Plesiomonas shigelloides was isolated from blood culture of a 53-year-old man with fever, who had treatment history of gastrointestinal malignancy. The patient showed neither clinical features nor hematological finding which suggest bacteremia. Identification of the isolate was delayed because of its similar characteristics with Aeromonas spp. and other gram-negative bacilli. The isolate was misinterpreted as susceptible to ampicillin by the first disk diffusion test. It may not always easy to identify P. shigelloides by conventional tests and to determine its antimicrobial susceptibility accurately, as laboratorians rarely have experience with the organism and as the organism may show unusual inhibition pattern when tested by disk diffusion method or Etest.
Aeromonas ; Ampicillin ; Bacteremia* ; Diffusion ; Fever ; Humans ; Middle Aged ; Plesiomonas*

Plesiomonas shigelloides was isolated from blood culture of a 53-year-old man with fever, who had treatment history of gastrointestinal malignancy. The patient showed neither clinical features nor hematological finding which suggest bacteremia. Identification of the isolate was delayed because of its similar characteristics with Aeromonas spp. and other gram-negative bacilli. The isolate was misinterpreted as susceptible to ampicillin by the first disk diffusion test. It may not always easy to identify P. shigelloides by conventional tests and to determine its antimicrobial susceptibility accurately, as laboratorians rarely have experience with the organism and as the organism may show unusual inhibition pattern when tested by disk diffusion method or Etest.
Aeromonas ; Ampicillin ; Bacteremia* ; Diffusion ; Fever ; Humans ; Middle Aged ; Plesiomonas*

PURPOSE: Identification of antibody specificity is difficult using a multiple antigen PRA (MA-PRA) assay. The purpose of this study was to determine the clinical impact of single antigen PRA (SA-PRA) ELISA assay on the transplant outcome and to analyze the clinical significance of SA-PRA compared with CDC-AHG, flow cytometric crossmatch (FCXM) and MA-PRA. METHODS: A total of 151 kidney transplanted patients were tested for the presence of HLA antibodies in the pre- and posttransplant period. The HLA specificities were classified as donor-specific antibodies (DSA) including donor private antigen specific (DS-HLA) or donor public antigen specific (DS-cross reactive group (CREG)), and nondonor specific HLA antibodies. RESULTS: Of the 151 recipients, 28 patients experienced acute rejection episodes (ARE). The pretransplant CDC-AHG, FCXM and MA-PRA tests were positive in 2, 8 and 18 patients, respectively and the concordance between FCXM and MA-PRA was 89.4% (135/151). Of the 47 sera which were tested with both MA-PRA and SA-PRA, 4 sera were SA-PRA positive and MA-PRA negative. The HLA specificities which were not determined with MA-PRA were detected with SA-PRA test. The patients with DSA showed higher incidence of ARE (7/12, 58% vs. 21/139, 15%; P<0.001) and lower glomerular filtration rate (GFR) at 6 posttransplant months (54.9+/-10.2 vs. 66.2+/-19.3; P=0.023) than the patients without DSA. The patients with ARE had higher incidence of posttransplant DS-HLA (6 (21%) vs. 0 (0%); P<0.001), DS- CREG (7 (25%) vs. 0 (0%); P<0.001), de novo HLA antibody (6 (21%) vs. 0 (0%); P<0.001) than the patients without ARE. CONCLUSION: This study suggests that analysis of HLA specificities using the SA-PRA may be useful as a supportive crossmatch test or as a monitoring test after transplantation for early detection of patients at risk of poor clinical outcome.
Antibodies ; Antibody Specificity ; Enzyme-Linked Immunosorbent Assay ; Glomerular Filtration Rate ; Humans ; Incidence ; Kidney ; Rejection (Psychology) ; Tissue Donors ; Transplants

BACKGROUND: The purpose of this study was to compare a 1% chlorhexidine gluconate/6l% ethanol (CHG/Ethanol) emollient and 7.5% povidone-iodine (PVI) scrub for antibacterial efficacy and effect on skin condition. METHODS: Twelve healthy newly employed nurses were recruited for this clinical study to evaluate the two hand cleansing agents. The CHG/Ethanol emollient hand preparation was applied without scrubbing and 7.5% PVI was applied using a scrub brush in 5-minute surgical scrubbing. Subjects used one method for 5 days and switched to the other method for another 5 days. Samples were taken for bacterial counts using the glove juice technique before and one minute after hand cleansing and again at the end of surgical operation on Day 1, 2, and 5. The VSS (Visual Scoring of Skin condition) scores and HSA (Hand Subject Assessment) scales were used to evaluate skin condition. RESULTS: Log reduction in bacterial counts by CHG/Ethanol emollient was greater than by PVI immediately after hand cleasing (log3.73 vs log1.66) and at the end of surgical operation (log3.49 vs log1.93) on Day 1. But there were no significant difference on Day 2 and 5. CHG/Ethanol emollient caused fewer skin problems than PVI; the VSS scores of the CHG/Ethanol emollient were better than those of PVI on Day 2, 3, 4, and 5 (P<0.05), and also HSA scale for change from baseline to the end of Day 5 was significantly better for the CHG/Ethanol emollient (22.5-->24.5 vs 23.0-->19.3). CONCLUSION: Compared to PVI, the CHG/Ethanol emollient hand preparation was shown to be more antibacterial and less irritation to skin. The results showed the possibility of using the waterless, scrubless agent for surgical hand scrub in Korea.
Bacterial Load ; Chlorhexidine ; Detergents ; Ethanol ; Hand ; Hand Disinfection ; Korea ; Povidone-Iodine* ; Skin ; Weights and Measures

