OBJECTIVE: Rheumatoid arthritis, the most common form of arthritis, is typically characterized by induced inflammatory pain in joints. Recent studies have reported on the expression of pain receptors such as transient receptor potential vanilloid 1 (TRPV1) and acid sensing ion channel 3 (ASIC3), which are related to pain induction and regulation. This study was conducted to investigate the expression of TRPV1 and ASIC3 in response to the analgesic effect of an arthritis treatment in a collagen-induced arthritis (CIA). METHODS: Mice were divided into 3 groups: Control, CIA, and CIA with arthritis treatment. Mice received intraperitoneal injection with 10 mg/kg infliximab and 10 mg/kg meloxicam five times per week for 3 weeks. Mechanical hyperalgesia, histologic examination of the feet, serum levels of inflammatory cytokine such as interleukin-6 (IL-6), and interleukin-17 (IL-17), TRPV1 and ASIC3 expression were investigated. RESULTS: The serum levels of IL-6 and IL-17 were lower in the treatment group (73.77+/-10.11 pg/mL and 26.75+/-7.17 pg/mL, respectively) compared to the CIA group (p<0.001). Histological analysis showed decreased synovial cell proliferation, leukocyte infiltration, and cartilage destruction in the treatment group compared with the CIA group. The CIA group that underwent arthritis treatment showed a significantly increased withdrawal threshold of mechanical nociception on the hind paw and increased expression of TRPV1 and ASIC3 compared to the CIA group. CONCLUSION: Arthritis treatment resulted in an anti-inflammatory and analgesic effect through upregulation of the activity of TRPV1 and ASIC3 in CIA mice.
Animals ; Arthritis* ; Arthritis, Experimental ; Arthritis, Rheumatoid* ; Cartilage ; Cell Proliferation ; Collagen* ; Foot ; Hyperalgesia ; Injections, Intraperitoneal ; Interleukin-17 ; Interleukin-6 ; Ion Channels ; Joints ; Leukocytes ; Mice ; Nociception ; Nociceptors* ; Up-Regulation ; Infliximab

When a patient presents with acute voiding dysfunction without a typical skin rash, it may be difficult to make a diagnosis of herpes zoster. Here, we present a case of scrub typhus in a 25-year-old man with the complication of urinary dysfunction. The patient complained of loss of urinary voiding sensation and constipation. After eight days, he had typical herpes zoster eruptions on the sacral dermatomes and hypalgesia of the S1-S5 dermatomes. No cases of dual infection with varicella zoster virus and Orientia tsutsugamushi were found in the literature. In the described case, scrub typhus probably induced sufficient stress to reactivate the varicella zoster virus. Early recognition of this problem is imperative for prompt and appropriate management, as misdiagnosis can lead to long-term urinary dysfunction. It is important that a diagnosis of herpes zoster be considered, especially in patients with sudden onset urinary retention.
Adult ; Constipation ; Diagnosis ; Diagnostic Errors ; Exanthema ; Herpes Zoster* ; Herpesvirus 3, Human ; Humans ; Orientia tsutsugamushi ; Scrub Typhus* ; Sensation ; Urinary Retention

Encephalitis associated with antibodies to the N-methyl-D-aspartate receptor (NMDAR) has variable clinical manifestations. Patients are often diagnosed with infectious processes because of prodromal symptoms and autonomic manifestations. Approximately 70% of patients have prodromal symptoms consisting of headache, fever, nausea, vomiting, and diarrhea, along with frequent autonomic manifestations, including tachycardia, and fluctuating blood pressure. A 36-year-old woman presented with uncontrolled fever and skin and soft tissue infections. She had shown psychiatric symptoms and abnormal behavior, and had been diagnosed with bipolar disorder. Antibodies to NMDAR were positive in cerebrospinal fluid (CSF) and serum samples, and pelvic computed tomography detected a large ovarian teratoma. The patient improved dramatically after removal of the teratoma and administration of corticosteroid therapy. When confronted with a young woman with uncontrolled fever and acute psychiatric symptoms, physicians should suspect anti-NMDAR encephalitis.
Adult ; Anti-N-Methyl-D-Aspartate Receptor Encephalitis* ; Antibodies ; Bipolar Disorder ; Blood Pressure ; Cerebrospinal Fluid ; Dermoid Cyst ; Diarrhea ; Encephalitis ; Female ; Fever ; Fever of Unknown Origin* ; Headache ; Humans ; N-Methylaspartate ; Nausea ; Prodromal Symptoms ; Skin ; Soft Tissue Infections ; Tachycardia ; Teratoma ; Vomiting

