1.Recurrent Bilateral Retinal Vasculitis as a Manifestation of Post-streptococcal Uveitis Syndrome.
Jinu HAN ; Sung Chul LEE ; Won Kyung SONG
Korean Journal of Ophthalmology 2012;26(4):309-311
We report a case of post-streptococcal uveitis mainly presenting with bilateral recurrent retinal vasculitis in Korea. A 14-year-old Asian female presented with decreased visual acuity of 20 / 30 in the right eye and 20 / 25 in the left eye. The patient had a history of glomerulonephritis nine months before onset of uveitis. The manifestation of uveitis was predominantly retinal vasculitis. We presumed post-streptococcal uveitis because probable streptococcal infection was confirmed by anti-streptolysin O titer elevation. With topical and oral steroid treatments, the patient experienced complete vision recovery. Post-streptococcal uveitis occurs rarely and mostly involves young patients in the form of non-granulomatous anterior uveitis. However, as this case shows, it may primarily involve the posterior uvea without anterior inflammation and may recur.
Adolescent
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Diagnosis, Differential
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Female
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Humans
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Recurrence
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Retinal Vasculitis/drug therapy/*microbiology
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Steroids/therapeutic use
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Streptococcal Infections/*diagnosis
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Uveitis/drug therapy/*microbiology
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Visual Acuity
2.Unusual Primary Peritonitis due to Streptococcus pyogenes in a Young Healthy Woman.
Ji Yoon PARK ; Soo youn MOON ; Jun Seong SON ; Mi Suk LEE ; Min Hyung JUNG
Journal of Korean Medical Science 2012;27(5):553-555
We describe the first case of primary peritonitis in Korea of a healthy person due to Streptococcus pyogenes. In the absence of comorbid conditions, such as liver cirrhosis, immunosuppression, or nephrotic syndrome, primary peritonitis is uncommon in a young healthy woman. Abdomen computed tomography revealed ascites in the lower abdomen and peritoneal enhancement suggesting peritonitis. In diagnostic laparoscopy, purulent ascites was found in the pelvic cavity but both ovaries and fallopian tubes were intact. There were no intra-abdominal abnormalities such as bowel perforation, appendicitis, or necrosis. The reports of blood culture, ascites culture, and cervical swab culture confirmed S. pyogenes. After use of antibiotics, the patient was cured and discharged without sequelae.
Adult
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Anti-Bacterial Agents/therapeutic use
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Female
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Humans
;
Laparoscopy
;
Peritonitis/*diagnosis/drug therapy/microbiology
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Streptococcal Infections/*diagnosis/drug therapy/microbiology
;
Streptococcus pyogenes/*isolation & purification
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Tomography, X-Ray Computed
3.Clinical characteristics and antimicrobial resistance of invasive group A β-hemolytic streptococcus infection in children.
Jiemin FAN ; Lin DONG ; Zhaoxing CHEN ; Dandan BEI
Chinese Journal of Pediatrics 2014;52(1):46-50
OBJECTIVEGroup A β-hemolytic streptococcus (GAS) or Streptococcus pyogenes may be encountered in diverse clinical situations in children. A rising incidence of invasive group A streptococcus (IGAS) infections has been noted in children in the past three decades. The aim of this study was to summarize the clinical characteristics and antimicrobial resistance of IGAS in children, and to raise the level of diagnosis and treatment of this infection.
METHODThe clinical data from 19 cases of IGAS younger than 14 years old seen from January 2004 to December 2011 treated in the authors' hospital were analyzed. IGAS infections are defined as the isolation of GAS from a normally sterile site in patients.