BACKGROUND: For the detection of HLA antibodies, solid-phase tests using purified HLA antigens are increasingly used. In this study, we analyzed the panel reactive antibody (PRA) test results using ELISA and Luminex methods, and the results were compared with those of crossmatch test. METHODS: A total of 111 sera including 90 sera from kidney transplanted patients were tested. ELISA-PRA was performed using Lambda Antigen Tray Class I and II Mixed kits (One Lambda Inc., USA) and additional test was performed to identify HLA specificities. Luminex-PRA tests were performed using LABScreen Mixed kits (One Lambda Inc., USA) and LIFECODES LifeScreen Deluxe kits (Tepnel Co., USA). RESULTS: The positive rates of PRA were higher in Tepnel (P=0.006) and One Lambda Luminex (P<0.001) methods than ELISA, without significant difference between two Luminex methods (P=0.087). The overall concordance rate among the three PRA tests was 62.2% (69/111). The positive and negative predictive values of PRA tests for the flow cytometric crossmatch were 33.3-45.7% and 85.7-89.5%, respectively. Of the two Luminex methods, One Lambda showed higher positive rate than Tepnel for the detection of class I antibodies. The sensitivity of pretransplant PRA for the detection of posttransplant acute rejection episodes was higher in Luminex (P=0.007 for Tepnel, P=0.003 for One lambda) than ELISA method. CONCLUSIONS: Different methods used to detect HLA antibodies showed discrepant results. As the Luminex method was more sensitive than ELISA for the detection of HLA antibodies, it can be used as a routine test in the transplantation laboratory.
Enzyme-Linked Immunosorbent Assay/*methods ; Flow Cytometry ; Histocompatibility Antigens Class I/*immunology ; Histocompatibility Antigens Class II/*immunology ; Humans ; Isoantibodies/*blood ; Kidney Transplantation/immunology ; Reagent Kits, Diagnostic ; Sensitivity and Specificity

BACKGROUND: Free light chain (FLC) is widely used to evaluate B-cell proliferative diseases. Herein, we estimated the clinical usefulness of serum FLC in multiple myeloma (MM). METHODS: Fifty-one patients were enrolled. We performed FLC analysis, protein electrophoresis (PEP), and immunofixation electrophoresis (IFE). FLC was measured using Toshiba 200 FR Neo with FREELITE(TM), and kappa/lambda (kappa/lambda) ratio was calculated. We compared these parameters in 41 patients with increased FLC before and after bortezomib treatment. Complete response (CR) was defined as the disappearance of monoclonal (M) protein in serum and/or urine as measured by IFE. Partial response (PR) was defined as > or =50% reduction of serum M protein. Early objective response (EOR) included both CR and PR. Minimal response (MR) was defined as 25-49% reduction of M protein and stable disease (SD) as <25% reduction. RESULTS: Forty-one (80.4%) of the 51 patients studied revealed increment of FLC and the five patients with no increment revealed an abnormal kappa/lambda ratio. Especially, all of the light chain myeloma and non-secretory myeloma showed increased FLC concentrations. Among the patients with EOR, 72.4% (21/29) showed a normal or subnormal FLC concentration after the first cycle of treatment. Otherwise, PEP and IFE normalized in 24.1% (7/29) and 24.1% (7/29), respectively. The ratio of decreased FLC after the first cycle of treatment was significantly different between EOR and other response groups (MR, SD) (90.6% vs 51.8%, P=0.011). CONCLUSIONS: FLC was considered as a good diagnostic method in complement with PEP and IFE in MM, especially in light chain myeloma or non-secretory myeloma. Moreover, FLC is a useful monitoring tool because it reflects therapy results more rapidly owing to a short serum half-life.
Adult ; Aged ; Boronic Acids/therapeutic use ; Female ; Humans ; Immunoelectrophoresis ; Immunoglobulin Light Chains/*blood/urine ; Male ; Middle Aged ; Multiple Myeloma/*diagnosis/therapy ; Pyrazines/therapeutic use ; Reagent Kits, Diagnostic

