PURPOSE: To compare the efficacy of inflammatory markers, the Laboratory-score, and a new laboratory combined model for predicting serious bacterial infection (SBI) in young febrile children.METHODS: The presence of SBI was reviewed in previously healthy children aged 3 years or younger with fever (> 38℃) who visited the emergency department from 2017 through 2018. Areas under the curves (AUCs) of the receiver operating characteristic curve for SBI were compared with individual inflammatory markers (white blood cells [WBC] count, erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], procalcitonin [PCT], and urine WBC count), the Laboratory-score, and a laboratory combined model. The latter model was developed using logistic regression analysis including ESR, CRP, and PCT.RESULTS: Of the 203 enrolled children, SBI was diagnosed in 58 (28.6%). For SBI prediction, the Laboratory-score showed 51.7% sensitivity (95% confidence interval [CI], 38.2%–65.0%) and 83.5% specificity (95% CI, 76.4%–89.1%). The AUC of the Laboratory-score (0.76) was significantly superior to the values of all individual inflammatory markers (WBC, 0.59 [P = 0.032]; ESR, 0.69; and CRP, 0.74 [P < 0.001]) except that of PCT (0.77, [P < 0.001]). The AUC of the laboratory combined model (0.80) was superior to that of the Laboratory-score (0.76) (P < 0.001).CONCLUSION: In this study, the new laboratory combined model showed good predictability for SBI. This finding suggests the usefulness of combining ESR, CRP, and PCT in predicting SBI.
Area Under Curve ; Bacterial Infections ; Blood Cells ; C-Reactive Protein ; Child ; Emergency Medicine ; Emergency Service, Hospital ; Erythrocyte Count ; Fever ; Humans ; Logistic Models ; Pediatrics ; ROC Curve ; Sensitivity and Specificity

Lactase non-persistence (LNP), one of the causes of lactose intolerance, is related to lactase gene associated single nucleotide polymorphisms (SNPs). Since the frequency of LNP varies by ethnic group and country, the research to reveal the presence or absence of LNP for specific people has been conducted worldwide. However, in East Asia, the study of lactase gene associated SNPs have not been sufficiently examined so far using ancient human specimens from archaeological sites. In our study of Joseon period human remains (n=14), we successfully revealed genetic information of lactase gene associated SNPs (rs1679771596, rs41525747, rs4988236, rs4988235, rs41380347, rs869051967, rs145946881 and rs182549), further confirming that as for eight SNPs, the pre-modern Korean people had a lactase non-persistent genotype. Our report contributes to the establishment of LNP associated SNP analysis technique that can be useful in forthcoming studies on human bones and mummy samples from East Asian archaeological sites.

Objective: A prolonged length of stay in the emergency department (EDLOS) is known to be associated with poorer outcomes in critically ill patients. However, this has not been proven in patients who visit the emergency department (ED) due to acute heart failure (AHF). We aimed to find out whether prolonged EDLOS is associated with major in-hospital complications in patients with AHF. Methods: This is a retrospective cohort study of AHF patients who were admitted to intensive care units (ICU) via the ED of a single academic hospital from January 2015 to December 2019. We divided the patients into two groups: EDLOS <24 hours and EDLOS≥24 hours. The primary outcome was major in-hospital complications, which included in-hospital death, application of continuous renal replacement therapy, or extracorporeal membrane oxygenation treatment. Secondary outcomes included in-hospital death, prolonged ICU stay (≥10 days), and prolonged hospital stay (≥14 days) excluding ED stay. Results: A total of 265 patients were enrolled. Of these 163 patients stayed in the ED for over 24 hours. The multivariable logistic analysis demonstrated that EDLOS ≥24 hours was independently associated with major in-hospital complications (odds ratio [OR], 3.296; 95% confidence interval [CI], 1.291-8.413; P=0.013). Analysis of the secondary outcomes showed that EDLOS ≥24 hours was associated with in-hospital death (OR, 2.607; 95% CI, 1.005-6.759; P=0.049) and prolonged hospital stay ≥14 days (OR, 2.458; 95% CI, 1.303-4.636; P=0.006). Conclusion Our study showed that in patients with AHF who visited ED and were admitted to the ICU, prolonged EDLOS was associated with major in-hospital complications.

