Bacteremia ; diagnosis ; Humans ; Infant, Newborn ; Male ; Pseudomonas Infections ; diagnosis

Bacteremia ; diagnosis ; epidemiology ; microbiology ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Pseudomonas Infections ; diagnosis ; epidemiology ; Pseudomonas aeruginosa ; Retrospective Studies ; Rural Population ; Urban Population

BACKGROUND: We evaluated the combined use of the modified Hodge test (MHT) and carbapenemase inhibition test (CIT) using phenylboronic acid (PBA) and EDTA to detect carbapenemase-producing Enterobacteriaceae (CPE) and metallo-beta-lactamase (MBL)-producing Pseudomonas spp. METHODS: A total of 49 isolates of CPE (15 Klebsiella pneumoniae carbapenemase [KPC], 5 Guiana extended-spectrum beta-lactamase [GES]-5, 9 New Delhi metallo-beta-lactamase [NDM]-1, 5 Verona integron-encoded metallo-beta-lactamase [VIM]-2, 3 imipenem-hydrolyzing beta-lactamase [IMP], and 12 oxacillinase [OXA]-48-like), 25 isolates of MBL-producing Pseudomonas spp. (14 VIM-2 and 11 IMP), and 35 carbapenemase-negative controls were included. The MHT was performed for all isolates as recommended by the Clinical and Laboratory Standards Institute. Enhanced growth of the indicator strain was measured in mm with a ruler. The CIT was performed by directly dripping PBA and EDTA solutions onto carbapenem disks that were placed on Mueller-Hinton agar plates seeded with the test strain. RESULTS: Considering the results of the MHT with the ertapenem disk in Enterobacteriaceae and Pseudomonas spp., the CIT with the meropenem disk in Enterobacteriaceae, and the imipenem disk in Pseudomonas spp., three combined disk tests, namely MHT-positive plus PBA-positive, EDTA-positive, and MHT-positive plus PBA-negative plus EDTA-negative, had excellent sensitivity and specificity for the detection of KPC- (100% sensitivity and 100% specificity), MBL- (94% sensitivity and 100% specificity), and OXA-48-like-producing isolates (100% sensitivity and 100% specificity), respectively. CONCLUSIONS: Combined use of the MHT and CIT with PBA and EDTA, for the detection of CPE and MBL-producing Pseudomonas spp., is effective in detecting and characterizing carbapenemases in routine laboratories.
Bacterial Proteins/antagonists & inhibitors/*metabolism ; Boronic Acids/chemistry/pharmacology ; Disk Diffusion Antimicrobial Tests/*methods ; Edetic Acid/chemistry/pharmacology ; Enterobacteriaceae/drug effects/*enzymology ; Enterobacteriaceae Infections/diagnosis ; Humans ; Pseudomonas/drug effects/*enzymology ; Pseudomonas Infections/diagnosis ; Sensitivity and Specificity ; beta-Lactamases/chemistry/*metabolism

The chest X-ray findings of 20 cases of pulmonary opportunistic infections were analyzed according tocausative agents. The results we as follows; 1. Final diagnoses of 20 cases of opportunistic infections weretuberculosis in 6 cases, pneumocystis carinii pneumonia in 5 cases, bacterial infection in 7 cases, and fungalinfection in 2 cases. 2. The underlying diseases were leukemia in 6 cases, kidney transplantation in 6 cases,lymphoma in 3 cases, nephrotic syndrome in 1 case, nasopharyngeal cancer in 1 case, multiple myeloma in 1 case,agranulocytosis in 1 case, and hypogammaglobulinemia in 1 case. 3. In tuberculosis, all the 6 cases showed severemanifestations such as miliary tuberculosis, tuberculous pneumonia, moderately advanced tuberculosis andtuberculous pericarditis. 4. In pneumocystis carinii pneumonia, the most frequent findings were bilateral alveolardensities and peripheral field of the lung was saved in most cases. 5. In 2 cases of fungal infections bilatarealmultiple cavitary nodules were noted. 6. In cases of bacterial infection there were more cases of gram negativeinfection than gram positive and 2 cases of pseudomonas revealed bilateral multiple cavitary nodules.
Agammaglobulinemia ; Bacterial Infections ; Diagnosis ; Kidney Transplantation ; Leukemia ; Lung ; Multiple Myeloma ; Nasopharyngeal Neoplasms ; Nephrotic Syndrome ; Opportunistic Infections ; Pericarditis ; Pneumonia ; Pneumonia, Pneumocystis ; Pseudomonas ; Thorax ; Tuberculosis ; Tuberculosis, Miliary