RESULTThe 19 cases were identified as IGAS infections, among whom 15 were male and 4 were female, and the ratio of them was 3.75. The age ranged from 1 day to 14 years, with a median age of 4 years. The course of disease was 4 h-10 days. The average length of stay was 12.2 days. In 13 cases the episodes of the infection occurred in winter and spring. In 18 cases the infection was community-acquired. Overall, 10 cases had neck or foot dorsum abscess, four cases had purulent peritonitis, and 3 cases were diagnosed as streptococcal toxic shock syndrome (STSS) complicated with empyema, pyopneumothorax occurred in 1 case and neonatal septicemia in another. Three cases had an underlying disease, including 2 cases wounded in a car accident and 1 case of congenital esophageal atresia and tracheoesophageal fistula. Before the isolation of GAS, 5 cases had stayed in ICUs, the length of ICU stay was 1-32 days, 4 cases had received intubation and mechanical ventilation, the ventilation time was 8 h-24 days, 2 cases had received major surgery; 5 cases had other pathogen coinfection, including 4 cases of abdominal pus at the same time and Escherichia coli was isolated, and 1 case had parainfluenza virus type I coinfection. Peripheral blood leucocyte increased in 18 cases, one case dropped off. The C-reactive protein (CRP) levels increased in all patients, including 16 cases who had 14-160 mg/L, 3 cases had levels higher than 160 mg/L. Twenty strains of GAS were isolated from 19 cases' sterile sites, of them 10 strains were isolated from abscess, 4 strains were isolated from blood and another 4 from ascites. Two strains were from the same patient at different times of pleural effusion. All 20 strains displayed a full susceptibility to cefazolin, levofloxacin and vancomycin, and the rates of resistance to both cefotaxime and penicillin were 10.0%. The rates of resistance to erythromycin and clindamycin were 55.0% and 70.0% respectively. Among the patients 3 cases were cured, 14 cases improved, and 2 cases died, of whom 1 case died of STSS secondary to multiple organ dysfunction, 1 case died of basic disease secondary to multiple organ dysfunction.
CONCLUSIONSkin and soft tissues were the most common IGAS infection sites in children, and IGAS infection also can lead to serious STSS and even can be life threatening. Penicillin and cephalosporin are still sensitive for children IGAS infections.
Abscess ; drug therapy ; epidemiology ; microbiology ; Adolescent ; Anti-Bacterial Agents ; pharmacology ; therapeutic use ; Cephalosporins ; therapeutic use ; Child ; Child, Preschool ; Clindamycin ; therapeutic use ; Community-Acquired Infections ; drug therapy ; epidemiology ; microbiology ; Drug Resistance, Bacterial ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Microbial Sensitivity Tests ; Retrospective Studies ; Soft Tissue Infections ; drug therapy ; epidemiology ; microbiology ; Streptococcal Infections ; drug therapy ; epidemiology ; microbiology ; Streptococcus pyogenes ; drug effects ; isolation & purification
4.Splenic Abscess: A Single Institution Study and Review of the Literature.
Won Suk LEE ; Sang Tae CHOI ; Keon Kuk KIM
Yonsei Medical Journal 2011;52(2):288-292
PURPOSE: The aim of this study was to review our experience with splenic abscesses, with respect to the relevant aspects of splenic abscesses and treatment outcomes. MATERIALS AND METHODS: We reviewed the cases of 18 patients who had splenic abscesses and who were treated at our hospital from November 1993 to December 2008. RESULTS: The most common symptom at presentation was abdominal pain in 12 patients (66.7%). The median duration from symptom onset until establishment of a diagnosis was 22 days. Streptococcus viridians was the most common pathogen (27.8%), follow by Klebsiella pneumoniae (22.2%). The mortality rate during the inpatient period and the previous 90 days was 16.6%. Three of four patients with Klebsiella pneumoniae showed a single abscess pocket. Four patients (22.2%) underwent percutaneous drainage, eight (44.5%) recieved antibiotic treatment only and six (33.3%) underwent splenectomy. CONCLUSION: There is no gold standard for treating splenic abscesses. Treatment should be customized for each patient.
Abscess/diagnosis/drug therapy/microbiology/surgery/*therapy
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Adult
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Aged
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Anti-Bacterial Agents/therapeutic use
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Drainage
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Female
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Humans
;
Klebsiella Infections/diagnosis/drug therapy/microbiology/surgery
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Klebsiella pneumoniae
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Male
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Middle Aged
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Splenectomy
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Splenic Diseases/diagnosis/drug therapy/*microbiology/surgery
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Streptococcal Infections/diagnosis/drug therapy/microbiology/surgery
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Treatment Outcome
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Viridans Streptococci
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Young Adult
5.Purulent Pericarditis Caused by Group G Streptococcus as an Initial Presentation of Colon Cancer.
