There is an increasing tendency of systemic fungal infection because of increase in the number of immunocomproised patients such as the patients receiving anticancer chmotherapy or organ transplant. The frequency of systemic fungal infection is problematic, since it is often difficult for clinicians to manage the patients with fungal infection. Amphotericin B was one of the representativ antifungal agent for the systemic antifungal infection even though it has many kinds of advers reactions for instance nephrotoxicity, electrolyte imbalance, etc. Therefore ketoconazole, fluconazole, and itraconazole were develped and prescribed with effect. Because of increase in the number of resistant strains of Candida, Fusarium or Trichosporon nowadays, as for azole antifungal agents there were something to be desired. Other new antifungal agents with fungicidal effect under develpment include polyoxins, echinocandins and pradimicin.
Amphotericin B ; Antifungal Agents* ; Candida ; Danazol ; Echinocandins ; Fluconazole ; Fusarium ; Humans ; Itraconazole ; Ketoconazole ; Transplants ; Trichosporon

Penicillin resistance in Streptococcus pneumoniae has increased sharply within the past few years and extended-spectrum cephalosporins haute been recommended for the empiric therapy of bacterial meningitis. However, therapeutic failure are being reported with increasing frequency due to extended-spectrum cephalosporin-resistant strains. We report two cases of meningitis caused by S. pneumoniae resistant to penicillin and cefotaxime. Both patients were recovered after ceftriaxone and vancomycin treatment, but one of them was left with neurological sequelae because of a delay in the institution of an antibiotic therapy appropriate for resistant pneumococci. This report indicates that extended-spectrum cephalosporin-resistance must be considered In all clinical isolates of S. pneumoniae and in vitro susceptibility testings should be performed promptly and accurately to detect antibiotic resistance.
Cefotaxime ; Ceftriaxone ; Cephalosporins ; Drug Resistance, Microbial ; Humans ; Meningitis* ; Meningitis, Bacterial ; Penicillin Resistance ; Penicillins ; Pneumonia ; Streptococcus pneumoniae* ; Streptococcus* ; Vancomycin

No abstract available.
Communicable Diseases* ; Diabetes Mellitus*

No abstract available.
Autopsy* ; Enzyme-Linked Immunosorbent Assay*

BACKGROUND: Group B streptococci (GBS) are major cause of meningitis and septicemia in neonates and pregnant women, but the importance in non-pregnant adults has not been clearly defined. METHODS: Medical records of all patients with group B streptococcal bacteremia from 1988 to 1997 at Asan Medical Center were reviewed. We compared the clinical and laboratory findings of non-pregnant adults to those of neonates. RESULTS: In a 8-year period there were 41 patients with GBS bacteremia. Thirteen (31.7%) patients were neonates (mean age 14.0+/-11.5 day) and 28 (68.3%) were non-pregnant adults (mean age 52.8+/-13.3 year). Community-acquired infections were 2 cases (15.4%) in the neonates and 7 cases (25.0%) in the non-pregnant adults. In the non-pregnant adults, the most common clinical diagnosis was bacteremia without identified source (15 cases, 53.6%). The others were bone or joint infection (6), urinary tract infection (4), pneumonia (2), skin infection (2), peritonitis (2), and meningitis (1). GBS bacteremia was more common in old age (50 years, 20 cases, 71.4%), the presence of diabetes mellitus (10), solid tumors (10) and liver cirrhosis (10). The mortality rate in non-pregnant adults was 35.7% (10 cases), accounting for 10.7% (3) of deaths related to GBS. In the neonates, early onset infection were 5 cases (38.5%) and late onset infection were 8 (61.5%). The presumed portal of entries were bacteremia without identified focus (5 cases, 38.5%), and meningitis (8, 61.5%). The mortality rate in the neonates was 23.1% (3 cases) and 7.1% (1) related to GBS bacteremia. CONCLUSION: GBS bacteremia is a serious problem not only in the neonates and pregnant women but also in the non-pregnant adults, especially those who are elderly patients with significant underlying diseases.
Adult* ; Aged ; Bacteremia* ; Chungcheongnam-do ; Community-Acquired Infections ; Diabetes Mellitus ; Diagnosis ; Female ; Humans ; Infant, Newborn* ; Joints ; Liver Cirrhosis ; Medical Records ; Meningitis ; Mortality ; Peritonitis ; Pneumonia ; Pregnant Women ; Sepsis ; Skin ; Urinary Tract Infections

