BACKGROUND: The principal acute febrile diseases reported in autumn, Korea, have been hemorrhagic fever with renal syndrome (HFRS), scrub typhus, murine METHODS: To evaluate the seroepidemiologic patterns of acute febrile illness in Korea, sera were collected from 5330 patients from 1994 to 1995, and examined for antibodies against Hantaan virus, Orientia tsutsuga-mushi, Rickettsia typhi, and Borrelia burgdorf eri by indirect immunofluorescent antibody technique(IFA) and by macroscopic agglutination test for Leptosp ira intero-gans. RESULTS: Of 640 seropositive cases against O. tsutsu-gamushi, 60% were female; age group of the seventh decade occupied 30%; 89% were reported during October and November. By IFA test, the seropositive rate of murine typhus was 3.5% (187/5330) with high incidence rate (44%) in the period from October to December, and males in their forties and fifties were mostly affected. Cases seropositive for leptospirosis consisted 1% of 5330 acute febrile illness cases. Of 55 seropositive cases, 71% were male; 71% were in their sixties; 78% occurred during the period from August to October. Hantavirus seropositive rate was 12.2% (649/5330) with a high incidence rate (70%) in the period from October to January and males in the thirties were mostly infected. No seropositive case of Lyme disease was present. CONCLUSION: The above results indicate that hantavirus, O. tsutsugamushi, R. typhi, and L. interogans were the main causative agents of acute febrile diseases during autumn season in Korea.
Agglutination Tests ; Antibodies ; Borrelia ; Female ; Hantaan virus ; Hantavirus ; Hemorrhagic Fever with Renal Syndrome ; Humans ; Incidence ; Korea* ; Leptospirosis ; Lyme Disease ; Male ; Rickettsia typhi ; Scrub Typhus ; Seasons ; Typhus, Endemic Flea-Borne

BACKGROUND: Typhoid fever is diagnosed by culture or serological study. The confirmative diagnosis of typhoid fever is made by culture of the causative orga-nism usually from body fluids. Serological test is a supportive diagnostic tool, which is useful for early dia-gnosis. In Severance Hospital, Vi-indirect fluorescent antibody test(Vi-IFAT) using the Vi-antigen of Salmo-nella typhi has been used in the diagnosis of typhoid fever since 1989. We investigated the test results from the past 7 years, in order to clarify the sensitivity and specificity of Vi-IFAT. METHODS: A retrospective study was done on pa-tients whose chief complaint was fever and who were tested using Vi-IFAT in the Severance Hospital from 1989 to 1996. The positive value for Vi-IFAT was de- fined as 1:64 or higher. RESULTS: The sensitivity and specificity of Vi-IFAT for typhoid fever was 94.4% and 95.1%, respectively. The positive and negative predictive values were 85.7% and 98.2% respectively. Positive rates of Vi-IFAT after fever onset increased with time and 68% were positive before the first week. From the first to the second week, 89.5% were positive and after the second week, 100% were positive. CONCLUSION: Vi-IFAT is not only a valuable sero-logic test for the diagnosis of typhoid fever, but also useful in the early diagnosis of the disease.
Body Fluids ; Diagnosis* ; Early Diagnosis ; Fever ; Retrospective Studies ; Sensitivity and Specificity* ; Serologic Tests ; Typhoid Fever*

BACKGROUND: Conventional diagnostic methods of pulmonary tuberculosis, such as acid-fast bacilli staining and culture of sputum, have the disadvantages of low sensitivity and long incubation period, respectively. The diagnosis of extrapulmonary tuberculosis needs invasive procedures. We investigated the value of PCR-based detection of Mycobacterium tuberculosis from peripheral blood mononuclear cells for diagnosis of pulmonary or extrapulmonary tuberculosis. METHODS: The peripheral blood mononuclear cells were collected from 23 patients with pulmonary tuber-culosis( n=10) and extrapulmonary tuberculosis(n=13), in-cluding miliary tuberculosis(n=5), and 10 healthy indi-viduals as negative controls. A pair of primers was used to produce a 314 bp amplification product from the insertion element IS6110, which is specific for M. tuberculosis. PCR products were detected by agarose gel electrophoresis and southern hybridization using a IS6110 specific oligoprobe. RESULTS: Eight out of ten with pulmonary tuberculo-sis and 9 out of 13 patients with extrapulmonary tuber-culosis showed positive results, yielding 73.9%(17/23) positivity on PCR assay. All five patients with miliary tuberculosis were positive. None of the healthy indivi-duals showed positive results. CONCLUSION: The PCR assay for M. tuberculosis from peripheral blood seems to be useful for diagnosis of tuberculosis, especially miliary tuberculosis. Further studies about the value of the PCR assay in monitoring treatment response are needed.
Diagnosis ; Electrophoresis, Agar Gel ; Humans ; Mycobacterium tuberculosis* ; Mycobacterium* ; Polymerase Chain Reaction* ; Sputum ; Tuberculosis* ; Tuberculosis, Miliary ; Tuberculosis, Pulmonary

