Erysipelothrix rhusiopathiae is an uncommon pathogen in human, which causes zoonotic infection. The most common type of human disease with E. rhusiopathiae is a localized skin infection (erysipeloed). E. rhusiopathiae endocarditis is very rare, which usually develops in normal heart valves and causes a variety of complications leading to valve replacement. We described a case of E. rhusiopathiae endocarditis which developed in a 56-year-old man without a predisposing valvular heart disease. In this case, aortic valve and mitral valve were involved and emergency valve replacement was required, which improved patient's condition markedly. Intravenous therapy with penicillin G and subsequent ceftriaxone were given for 8 weeks after surgery and he was recovered without relapse.
Aortic Valve ; Ceftriaxone ; Emergencies ; Endocarditis* ; Erysipelothrix* ; Heart Valve Diseases ; Heart Valves ; Humans ; Middle Aged ; Mitral Valve ; Penicillin G ; Recurrence ; Skin ; Zoonoses

Clostridium septicum is a toxin producing anaerobic, motile, spore-forming, spindle shaped Gram positive rod that may cause devastating systemic illness in patients with neutropenia and underlying hematologic or gastrointestinal malignancy. Clostridium septicum sepsis usually have fulminating clinical courses, and unless the appropriate antibiotics are administered soon after admission, the outcome is fatal. We experienced a case of sepsis due to Clostridium septicum, in a 65-year-old woman with peripheral T-cell lymphoma and diabetes mellitus. She was admitted due to abdominal pain, fever, chilling, nausea, vomiting and watery diarrhea, followed by rapidly progressive course. This patient was not improved by intensive care and continuous antibiotic therapy, expired at the 4th hospital day. Clostridium septicum grew from premortem blood cultures.
Abdominal Pain ; Aged ; Anti-Bacterial Agents ; Clostridium septicum* ; Clostridium* ; Diabetes Mellitus ; Diarrhea ; Female ; Fever ; Humans ; Critical Care ; Lymphoma, T-Cell, Peripheral ; Nausea ; Neutropenia ; Sepsis* ; Vomiting

BACKGROUND: Annual occurrence of vivax malaria in Republic of Korea (ROK) has exceeded 1,000 cases since 1997. Military system is thought to be a important source of the current outbreak. We collected the information on malaria cases of ROK army, veterans and civilians which occurred in 1999, and analyzed the characteristics of the current outbreak. METHODS: Informations on malaria cases of ROK army, including name, age, sex, rank, force, day of onset, region, etc., were collected through the Office of Surgeon General at Headquarters of ROK army and then analyzed. Informations about malaria cases of veterans and civilians, including age, sex, day of onset, region, etc., were collected through the National Institute of Health and then analyzed. RESULTS:Among a total of 3,628 cases in 1999, 1,085 (29.91%) occurred in the military, 996 (27.45%) occurred in veterans, and 1,547 (42.64%) occurred in civilians. Monthly occurrence reached its peak level at July and had maintained to August. Yeoncheon, Cheolwon and Paju were the highest prevalence region. CONCLUSION: Case occurrence in ROK decreased in 1999 and it was contributed by chemoprophylaxis which has been done since 1997 in the military. It is thought that more attention must be given to protect the further spread of malaria infection.
Chemoprevention ; Humans ; Malaria ; Malaria, Vivax* ; Military Personnel ; Prevalence ; Republic of Korea* ; Veterans