BACKGROUND: Arbekacin was introduced to treat methicillin-resistant Staphylococcus aureus (MRSA) infection. It is an aminoglycoside with proven in vitro activity against MRSA strains. Pharmacokinetic advantages such as concentration-dependant bactericidal activity, prolonged post-antibiotic effect are its feature of aminoglycoside like others. But there are only few clinical data of this new kind of antibiotics outside of Japan, the first country approved its use against MRSA infections. We studied the clinical and bacteriological efficacy and safety of arbekacin in the treatment of infections caused by MRSA. METHODS: During the period between December 2001 and October 2002, we prospectively enrolled 21 patients with culture proven MRSA infection and evaluated the clinical and bacteriological efficacy and adverse events of arbekacin. Patients were treated with arbekacin sulphate 100 mg intravenously twice daily for 14 days. RESULTS: Patients were included if they had signs and symptoms of active MRSA infection including bacteremia, soft tissue infection, urinary tract infection, pneumonia etc. A total of 21 patients with MRSA infection were enrolled. Four patients experienced adverse events; 3 nephrotoxicities, 1 hepatotoxicity. One of them with elevated creatinine was unable to continue the study. Efficacy were evaluated on 19 patients with duration of arbekacin longer than 9 days. A favorable bacteriological response (eradicated or presumed eradicated) occurred in 13 (68.5%) patients. CONCLUSION: Although this clinical study was limited in number and in proper randomization, arbekacin alone was less effective than combination therapy with glycopeptides for the treatment of MRSA infection. However, our limited data suggested the efficacy of arbekacin alone for the treatment which needs shorter duration. The combination treatment of arbekacin and glycopeptide appeared to be less nephrotoxic than other aminoglycosides. The combination therapy of arbekacin and glycopeptide appeared to be less nephrotoxic than other aminoglycoside.
Aminoglycosides ; Anti-Bacterial Agents ; Bacteremia ; Creatinine ; Glycopeptides ; Humans ; Japan ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Pneumonia ; Prospective Studies ; Random Allocation ; Soft Tissue Infections ; Urinary Tract Infections

BACKGROUND: Toxic shock syndrome toxin 1 (TSST-1) is an important pathogenic factor in toxic shock syndrome, and its structural gene, tst has been cloned and sequenced, many of its biological and physicochemical properties have been determined, and immunostimulatory properties such as TNF production have been assigned to it. We investigated to know the proportion of strains possessing tst gene among pathogenic Strains of Staphylococcus aureus isolated from hospitalized patients and to elucidate the coexistence of mecA gene and tst gene. METHODS: S. aureus strains isolated in Asan Medical Center from December 1996 to June 1997 were incubated in brain-heart infusion media and harvested. Chromosomal DNA was prepared and polymerase chain reaction (PCR) was performed to detect mecA gene and tst gene in pathogenic S. aureus. RESULTS: A total of 126 strains were included. Among these, 11 strains (8.7%) were positive in PCR for tst gene. Ten out of these were mecA-positive strains and only one was mecA-negative. That is to say, among 60 strains of mecA-positive MRSA, 10 (16.7%) were tst-positive, and among 66 strains of mecA-negative MSSA, only one (1.5%) was tst-positive. CONCLUSION: Among S. aureus isolated from hospitalized patients, tst- possessing strains were 8.7%. TSST-1 gene was more prevalent in mecA-positive S. aureus than in mecA-negative S. aureus.
Chungcheongnam-do ; Clone Cells ; DNA ; Epidemiological Monitoring* ; Humans ; Methicillin-Resistant Staphylococcus aureus ; Polymerase Chain Reaction ; Shock, Septic ; Staphylococcus aureus* ; Staphylococcus*

Trichosporonosis is a potentially life-threatening infection with Trichosporon beigelii, the causative agent of white piedra. The systemic infection by this fungus has been most frequently described in immunocompromised hosts with neutropenia. Here, we report the first patient with disseminated infection by T. beigelii in Korea, acquired during a period of severe neutropenia after chemo-therapy for myelodysplastic syndrome. The patient recovered from the infection after an early-intensified treatment with amphotericin B and a rapid neutrophil recovery. The disseminated infection by T. beigelii is still rare, however, is an emerging fatal mycosis in immunocompromised patients with severe neutropenia.
Adult ; Amphotericin B/therapeutic use ; Human ; Male ; Mycoses/drug therapy/*etiology ; Myelodysplastic Syndromes/*complications/drug therapy

Dengue Hemorrhagic Fever/dengue shock syndrome (DHF/DSS) is an acute febrile illness characterized by decreased platelet counts and hypovolemic shock due to increased vascular permeability and plasma leakage in patients infected with any one of four serotypes of dengue virus. The disease is one of the principal causes of hospitalization and death among children in several Southeast Asia, Central and South Americas, and Africa. With increasing use of air or ship transport, more travelers and sailors to the tropics are returning within the incubation period of acute febrile infection. We experienced a case of a Korean traveler who had presented with fever, chills, nausea, loss of consciousness, gastrointestinal bleeding, and thrombocytopenia after returning from the Philippines and diagnosed his illness as Dengue Hemorrhagic Fever by serologic test (Indirect immunofluorescent : Dengue duo IgM and IgG rapid strip test).
Africa ; Asia, Southeastern ; Capillary Permeability ; Child ; Chills ; Dengue Virus ; Dengue* ; Fever ; Hemorrhage ; Hospitalization ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Military Personnel ; Nausea ; Philippines* ; Plasma ; Platelet Count ; Serologic Tests ; Severe Dengue* ; Ships ; Shock ; South America ; Thrombocytopenia ; Unconsciousness

We report a case of pyelonephritis caused by Candida kefyr, which has been previously described as C. pseudotropicalis. The patient who had been having multiple intrarenal stones and ureteral stones for ten years was admitted for fever, left flank pain, and dysuria. In the blood culture, C. kefyr was isolated. These symptoms and signs were successfully resolved with a new antifungal agent, voriconazole. After the resolution of symptoms and signs, the patient took extracorporeal shock wave lithotripsy for intrarenal stones and ureteral stones.
Candida* ; Dysuria ; Fever ; Flank Pain ; Humans ; Lithotripsy ; Pyelonephritis* ; Shock ; Ureter