Bronchiectasis is a chronic lung disorder and a number of bacterial pathogens are involved. However, 30%-40% of sputum and purulent samples in good quality failed to grow any pathogenic bacteria, making it difficult to confirm the pathogen. In this study, we collected bronchoalveolar lavage fluid from a bronchiectasis patient undergoing acute exacerbation, and sent for 16S rDNA pyrosequencing by a 454 GS Junior machine. Metagenomic analysis showed the composition of bacterial community in sample was complex. More than a half of reads (51.3%) were from Pseudomonas aeruginosa. This result was corresponding with the culture result but came out 2 d earlier, which is meaningful for early diagnosis and treatment. The detection with 16S rDNA pyrosequencing technology is more sensitive and rapid than routine culture, and can detect the co-infection or symbiosis in airway, giving us a novel and convenient approach to perform rapid diagnosis.
Bronchiectasis ; microbiology ; Bronchoalveolar Lavage Fluid ; chemistry ; microbiology ; Early Diagnosis ; Female ; Humans ; Metagenome ; genetics ; Metagenomics ; methods ; Middle Aged ; Pseudomonas Infections ; microbiology ; Pseudomonas aeruginosa ; genetics ; isolation & purification ; RNA, Ribosomal, 16S ; genetics ; Time Factors

Despite advances in neuroimaging and neurosurgical treatment modalities, spinal epidural abscess remains a challenging problem. Early diagnosis is often difficult and treatment is always delayed. Spinal epidural abscess usually develops in patients with predisposing factors such as IV drug abuse, senillity, diabetes mellitus, spinal attempts, alcoholism, immunosuppression, liver diseases and catheterizations. It is rarely seen in cervical region. A successful treatment is only possible with early diagnosis and accurate surgical and medical treatment. Optimal management is unclear and morbidity and mortality are significant. We present two adult haemodialysis patients with end-stage renal insufficiency who developed cervical epidural abscess following central venous catheter placement. Early surgical intervention is mandatory in cases those have progressive neurological deficit and spinal deformity, and this is also increases the success rate of medical therapy.
Aged ; Anti-Bacterial Agents/therapeutic use ; Catheterization, Central Venous ; *Cervical Vertebrae ; Epidural Abscess/*diagnosis/surgery ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pseudomonas Infections/diagnosis ; Renal Dialysis ; Staphylococcal Infections/diagnosis

Pyogenic sacroiliitis is a rare joint infection, with a challenging diagnosis due to its nonspecific indicators and symptoms. Staphylococcus aureus is the most common causative bacteria of pyogenic sacroiliitis, with Pseudomonas aeruginosa being the most common causative gram-negative bacteria. Interestingly, whereas Salmonella species. is reportedly the second most common cause of this disorder there have been no reported cases of acute sacroiliitis due to Salmonella spp. in Korea, to the best of our knowledge. In this study, we report on the first case in a young Korean adult caused by Salmonella enterica serotype Livingstone, with no underlying disease or predisposing factors.
Adult ; Bacteremia ; Bacteria ; Causality ; Diagnosis ; Gram-Negative Bacteria ; Humans ; Joints ; Korea ; Pseudomonas aeruginosa ; Sacroiliitis* ; Salmonella ; Salmonella enterica* ; Salmonella Infections ; Staphylococcus aureus