BACKGROUND: Hospital infection surveillance is a dynamic process for gathering, managing, analyzing, reporting and re-evaluating the data. Recently there has been an increased awareness of the importance of hospital infection surveillance and management program in Korea. The most ideal way among the hospital infection surveillance systems is known to be the "reference method". In this method all hospital patient records and charts are reviewed and the infected patient are investigated in daily basis. However it requires enormous efforts to apply this method in hospitals with limited personnel resources. Although the number of the hospital having full-time hospital infection control nurses has been increased considerably in Korea the effective hospital control programs have not been established yet in most hospitals owing to the lack of full-time hospital infection control nurses. Nevertheless it became indispensable to develop an alternative hospital infection surveillance program that is readily available. This study was carried out to investigate epidemiologic characteristics, and assess the efficiency and validity of ward liaison surveillance method for nosocomial infection surveillance in a general hospital without full-time infection control nurses. METHOD: During the period of the study, from March 1 to March 31, 2000, cases of hospital infection collected by two different methods, reference method and ward liaison nurse surveillance, were compared. The validity of ward liaison surveillance data was examined using the data collected by the reference method as gold standard. RESULT: In the data collected by the reference method, 94 cases of hospital infection were identified whereas 83 cases by the ward liaison nurses. The incidence rate of hospital infection was 9.5% during one month; the incidence rates were higher in males (12.6%) than female (6.7%) and in age group of 50s. The incidence rates by ward were 38.8% in intensive care unit, 45.5% in neurosurgery, 18.6% in neurology ward, 12.8% in internal medicine, 10.6% in orthopedic ward, and 8.6% in general surgery. Sites of hospital infection in the order of decreasing frequency were urinary tract (24.8/1000 discharge patients), lung (22.2), wound (18.2), and other respiratory systems (15.2). The type of microorganisms isolated were 16: three gram-positive bacteria, eleven gram-negatives and two fungi. Staphylococcus was the most frequently isolated organism, 21 strains, among which 17 strains were methicillin-resistant Staphylococcus aureus (only one strain was sensitive to methicillin) and three strains were methicillin resistant Staphylococcus epidermidis. Seventeen strains of Pseudomonas aeruginosa were isolated from pneumonia, urinary tract, and wound. Escherichia. coli, Serratia marcencecs, Acinetobacter baumannii, Klebsiella pneumoniae, Enterococcus faecalis, E. faecium, Enterobacter cloacae, Streptococcus pneumoniae, and Candida albicans were also isolated. There were twenty-two specimens that revealed no growth of any organisms. In the ward liaison nurse surveillance method, the number of false positive hospital infection was eleven cases and the false negative was 22 cases. The validity evaluated by four different measurements were sensitivity 76,7%, specificity 98.7%, positive predicted value 86.7%, negative predicted value 97.5%. Thus the ward liaison nurse surveillance method was shown to be a valid method with high efficiency. The false positive and false negative cases were mainly occurred by the deficient knowledge in the definition of hospital infection, and deficient skills of investigating the patient's symptoms and clinical course; the liaison nurses had not checked all the surgical site resulting in low sensitivity in surgical site infection. CONCLUSION: According to the results, the epidemiologic characteristic of hospital infection in this particular community hospital studied was not much different from other study results; the incidence rate of hospital infection for one month was 9.5%. On the other hand the ward liaison nurse surveillance method was shown to be satisfactory in detecting hospital infection. This could be a useful method for hospitals without full-time infection control nurses. Furthermore, the validity of this method could be improved by accumulation of the knowledge and skills on hospital infection surveillance through a well planned on-the-job training program for the nurses.
Acinetobacter baumannii ; Candida albicans ; Cross Infection* ; Enterobacter cloacae ; Enterococcus faecalis ; Escherichia ; Female ; Fungi ; Gram-Positive Bacteria ; Hand ; Hospitals, Community ; Hospitals, General ; Humans ; Incidence ; Infection Control ; Inservice Training ; Intensive Care Units ; Internal Medicine ; Klebsiella pneumoniae ; Korea ; Lung ; Male ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Neurology ; Neurosurgery ; Orthopedics ; Pneumonia ; Pseudomonas aeruginosa ; Respiratory System ; Sensitivity and Specificity ; Serratia ; Staphylococcus ; Staphylococcus epidermidis ; Streptococcus pneumoniae ; Urinary Tract ; Wounds and Injuries

BACKGROUND: The purpose of this study is to investigate the epidemiology and microbiological susceptibility patterns of vancomycin-resistant enterococci (VRE) in Seoul National University Hospital. METHODS: The VRE isolates between May 1998 and October 1999 were studied. We reviewed the medical records of VRE-isolated patients for clinical and epidemiologic data. The susceptibility of VRE to ampicillin, vancomycin, teicoplanin, gentamicin, streptomycin, ciprofloxacin, imipenem, rifampin, tetracyclin were determined by micro-dilution method. PCR for genotyping and PFGE for molecular epidemiology were performed. RESULTS: Twenty-nine VRE isolates were identified from 14 patients, 12 patients from clinical specimens and two from only rectal surveillence cultures. All strains were E. faecium and expressed vanA genotype. The vancomycin MIC and teicoplanin MIC were >128microgram/mL for all isolates. All isolates also resistant to most other antibiotics tested (ampicillin 84.2%, gentamicin 73.7%, streptomycin 73.7%, ciprofloxacin 84.2%, tetracycline 63.2%, rifampin 84.2%, imipenem 94.7%). PFGE analysis revealed 17 distinct PFGE strain types from 14 patients and there were no predominent types. Two patterns, each of them represented by two isolates, were identical. One of which was not associated epidemiologically but the other was associated with direct spread from colonized patient at the intensive care unit. CONCLUSION: The majority of VRE cases occurring at Seoul National University Hospital were not caused by epidemiologic strains but sporadic isolations although there was one case of patient to patient spread.
Ampicillin ; Anti-Bacterial Agents ; Ciprofloxacin ; Colon ; Electrophoresis, Gel, Pulsed-Field ; Epidemiology ; Genotype ; Gentamicins ; Humans ; Imipenem ; Intensive Care Units ; Medical Records ; Molecular Epidemiology* ; Polymerase Chain Reaction ; Rifampin ; Seoul* ; Streptomycin ; Teicoplanin ; Tetracycline ; Vancomycin

