The first case was 7-month-old immunodeficiency girl in whom the diagnosis of Acanthamoeba pneumonia was established by culture of a bronchial washing. The patient had been ill for a month when she was admitted due to neonatal thrombocytopenia with respiratory difficulty and treated with gammaglobulin and steroid. Her chest X-ray showed diffuse alveolar consolidation on the left lung with interstitial hazziness and a partial sign of hyperinflation on the right lung. Laboratory tests showed that the Candida antigen was negative and Pneumocystis carinii was not detected. Mycoplasma antigen was negative. All the immunoglobulin levels (IgG, IgA, IgM) were below the normal range. Five days later the patient expired. The second case was an immunosuppressed 7-year-old boy in whom Acanthamoeba trophozoites were found in the skin biopsy, followed by meningitis leading to death. About five days after a laceration on the region of the left eyebrow, a painful bean-sized nodule developed at the suture site and it was treated with antibiotics and corticosteroid. The skin biopsy showed severe inflammatory cell infiltration. Trophozoites were scattered near the blood vessels throughout the inflammatory zone. From one weak prior to admission, the patient had suffered from vomiting, indigestion and mild fever. Skin nodules with tenderness appeared all over his body surface. Examination of cerebrospinal fluid showed clear, Gram stain was negative, bacterial culture negative, India ink preparation negative, and organism on wet smear negaive. On admission day 10, focal seizure of the left extremity occurred. Brain CT revealed calcific density on the left parietal lobe area and hypodensity on the left basal ganglia. He became comatous and died immediately after discharge. Until now in Korea, two cases that are described in this paper, one Acanthamoeba meningoencephalitis case and seven Acanthamoeba keratitis cases including two unreported keratitis cases that are reported in this paper have been presented.
Acanthamoeba*/isolation & purification ; Amebiasis*/parasitology ; Animal ; Case Report ; Child ; Female ; Human ; Immunocompromised Host ; Infant ; Korea ; Male ; Meningitis/parasitology* ; Pneumonia/parasitology*

A pathological study was done to elucidate sequential changes of the lungs in various time intervals following experimental paragonimiasis in 15 dogs and 15 cats. The dogs and cats were fed with 30-50 metacercariae of Paragonimus westermani, and were sacrificed at 15, 20, 30, 45, 60, 90 and 120 days after infection respecively. Autopsies were performed immediately after death. Gross and microscopic examination of the lungs showed following findings: There were no qualitative difference in pathological findings between dogs and cats. Pathological findings were first noticed at 20 days of infection in thoracic cavity, which consisted of fibrinous plueritis along with superficial hemorrhage. Although no worm was found in the lung parenchyma at this period, juveniles were seen in pleural cavity together with turbid effusion. Paragonimus juveniles were first recognized inside the lung parenchyma by 30 days of infection. This was the period when the lungs showed multiple areas of hemorrhage and probably active penetration by smaller worms. Hemorrhagic bronchopneumonia was quite pronounced from this stage through 45 days of infection. Paragonimus worm cyst was essentially composed of fibrous scar and heavy inflammatory cellular infiltrate. The lining epithelial cells were first became noticed by 2 months of infection. And these epithelial cells were thought to be probably transformed alveolar lining cells rather than bronchiolar epithelial cells. As the infection progress, the cyst wall became more stabilized and often showed squamous metaplasia. Fibrinous pleuritis with pleural effusion was very prominent finding in early periods of infection. Bronchiolitis and focal vascular sclerosis were often seen in experimental paragonimiasis.
parasitology-helminth-trematoda ; Paragonimus westermani ; paragonimiasis ; pneumonia ; cyst ; hemorrhage ; pleuritis ; effusion ; bronchiolitis ; sclerosis