BACKGROUND: Infection is the major life-threatening complication of acute leukemia. For the empirical treat-ment of infections in acute leukemia, monitoring of the patterns and trends of the infectious complications is im-portant. METHODS: We prospectively evaluated the febrile epi-sodes in patients with acute leukemia who were admitted to the Seoul National University Hospital during the period from January 1997 to December 1997. RESULTS: Seventy-eight febrile episodes in 56 patients were evaluated. Seventy percent of the febrile episodes were associated with chemotherapy, and 90% of them occurred during the neutropenic period. Common sites of infections were the gastrointestinal tract, followed by oropharynx, central venous catheter, perianal area, skin and soft tissue, blood stream, lung, paranasal sinus, liver, and urinary tract. Sixty-six percent of microbiologically- documented infections were caused by gram-negative organisms, and 26% by gram-positive organisms. Escheri-chia coli was the most common pathogen, and Staphy-lococcus aureus, Klebsiella pneumoniae, Enterobacter cloacae, Staphylococcus ep idermidis, Streptococcus species were common in decreasing order. Ninety-one percent of the total infections were controlled with antimicrobial therapy. CONCLUSION: The gastrointestinal tract was the most frequent site of infections in acute leukemic patients. Gram-negative organisms were responsible for 66% of the microbiologically documented infections. Ninety-one percent of the infectious complications were controlled with antimicrobial therapy.
Central Venous Catheters ; Drug Therapy ; Enterobacter cloacae ; Gastrointestinal Tract ; Humans ; Klebsiella pneumoniae ; Leukemia* ; Liver ; Lung ; Opportunistic Infections ; Oropharynx ; Prospective Studies ; Rivers ; Seoul ; Skin ; Staphylococcus ; Streptococcus ; Urinary Tract

BACKGROUND: Cytomegalovirus (CMV) infection is one of the important opportunistic infections in immuno-compromised patients. In Korea, seroprevalence of IgG against CMV is over 95%. Therefore, CMV diseases are expected to be a prevalent opportunistic infection in AIDS patients in Korea. METHODS: We reviewed the medical records of 128 patients with HIV infection who visited the Seoul Na-tional University Hospital during the period from Nov. 1987 to Sep. 1996. All the patients were examined by one ophthalmologist and the diagnosis of CMV retinitis were made by funduscopic findings. Other CMV dise-ases were diagnosed when histopathologic examinations showed the characteristic cytomegalic cells. RESULTS: Median duration of follow-up was 8 (0 ~ 59) months. Eleven CMV diseases were found in 7 patients (5.4%) : 6 patients had retinitis, 2 esophagitis, 1 colitis, 1 pneumonitis, and one patient developed disse-minated infection. Fifteen percent (6/33) of the patients whose CD4 + lymphocyte counts were less than 200/ mm 3 at baseline developed CMV diseases. Out of the 9 cases treated with ganciclovir, 7 improved or were stabi-lized. No patient received maintenance treatment and 3 had relapsed. CONCLUSION: CMV diseases are common opportuni-stic infections in AIDS patients in Korea.
Colitis ; Cytomegalovirus* ; Diagnosis ; Esophagitis ; Follow-Up Studies ; Ganciclovir ; HIV ; HIV Infections ; Humans ; Immunoglobulin G ; Korea ; Lymphocyte Count ; Medical Records ; Opportunistic Infections ; Pneumonia ; Retinitis ; Seoul ; Seroepidemiologic Studies

BACKGROUND: The changes in the epidemiology of native valve endocarditis have been known in western countries recent years due to the decrease in the inci-dence of rheumatic heart disease, increased longevity of patients with valvular or congenital heart diseases, and the increase in degenerative heart disease due to the in-crease in the average life span of the general popula-tion. In this study, we analyzed and compared the epide-miological and clinical characteristics of patients with na-tive valvular endocarditis fro two different time periods. METHODS: We compared native valve endocarditis patients diagnosed from 1979 - 1984(group I) with those diagnosed from 1991 - 1996(group II). We used modified Duke' s criteria for the diagnosis and statistical analysis was done using SPSS window program. RESULTS: In our study, mean age of the population was higher in group II and significantly larger number of patients were over the age of 50 in group II. Involve-ment of multiple valves with vegetations and peri-valvular abscess were found more frequently in group II. Also, significantly higher percentage of patients from group II underwent surgical treatment. CONCLUSION: The results of this study suggest that the epidemiolocaland clinical characteristics of infective endocarsitis in Korea may change to resemble those in western countries. Further studies regarding this subject are needed.
Abscess ; Diagnosis ; Endocarditis* ; Epidemiology ; Heart Diseases ; Humans ; Korea ; Longevity ; Rheumatic Heart Disease

