Hepatocellular carcinoma (HCC) is one of the most common malignancies in Korea. Transarterial chemoembolization (TACE) is an effective modality for treating HCC with a few complications. Liver abscess is most common infectious complication during post-TACE period. However, liver abscess caused by Salmonella typhi has never been reported. We experienced two cases of liver abscess following TACE, caused by S. typhi. Th clinical manifestations of S. typhi liver abscess are similar with other pyogenic liver abscesses. The CT scans showed liver abscesses mixed with necrotic materials after TACE, and the cultures of blood and abscess aspirates yielded S. typhi. The patients did not respond well only with the antibiotic treatment and was controlled after percutaneous drainage. A possible pathogenesis of these liver abscesses is considered as secondary infection in the necrotic liver tissues in biliary carrier of S. typhi.
Abscess ; Carcinoma, Hepatocellular ; Coinfection ; Drainage ; Humans ; Korea ; Liver Abscess* ; Liver Abscess, Pyogenic ; Liver* ; Salmonella typhi* ; Salmonella* ; Tomography, X-Ray Computed

Pneumonia is a fatal disease in immunocompromised patients including bone marrow transplantation recipients. Etiological agents include fungi, cytomegalovirus, Pneumocystis carinii, influenza virus and parainfluenza virus. We describe a community-acquired respiratory syncytial virus pneumonia in a patient who received intense chemotherapy followed by peripheral stem cell transplantation for acute leukemia. The patient was treated with intravenous immunoglobulin and ribavirin aerosol. About 1 month later, she was recovered.
Bone Marrow Transplantation ; Cytomegalovirus ; Drug Therapy ; Fungi ; Humans ; Immunocompromised Host ; Immunoglobulins ; Leukemia ; Orthomyxoviridae ; Paramyxoviridae Infections ; Peripheral Blood Stem Cell Transplantation* ; Pneumocystis carinii ; Pneumonia* ; Respiratory Syncytial Viruses* ; Ribavirin

Campylobacter jejuni enterocolitis is one of the common causes of acute infectious diarrhea, but most of them remain unrecognized by routine microbiologic examination. Its clinical manifestations are watery diarrhea, malaise, fever and abdominal pain. The clinical course is self-limited in majority of cases. However cases of Campylobacter jejuni infections as cholecystitis, pancreatitis, peritonitis or cystitis have been infrequently reported. Moreover, reactive arthritis, hepatitis, interstitial nephritis or hemolytic uremic syndrome rarely develops in Campylobacter jejuni enterocolitis. We experienced a patient with Campylobacter jejuni enterocolitis, who had shown complex clinical features manifested by pancreatitis and hemolytic uremic syndrome. We reported the case with literature reviews.
Abdominal Pain ; Arthritis, Reactive ; Campylobacter jejuni* ; Campylobacter* ; Cholecystitis ; Cystitis ; Diarrhea ; Enterocolitis* ; Fever ; Hemolytic-Uremic Syndrome* ; Hepatitis ; Humans ; Nephritis, Interstitial ; Pancreatitis* ; Peritonitis

Central nervous system cryptococcosis is common in the AIDS patients with reported incidences ranging from 1.9% to 11.0%. Cryptococcosis may be the initial manifestation of HIV infection or occur simultaneously with other opportunistic infections. HIV-infected patients with central nervous system cryptococcosis complain of fever, headache, nausea and vomiting, and cognitive dysfunction. Meningeal signs and photophobia are less common than in HIV-negative patients. Focal neurologic signs and seizures are uncommon. Disseminated cryptococcosis is often concomitantly found at the time of central nervous system cryptococcosis. We report a case of 49 year-old Korean female with HIV infection who died of disseminated cryptococcosis with autopsy findings.
Autopsy* ; Central Nervous System ; Cryptococcosis* ; Female ; Fever ; Headache ; HIV Infections ; Humans ; Incidence ; Middle Aged ; Nausea ; Neurologic Manifestations ; Opportunistic Infections ; Photophobia ; Seizures ; Vomiting