In order to understand the tissue responses of albino rat host against Paragonimus iloktsuenensis infection, the histopathological changes of the spleen and the lungs in 6 experimental groups of rats were observed in relation with the growth, maturation and migration of this lung fluke. Rats of the experimental groups, each group consisted of 5 rats, were infected with the metacercariae of P. iloktsuenensis which were isolated from brackish water crab, Sesarma dehaani, and were kept for 3 days, 3 weeks, 4 weeks, 7 weeks, 10 weeks and 14 weeks of infection period. Peripheral blood smear slides for the differential leukocyte count were prepared and also worm collection was completed immediately after the infection period. Paraffin sections of the spleen and the lung tissue were stained with hematoxylin-eosin and methyl-green-pyronin (MGP) stain. Those materials from the experimental groups were examined in comparison with the materials obtained from control group, with special reference to immunologic aspects of host response. The results obtained were as follows: The counts of large pyroninophilic cell (LPC) in the periarterial sheath of spleen were rapidly increased in earlier period of infection, and those of peribronchial lymphatic tissue started to increase after the penetration of lungfluke into the lungs. The LPC counts of both the spleen and the lungs were on the decrease in conjunction with the necrosis of the lung fluke in 14th week of infection. On observing differential leukocyte count of peripheral blood smear, the fluctuation of lymphocyte count was proportional to that of LPC count, and the lymphocyte count was consistently higher than that of normal rats. On the other hand, neutrophil count of experimental group showed reciprocal relation to the LPC counts. The nature and characteristics of pulmonary lesion produced by the P. iloktsuenensis were just the same as those produced by P. westermani. The lesions were represented by thick and fibrosclerotic cavern, granuloma due to eggs, pneumonic process and cellular infiltrations.
parasitology-helminth-trematoda ; paragonimiasis ; Paragonimus iloktsuenensis ; histology ; pathology ; lung ; spleen ; granuloma ; pneumonia ; hematoxylin-eosin ; methyl-green-pyronin

In order to evaluate the diagnostic value of fibrotic bronchoscopy (FB) in the pulmonary infiltration following bone marrow transplantation (BMT), 18 patients with pulmonary complications after BMT from November 2003 to March 2006 were performed with FB. Bronchoalveolar lavage (BAL) and brushing were performed in patients who had received short-term empirical therapy without good response, and transbronchial lung biopsy (TBLB) was carried out in 3 cases. The results showed that 9 out of 10 cases with pulmonary infection, including bacterial pneumonia (n = 3), aspergillosis (n = 2), pneumocystis carinii pneumonia (n = 3) and viral infection (n = 1) were diagnosed by using FB. One case was diagnosed as tuberculosis after open lung biopsy following negative results from twice BAL. 2 out of 8 cases were diagnosed by TBLB as noninfectious pulmonary complications. In conclusion, FB, especially with BAL, is a safe and useful procedure for the evaluation of pulmonary complications, which is particularly suitable for diagnosis of pulmonary infection after BMT. Furthermore, TBLB should be recommended in order to avoid open lung biopsy, if the patients tolerate the operation.
Adolescent ; Adult ; Bone Marrow Transplantation ; adverse effects ; Bronchoalveolar Lavage Fluid ; microbiology ; parasitology ; Bronchoscopy ; Child ; Female ; Humans ; Lung Diseases ; diagnosis ; etiology ; Male ; Middle Aged ; Pneumonia ; diagnosis ; etiology ; microbiology ; Pneumonia, Pneumocystis ; diagnosis ; etiology ; microbiology ; Young Adult

Annual proficiency surveys were conducted in March, June, and September in 2015 by the Clinical Microbiology Subcommittee of the Korean Association of External Quality Assessment Service. The program covers the sections of bacteriology, advanced bacteriology and mycology, mycobacteriology, and parasitology. Each trial was composed of three sets of different combinations of five bacteria and yeasts. These sets were distributed among laboratories for Gram staining, culture, identification, and antimicrobial susceptibility tests. Five slides with fixed sputum smears were provided as part of each trial for acid-fast bacilli detection. The survey material distribution was section-based. Two survey materials were provided in each trial, while five specimens for mycobacterial culture and identification, five specimens for anti-tuberculosis susceptibility testing and two Mycobacterium tuberculosis strains for rapid detection of rifampin and isoniazid resistance were distributed in the March and June trials. Five virtual microscopy files for stool parasite examination were availed by registered participants in the June trial. Out of the 334 enrolled laboratories, 328 (98.2%), 328 (98.2%), and 329 (98.5%) submitted responses in trials I, II, and III, respectively. Identification of bacteria, namely, Escherichia coli, Klebsiella pneumoniae, Enterococcus faecalis, Pseudomonas aeruginosa, Streptococcus pneumoniae, and Vibrio fluvialis by more than 95% of participants was acceptable. Surveillance cultures for vancomycin-resistant enterococci and carbapenem-resistant Enterobacteriaceae were determined accurately by 75.8%–85.3% and 93.1% of the respondents, respectively. Species-level identification of Candida krusei, Candida lusitanae, and Candida guilliermondii was still low at 79.8%, 55.7%, and 42.7%, respectively. Disk diffusion method revealed an unacceptably high false-positive rate of resistance to glycopeptides in E. faecalis and to trimethoprim-sulfamethoxazole in S. pneumoniae. Advanced bacteriology trials revealed unsatisfactory results for species-level identification of moulds. Mycobacterial culture, identification and susceptibility testing, and molecular detection of rifampin and isoniazid resistance were performed exceedingly well by participants. Hymenolepsis diminuta could not be identified by participants, with a correct answer rate of only 46.5% and ‘no parasite seen’ answer rate of only 31.8% for negative specimens. Species-level identification of Candida and moulds was challenging for clinical microbiology laboratories. Disk diffusion method was found to be problematic in testing the susceptibility of microorganisms to glycopeptides and trimethoprim-sulfamethoxazole. Improvement is required in result interpretation of negative specimens in parasitology.
Bacteria ; Bacteriology ; Candida ; Diffusion ; Enterobacteriaceae ; Enterococcus faecalis ; Escherichia coli ; Glycopeptides ; Isoniazid ; Klebsiella pneumoniae ; Korea* ; Methods ; Microscopy ; Mycobacterium ; Mycobacterium tuberculosis ; Mycology ; Parasites ; Parasitology ; Pneumonia ; Pseudomonas aeruginosa ; Quality Control ; Rifampin ; Sputum ; Streptococcus pneumoniae ; Surveys and Questionnaires ; Trimethoprim, Sulfamethoxazole Drug Combination ; Vancomycin-Resistant Enterococci ; Vibrio ; Yeasts

