No abstract available.
Communicable Diseases*

No abstract available.
Candidiasis*

Current antifungal agents, such as amphotericin B, fluconazole and itraconazole, have limitations in clinical use because of toxicity, low efficacy, and drug resistance. Newer systemic antifungal agents are available for better efficacy and lower toxicity. They include antifungal agents of a new class and a new generation of an existing class. Caspofungin, the first available echinocandin, inhibits cell wall synthesis and has broad antifungal spectrums. Caspofungin shows better antifungal activity against fluconazole resistant Candida and Aspergillus. Caspofungin was very effective in salvage therapy for amphotericinrefractory or intolerant aspergillosis. Voriconazole, the first available second-generation triazole, is a derivative of fluconazole. Voriconazole is more active against Aspergillus than other antifungal agents and shows lower MIC (minimal inhibitory concentrations) against Candida. The clinical efficacy of voriconazole in the treatment of invasive aspergillosis is superior to amphotericin B. Voriconazole has some limitations, including visual adverse events, liver enzyme elevation as well as a number of drug interactions. Caspofungin and voriconazole should be judiciously used in clinical practices based on clinical efficacy, adverse events, and costs.
Amphotericin B ; Antifungal Agents* ; Aspergillosis ; Aspergillus ; Candida ; Cell Wall ; Drug Interactions ; Drug Resistance ; Fluconazole ; Itraconazole ; Liver ; Salvage Therapy

Community-acquired pneumonia (CAP) still remains one of the most important causes of morbidity and mortality. Improving the care of patients with CAP has been the focus of many different organizations, and several guidelines have been published in the United States and Europe. When the patients are treated according to the guidelines, there are beneficial effects in outcome. Empirical treatment should depend on the regional epidemiological information on the pathogen distribution and their antimicrobial resistance. Therefore, the guidelines from other countries could not be directly applied to the treatment of CAP in Korea. Inappropriate empirical treatment has been related with treatment failure. Therefore, physicians should be aware of the recent epidemiological data on antimicrobial resistance of the most common pathogens in order to choose the active agents against pneumococcus and atypical pathogens for the treatment of CAP.
Europe ; Humans ; Korea* ; Mortality ; Pneumonia* ; Streptococcus pneumoniae ; Treatment Failure ; United States

Antibiotic treatment of acute upper respiratory tract infections (URI), especially nonspecific respiratory tract infections (common cold) and acute bronchitis, is inappropriate in almost all occasions because they are usually caused by nonbacterial infections. Purulent secretions from the nares or throat do not indicate bacterial infection or benefit from antibiotic treatment. Antibiotic treatment of adults with non-specific URI does not facilitate the resolution of illness or prevent complications. Acute pharyngitis and acute sinusitis sometimes have a bacterial cause, and antibiotic treatment is generally not justified unless otherwise indicated. Streptococcus pyogenes is the cause of acute pharyngitis only in 5~15% of adult patients. Therefore, antibiotics are recommended to patients who are highly likely to have streptococcal pharyngitis. Following strategies would be appropriate: 1) limit the antibiotic trea-tment to patients with three or four criteria, that is, fever, tonsillar exudates, no cough, and tender anterior cervical lymphadenopathy; or 2) test patients with two or three criteria by using a rapid antigen test, and limit antibiotic treatment to patients with positive test results or those with four criteria. Most patients with viral URI nearly recover within 7~10 days, and acute bacterial rhinosinusitis is not common in patients whose symptoms last for less than 7 days. Patients without purulent nasal discharge, maxillary facial or tooth pain or tenderness, or both are unlikely to have bacterial rhinosinusitis, regardless of the duration of illness. Antibiotic treatment is appropriate for patients with specific symptoms of 10 days or longer. Lastly, the choice of antibiotics should be based on the epidemiologic data on susceptibility of major pathogens.
Adult* ; Anti-Bacterial Agents* ; Bacterial Infections ; Bronchitis ; Cough ; Exudates and Transudates ; Fever ; Humans ; Lymphatic Diseases ; Pharyngitis ; Pharynx ; Respiratory Tract Infections* ; Sinusitis ; Streptococcus pyogenes ; Tooth

No abstract available.

Background: Nonpharmaceutical intervention strategy is significantly important to mitigate the coronavirus disease 2019 (COVID-19) spread. One of the interventions implemented by the government is a school closure. The Ministry of Education decided to postpone the school opening from March 2 to April 6 to minimize epidemic size. We aimed to quantify the school closure effect on the COVID-19 epidemic. Methods: The potential effects of school opening were measured using a mathematical model considering two age groups: children (aged 19 years and younger) and adults (aged over 19). Based on susceptible-exposed-infectious-recovered model, isolation and behavior-changed susceptible individuals are additionally considered. The transmission parameters were estimated from the laboratory confirmed data reported by the Korea Centers for Disease Control and Prevention from February 16 to March 22. The model was extended with estimated parameters and estimated the expected number of confirmed cases as the transmission rate increased after school opening. Results: Assuming the transmission rate between children group would be increasing 10 fold after the schools open, approximately additional 60 cases are expected to occur from March 2 to March 9, and approximately additional 100 children cases are expected from March 9 to March 23. After March 23, the number of expected cases for children is 28.4 for 7 days and 33.6 for 14 days. Conclusion The simulation results show that the government could reduce at least 200 cases, with two announcements by the Ministry of education. After March 23, although the possibility of massive transmission in the children's age group is lower, group transmission is possible to occur.

Opportunistic infections are major causes of morbidity and mortality in hematopoietic stem-cell transplant and solid organ transplant recipients. The epidemiology and incidence of opportunistic infections in those patients have been dramatically changed with use of potent immunosuppressive agents as well as routine prophylaxis against various microorganisms such as common bacterial pathogens, fungi, cytomegalovirus, Pneumocystis jirovecii, and so on. Because transplant recipients are at the greatest risk for infection during early phase (1-3 months) after transplant, safe and effective prevention strategies should be implemented in this period. Moreover, beyond early phase, recipients are often susceptible to infections due to prolonged immunosuppressive therapy for graft rejection or chronic graft-versus-host diseases. Therefore, clinicians should assess a recipient's risk of infection on the basis of concomitant graft function, intensity of immunosuppression, and other factors that may contribute to susceptibility to infections. We discussed infection prevention strategies among recipients of hematopoietic stem-cell and solid organ transplantation against various opportunistic pathogens. Vaccinations should also be recommended for pre-transplant candidates and post-transplant recipients for the best prevention of infections.
Candidiasis, Invasive ; Cytomegalovirus ; Fungi ; Graft Rejection ; Graft vs Host Disease ; Humans ; Immunosuppression ; Immunosuppressive Agents ; Incidence ; Opportunistic Infections ; Organ Transplantation ; Pneumocystis jirovecii ; Pneumonia, Pneumocystis ; Transplants ; Vaccination