Systemic infection due to Trichosporon beigelii is uncommon but increasingly reported in immunocompromised patients. Trichosporonosis is often refractory to conventional antifungal therapy and frequently fatal. We report a case of systemic T. beigelii infection in a patient with acute leukemia. The 35-year-old male patient had been diagnosed as acute myelogenous leukemia with severe neutropenia and received cytotoxic drug therapy. As a fever developed on the day 21 of chemotherapy, broad spectrum antibiotics were administered empirically. Even though an antifungal drug, amphotericin B was replaced because the blood cultures resulted in T. beigelii, the patient died of the septic shock. We think that T. beigelii should be included as a potential life-threatening pathogen capable of causing widespread systemic disease in the immunocompromised host.
Adult ; Amphotericin B ; Anti-Bacterial Agents ; Drug Therapy ; Fever ; Humans ; Immunocompromised Host ; Leukemia* ; Leukemia, Myeloid, Acute ; Male ; Neutropenia ; Shock, Septic ; Trichosporon* ; Trichosporonosis

Although Malassezia furfur is normal skin flora causing superficial skin diseases, cases of fungemia have been reported recently in premature newborns or immunocompromised patients related to prolonged central venous catheterization for lipid supplementation. We report a case of M. furfur fungemia in a premature infant receiving intravenous lipid supplementation through central venous circulation. She was treated only with antifungal agents without removal of the catheter or discontinuation of lipid supplementation. Soon after, symptoms and signs of the patient seemed to be improved. However, central venous catheter was removed because of recurrent septicemia of Staphylococcus aureus and the culture of central venous catheter tip showed colonization of M. furfur.
Antifungal Agents ; Catheterization, Central Venous ; Catheters ; Central Venous Catheters* ; Colon ; Fungemia* ; Humans ; Immunocompromised Host ; Infant, Newborn ; Infant, Premature ; Malassezia* ; Sepsis ; Skin ; Skin Diseases ; Staphylococcus aureus

V. parahaemolyticus was isolated from blood culture of a 34-year old female patient with HCV viral hepatitis and liver cirrhosis. V. parahaemolyticus is one of the frequent causative agents of gastrointestinal infection, but rarely causes septicemia. This case is thought to be the 3rd report of V. parahaemolyticus septicemia in Korea.
Adult ; Female ; Hepatitis ; Humans ; Korea ; Liver Cirrhosis* ; Liver* ; Sepsis* ; Vibrio parahaemolyticus* ; Vibrio*

Methicillin-resistant Staphylococcus aureus colony variants (SCVs) are frequently auxotrophic for hemin, menadione, thiamine, and CO2 involved in biosynthesis of the electron transport chain element. This phenotype grows slowly, and forms very small, nonhemolytic colonies in routine culture, so it may be led to the misidentification of this organism. We isolated an organism with catalase-positive, gram-positive cocci in cluster from the urine of a 55-years-old woman with persistent and relapsing bladder stone, who had undergone the antibiotic treatment with cefotaxime, ceftizoxime, amikacin, and/or micronomicin, intermittently for three years. The possibility of SCVs should have been ruled out because this organism didn't grow on Mueller-Hinton agar (MHA) for the susceptibility test. It formed small colonies on blood agar plate overnight, and grew only on MHA with supplement of hemin, or with 5% CO2. This organism was coagulase-positive, DNase-positive, manitol-salt positive, and identified as S. aureus with VITEK GPI card. The susceptibility test could be performed after adding hemin(1mg/mL) into bacterial suspension and showed susceptibility against vancomycin, teicoplanin, and rifampin. Because these phenotypes can be misidentifide as other non-pathogenic organisms due to their atypical characteristics, we should consider SCVs in case of small, nonhemolytic colonies with catalase-positive, gram-positive cocci in cluster, showing no growth on MHA. In addition, infections caused by SCVs are recently recognized in relation to persistent and relapsing infection, so they could be isolated from the patients with long-term antibiotic therapy.
Agar ; Amikacin ; Cefotaxime ; Ceftizoxime ; Electron Transport ; Female ; Gram-Positive Cocci ; Hemin ; Humans ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Phenotype ; Rifampin ; Teicoplanin ; Thiamine ; Urinary Bladder Calculi* ; Urinary Bladder* ; Vancomycin ; Vitamin K 3

