No abstract available.
Liver* ; Mesenchymoma*

Hyperbilirubinemia is frequently observed in Caucasian HIV patients treated with atazanavir. UDP-glucuronosyltransferase 1A1 polymorphism, UGT1A1*28, which is associated with atazanavir-induced hyperbilirubinemia, is less common in Asians than in Caucasians. However, little is known about the incidence of atazanavir-associated hyperbilirubinemia in Asian populations. Our objective was to investigate the incidence of and tolerability of atazanavir-associated hyperbilirubinemia in Korean HIV patients. The prevalence and cumulative incidence of atazanavir-associated hyperbilirubinemia and UGT1A1*28 allele frequency was investigated in 190 Korean HIV-infected patients treated with atazanavir 400 mg per day. The UGT1A1*28 were examined by direct sequencing of DNA from peripheral whole blood. The UGT1A1*28 allele frequency was 11%. The cumulative incidence of any grade of hyperbilirubinemia was 77%, 89%, 98%, and 100%, at 3, 12, 24, and 30 months, respectively. The cumulative incidence of severe (grade 3-4) hyperbilirubinemia was 21%, 41%, 66%, and 75%, at 3, 12, 24, and 30 months, respectively. However, the point prevalence of severe hyperbilirubinemia did not increase with time and remained around 25%. Our data suggest that atazanavir-associated hyperbilirubinemia is common but transient in a population with low UGT1A1*28 allele frequency.
Adult ; Alleles ; Anti-HIV Agents/*adverse effects/therapeutic use ; Asian Continental Ancestry Group/*genetics ; Female ; Follow-Up Studies ; Gene Frequency ; Glucuronosyltransferase/blood/*genetics ; HIV Infections/complications/*drug therapy ; Humans ; Hyperbilirubinemia/complications/*epidemiology/genetics ; Incidence ; Male ; Middle Aged ; Oligopeptides/*adverse effects/therapeutic use ; Promoter Regions, Genetic ; Pyridines/*adverse effects/therapeutic use ; Republic of Korea

Tumor necrosis factor-alpha (TNF-alpha) inhibitors are increasingly used in treatment of inflammatory disorders because of their immunomodulatory efficacy. Increased risk of infection is an adverse effect of anti-TNF-alpha therapy. The incidence rate and severity of herpes zoster is significantly higher in patients on anti-TNF-alpha therapy than in the general population. The clinical presentation of varicella zoster virus infection is also often atypical in these patients. We experienced a patient who presented with a disseminated varicelliform rash while on etanercept therapy for ankylosing spondylitis.
Exanthema ; Herpes Zoster* ; Herpesvirus 3, Human ; Humans ; Incidence ; Spondylitis, Ankylosing* ; Tumor Necrosis Factor-alpha ; Etanercept

Korea is a low prevalence country for human immunodeficiency virus (HIV) infection and has an intermediate tuberculosis (TB) burden. We previously reported that the incidence of TB in HIV-infected patients was 9.6 cases per 100 person-years (P-Y) between 1988 and 1997. The aims of the present study were to measure any change in incidence from the previous study, and to identify risk factors for TB in HIV-infected patients. We reviewed all medical records of HIV-infected patients who were followed-up in one tertiary hospital between 1998 and 2010. Over the total observation period of 5858.33 P-Y, TB developed in 70 patients (1.19 cases per 100 P-Y; 95% confidence interval [CI], 0.91-1.47 cases per 100 P-Y). Based on Poisson regression, one risk factor associated with TB was an initial CD4+ cell count below 200 cells/microliter (relative risk, 2.34; 95% CI, 1.47-3.73). Mean CD4+ cell counts of pulmonary, extrapulmonary, and both pulmonary and extrapulmonary TB were 179.8 cells/microliter, 138.3 cells/microliter, and 114.2 cells/microliter, respectively (P = 0.55). In conclusion, the incidence of TB in HIV-infected patients has decreased since the previous study. An initial CD4+ cell count below 200 cells/microliter is an independent risk factor for development of TB in HIV-infected patients.
Adult ; CD4 Lymphocyte Count ; Female ; HIV Infections/*complications ; Humans ; Incidence ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Tuberculosis/complications/*epidemiology/mortality