Q fever is an orthozoonotic infection caused by Coxiella burnetii, which was recently reclassified from the order Rickettsials to the order Legionellales. Although Q fever is usually mild and self-limiting, it may be manifested as a serious disease, such as pneumonia, endocarditis, or meningoencephalitis. We describe three separate cases of acute Q fever, which were diagnosed by an indirect micro-immunofluorescence assay (MIFA) test and DNA amplification (PCR). Three adult patients were admitted between December 2004 and August 2006 because of a fever of greater than three weeks duration. Only one patient had contact history with a dog. Of the three patients, two patients had myalgia, headache, skin rash, lymphadenopathy, and hepatosplenomegaly. Although all sets of blood cultures were negative, anti-phase II antibody titers by using an indirect MIFA (IgG 1:512 - 1,024 and IgM 1:320) were markedly increased in sera from all of three patients. Concomitant PCR assays also demonstrated the presence of OMP com1 for C. burnetii in blood from all of the three patients. Two patients had complete resolution of symptoms and signs with a two week course of doxycycline, while one patient had spontaneous defervescence. Although the incidence of Q fever is not well known yet in Korea, it should be considered in the differential diagnosis of patients with fever of unknown origin.
Adult ; Animals ; Coxiella burnetii ; Diagnosis, Differential ; DNA ; Dogs ; Doxycycline ; Endocarditis ; Exanthema ; Fever ; Fever of Unknown Origin ; Headache ; Humans ; Immunoglobulin M ; Incidence ; Korea ; Lymphatic Diseases ; Meningoencephalitis ; Pneumonia ; Polymerase Chain Reaction ; Q Fever

TNF-alpha antagonists have been successfully utilized in the treatment of autoimmune diseases, including psoriasis and psoriatic arthritis. Paradoxically, new onset or exacerbation of psoriatic lesions during treatment with TNF-alpha antagonists have been reported. It has been postulated that TNF-alpha blockade may cause disruption in the balance between TNF-alpha and type 1 interferon (IFN)-alpha, which are the key players in the pathogenesis of psoriasis. We report a case of psoriasis exacerbation during TNF-alpha antagonist therapy in a 53-years-old man with ankylosing spondylitis. The patient has been treated with etanercept for 3 years and 7 months when he developed accelerated deterioration of psoriasis. His condition was previously under control solely by local treatment. Physical examination revealed vigorous desquamative lesions with silvery scale in both lower legs. Deterioration of psoriasis was attributed to etanercept therapy and was subsequently discontinued. Clinical improvement of psoriasis has been observed 2 months following cessation of etanercept.
Arthritis, Psoriatic ; Autoimmune Diseases ; Humans ; Etanercept ; Immunoglobulin G ; Interferons ; Leg ; Physical Examination ; Psoriasis ; Receptors, Tumor Necrosis Factor ; Skin ; Spondylitis, Ankylosing ; Tumor Necrosis Factor-alpha

This study was undertaken to evaluate the in vitro activities of arbekacin-based combination regimens against vancomycin hetero-intermediate Staphylococcus aureus (hetero-VISA). Combinations of arbekacin with vancomycin, rifampin, ampicillin-sulbactam, teicoplanin, or quinipristin-dalfopristin against seven hetero-VISA strains and two methicillin-resistant S. aureus strains were evaluated by the time-kill assay. The combinations of arbekacin with vancomycin, teicoplanin, or ampicillinsulbactam showed the synergistic interaction against hetero-VISA strains. Data suggest that these arbekacin-based combination regimens may be useful candidates for treatment options of hetero-VISA infections.
Virginiamycin/administration & dosage ; Vancomycin/*administration & dosage ; Teicoplanin/administration & dosage ; Sulbactam/administration & dosage ; Staphylococcus aureus/*drug effects/isolation & purification ; Staphylococcal Infections/drug therapy/microbiology ; Microbial Sensitivity Tests ; Methicillin Resistance ; Humans ; Drug Synergism ; Drug Resistance, Bacterial ; Dibekacin/administration & dosage/*analogs & derivatives ; Anti-Bacterial Agents/*administration & dosage ; Ampicillin/administration & dosage ; Aminoglycosides/*administration & dosage

Sweet syndrome is characterized by fever and abrupt appearance of painful, erythematous plaques: a dermal infiltrate of mature neutrophils. Extracutaneous manifestations often occur in Sweet syndrome, but intestinal involvement is extremely rare. We report a case of Sweet syndrome involving small bowel in a 56-year old male with fever and abdominal pain. An abdominal CT showed diffuse wall thickening in the ileal loop. He underwent explorative laparotomy and segmental resection of involved small bowel. Skin, bone marrow, and muscle biopsies were done because he had persistent fever, cutaneous plaques, pancytopenia, and swelling of lower extremities after operation. Finally, he was diagnosed as myelodysplastic syndrome combined with Sweet syndrome, which involved small bowel, skin, and muscle simultaneously. Fever, cutaneous plaques and leg swelling resolved after systemic administration of corticosteroids.
Abdominal Pain ; Adrenal Cortex Hormones ; Biopsy ; Bone Marrow ; Fever ; Humans ; Intestines ; Laparotomy ; Leg ; Lower Extremity ; Male ; Middle Aged ; Myelodysplastic Syndromes ; Neutrophils ; Pancytopenia ; Skin ; Sweet Syndrome* ; Tomography, X-Ray Computed