Active and prompt scale-up screening tests are essential to efficiently control the coronavirus disease 2019 (COVID-19) outbreak. The goal of this work was to identify shortcomings in the conventional screening system (CSS) implemented in the beginning of the outbreak. To overcome these shortcomings, we then introduced a novel, independently developed system called the Yeungnam University type drive-through (YU-Thru), and distributed it nationwide in Korea. This system is similar to the drive-throughs utilized by fast food restaurants. YU-Thru system has shortened the time taken to test a single person to 2–4 minutes, by completely eliminating the time required to clean and ventilate the specimen collection room. This time requirement was a major drawback of the CSS. YU-Thru system also reduced the risk of subjects and medical staff infecting one another by using a separate and closed examination system. On average, 50 to 60 tests were conducted per day when using the CSS, while now up to 350 tests per day are conducted with the YU-Thru system. We believe that the YU-Thru system has made an important contribution to the rapid detection of COVID-19 in Daegu, South Korea. Here, we will describe the YU-Thru system in detail so that other countries experiencing COVID-19 outbreaks can take advantage of this system.

Giant cell arteritis (GCA) is a chronic vasculitis that mainly involves the cranial branches of arteries, and typically it presents with a cephalic sign such as a new headache, jaw claudication and/or visual symptoms. Although the tender, swollen or beaded arteries are adequate sites for biopsy, random temporal artery biopsy should be performed in all the patients suspected of suffering with GCA and even if cephalic signs are not present. Several cases of typical GCA have been reported in Korea, but so far there have been no reports of an atypical case presenting with Raynaud's phenomenon, and the patient was diagnosed by random temporal artery biopsy. Here we describe a case that showed the typical pathological findings of GCA in an asymptomatic temporal artery. The patient complained of only Raynaud's phnomenon and the patient was without any cephalic symptoms.
Arteries ; Biopsy ; Giant Cell Arteritis ; Giant Cells ; Headache ; Humans ; Jaw ; Korea ; Stress, Psychological ; Temporal Arteries ; Vasculitis

Leukocytoclastic vasculitis (LV) is a systemic inflammatory disorder involving the small vessels. The exact cause of LV remains unknown, yet malignancy has been considered as a causative factor for LV. We experienced a 60-year-old male with purpura on his extremities. Computed tomography of the chest showed a mass lesion that was suspected to be a non-small-cell lung cancer and the biopsy revealed an adenosquamous carcinoma. There has been no report of LV associated with adenosquamous carcinoma of the lung in Korea. Thus, we report here on this case along with a review of the relevant articles.
Biopsy ; Carcinoma, Adenosquamous ; Extremities ; Humans ; Korea ; Lung ; Lung Neoplasms ; Male ; Middle Aged ; Purpura ; Thorax ; Vasculitis ; Vasculitis, Leukocytoclastic, Cutaneous

Actinomycosis is a rare subacute-to-chronic infection that causes sinus fistula, tract, or abscess due to the invasion surrounding the soft tissue. Actinomyces colonize the mouth, colon, and vagina. Mucosal disruption may lead to infection at virtually any site in the body. Cervicofacial infection accounts for 50-60% of all actinomycosis cases. The mandible and nasopharynx are the sites of predilection, but maxillary sinus infection is rare. Reported herein is a case involving a 57-year-old female with acute myeloid leukemia who had simultaneous actinomycosis with mucormycosis in the maxillary sinus.
Abscess ; Actinomyces ; Actinomycosis ; Colon ; Female ; Fistula ; Humans ; Leukemia, Myeloid, Acute ; Mandible ; Maxillary Sinus ; Maxillary Sinusitis ; Mouth ; Mucormycosis ; Nasopharynx ; Vagina