BACKGROUND: Patients infected with Staphylococcus aureus related to the use of propofol have been reported. The purpose of this study was to assess and compare the growth of S. aureus in propofol, thiopental, midazolam and ketamine. METHODS: These intravenous anesthetics were inoculated with S. aureus and they were plated onto blood agar at 0, 3, 6, 21, 24 and 27 hrs. The number of colony forming units (CFU) on the plate was counted after 24 hours of incubation. RESULTS: Samples from ketamine and midazolam showed no CFU at the 3 hr and thereafter. The 21hr, thiopental exhibited no CFU. The inoculated propofol emulsion showed a significant increase in number of CFU at the 21, 24 and 27hr compared with the zero time (P<0.05). CONCLUSIONS: This study shown that propofol was the only anesthetic that provided a medium for the growth of S. aureus. Therefore when handling propofol, meticulous sterile technique is advised.
Agar ; Anesthetics ; Anesthetics, Intravenous* ; Humans ; Ketamine ; Midazolam ; Propofol ; Staphylococcus aureus* ; Staphylococcus* ; Stem Cells ; Thiopental

BACKGROUND: Carbapenem-resistant Acinetobacter spp. are being isolated with increasing frequency from clinical sources. This study was designed to determine the resistance mechanism to carbapenems of Acinetobacter spp. isolates from patients of a tertiary care hospital in Busan, Korea. METHODS: Nonduplicated clinical isolates of Acinetobacter spp. resistant to carbapenems were collected during the period of 2000-2001 in Kosin Medical Center, Busan, Korea. Antimicrobial susceptibilities were tested by disk diffusion method. Carbapenem-resistant Acinetobacter spp. isolates were examined for metallo-beta-lactamase-production by modified Hodge and EDTA-disk synergy tests. For the detection of blaIMP-1 and blaVIM-2 genes, polymerase chain reactions (PCR) were performed, and the DNA sequences of amplified products were determined by using dideoxy- chain termination method. RESULTS: Among 21 clinical isolates of Acinetobacter spp. intermediate or resistant to carbapenems, 17 isolates showed positive reactions in modified Hodge and EDTA-disk synergy tests. Nine isolates showed positive reaction in PCR for the detection of blaIMP-1 genes, and 8 isolates showed positive reaction in PCR for the detection of blaVIM-2 genes. Sequencing of amplified products showed that they were blaIMP-1 or blaVIM-2 genes. CONCLUSION: Acinetobacter spp. isolates with carbapenem-resistance are not uncommon in Kosin Medical Center, and most of the carbapenem-resistant isolates acquired resistance by production of IMP-1 or VIM-2 metallo-beta-lactamases. The spread of metallo-beta-lactamase genes could compromise the future usefulness of carbapenem for the treatment of gram-negative bacilli infections.
Acinetobacter* ; Base Sequence ; Busan ; Carbapenems ; Diffusion ; Genotype* ; Humans ; Korea ; Polymerase Chain Reaction ; Tertiary Healthcare

