Haemophilus aphrophilus is a facultative anaerobic, gram-negative coccobacillus or bacillus and its growth is stimulated by 5 to 10% CO2. Most Haemophilus species require either exogenous X or V factor or both to grow, but H. aphrophilus can grow without these factors. H. aphrophilus rarely causes invasive infections such as endocarditis, septicemia, pneumonia and peritonitis in human. Two cases of infective endocarditis by H. aphrophilus have been reported in Korea. However, there has been no report of polymicrobial endocarditis by H. aphrophilus and other bacteria. We isolated H. aphrophilus and coagulase-negative staphylococci (CNS) from the blood of a 38-year-old woman with prosthetic valve endocarditis. She underwent an emergent operation and a culture of the prosthetic valve grew H. aphrophilus. Brain abscess was developed at hospital day 11. H. aphrophilus was susceptible to all antibiotics tested such as ampicillin and cefotaxime, and CNS was susceptible to oxacillin and vancomycin. The patient responded well to therapy with ceftriaxone, teicoplanin, and gentamicin.
Adult ; Aggregatibacter aphrophilus* ; Ampicillin ; Anti-Bacterial Agents ; Bacillus ; Bacteria ; Brain Abscess ; Cefotaxime ; Ceftriaxone ; Endocarditis* ; Female ; Gentamicins ; Haemophilus* ; Humans ; Korea ; Oxacillin ; Peritonitis ; Pneumonia ; Sepsis ; Teicoplanin ; Vancomycin

alpha-hemolytic streptococci (AHS) are common normal oropharyngeal flora that can transfer antibiotic-resistance genes to Streptococcus pneumoniae. Reports on antibiotic resistance in AHS from throats are rare in Korea. A total of 333 healthy school children were subjected to recovery of AHS from the throat, and antibiotic susceptibility tests were screened with the disk diffusion method. The rate of resistance to erythromycin was 22.2%, to clindamycin 12.0%, and to cefotaxime 3.0%. Whereas the resistance rate of S. pneumoniae to erythromycin exceeds 70% in Korea, pharyngeal AHS showed low resistance rates.
Cefotaxime ; Child ; Clindamycin ; Diffusion ; Drug Resistance, Microbial ; Erythromycin ; Humans ; Korea ; Pharynx ; Pneumonia ; Streptococcus pneumoniae

Escherichia coli O157 is an important serotype of enterohemorrhagic E. coli that causes hemorrhagic colitis worldwide. Outbreaks of E. coli O157 have been assocoated with contaminated food like meat, raw milk, and water, but recently vegetables and fruits have accounted for a growing number of recognized outbreaks. We isolated verotoxin producing E. coli O157 from the stool of a 3 year-old female with bloody diarrhea and abdominal pain. The child had been eating salad with vegetables and fruits frequently.
Abdominal Pain ; Child ; Colitis ; Diarrhea ; Disease Outbreaks ; Eating ; Enterohemorrhagic Escherichia coli ; Escherichia ; Escherichia coli ; Escherichia coli O157 ; Female ; Fruit ; Humans ; Meat ; Milk ; Shiga Toxins ; Vegetables

Granulicatella adiacens is one of the fastidious gram positive cocci previously described as nutritionally variant streptococci due to their requirement of L-cysteine, pyridoxal, or thiol compounds for growth. These bacteria have been identified as significant causative agents of endocarditis, opthalmic infections, and meningitis. We report a case of septicemia caused by G. adiacens in an 80-year-old patient with cholangiocarcinoma. The organism was identified by phenotypic and 16S rRNA sequencing analyses.
Aged, 80 and over ; Bacteria ; Cholangiocarcinoma ; Cysteine ; Endocarditis ; Gram-Positive Cocci ; Humans ; Meningitis ; Pyridoxal ; Sepsis