BACKGROUND: Carefully switching from intravenous to oral antibiotic therapy has shown to reduce treatment costs and lengths of hospital stay as well as increase safety and comfort in patients with infections. The aim of this study was to compare the clinical efficacy and safety between the patients treated with glycopeptides (case group), and the patients given oral antibiotics, as the initial or step-down therapy (control group), in the treatment of patients with methicillin-resistant Staphylococcus aureus (MRSA) infection. MATERIALS AND METHODS: A multicenter observational study was retrospectively performed in 7 teaching hospitals in Korea from January to December 2012. The study included adult patients (> or = 18 years) with infection caused by MRSA isolates, susceptible to clindamycin, erythromycin, and ciprofloxacin. The primary end point was treatment outcome, including all-cause mortality and switching of antibiotics. Drug-related adverse events and the lengths of hospital stay were also compared between the two treatment groups. RESULTS: During the study period, 107 patients (43 cases and 64 controls) with MRSA infections were enrolled from the participating hospitals. The most common sites of MRSA infection were skin and soft tissue (n = 28) and bone and joint (n = 26). The median Charlson comorbidity index (P = 0. 560), the frequency of severe sepsis (P = 0.682) or thrombocytopenia (P = 1.000), and median level of serum C-reactive protein (P = 0.157) at the onset of MRSA infections were not significantly different between the case and control groups. The oral antibiotics most frequently prescribed in the case group, were fluoroquinolones (n = 29) and clindamycin (n = 8). The median duration of antibiotic treatment (P = 0.090) and the occurrence of drug-related adverse events (P = 0.460) did not reach statistically significant difference between the two groups, whereas the total length of hospital stay after the onset of MRSA infection was significantly shorter in the case group than the control group [median (interquartile range), 23 days (8-41) vs. 32 days (15-54), P = 0.017]. In multivariate analyses, the type of antibiotic used was not an independent risk factor for treatment failure. The statistically significant factors associated with treatment failure included underlying hepatic diseases, prior receipt of antibiotics, and foreign body retention. CONCLUSIONS: This study indicates that oral antibiotic therapy with active agents against MRSA isolates can be considered as the initial or step-down therapy for the treatment of MRSA infections and also reduce the length of hospital stay.
Adult ; Anti-Bacterial Agents ; C-Reactive Protein ; Ciprofloxacin ; Clindamycin ; Comorbidity ; Erythromycin ; Fluoroquinolones ; Foreign Bodies ; Glycopeptides ; Health Care Costs ; Hospitals, Teaching ; Humans ; Joints ; Korea ; Length of Stay* ; Methicillin-Resistant Staphylococcus aureus* ; Mortality ; Multivariate Analysis ; Observational Study ; Retrospective Studies ; Risk Factors ; Sepsis ; Skin ; Thrombocytopenia ; Treatment Failure ; Treatment Outcome

BACKGROUND: Successful therapy for community-acquired pneumonia (CAP) requires appropriate empirical antimicrobial therapy based on the local microbe and resistance patterns. However, the available data on the bacterial etiology and antimicrobial susceptibility of CAP in Korea is very limited. MATERIALS AND METHODS: A nationwide prospective multicenter study of CAP in adult patients was carried out between March 2009 and February 2010. Most patients underwent detailed assessment for bacterial and viral pathogens (cultures, urinary antigen testing, serological methods and polymerase chain reaction). RESULTS: A total of 619 patients were studied. More than half (50.4%) of the patients were > or =65 years, 59.3% were males and 48.1% had underlying illness. The etiology was identified in 246 (39.7%) of the patients. The most common etiologic agent was Streptococcus pneumoniae (52 episodes, 21.1%), and the majority (36/52) of which were diagnosed by a positive urinary antigen test alone. The other common bacterial agents included Mycoplasma pneumoniae (41, 16.7%), Klebsiella pneumoniae (26, 10.6%), Chlamydia pneumoniae (13, 5.3%), Pseudomonas aeruginosa (11, 4.3%) and Staphylococcus aureus (8, 3.1%). All S. pneumoniae isolates were susceptible to penicillin with MIC of 2 microg/mL or less, only 1/16 (6.2%) was resistant to levofloxacin and 10/16 (62.5%) were resistant to erythromycin. Of the 26 K. pneumoniae isolates, 25 (96.2%) were susceptible to cefotaxime and ciprofloxacin. CONCLUSIONS: S. pneumoniae remains the most frequent pathogen in adults with CAP and this should be covered with empirical antimicrobial treatment. Atypical pathogens such as M. pneumoniae and C. pneumoniae were the second most common etiologic agents and they should be tested for. The rate of CAP caused by gram-negative bacilli such as K. pneumoniae and P. aeruginosa was high, which is similar to that of the previous Korean studies. Further study, with excluding healthcare-associated pneumonia, is needed to clarify the etiology of CAP in Korea.
Adult ; Cefotaxime ; Chlamydophila pneumoniae ; Erythromycin ; Humans ; Klebsiella pneumoniae ; Korea ; Male ; Mycoplasma pneumoniae ; Ofloxacin ; Penicillins ; Pneumonia ; Pneumonia, Bacterial ; Pneumonia, Mycoplasma ; Prospective Studies ; Pseudomonas aeruginosa ; Staphylococcus aureus ; Streptococcus pneumoniae

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