BACKGROUND: Acute pyelonephritis in women can be treated with trimethoprim-sulfamethoxazole (SXT), fluoroquinolone, aminoglycosides, second- and third- generation cephalosporins. The purpose of this study is to provide basic informations for the choice of the most effectve and economic first-line antibiotics among several agents to clinicians, who manage community- acquired acute pyelonephritis. METHODS: We investigated antibiotic sensitivities of 130 organisms isolated from urine culture of 165 patients, who admitted to Catholic University St. Vincent's Hospital due to community-acquired acute pyelonephritis from February 2001 to November 2002. All those patients had more than 105 cfu/mL on urine culture and we analyzed the usage of antibiotics and clinical course in those patients. RESULTS: Among 130 isolates, 120 isolates were E. coli, 6 K. pneumoniae, 1 K. oxytoca, 1 Enterobacter aerogenes and 2 Proteus mirabilis. Among 120 E. coli, the rates of resistance were 59.2% to piperacillin, 58.3% to cephalothin, 36.7% to sulfamethoxazole, 19.2 % to gentamicin, and 7.5% to ciprofloxacin in order. For 120 E. coli isolates, 100%, 99.2%, 99.2%, 99.2%, and 97.5% were susceptible to imipenem, cefotaxime, cefuroxime, amikacin, and piperacillin/tazobactam, respectively. Among 165 patients, 130 patients who had positive urine or blood culture, were divided into three groups according to the first-line antibiotics administered on the day of admission. Gentamicin (5 mg/kg q 24h) were infused to 90 patients, and 9 (10%) of 90 patients revealed clinical manifestations of therapeutic failure such as persistent fever and pyuria in group I. Cefuroxime were administered to 36 patients in group II and all 36 patients revealed evidences of clinical success such as defervescence and absence of pyuria. Intravenous antibiotics changed to oral administration of the first-, second-cephalosporin, and trimethoprim- sulfamethoxazole in all patients except one patient, who received oral fluoroquinolone according to the results of antibiotic sensitivities. CONCLUSION: Cefuroxime, amikacin, and the third- generation cephalosporins showed excellent antibacterial activity against isolated organisms from women with acute pyelonephritis in this study, and gentamicin could be used as initial empiric regimen with careful monitoring of clinical response and antibiotic sensitivities of isolated microorganisms. These findings would be useful informations to physicians, who are trying to use low-priced antibiotics with narrow spectrum antibacterial activity, sparing more expensive and broad spectrum antibiotics in managing urinary tract infections.
Administration, Oral ; Amikacin ; Aminoglycosides ; Anti-Bacterial Agents* ; Cefotaxime ; Cefuroxime ; Cephalosporins ; Cephalothin ; Ciprofloxacin ; Enterobacter aerogenes ; Female ; Fever ; Gentamicins ; Humans ; Imipenem ; Piperacillin ; Pneumonia ; Proteus mirabilis ; Pyelonephritis* ; Pyuria ; Sulfamethoxazole ; Trimethoprim, Sulfamethoxazole Drug Combination ; Urinary Tract Infections

We report a case of acute retroviral syndrome presen-ting as a fever of unknown origin. A 22-year-old man was admitted to the hospital because of fever. He had been well untill 20 days earlier when he experienced fe-ver and headache. Three days before admission diarrhea, vomiting, sore throat and myalgia developed. Physical examination revealed skin rash, and multiple lymphadeno-pathy. Acute human immunodeficiency virus (HIV) infec- tion was confirmed by seroconversion. As the number of patients with HIV infection is increasing in Korea, acute retroviral syndrome should be included in the differential diagnosis of fever of unknown origin.
Diagnosis, Differential ; Diarrhea ; Exanthema ; Fever of Unknown Origin* ; Fever* ; Headache ; HIV ; HIV Infections ; Humans ; Korea ; Myalgia ; Pharyngitis ; Physical Examination ; Vomiting ; Young Adult ; Zidovudine*

Mycobacterium tuberculosis infrequently infects muscle. We experienced a case of tuberculosis myositis compli-cated with usual interstitial pneumonia(UIP). A 56 year-old male patient was admitted due to erythematous painful swelling on left proximal upper ex-tremity and right inner thigh for 10 months. The level of serum creatine kinase, lactic acid dehydrogenase, serum glutamic oxaloacetic transaminase, serum glutamic pyru-vate transaminase and aldolase were elevated. Electromyo-graphy showed low amplitude, short duration, polyphasic motor unit potentials at left biceps brachii, flexor carpi radialis longus, extensor carpi radialis longus, right adductor longus and early recruitment pattern at right biceps brachii. Mcscle biopy showed the findings compatible with tuberculosis. Interstitial lung disease was suspected on chest x-ray and high-resornance computerized tomography, usual in-terstitial pneumonia(UIP) was confirmed by open lung biopsy. We started anti-tuberculosis medication and pred-nisolone for the treatment of tuberculous myositis and UIP, respectively. After 4 weeks of treatment, patient' s symptoms of myositis were improved. The patient is being followed up for monitoring treatment response to prednisolne for UIP.
Aspartate Aminotransferases ; Biopsy ; Creatine Kinase ; Fructose-Bisphosphate Aldolase ; Humans ; Idiopathic Pulmonary Fibrosis* ; Lactic Acid ; Lung ; Lung Diseases, Interstitial ; Male ; Middle Aged ; Mycobacterium tuberculosis ; Myositis* ; Oxidoreductases ; Thigh ; Thorax ; Tuberculosis

No abstract available.
Korea* ; Malaria*