BACKGROUND: Although enriched broth cultures have been recommended as an adjuvant to the direct plating of tissue and body fluid specimens, the cost-effectiveness of broth cultures has been questioned in regard with the clinical significance of "broth only isolates(BOI)". The purpose of this study was to investigate the usefulness of thioglycollate broth(THIO) cultures. METHODS: We reviewed retrospectively results in the culture specimens of body fluids, tissue biopsies, and puses received during the month of July 1997. All specimens were inoculated into THIO in addition to agar plates. We reviewed the medical records of culture-positive patients to determine the clinical significance and relevance of their isolates. Clinically significant isolates were defined as those for which an appropriate antimicrobial therapy was done except one judged as contaminants by clinicians and clinically relevant isolates as the clinically significant one isolated first. RESULT: Of 2,008 specimens, 512(25.4%) from 365 patients grow 561 isolates 464 plate isolates and 97 BOI. Two hundred eighty nine(62.3%) of the 464 isolates from plate cultures were clinically significant, compared to only 12(12.4%) of 97 BOI (P<0.05). Only four (4.1%) BOI were clinically relevant, including one Pseudomonas aerugiosa from ascites. one Klebsiella pneumoniae and two Staphylococcus aureus from tissue specimens. CONCLUSION: A routine use of enriched broth culture rarely recover clinically relevant isolates. Considering the laboratory and medical costs of the recovery of contaminants and clinically irrelevant isolates, the enrichment broth cultures should be used more selectively.
Agar ; Ascites ; Biopsy ; Body Fluids ; Humans ; Klebsiella pneumoniae ; Medical Records ; Pseudomonas ; Retrospective Studies ; Staphylococcus aureus

BACKGROUND: Direct wet mount examination of vaginal secretion, widely applied for the diagnosis of Trichomonas vaginalis infection in woman patients, is rapid and economical. However, the sensitivity of this technique is not so high. In this study enzyme-linked immunosorbent assay(ELISA) was employed for the detection of serum anti-T. vaginalis IgG antibodies from vaginal trichomoniasis patients. METHODS: Eighty sera from trichomonoasis patients who visited a Dr. Yoon Kyong's Obstetric & Gynecologic Clinic in Songnam and 30 non-infected healthy men were tested for detection of anti-T. vaginalis IgG antibody. Soluble lysate and excretory-secretory antigen prepared by mixing of six isolates of T. vaginalis, and lysate from one isolate(KT4) were used as antigen for ELISA. RESULTS: The sensitivity of ELISA using lysate of six isolates was 95.0%, and the sensitivity of the lysate from KT4 and mixed excretory-secretory antigen from 6 isolates were 86.4% and 76.3%, respectively. Specificities of ELISA by three 93.3%, 96.3% and 92.0%, respectively. CONCLUSION: It is suggested that ELISA using mixed lysate of T. vaginalis six isolates could be useful tools for the diagnosis of trichomoniasis.
Antibodies ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Female ; Gyeonggi-do ; Humans ; Immunoglobulin G* ; Male ; Trichomonas vaginalis ; Trichomonas*

Microscopic examination of peripheral blood smear (PBS) for detection of microorganisms is simple method that can be used for doctors to confirm the septicemia more swiftly and to select more specific therapy. But it is unusual to find microorganisms in PBS. We report a case of gram negative bacteremia diagnosed by PBS in a severe thrombocytopenic pediatric surgical patient. A 6-month and 2 week old baby with cyanosis was diagnosed congenital heart diseases such as transposition of great arteries, atrial septal defect, and patent ductus arteriosus. The infant underwent surgical operations and the postoperative platelet count progressively decreased in spite of transfusion of multiple platelet concentrates. We performed routine examination of a PBS for evaluation of severe thrombocytopenia. The PBS revealed severe thrombocytopenia, leukopenia with left shifted and some extracellular bacilli. Toxic granulations, toxic vacuoles and some bacilli were observed in the neutrophils. The bacilli were identified as Pseudomonas aeruginosa and Serratia marcescens in blood culture. To our knowledge, this is the second case of bacteremia diagnosed by PBS before the positive blood culture in Korea. We suggest that a PBS is useful for the rapid detection of organisms in cases of septicemia with severe thrombocytopenic pediatric surgical patient.
Bacteremia ; Blood Platelets ; Cyanosis ; Ductus Arteriosus, Patent ; Heart Diseases ; Heart Septal Defects, Atrial ; Humans ; Infant ; Korea ; Leukopenia ; Neutrophils ; Platelet Count ; Pseudomonas aeruginosa ; Sepsis ; Serratia marcescens ; Thrombocytopenia ; Transposition of Great Vessels ; Vacuoles