BACKGROUND: Fever of unknown origin (FUO) remains a challenging problem despite recent advances in diagnostic modalities. The spectrum of disease causing FUO seems to change with time as well as geographical factors. To evaluate the causes of FUO and identify important trends, a retrospective study was performed. METHODS: All adult patients with FUO admitted to the hospital from January 1995 to August 2005 were included. The criteria for diagnosis of FUO were adopted from Durack and Street. RESULTS: A total of 148 patients (mean age, 42.5 years ; M : F, 70 : 78) were enrolled. Of these, 116 (79%) patients were finally diagnosed with one of the following etiologies: infectious disease (37%), connective tissue disorders (16%), malignancy (14%), and miscellaneous disorders (12%) including Kikuchi's disease, factitious fever, drug-related fever and thyroiditis. Lymphoma (14%) was the most common cause of FUO, followed by tuberculosis (12.8%) and adult-onset Still's disease (6.8%). An older age (>50 years), thrombocytopenia, lower CRP level and splenomegaly were predictive factors for malignant disease.. However, 31 patients (21%) did not fit a definite diagnosis despite intensive investigation. Moreover, the proportion (26%) of undiagnosed patients during the period of 2000~2005 was significantly higher than that (13%) during the period of 1995~1999 (p<0.044). CONCLUSIONS: Although infectious disease remains a major cause of FUO, lymphoma was identified as the most common disease entity. The presence of older age, thrombocytopenia, lower CRP and splenomegaly were predictive of malignant disease and therefore require intensive diagnostic work-up.
Adult ; Communicable Diseases ; Connective Tissue ; Diagnosis ; Fever of Unknown Origin* ; Fever* ; Histiocytic Necrotizing Lymphadenitis ; Humans ; Lymphoma ; Retrospective Studies ; Splenomegaly ; Still's Disease, Adult-Onset ; Thrombocytopenia ; Thyroid Gland ; Thyroiditis ; Tuberculosis

The increasing prevalence of methicillin-resistant Staphylococcus aureus (MRSA) has become of great concern in both hospital and community settings. To evaluate the prevalence and risk factors for methicillin resistance among Staphylococcus aureus, blood isolates in our Emergency Department (ED) were collected. All patients with S. aureus bacteremia (SAB) who presented to the ED from January 2000 to August 2005 were included, and a retrospective study was performed. A total of 231 patients with SAB were enrolled (median age, 59 yr; M:F, 125:106). Among these patients, methicillin-resistant strains accounted for 27.3% (63 patients). Catheter-related infection was the most frequent primary site of SAB (39.0%), followed by skin and soft tissue infection (16.5%). In multivariate analysis, recent surgery (OR, 3.41; 95% CI, 1.48-7.85), recent hospitalization (2.17; 1.06-4.62), and older age (> or =61 yr) (2.39; 1.25-4.57) were independently associated with the acquisition of methicillin-resistant strains. When antimicrobial therapy is considered for the treatment of a patient with suspected SAB, clinicians should consider obtaining cultures and modifying empirical therapy to provide MRSA coverage for patients with risk factors: older age, recent hospitalization, and recent surgery.
Adult ; Age Factors ; Aged ; Anti-Bacterial Agents/pharmacology/therapeutic use ; Cross Infection/blood/drug therapy/microbiology ; Emergency Service, Hospital/statistics & numerical data ; Female ; Humans ; Male ; Methicillin/pharmacology/*therapeutic use ; *Methicillin Resistance ; Middle Aged ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Staphylococcal Infections/blood/drug therapy/*microbiology ; Staphylococcus aureus/*drug effects/isolation & purification

Nocardia farcinica is an emerging pathogen in immunocompromised hosts. Even though several species of Nocardia have been reported as causative pathogens of catheter-related blood stream infections (CRBSI), CRBSI caused by N. farcinica has not been reported. A 70-yr-old man with a tunneled central venous catheter (CVC) for home parenteral nutrition was admitted with fever for two days. Norcardia species was isolated from the blood through CVC and peripheral bloods and identified to N. farcinica by 16S rRNA and rpoB gene sequence analyses. This report emphasizes the rapid and correct identification of causative agents in infectious diseases in the selection of antimicrobial agents and the consideration of catheter removal.
Aged ; Bacterial Proteins/genetics/metabolism ; Blood/microbiology ; Catheter-Related Infections/*diagnosis/microbiology/nursing ; Catheterization, Central Venous/*adverse effects ; Humans ; Immunocompromised Host ; Male ; Nocardia/classification/genetics/*isolation & purification ; Nocardia Infections/*diagnosis ; Parenteral Nutrition/nursing ; Polymerase Chain Reaction ; RNA, Ribosomal, 16S/genetics/metabolism ; Sequence Analysis, DNA