Annual proficiency surveys were performed in March, June and September 2014 by clinical microbiology division of The Korean Association of Quality Assurance for Clinical Laboratory. Parasitology part has been newly incorporated in this survey. For each trial, three sets which were composed of different combinations of five bacteria and yeast were distributed for gram stain, culture, identification, and antimicrobial susceptibility tests of general bacteriology and five fixed sputum smear on slides were distributed for acid fast bacilli stain. Two advanced bacteriology survey materials for culture and identification of anaerobic bacteria and mold were distributed to the voluntary participants in every trial and five mycobacterial culture and identification specimens, five anti-tuberculosis susceptibility testing specimens, and two Mycobacterium tuberculosis strains for rapid detection of rifampin and isoniazid resistance were distributed to the voluntary participants in March and June trials. Five virtual microscopic slides for stool parasite examination were open for the registered participants in June trial. A total of 340 laboratories were enrolled and 330 (97.0%), 331 (97.4%), and 331 (97.4%) returned the results on trial I, II, and III, respectively. For bacterial identification, the percent acceptable identification of Burkholderia cepacia, Klebsiella pneumoniae, Streptococcus pyogenes, Staphylococcus aureus, Pseudomonas aeruginosa, Streptococcus pneumoniae, Streptococcus agalactiae, Plesiomonas shigelloides, and Enterococcus faecalis were greater than 95%. Group C and group D Salmonella species challenged as the different sets of M1422 resulted in the acceptable rate lower than 95% because nine participants reported the identification of different sets. Surveillance cultures for methicillin-resistant S. aureus and vancomycin-resistant enterococci were correctly determined by 89.6% and 69.0% of the respondents, respectively. Correct identification to species level of Candida albicans, Candida auris, Candida glabrata, and Candida parapsilosis were 86.1%, 1.6%, 48.1%, and 83.8%. Vancomycin disk diffusion test in S. aureus, missing oxacillin screen or penicillin susceptibility test in S. pneumoniae and lack of reliable methods of quinolone resistance detection in Salmonella species caused unacceptable results in antimicrobial susceptibility testing. Advanced bacteriology trials revealed low performance in species identification of mold. Mycobacterial culture, identification and susceptibility test performance was kept in excellence. The performance of identification of stool parasites was acceptable >90% for detection of helminth eggs and amebic cysts but 28.6% false positive responses resulted from negative specimens. In conclusion, species-level identification of fungi of both candida species and mold were challenging to clinical microbiology laboratories. Vancomycin disk diffusion method for S. aureus and lack of proper penicillin susceptibility test for S. pneumoniae were still common cause of inaccurate results. Virtual microscopic survey has been successfully introduced in parasitology.
Bacteria ; Bacteria, Anaerobic ; Bacteriology ; Burkholderia cepacia ; Candida ; Candida albicans ; Candida glabrata ; Surveys and Questionnaires ; Diffusion ; Eggs ; Enterococcus faecalis ; Fungi ; Helminths ; Isoniazid ; Klebsiella pneumoniae ; Korea* ; Methicillin Resistance ; Mycobacterium tuberculosis ; Ovum ; Oxacillin ; Parasites ; Parasitology ; Penicillins ; Plesiomonas ; Pneumonia ; Pseudomonas aeruginosa ; Rifampin ; Salmonella ; Sputum ; Staphylococcus aureus ; Streptococcus agalactiae ; Streptococcus pneumoniae ; Streptococcus pyogenes ; Vancomycin ; Yeasts