Capnocytophaga spp. are thin, spindle-shaped, gram-negative bacilli, similar to fusobacteria. We isolated Capnocytophaga from the blood of three patients with fever: two acute myelogenous leukemia patients and one chronic osteomyelitis patient. The patients showed mild course of disease without hypotension or the change of mental status. As Capnocytophaga spp. are slow growing bacteria, there were difficulties in the isolation and susceptibility test of bacteria. More concerns should be given to the uncommonly isolated bacteria such as Capnocytophaga.
Bacteremia* ; Bacteria ; Capnocytophaga* ; Fever ; Fusobacteria ; Humans ; Hypotension ; Leukemia, Myeloid, Acute ; Osteomyelitis

No abstract available.
Humans

BACKGROUND: Real-time PCR for quantification of JAK2 V617F has recently been introduced and used to evaluate the importance of mutant allele burden in both diagnosis and disease progression in myeloproliferative diseases (MPDs). We evaluated the usefulness of JAK2 MutaScreen(TM) kit that uses a real-time semiquantitative PCR method and has been designed to screen JAK2 V617F mutant allele burden. METHODS: Forty MPD patients were included in this study. We screened JAK2 V617F and determined the mutant allele burden using JAK2 MutaScreen(TM) kit. The mutant allele burden was estimated by six-scaled standards of JAK2 V617F mutant allele (2%, 5%, 12.5%, 31%, 50%, and 78%). For evaluation of test performance, an allele-specific PCR (AS-PCR) was carried out in all samples by using Seeplex JAK2 Genotyping kit. We assessed the clinical differences in distinct disease entities of MPDs according to JAK2 V617F mutant allele burden. RESULTS: JAK2 V617F mutation was detected in 30 cases, including 10 of 11 cases (91%) of polycythemia vera (PV), 13 of 20 cases (65%) of essential thrombocythemia (ET), and 2 of 3 cases (67%) of chronic idiopathic myelofibrosis (CIMF). The concordance rate between the two tests was 95% (38/40). JAK2 V617F mutant allele burden was greater than 50% in 17 cases, and 10 of them (59%) were PV. In contrast, mutant allele burden was less than 50% in 13 cases and 11 of them (85%) were ET. CONCLUSIONS: JAK2 MutaScreen(TM) kit that utilizes a real-time semi-quantitative PCR method is a useful tool for diagnosing MPDs precisely. It can be used to assess the grade of mutant allele burden as well as to screen JAK2 V617F simultaneously.
Adult ; Aged ; *Alleles ; Amino Acid Substitution ; DNA Mutational Analysis ; Disease Progression ; Female ; Humans ; Janus Kinase 2/*genetics ; Male ; Middle Aged ; Mutation ; Myeloproliferative Disorders/*diagnosis/genetics ; Polymerase Chain Reaction/*methods ; Reagent Kits, Diagnostic

PURPOSE: Acute promyelocytic leukemia (APL) is a distinct subtype of acute myelogenous leukemia characterized by the morphology of blast cells (M3 in FAB classification), the t (15;17) translocation, and a coagulopathy combining disseminated intravascular coagulation and fibrinolysis. It has been considered to have better response to combination chemo- therapy of an anthracycline and cytosine arabinoside and a higher cure rate than other subtypes because of recent approach of differentiating leukemic blasts by all-transretinoic acid (ATRA). The role of stem cell transplantation in APL has to be determined in comparison with that of consolidation chemotherapy. MATERIALS AND METHODS: We compared the leukemia-free survival and overall survival between APL patients receiving the consolidation chemotherapy and those undergoing the allogeneic or autologous stem cell transplantation following the high-dose anticancer therapy. Of the 65 patients achieving the first complete remission from 1992 to 1997, 33 patients were treated with 3 courses of consolidation chemotherapies and 32 with the stem cell transplantation. RESULTS: With a median follow-up of 22 months (8-60), the actuarial leukemia-free survival at 3 years was significantly higher in transplantation group than in chematherapy group (73.8% versus 33.5%; P=0.0087), and the probability of leukemic relapse was considerably lower in transplantation group than in chemotherapy group (6.3% versus 57.5%; P=0.001). The treatment-related mortalities of the groups were 0% in chemotherapy group and 14.3% in transplantation group. The main cause of deaths was relapse in the consolidation chemotherapy group. CONCLUSION: These data demonstrate that the stem cell transplantation results in better leukemia-free survival than the consolidation chemotherapy for patients with APL in the first complete remission because of lower risk of relapse.
Bone Marrow Transplantation* ; Bone Marrow* ; Cause of Death ; Consolidation Chemotherapy* ; Cytarabine ; Disseminated Intravascular Coagulation ; Drug Therapy ; Fibrinolysis ; Follow-Up Studies ; Humans ; Leukemia, Myeloid, Acute ; Leukemia, Promyelocytic, Acute* ; Mortality ; Recurrence ; Stem Cell Transplantation