BACKGROUND: Serologic tests for specific antibody nowadays are widely employed for the diagnosis of parasitic diseases. Recently, an increasing numbers of kits have adopted enzyme-linked immunosorbent assay (ELISA) for the detection of parasitic antibodies. In this study, we evaluated two ELISA reagents for the diagnosis of parasitic diseases. METHODS: A total of 553 serum and 156 CSF samples were assayed using an in-house micro-ELISA and Genedia(R) Ab ELISA (Green cross PBM, Korea) for Cysticercus, Paragonimus westermani, Clonorchis sinensis, and Sparganum. We reviewed the medical records of all patients. The results from Genedia(R) Ab ELISA kit were compared with those from the in- house micro-ELISA method. RESULTS: The overall concordance rate between the two ELISA tests was 95.5%. When compared with the clinical information, the sensitivity, specificity, positive predictive value, and negative predictive value of the in-house micro-ELISA were 100%, 99.0~99.6%, 82.4~96.4%, and 100%, and the respective figures for Genedia(R) Ab ELISA kit were 92.9~100%, 88.0~97.3%, 41.7~50%, and 99.9~100% with kappa agreement of 0.53-0.63. Comparison of two ELISA methods showed a significant difference (P<0.05). Retesting of 85 discordant samples showed that the concordance rate of the in-house ELISA was 97.7% and that of Genedia(R) Ab ELISA was 28.2%. CONCLUSION: Genedia(R) Ab ELISA kit showed an intermediate level of kappa agreement compared with the in-house ELISA. Further studies are necessary to improve the concordance rate of the two methods, and a careful interpretation of these results is required for a precise diagnosis.
Antibodies ; Clonorchis sinensis ; Cysticercus ; Enzyme-Linked Immunosorbent Assay ; Humans ; Indicators and Reagents ; Medical Records ; Paragonimus westermani ; Parasitic Diseases ; Sensitivity and Specificity ; Serologic Tests ; Sparganum ; Streptothricins

BACKGROUND: Fungemia has increased over the past decade and is an important cause of significant morbidity and mortality. Since 1980, there has been an increase in the worldwide studies of nosocomial bloodstream fungal infections. We analyzed the distribution and the clinical characteristics of fungemia at a tertiary care hospital, Kyung Hee University hospital. METHODS: We retrospectively reviewed medical records and laboratory findings of 139 patients who had fungemia from January 2000 to December 2006. We investigated the incidence of each fungal species, yearly occurrence, underlying diseases, hospitalized units, predisposing factors, use of the antifungal agents, mortality, and the characteristics of the expired group. RESULTS: The most common species isolated was C. albicans (40.3%), followed by C. tropicalis (24.5%). Overall, fungemia occurrence showed an increasing trend during the study period, except for the year 2004. Common predisposing factors were previous antimicrobial therapy (89.2%), central venous catheter (78.4%), and ICU admission state at diagnosis (59.7%). among the 139 patients, 98 (70.5%) were treated. Primary choice of antifungal agents included fluconazole (70.4%) and amphotericin B (29.0%). Overall mortality was 38.9% with the highest rate (47.1%) in patients with C. tropicalis and the lowest one (22.2%) in patients with C. parapsilosis. Predisposing factors for mortality due to fungemia in the univariate analysis included only mechanical ventilation (P=0.008). CONCLUSION: Fungemia in the tertiary care hospital was caused predominantly by C. albicans and followed by C. tropicalis. The mortality rate was high and interspecies differences existed.
Amphotericin B ; Antifungal Agents ; Central Venous Catheters ; Fluconazole ; Fungemia ; Humans ; Incidence ; Medical Records ; Respiration, Artificial ; Retrospective Studies ; Tertiary Healthcare

BACKGROUND: The purposes of the current study were to evaluate the concordant rates of anti-mycobacterial drug susceptibility test (DST) results in different solid media performed in different institutes, and to determine reliable susceptible testing methods. METHODS: One hundred and twenty two Mycobacterium tuberculosis strains were isolated from patients in A Hospital in 2005. DSTs were performed by the absolute concentration method using L?wenstein Jensen medium in both A Hospital (method A-1) and B Institute (method B-1) and by the proportion method using Middlebrook 7H10 agar in B Institute (method B-2). Nine drugs were used including isoniazid and rifampin. Sensitivity and specificity of each method were estimated by using the acceptable standard of 90% for isoniazid and rifampin and 80% for other drugs. The therapeutic outcomes of quinolone-administered patients were evaluated according to ofloxacin susceptibility results. RESULTS: Method B-1 showed sensitivity and specificity levels over the acceptable standard levels for all drugs. Method B-2 showed specificity lower than the acceptable levels for rifampin and cycloserine. Method A-1 showed specificity lower than the acceptable levels for isoniazid, streptomycin, p-aminosalicylic acid, and ofloxacin and sensitivity lower than the acceptable levels for prothionamide and cycloserine. The concordance rates of therapeutic outcomes with method B-1, method B-2, and method A-1 were 77%, 74%, and 65%, respectively. CONCLUSION: The drug susceptibility results for some drugs were discordant between the testing laboratories and media, requiring an urgent application of quality control programs to raise the reliability of anti-mycobacterial DST.
Academies and Institutes ; Agar ; Aminosalicylic Acid ; Culture Media ; Cycloserine ; Humans ; Isoniazid ; Mycobacterium tuberculosis ; Ofloxacin ; Prothionamide ; Quality Control ; Rifampin ; Sensitivity and Specificity ; Streptomycin