Balantidium coli is the only largest ciliated protozoon known to infect human and nonhuman primates. Balantidiasis is a zoonotic disease and is acquired by humans via fecal-oral contact between pigs and humans. The clinical manifestation includes mainly gastrointestinal symptoms; diarrhea and abdominal pain, but in rare cases extraintestinal spread to lungs has been reported. A few reports of B. coli were found in vaginal secretion, skin, gastric juice, and omentum, but there have been no previous isolated cases in the respiratory tract in Korea. We reported that the first case of pneumonia caused by B. coli in Korea in an immunocompetent 40-year-old woman who displayed symptoms of chest discomfort and cough, and was cured with metronidazole.
Abdominal Pain ; Adult ; Balantidiasis ; Balantidium ; Cough ; Diarrhea ; Female ; Gastric Juice ; Humans ; Korea ; Lung ; Metronidazole ; Omentum ; Pneumonia ; Primates ; Respiratory System ; Skin ; Swine ; Thorax

Microbacterium oxydans, a coryneform gram-positive bacillus, have been isolated from a wide variety of environmental sources and reported its pathogenic potential with increasing frequency in the last few years. Microbacterium comprises more than 60 species. 16S rRNA sequences in different Microbacterium species are highly conserved and the differences of biochemical characteristics between several species are unclear. As a result, identification of Microbacterium to species level has been difficult in most clinical microbiology laboratories. In this article, we report a case of catheter-related bacteremia caused by M. oxydans that was identified by 16S rRNA sequencing analysis and phenotypic characteristics in patient with diffuse large B-cell lymphoma.
Bacillus ; Bacteremia ; Humans ; Lymphoma, B-Cell

BACKGROUND: Metallo-beta-lactamases (MBLs) have been reported in gram negative bacilli and are becoming increasingly important clinically because the enzymes hydrolyse almost all beta-lactams, including carbapenems. Thus, the present study was conducted to determine the prevalence of MBL types in imipenem-nonsusceptible Pseudomonas aeruginosa and Acinetobacter baumannii isolated from a tertiary teaching hospital. METHODS: Imipenem-nonsusceptible strains, 128 P. aeruginosa and 93 A. baumannii, were collected from clinical specimens. Identification and susceptibility tests were determined by Vitek GNI and GNS cards. MBL production was determined by modified Hodge test and imipenem-EDTA synergy test. Multiplex PCR amplification of MBL genes including blaIMP-1, blaVIM-1 and blaVIM-2 were performed. RESULTS: Thirty-one P. aeruginosa (24.2%) isolates and 3 A. baumannii (3.2%) were found to be MBL producers. In P. aeruginosa, 20 (15.6%) and 11 (8.6%) isolates were positive for blaIMP-1 and blaVIM-2, respectively whereas 1 (1.0%) and 2 (2.2%) isolates in A. baumannii, respectively. CONCLUSION: IMP-1 is more prevalent MBL type than VIM-2 among imipenem-nonsusceptible P. aeruginosa unlike in other studies. Larger numbers of isolates and sequential studies are strongly recommended for the useful evaluation and monitoring of MBL production in the hospital setting to infection-control.
Acinetobacter ; Acinetobacter baumannii ; beta-Lactams ; Carbapenems ; Drug Resistance, Multiple ; Multiplex Polymerase Chain Reaction ; Prevalence ; Pseudomonas ; Pseudomonas aeruginosa