We evaluated risk factors for neutropenic fever and febrile prolonged neutropenia during vincristine-including chemotherapy to treat HIV-related lymphoma to investigate whether protease inhibitor (PI) treatment is associated with infectious complications due to drug interactions with chemotherapeutic agents. We included all HIV patients who received chemotherapy including vincristine for lymphoma at a single referral center in 1999-2010. Neutropenic fever was defined as absolute neutrophil count < 500 cells/microL with body temperature over 38degrees C; and prolonged neutropenia was defined if it persisted over 7 days. CODOX-M/IVAC and Stanford regimens were considered high-risk regimens for prolonged neutropenia. We analyzed 48 cycles of chemotherapy in 17 HIV patients with lymphoma. There were 22 neutropenic fever and 12 febrile prolonged neutropenia events. In multivariate analysis, neutropenic fever was associated with old age and low CD4 cell count, but not with PI use or ritonavir-boosted PI use. Low CD4 cell count and high-risk regimens were associated with febrile prolonged neutropenia. Neutropenic fever and febrile prolonged neutropenia is associated with old age, low CD4 cell count, and high-risk regimens, but not PI use, in HIV patients undergoing chemotherapy including vincristine for lymphoma.
Adult ; Age Factors ; Antineoplastic Agents, Phytogenic/*therapeutic use ; Body Temperature ; CD4 Lymphocyte Count ; Fever/*etiology ; HIV Infections/complications ; Humans ; Lymphoma, AIDS-Related/complications/*drug therapy/pathology ; Male ; Middle Aged ; Multivariate Analysis ; Neutropenia/*etiology ; Retrospective Studies ; Risk Factors ; Vincristine/*therapeutic use

During the 2015 outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) in Korea, 186 persons were infected, resulting in 38 fatalities. We isolated MERS-CoV from the oropharyngeal sample obtained from a patient of the outbreak. Cytopathic effects showing detachment and rounding of cells were observed in Vero cell cultures 3 days after inoculation of the sample. Spherical virus particles were observed by transmission electron microscopy. Full-length genome sequence of the virus isolate was obtained and phylogenetic analyses showed that it clustered with clade B of MERS-CoV.
Animals ; Cercopithecus aethiops ; Coronavirus Infections/*diagnosis/epidemiology/*virology ; Disease Outbreaks ; Humans ; Microscopy, Electron ; Middle East Respiratory Syndrome Coronavirus/classification/genetics/*isolation & purification/ultrastructure ; Phylogeny ; Polymerase Chain Reaction ; RNA, Viral/analysis/chemistry/metabolism ; Republic of Korea/epidemiology ; Sequence Analysis, RNA ; Vero Cells

Novel coronavirus (SARS-CoV-2) is found to cause a large outbreak started from Wuhan since December 2019 in China and SARS-CoV-2 infections have been reported with epidemiological linkage to China in 25 countries until now. We isolated SARS-CoV-2 from the oropharyngeal sample obtained from the patient with the first laboratory-confirmed SARS-CoV-2 infection in Korea. Cytopathic effects of SARS-CoV-2 in the Vero cell cultures were confluent 3 days after the first blind passage of the sample. Coronavirus was confirmed with spherical particle having a fringe reminiscent of crown on transmission electron microscopy. Phylogenetic analyses of whole genome sequences showed that it clustered with other SARS-CoV-2 reported from Wuhan.
China ; Coronavirus ; Crowns ; Genome ; Humans ; Korea ; Microscopy, Electron ; Microscopy, Electron, Transmission ; Phylogeny ; Vero Cells