BACKGROUND: Infections caused by nontuberculous mycobacteria (NTM) are significantly increasing over the last decade. Due to the uncertainty in the clinical significance of these organisms, their effective diagnosis and treatment has been challenging. The purpose of this study was to investigate the distribution and clinical significance of NTM in clinical specimens. METHODS: Acid-fast culture positive 3,107 clinical specimens were identified by mycolic acid analysis using high performance liquid chromatography (HPLC.) The HPLC patterns of 384 NTM strains were compared with those of standard mycobacterium species. Clinical significance of NTM was investigated by a retrospective study including acid-fast stain and culture, medical history, symptoms and signs, radiological and other laboratory findings, pathologic findings, response to treatment, and follow-up study, and was confirmed according to the guideline of American Thoracic Society. RESULTS: Among the 3,107 Mycobacterium-positive specimens, 384 (12.4%) were found to be positive for NTM. Of these, 367 (95.6%) were successfully identified by HPLC as 19 different species, each of which comprising 0.3% to 15.9% of the total NTM, Studies on the pathogenic role of NTM showed that 0~79.6% of each species or 0~100% of isolates from each specimen could be considered clinically significant. CONCLUSION: HPLC method is highly discriminative for the identification of NTM in clinical specimens. When NTM is isolated from clinical specimens in the Ulsan area, the findings from this study could serve as a database on which to determine its clinical significance depending on species type and also specimen type.
Chromatography, High Pressure Liquid ; Chromatography, Liquid ; Follow-Up Studies ; Mycobacterium ; Mycolic Acids ; Nontuberculous Mycobacteria ; Retrospective Studies ; Uncertainty

Although Leuconostoc species with intrinsic high-level vancomycin resistance have rarely been isolated from clinical specimens, this organism may cause serious invasive infections such as bacteremia and meningitis in immunocompromised hosts or patients with a wide spectrum of underlying diseases including alcoholic liver diseases and gastrointestinal diseases. Predisposing factors of Leuconostoc bacteremia include intravenous or enteral feeding catheters, other invasive access devices such as tracheostomy, gastrostomy or endotracheal tubes, and previous antimicrobial treatment. This low prevalence may be due, in part, to the inability of automated systems to recognize this organism. It is important that all Leuconostoc isolates obtained from clinical specimens that are related to serious infections should be identified to species level for appropriate antibiotic therapy. We report two cases of Leuconostoc bacteremia occurring in a 65-year-old male with variceal bleeding, and in a 5 month child with ileostomy receiving total parenteral nutrition therapy.
Aged ; Bacteremia* ; Catheters ; Causality ; Child ; Enteral Nutrition ; Esophageal and Gastric Varices ; Gastrointestinal Diseases ; Gastrostomy ; Humans ; Ileostomy ; Immunocompromised Host ; Leuconostoc* ; Liver Diseases, Alcoholic ; Male ; Meningitis ; Parenteral Nutrition, Total ; Prevalence ; Tracheostomy ; Vancomycin Resistance

Streptococcus pneumoniae is the most common cause of community-acquired pneumonia in adults and an important agent in other infections, including meningitis, otitis media, and conjunctivitis, etc. The optochin susceptibility test is the most widely used method to discriminate S. pneumoniae from other streptococci. However, 0.8-1.5% of S. pneumoniae contain optochin resistant population. Recently, we experienced three cases of variants of S. pneumoniae with decreased susceptibility to optochin. Equivocal optochin disk test should be confirmed by bile solubility, agglutination test, or DNA probe test.
Adult ; Agglutination Tests ; Bile ; Conjunctivitis ; DNA ; Humans ; Meningitis ; Otitis Media ; Pneumonia ; Solubility ; Streptococcus pneumoniae* ; Streptococcus*