The urinary tract infection(UTI) is a very common complication of rehabilitation patients with neurogenic bladder. Proper diagnosis and early treatment are very important for the long term rehabilitation outcomes. Many reports are available in the literature on the characteristics of UTI in spinal cord injury(SCI) patients, however only few reports appear on non-SCI patients. We have done comprehensive chart reviews of 1,251 patients with neurogenic bladder who were admitted to the rehabilitation medicine department, PMC from January 1982 to August 1996. Patients were divided into 4 groups: patients with stroke, spinal cord injury, traumatic brain injury and other neurologic diseases, and we have studied: incidence of UTI, commonly cultured organisms, antibiotic sensitivities, urinary pH, voiding methods, and residual urine volumes. The incidences of UTI are 50.9% for all patients, 48.1% in Stroke, 72.3% in Spinal cord injury, 38.9% in Traumatic brain injury, and 34.1% in other neurologic diseases. There has been increase of Gram(+) cocci and decrease of Gram(-) rod during study period. Commonly cultured organisms are Escherichia coli(E. coli), Pseudomonas, Klebsiella. The decreased antibiotic sensitivities are noted in almost all organisms. Positive correlations are found between the incidence of UTI, high urine pH, high residual urine volumes, and use of catheters. In conclusion, despite of many variable factors, the trends of UTI in each groups show no significant difference.
Brain Injuries ; Catheters ; Diagnosis ; Escherichia ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Klebsiella ; Pseudomonas ; Rehabilitation ; Spinal Cord ; Spinal Cord Injuries ; Stroke ; Urinary Bladder, Neurogenic* ; Urinary Tract Infections* ; Urinary Tract*

Glomerulonephritis associated with visceral abscess is being increasingly recognized. The association of glomerulonephritis with visceral suppuration in the absence of endocarditis was first described by Whitworth and associates. Abscesses were most frequently located in the respiratory tract but have been reported at numerous other sites, including appendix, uterus, aorto-femoral bypass graft and cutaneous wound. This report documents the apparently rare occurrence of glomerulonephritis with acute renal failure in association with pyogenic liver abscess. The need for awareness of glomerulonephritis as a cause of acute renal failure in pyogenic liver abscess is highlighted.
Aged ; Antibiotics/administration & dosage ; Biopsy, Needle ; Case Report ; Drainage/methods ; Follow-Up Studies ; Glomerulonephritis/*complications/*diagnosis/therapy ; Human ; Liver Abscess/*complications/*diagnosis/therapy ; Male ; Pseudomonas Infections/*complications/*diagnosis/therapy ; Tomography, X-Ray Computed ; Treatment Outcome

PURPOSE:Primary immunodeficiency diseases are disorders in which part of the body's immune system is missing or does not function properly due to intrinsic defects in the immune system. These patients have an increased susceptibility to pulmonary complications as well as primary infections. This study was to investigate pulmonary complications in patients with primary immunodeficiency diseases and characterize their patterns according to specific immune defects. METHODS:We retrospectively reviewed the medical records of 37 different cases of primary immunodeficiency diseases that were admitted to Severance hospital in Seoul between 1990 and 2006. RESULTS:Many patients had a previous history of recurrent respiratory infections and some suffered from pulmonary complications. Eight patients with hypogammaglobulinemia showed peribronchial wall thickening or bronchiectasis, and pneumatoceles or emphysematous changes were characteristic complications in two patients with hyper IgE syndrome. On microbiological examination, various bacteria, including Staphylococcus aureus, Pseudomonas aeroginosa, Streptococcus pneumoniae, were isolated from the hypogammaglobulinemia patients' sputum or ear discharge. In some patients with cell-mediated immune defects, such as chronic granulomatous disease or severe combined immune deficiency, yeast and ameba were isolated from the sputum and bronchial washing fluid respectively. CONCLUSION:Infections account for most of these complications, but the host reaction to infection seems to cause characteristic findings that could be helpful for diagnosis. The physician should be alert for the early diagnosis of children with primary immunodeficiency in order to prevent pulmonary complications.
Agammaglobulinemia ; Amoeba ; Bacteria ; Bronchiectasis ; Child ; Diagnosis ; Ear ; Early Diagnosis ; Granulomatous Disease, Chronic ; Humans ; Immune System ; Immunologic Deficiency Syndromes ; Job Syndrome ; Lung Diseases ; Medical Records ; Pseudomonas ; Respiratory Tract Infections ; Retrospective Studies ; Seoul ; Sputum ; Staphylococcus aureus ; Streptococcus pneumoniae ; Yeasts