From the prudent use of quinolone in clinical practice, quinolone-resistant E. coli strains are being isolated with increasing frequency in the community as well as in the hospital. To analyze the risk factors, clinical features and prognosis of QREC, we reviewed the microbiologic records of E. coli bacteremia patients, estimated the quinolone consumption and performed the PFGE to compare genetic diversity. From 1994 to 1998, 40 episodes of QREC bacteremia were observed, 15 cases (37.5%) were hospital acquired. Overall, there is significant correlation between the increased incidence of QREC bacteremia and the upward trend in quinolone use in the hospital as out-and in-patients medication (P=0.003, r=0.98). When we compare the 40 case patients with 80 simultaneous control patients who had quinolone-susceptible E. coli bacteremia, the case patients more frequently had chronic underlying illness, prior use of quinolones and other antibiotics. Quinolone resistance was not significantly associated with higher mortality. A logistic regression analysis identified prior quinolone (P=0.001) use and prior use of other antibiotics (P=0.04) as the only independent risk factors for QREC bacteremia. 10-or 8-different PFGE patterns were observed in QREC isolates from community and hospital. They revealed little evidence of clonal spread, and may have emerged in direct response to the selective pressure exerted by antibiotic use.
Anti-Bacterial Agents ; Bacteremia* ; Genetic Variation ; Humans ; Incidence ; Logistic Models ; Mortality ; Prognosis ; Quinolones ; Risk Factors

BACKGROUND: Success in orthopedic implant surgery relies on reducing infection by preventive methods including antibiotic prophylaxis. The lack of published data on orthopedic implant infections with methicillin-resistance Staphylococcus aureus (MRSA) and methicillin-resistance coagulase-negative staphylococcus (MRCNS) makes it difficult to choose correct prophylactic antibiotics. We therefore reviewed the etiology of prosthetic joint infection and the effectiveness of current antibiotic prophylaxis. METHODS: We reviewed retrospectively the clinical notes and microbial records of patients with prosthetic joint infection who had admitted in Asan Medical Center from June 1989 to July 1999. RESULTS: During a eleven-year period, prosthetic joint infections occurred in 18 (0.9%) of 2,028 patients who received a total hip or total knee arthroplasty at Asan Medical Center (AMC). The cephalosporins were administered to most of patients before surgery for prophylaxis. Twenty two patients were referred to our institution because of prosthetic joint infection. Thirty five patients had positive bacteriological cultures from tissue removed at the time of surgery or joint aspiration. Staphylococci were the most common pathogens and accounted for twenty four (68.8%) of the 35 isolates. Seven (50%) of the fourteen isolates of coagulase-negative staphylococci were MRCNS. Eight (80 %) of the ten ioslates of S. aureus were MRSA. Gram-negative bacilli accounted for five (14.3%) of the isolates and included Escherichia coli, Serratia marcescens, Pseudomonas aeruginosa. CONCLUSION: First-or second-generation cephalosporins were effective prophylatic antibiotics in total hip or total knee arthroplasty because the rate of prosthetic joint infections was low (0.9%). But the prevalence of MRCNS or MRSA prosthetic joint infection was high, we must consider glycopeptides prophylaxis if there is, or has been, infection or carriage with MRCNS or MRSA.
Anti-Bacterial Agents ; Antibiotic Prophylaxis* ; Arthroplasty ; Cephalosporins ; Chungcheongnam-do ; Escherichia coli ; Glycopeptides ; Hip ; Humans ; Joints* ; Knee ; Methicillin-Resistant Staphylococcus aureus ; Orthopedics ; Prevalence ; Pseudomonas aeruginosa ; Retrospective Studies ; Serratia marcescens ; Staphylococcus ; Staphylococcus aureus