BACKGROUND: Recently, new plasmid-mediated extended-spectrum beta-lactamases have been reported. These are not derived from TEM or SHV enzymes but are related to cephalosporins of Enterobacteriaceae (AmpCenzymes), that confer to all cephalosporins including cefoxitin. METHODS: Fifteen clinical isolates of cefoxitin-resistant Klebsiella pneumoniae were charaterized. Antimicroilutin method. Crude beta-lactamases were prepared by sonication and isoelectric focusing of the enzyme preparations was performed in polyacrylamide gel. The transmissibility of resistance was tested by mating to E. coli J53. We performed PCR and hybridization for further characterization of the AmpC-type beta-lactamse. RESULTS: Seven strains were found to have the plasmid-mediated AmpC type beta-lactamase as a pI of 8.0 and this was confirmed to be cmy-1 beta-lactamase by PCR and hybridization analysis. These strains were resistant to ampicillin and piperacillin with MICs above 128microgram/ml. Cefoxitin resistance could be transferred from 4 strains via a large plasmi with molecular sizes approximately 77 or 130 kb. The molecular weight of CMY-1 enzyme is approximately 38kDa. We analyzed the OMP of six cefoxitin-resistance K. pneumoniae. Two of six strains were lacking a major OMP of approximately 40 kDa, but four of them showed another 39 kDa sized band just below the 40 kDa major OMP, which were thought to be a modified 40 kDa OMP. CONCLUSION: With these results, we conclude that resistance to cefoxitin in K. pneumoniae isolated from Korean patients is either associated with the productin of CMY-a, a plasmid-mediated AmpC type beta-lactamase, of altered expressin of an outer membrane protein.
Ampicillin ; beta-Lactamases* ; beta-Lactams ; Cefoxitin ; Cephalosporins ; Enterobacteriaceae ; Humans ; Isoelectric Focusing ; Klebsiella pneumoniae* ; Klebsiella* ; Membrane Proteins ; Molecular Weight ; Piperacillin ; Pneumonia ; Polymerase Chain Reaction ; Sonication

BACKGROUND: Humoral immune response is essential for resistance against leptospirosis, and the antigens in-volved in the response might be responsible for pathoge-nesis, diagnosis or immunity. The aim of this study is to clone, overexpress and purify one of leptospiral pro-tein antigens recognized by patients' sera and elucidate it as a diagnostic antigen. METHODS: We isolated a reactive clone LIA5 from a genomic library of Leptosp ira interrogans serovar lai which expressed a 62 kDa protein co-migrated to a predominant protein of Leptospira by immunoblotting with patients' sera. The sequence of the clone with 2.7 kb leptospiral DNA was determined. The 62 kDa protein encoded by an open reading frame with 1,637 bp was overexpressed in E. coli by pT7 expression vector, and purified to homogeneity by Ni-affinity resin and further electroelution. Patients' sera were examined for IgM or IgG antibodies reacting with the recombinant antigen by strip immunoblot. RESULTS: Sequence analysis of the clone identified two genes homologous to the hsp58 and hsp 10 of Lepto-sp ira serovar cop enhageni, homologues of the E. coli heat shock protein genes groEL and groES, respectively. The Hsp58 protein was detected commonly in several leptospires by immunoblotting with both patients' sera and rabbit anti-Hsp58 antibody raised against the purified recombinant Hsp58 protein(rHsp58). The predominant class of reacting antibody against rHsp58 in in patients' sera was IgG . CONCLUSION: The results indicate that Hsp58 is a highly conserved, dominant antigen in humoral immune response to leptospirosis. Further studies are needed to test the rHSP as an immunodiagnostic antigen.
Antibodies ; Clone Cells* ; Cloning, Organism* ; Diagnosis ; DNA ; Genomic Library ; Heat-Shock Proteins* ; Hot Temperature* ; Immunity, Humoral ; Immunoblotting ; Immunoglobulin G ; Immunoglobulin M ; Leptospira* ; Leptospirosis ; Open Reading Frames ; Sequence Analysis

