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

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

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

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

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

Infective endocarditis is a very rare cardiac manifestation of salmonella infection, and splenic infarction is a rare noncardiac complication. We describe a case of Salmonella enterica serovar Typhi bacteremia which was complicated by infective endocarditis with multiple splenic infarctions in a previously healthy 47-year-old female. She didn't have any history of foreign travel. The isolate of Salmonella enterica serovar Typhi was susceptible to cephalosporins, aminoglycosides, quinolones but resistant to ampicillin. After 3 weeks of intravenous and oral therapy with ciprofloxacin, follow up transthoracic and transesophageal echocardiography showed no vegetation. In addition, follow up abdominal CT showed decreased size of splenic infarctions. The patient was treated with 2 weeks of intravenous and 4 weeks of oral ciprofloxacin, and was cured without sequelae or relapse for 6 months follow-up.
Aminoglycosides ; Ampicillin ; Bacteremia ; Cephalosporins ; Ciprofloxacin ; Echocardiography, Transesophageal ; Endocarditis ; Female ; Follow-Up Studies ; Humans ; Middle Aged ; Quinolones ; Recurrence ; Salmonella enterica* ; Salmonella Infections ; Salmonella typhi* ; Salmonella* ; Splenic Infarction* ; Tomography, X-Ray Computed

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

Babesiosis is a tick-borne, malaria-like illness caused by Babesia species that infect erythrocytes of mammals incidentally. The family Babesiidae is characterized by consisting of non-pigmented intraerythrocytic parasites that reproduce within erythrocytes by asynchronous, asexual budding into two or four daughter cells (tetrad). We experienced a case of human babesiosis presenting fever and chills. The patient was a 49-year old man, who had been in Africa (Ethiopia, Uganda). Three weeks before admission intermittent spiking fever had developed, which had been accompanied by severe chills. The peripheral blood smear (Giemsa-stain) revealed characteristic forms of an intracellular quadruplet parasite compatible with Babesia. The patient was improved significantly by the treatment with quinine and clindamycin for a week.
Africa ; Animals ; Babesia ; Babesiosis* ; Chills ; Clindamycin ; Erythrocytes ; Fever ; Humans ; Mammals ; Middle Aged ; Nuclear Family ; Parasites ; Quadruplets ; Quinine