BACKGROUND: Recently isolates of S. aureus with intermediate (VISA) and heterogeneous resistance (hetero-VRSA) to vancomycin, which has been the only effective against MRSA infections, were identified. Several infections due to these isolates did not respond to adequate antibiotic treatments. In Japan, the prevalences of hetero-VRSA ranged from 0 to 48%. The aim of this study was to determine the prevalence of S. aureus heterogenously resistant to vancomycin and VISA. METHODS: The isolates were collected at Seoul National University Hospital from April 1998 to August 1999. To detect S. aureus with reduced susceptibility to vancomycin, brain heart infusion (BHI) agar with 4 mg/L of vancomycin and Mu-3 agar were used. Analysis of resistant subpopulations of bacteria (population analysis) was done. Minimum inhibitory concentration (MIC) for vancomycin was determined by microbroth and agar dilution methods, respectively according to NCCLS and Hiramatsu's recommendation. Coagulase type was determined with type I-VIII antisera. RESULTS: Total 235 MRSA, including 88 isolates from blood and 147 from other specimens, were collected. After 88 blood isolates were inoculated on BHI agar with 4 mg/L of vancomycin, 14 isolates (16 %) grew in variable colonies. But there were no subclones with vancomycin MIC > or =8 mg/L on population analysis and no isolates which grew confluently on Mu-3 agar with beta-lactam disks. In addition, 147 isolates from other specimens did not grow confluently on Mu-3 agar. Among 64 MRSA and 32 MSSA isolates, coagulase type II (49, 77%) and Vll(8, 25%) were respectively the most common types. CONCLUSION: In our tertiary-care hospital, there were no MRSA isolates with reduced susceptibilities to vancomycin.
Agar ; Bacteria ; Brain ; Coagulase ; Heart ; Immune Sera ; Japan ; Methicillin-Resistant Staphylococcus aureus ; Microbial Sensitivity Tests ; Prevalence* ; Seoul ; Staphylococcus aureus* ; Staphylococcus* ; Tertiary Care Centers* ; Vancomycin*

BACKGROUND: Epstein-Barr virus (EBV) is causative agent of infectious mononucleosis and nasopharyngeal carcinoma and associated with Burkitt lymphoma and other tumors. The recombinant protein is needed for the rapid and sensitive serodiagnosis of EBV infection. METHODS: EBV gene encoding the protein reactive with the sera of EBV-infected patient was cloned and characterized with lambda gt11 expression library of cDNA of EBV B95-8 strain. RESULTS: The recombinant proteins from clone 12, 15 and 21 were expressed as 120, 118, 160 kDa-usion protein with beta-galactosidase, respectively, which were reactive with IgG anti-EBV antibody-positive sera, but not with anti-EBV antibody-negative sera. A homology search of the DNA sequence of the cloned gene with EBV B95-8 sequences revealed that those were located at 61716~62087, 61898~62085, and 102128~103158, respectively. These positions correspond to BFRF3, BFRF3, and BZLF1, respectively, which were reported as immunogenic protein which evoked strong and longstanding antibody response and had no sequence homology with the proteins of other herpesviruses. All the patients' sera were reactive with clone 12 protein, but only 5 out of 9 patients' sera were reactive with clone 21 protein. CONCLUSION: Clone 21 protein expressing BFRF3 fragment was immunoreactive in patient sera from natural EBV infection and was regarded as useful candidate for the serodiagnosis of EBV infection.
Antibody Formation ; Base Sequence ; beta-Galactosidase ; Burkitt Lymphoma ; Clone Cells* ; Cloning, Organism* ; DNA, Complementary ; Epstein-Barr Virus Infections ; Herpesviridae ; Herpesvirus 4, Human* ; Humans ; Immunoglobulin G ; Infectious Mononucleosis ; Recombinant Proteins ; Sequence Homology ; Serologic Tests

BACKGROUND: Human herpesvirus-6 (HHV-6) is recently known as a major pathogen associated with various diseases in hematopoietic stem cell transplant (HSCT) recipients. We prospectively evaluated the frequency and clinical manifestations of HHV-6 infection in HSCT recipient in a single HSCT center in Korea. METHODS: Serum and peripheral blood mononuclear cells (PBMC) were weekly obtained from 1 week before HSCT to 4 weeks after HSCT. Three months' and six months' samples were obtained in some cases. HHV-6 was detected by nested polymerase chain reaction. RESULTS: Two hundred and seventy-eight samples from 54 HSCT recipients were collected from February to November, 1999. HHV-6 was detected in 32 out of 54 recipients (59.3%) at least once during study period in their PBMC or serum. HHV-6 DNA positive rate of PBMC and serum samples were 38.1% and 4.3 % respectively. HHV-6 DNAemia (HHV-6 DNA positive in serum) was detected and peaked at 2 weeks after HSCT and continued to 4 weeks. HHV-6 DNA in peripheral blood was not associated with unexplained fever, acute graft-versus-host disease, engraftment delay, or cytomegalovirus infection in this study. CONCLUSION: Reactivation and development of DNAemia of HHV-6 certainly occurred after HSCT, but the clinical manifestations and association with other diseases were unclear in this study. The large-scaled, nation-wide detail studies about the prevalence and characteristics of HHV-6 in general population and patients of specific disease entities must be considered.
Cytomegalovirus Infections ; DNA ; Fever ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation ; Hematopoietic Stem Cells* ; Herpesvirus 6, Human ; Humans* ; Korea ; Polymerase Chain Reaction ; Prevalence ; Prospective Studies ; Transplantation*