinia virus was recovered from 126 (81%) of the 156 vaccination lesion samples collected from the 40 participants. A high virus titer was recovered from the vaccination lesion (geometric mean titer (log10)=3.91 on day 8). Of the 39 swab samples obtained from the gauze surface of the gauze, 16 (41%) were positive for virus. An intermediate titer was recovered from the gauze surface (geometric mean titer (log10)=0.91 on day 8). Of the 133 swab samples obtained from the outer surface, only one (0.8%) was positive for vaccinia. No virus was recovered from the outer surface on day 8. CONCLUSION: Our findings suggest that the addition of a semipermeable dressing to the folded gauze further reduces viral shedding and therefore increases protection.
Bandages* ; Membranes ; Smallpox* ; Vaccination* ; Vaccinia virus* ; Vaccinia* ; Viral Load ; Virus Shedding ; Volunteers

BACKGROUND: To identify specific risk factors for Pseudomonas aeruginosa and evaluate the relationship between the mortality rate and P. aeruginosa bacteraemia in bloodstream infections, we compared the clinical features and outcomes of patients with P. aeruginosa bacteremia with the patients with Klebsiella pneumoniae or Enterobacter bacteremia. MATERIALS AND METHODS: A total of 190 patients with P. aeruginosa bacteremia were identified from January 1998 to December 2002 and included in this retrospective analysis. During the same period, 377 patients with K. pneumoniae bacteremia and 183 patients with Enterobacter bacteremia were identified and compared with those with P. aeruginosa bacteremia. RESULTS: Factors associated with P. aeruginosa bacteremia in the multivariate analysis included pneumonia, soft tissue infection, nosocomial acquisition, neutropenia, and prior invasive procedure (All P<0.05). The 30-day mortality rate was 37.9% (72/190) in patients with P. aeruginosa bacteremia, 24.1% (91/377) in those with K. pneumoniae, and 25.7% (47/183) in those with Enterobacter bacteremia (P<0.001). However, in the analysis including patients who had received appropriate initial antimicrobial therapy (n=552), the mortality rate of P. aeruginosa bacteremia was not significantly higher than that of non-pseudomonas bacteremia (28.6% [18/63] vs. 22.5% [110/489]; P=0.282). Inappropriate initial antimicrobial therapy was found to be one of the significant independent predictors of mortality. P. aeruginosa bacteremia as a risk factor for mortality did not reach statistical significance (OR, 1.30; 95% CI, 0.73-2.32; P=0.371), after adjusting for underlying illness and adequacy of antimicrobial therapy. CONCLUSION: An initial empirical antimicrobial coverage of P. aeruginosa should be seriously considered in patients with pneumonia, soft tissue infection, neutropenia, and prior invasive procedure, when gram-negative sepsis was suspected in nosocomial infection.
Bacteremia* ; Cross Infection ; Enterobacter* ; Gram-Negative Bacterial Infections ; Humans ; Klebsiella pneumoniae* ; Klebsiella* ; Mortality ; Multivariate Analysis ; Neutropenia ; Pneumonia ; Pseudomonas aeruginosa* ; Pseudomonas* ; Retrospective Studies ; Risk Factors ; Sepsis ; Soft Tissue Infections ; Treatment Outcome

BACKGROUND: This study was conducted to evaluate risk factors for infection and treatment outcome of bloodstream infection due to extended spectrum beta-lactamases(ESBL)-producing K. pneumoniae. METHODS: ESBL production was evaluated by NCCLS guidelines and/or double-disk synergy test in K. pneumoniae blood isolates stored from January, 1998 to April, 2002. Sixty patients with bloodstream infection due to ESBL-producing K. pneumoniae (case patients) were compared with 159 matched control patients with bloodstream infection of non-ESBL-producing K. pneumoniae. Retrospective case-control study was performed. RESULTS: There were no significant differences in age, sex, APACHE II score, and the primary site of infection between the case and control groups. In multivariate analysis, significant independent risk factors associated with bloodstream infection due to ESBL-producing K. pneumoniae were urinary catheterization, invasive procedure within previous 72 hours, and the number of antibiotics administered within previous 30 days. In clinical response at 72 hours after initial antibiotic treatment, complete response rate was higher in the controls (13.3% vs. 40.3%, respectively, P<0.001), however, treatment failure rate was higher in the cases (33.3% vs. 11.9%, respectively, P<0.001). Overall 7- day mortality rates in the cases and the controls were was 20% (12/60) and 15.7% (25/159) (P= 0.451), respectively, and overall 30-day mortality rates were 30% (18/60) and 24.5% (39/159), respectively (P=0.410). When the patients with bloodstream infection of ESBL-producing organism were evaluated and the patients who received inadequate definitive antibiotic treatment were excluded, delayed effective antibiotic treatment was found to be not associated with higher mortality. CONCLUSION: In patients infected with ESBL-producing K. pneumoniae bacteremia, clinical response rate at 72 hours after antimicrobial therapy was lower, but the increase of mortality rate was not significant. Delayed effective antibiotic treatment was not associated with higher mortality, when definitive appropriate antibiotic treatment was prescribed.
Anti-Bacterial Agents ; APACHE ; Bacteremia ; beta-Lactamases* ; Case-Control Studies ; Humans ; Klebsiella pneumoniae* ; Klebsiella* ; Mortality ; Multivariate Analysis ; Pneumonia ; Retrospective Studies ; Risk Factors* ; Treatment Failure ; Treatment Outcome* ; Urinary Catheterization ; Urinary Catheters