Infectious diseases imported from other countries have increased as more and more Koreans are going abroad for various purposes. Tsutsugamushi disease from other endemic area such as Southeast Asia is important, because it can occur in any season and eschar may be absent. We report a case of imported tsutsugamushi disease acquired in the Philippines. A patient presented with fever, headache, and maculopapular skin rash. However, eschar was absent. Polymerase chain reaction (PCR) for 56-kDa gene of Orientia tsutsugamushi using buffy coat was positive. Serum indirect immunofluorescent antibody assay was initially negative but became positive with a titer of 1:320 at follow-up. Sequencing analysis revealed the strain to be 100% identical to the TW73R strain identified in Taiwan. After the patient received doxycycline, body temperature normalized in 12 hours. Tsutsugamushi disease is one of the differential diagnoses that should be included for patients with fever who have recently returned from Southeast Asian countries. PCR for O. tsutsugamushi using patient's buffy coat was useful for early diagnosis.
Asia, Southeastern ; Asian Continental Ancestry Group ; Body Temperature ; Communicable Diseases ; Diagnosis, Differential ; Doxycycline ; Early Diagnosis ; Exanthema ; Fever ; Follow-Up Studies ; Headache ; Humans ; Orientia tsutsugamushi ; Philippines ; Polymerase Chain Reaction ; Scrub Typhus ; Seasons ; Sprains and Strains ; Taiwan

Diabetic foot infection is one of the important complications in patients with advanced diabetes mellitus. Limb threatening infections such as osteomyelitis, abscess, and necrotizing fasciitis are frequently accompanied by the disease. Non-tuberculous mycobacterium (NTM) is a rare causative organism of diabetic foot infection. Thus, if one is not suspicious or meticulous, infection due to NTM will be easily overlooked and this will result in delayed diagnose and treat. Therefore, it is necessary to consider NTM as the causative organism if the wound does not respond to the conventional antibiotic treatment and the culture from the adequately obtained specimen reveals atypical acid-fast bacilli. We present a case of diabetic foot infection with osteomyelitis and abscess due to Mycobacterium mageritense, one of the rapid growing mycobacteria, that was successfully treated with surgical debridement and appropriate antibiotic treatment.
Abscess ; Debridement ; Diabetes Mellitus ; Diabetic Foot ; Extremities ; Fasciitis, Necrotizing ; Humans ; Mycobacterium ; Osteomyelitis

BACKGROUND: Local epidemiologic data on prevalent pathogens are important to guide empirical antibiotic therapy. In this study, we observed annual changes in frequency of occurrence and in vitro antimicrobial susceptibility of blood isolates over a period of 13 years. MATERIALS AND METHODS: We reviewed blood isolates identified during the period from 1998 to 2010 at Seoul National University Hospital. Only first isolates for each patient were included in the analysis. We analyzed the frequency of isolates and their trend with regard to in vitro antimicrobial susceptibility. Data were presented according to guidelines of the Clinical and Laboratory Standards Institute (CLSI) (2009). RESULTS: A total of 23,501 isolates were identified during the period from 1998 to 2010. Fifty-five percent of the isolates were gram-positive cocci, 38% were gram-negative rods, and 3% were fungi. Coagulase-negative Staphylococcus (CoNS) (24%), Escherichia coli (16%), Staphylococcus aureus (10%), and Klebsiella pneumoniae (8%) were the most commonly isolated bacteria, and Candida albicans (2%) was the most commonly isolated fungus. The frequency of CoNS increased from 18.0% to 26.8%, whereas the frequency of E. coli and K. pneumoniae decreased from 20.2% to 13.7% and from 11.7% to 6.7%, respectively. Overall, the proportion of methicillin-resistant S. aureus changed from 47.9% to 62.1%. In E. coli, the resistance rate of cefotaxime and ciprofloxacin increased over a period of 13 years. However, such an increase of resistance was not observed in K. pneumoniae. In P. aeruginosa, and particularly in A. baumannii, resistance to imipenem rose alarmingly (3% in 1998 to 27.8% in 2010, 5% in 1998 to 68.9% in 2010, respectively). CONCLUSIONS: Over the last 13 years, the proportion of CoNS in blood isolates increased, which led to a relative decrease of isolated gram-negative rods. Proportions of MRSA showed no significant change, whereas cefotaxime resistant and ciprofloxacin resistant E. coli increased. Imipenem resistant P. aeruginosa and A. baumannii also increased during the study period.
Bacteremia ; Bacteria ; Candida albicans ; Cefotaxime ; Ciprofloxacin ; Escherichia coli ; Fungi ; Gram-Positive Cocci ; Humans ; Imipenem ; Klebsiella pneumoniae ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Pneumonia ; Republic of Korea ; Staphylococcus ; Staphylococcus aureus