BACKGROUND: Hemorrhagic fever with renal syndrome is a serious health problem in Korea. Formalin inactivated mouse brain-derived Hantaan virus vaccine (HantavaxR) has been available since 1990 and recom-mended in national immunization programs for children and adults by the health authority. However, Hantavax has not been evaluated for efficacy in a randomized, placebo-controlled clinical trial and data on neutralizing antibody responses in human trials are limited. To investigate humoral immune responses to Hantavax, we studied volunteers immunized according to the recom-mended two dose schedule. METHODS: With informed consent, 30 healthy adults were immunized with two doses of Hantavax (Lot No. 6001, 2360002) 0.5ml given intramuscularly on deltoid muscle 4 weeks apart. The monovalent vaccine, pro-duced from the ROK 84-105 strain, is inactivated with 0.05% formalin and has an ELISA antigen titer of 4096. Sera were collected before vaccination and 4 weeks after each dose for a total of 90 serum samples from 30 vaccinees. Neutralizing antibodies were measured at Unit-ed States Army Medical Research Institute of Infectious Disease (Ft. Detrick, MD) in plaque reduction neutrali-zation tests. Antibody titers were expressed as the highest serum dilution that reduced the standard viral dose (45 ~ 58 plaque forming units of Hantaan virus strain 76-118 by 50 percent. Serum binding antibodies also were mea-sured in a high density particle agglutination test (Hanta-dia R) at Yonsei University. RESULTS: Neutralizing antibodies were detected in only 5 of 30 vaccinees given two doses of Hantavax, yielding seroconversion rate of 16.7%. The endpoint titers of reactive sera were 1:320, 1:10, 1:10, 1:10, and 1:40 respectively. The seroconversion rate measured by high density particle agglutination test was 80.0% (24/30). CONCLUSION: These results indicated that the poor neutralizing antibody response observed in this study suggests that further evaluations of the protective effi-cacy of inactivated mouse brain-derived Hantaan virus vaccine against HFRS.
Academies and Institutes ; Adult* ; Agglutination Tests ; Animals ; Antibodies ; Antibodies, Neutralizing* ; Appointments and Schedules ; Child ; Communicable Diseases ; Deltoid Muscle ; Enzyme-Linked Immunosorbent Assay ; Formaldehyde* ; Hantaan virus* ; Hemorrhagic Fever with Renal Syndrome ; Humans ; Immunity, Humoral ; Immunization Programs ; Informed Consent ; Korea ; Mice* ; Vaccination ; Volunteers

BACKGROUND: Hantavax(TM) was developed for preven-tion of hemorrhagic fever with renal syndrome caused by Hantaan or Seoul virus in 1990, and has been commer-cially available in Korea since then. Because Hantavax (TM) has such short usage history, the duration of antibody persistency in vaccinees has not been well studied. METHODS: 61 healthy people were immunized subcu-taneously with Hantavax (TM) twice at one month intervals as primary vaccination. 21 vaccinees were tested at 1 ~4 months after primary vaccination and 40 vaccinees were tested at one year after primary vaccination and then one month and 1 ~2 years after booster vaccination. Antibody titers were measured by immunofluorescent assay(IFA), Hantaan virus antigen-coated high density particle agglu-tination assay(HDPA), and plaque reduction neutralization test(PRNT). RESULTS: Seroconversion rates of 21 vaccinees at 1 ~ 4 months after primay vaccination were 20/21(95.2%), 19/21(90.5%) and 14/21(66.7%); seropositivity of 40 vaccinees at one year after primary vaccination was 25/40 (62.5%), 18/40(45.0%), and 9/40(22.5%) by IFA, HDPA, and PRNT, respectively. Seroconversion rates of 8 vaccinees at one month after booster vaccination were 8/ 8(100 %), 8/ 8(100%); antibody persistence rate of 11 vaccinees at 20 months after booster vaccination were 11/ 12 (91.7%), 9/ 12(75.0%), and seroconversion rates of 7 vaccinees at 3 months after second booster vaccination were 7/7(100%) and 6/7(85.7%) by IFA and PRNT, respectively. Geometric mean antibody titers of 21 vaccinees at 1-4 months after primary basic vaccination were 262, 248, 120; and those of 40 vaccinees at one year after primary vaccination were 90, 56, and 24 by IFA, HDPA, and PRNT, respectively. Geometric mean antibody titers of 8 vaccinees at one month after booster vaccination were 852, 183, of 12 vaccinees at 20 months after booster vaccination were 296, 33, and of 7 vaccinees at 3 months after second booster vaccination were 549 and 46 by IFA and PRNT, respectively. CONCLUSION: The booster vaccination is necessary at 12 months after primary vaccination to maintain high levels of antibodies which persist at least two years after booster vaccination.
Antibodies ; Hantaan virus* ; Hemorrhagic Fever with Renal Syndrome ; Korea ; Seoul virus ; Vaccination