Nam Ho KIM ; Jong Pil PARK ; Seong Hui JEON ; Youn Jeong LEE ; Hyeon Jong CHOI ; Keum Mo JEONG ; Jin Gu LEE ; Sun Pil CHOI ; Ji Hyun LIM ; Yang Ho KIM ; Yong Seok KIM ; Yong Moon KIM ; Min Ho HWANG ; Jin Woong CHO ; Young MOON ; Seok Kyu OH ; Jin Won JEONG
Journal of Korean Medical Science 2002;17(4):571-573
Bacterial pericarditis has been recognized as a rare disease since the development of antibiotics. Usually, the disease is associated with underlying conditions or a seeding of infection elsewhere to the pericardium. Here we describe a case of group G streptococcal pericarditis as an initial presentation of colon cancer. A 52-yr-old man was admitted because of dyspnea. An electrocardiogram showed a diffuse ST-segment elevation and a two-dimensional echocardiogram showed a large amount of pericardial effusion. A pericardiocentesis was done and purulent fluid was drained. Group G streptococci was cultured in pericardial fluid. The patient was treated with antibiotics and pericardiostomy with saline irrigation. A colonoscopy revealed a small mass with moderately differentiated adenocarcinoma in rectosigmoid colon. He underwent a mucosectomy and was recovered without any complication.
Adenocarcinoma/complications/*diagnosis/surgery
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Colonic Neoplasms/complications/*diagnosis/surgery
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Echocardiography
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Electrocardiography
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Humans
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Male
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Middle Aged
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Pericardial Effusion
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Pericarditis/complications/drug therapy/*microbiology/surgery
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Streptococcal Infections/complications/drug therapy/*microbiology/surgery
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Streptococcus/*classification
6.A Case of Necrotizing Fasciitis Due to Streptococcus agalactiae, Arcanobacterium haemolyticum, and Finegoldia magna in a Dog-bitten Patient with Diabetes.
Sungsil LEE ; Kyoung Ho ROH ; Chang Ki KIM ; Dongeun YONG ; Jun Yong CHOI ; Jin Woo LEE ; Kyungwon LEE ; Yunsop CHONG
The Korean Journal of Laboratory Medicine 2008;28(3):191-195
We report a case of necrotizing fasciitis involving Streptococcus agalactiae, Arcanobacterium haemolyticum, and Finegoldia magna in a 36-yr-old female diabetic patient, which started after a minor dog bite to the toe of the patient. This case suggested that a trivial infection after a minor dog bite in an immunocompromised patient such as diabetes patient could result in a significant complication such as necrotizing fasciitis. The life-threatening infection was cured by timely above-the-knee amputation, as well as penicillin G and clindamycin therapy.
Actinomycetales Infections/diagnosis/microbiology
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Adult
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Animals
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Anti-Bacterial Agents/therapeutic use
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Arcanobacterium
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Bites and Stings/*complications
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Clindamycin/therapeutic use
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Diabetes Mellitus/diagnosis/therapy
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*Dogs
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Fasciitis, Necrotizing/diagnosis/drug therapy/*microbiology
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Female
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Gram-Positive Bacterial Infections/diagnosis/microbiology
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Humans
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Penicillin G/therapeutic use
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Peptostreptococcus
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Streptococcal Infections/diagnosis/microbiology
;
Streptococcus agalactiae
7.Fatal Necrotizing Fasciitis Due to Streptococcus pneumoniae: A Case Report.
So Youn PARK ; So Young PARK ; Soo youn MOON ; Jun Seong SON ; Mi Suk LEE
Journal of Korean Medical Science 2011;26(1):131-134
Necrotizing fasciitis is known to be a highly lethal infection of deep-seated subcutaneous tissue and superficial fascia. Reports of necrotizing fasciitis due to Streptococcus pneumoniae are exceedingly rare. We report a case of necrotizing fasciitis in a 62-yr-old man with liver cirrhosis and diabetes mellitus. He presented with painful swelling of left leg and right hand. On the day of admission, compartment syndrome was aggravated and the patient underwent surgical exploration. Intra-operative findings revealed necrotizing fasciitis and cultures of two blood samples and wound aspirates showed S. pneumoniae. The patient died despite debridement and proper antimicrobial treatment. To the best of our knowledge, this is the first case of fatal necrotizing fasciitis with meningitis reported in Korea. We also review and discuss the literature on pneumococcal necrotizing fasciitis.
Anti-Bacterial Agents/therapeutic use
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Diabetes Mellitus, Type 2/complications/diagnosis
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Fasciitis, Necrotizing/*diagnosis/drug therapy/microbiology/surgery
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Fatal Outcome
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Humans
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Leg/surgery
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Liver Cirrhosis/complications/diagnosis
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Male
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Middle Aged
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Streptococcal Infections/*diagnosis/drug therapy
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Streptococcus pneumoniae/isolation & purification
8.A case of streptococcus pyogenes endophthalmitis following cataract surgery.
Yoon Hee KIM ; Young UH ; Seok Joon LEE ; Won Seok SONG
Korean Journal of Ophthalmology 2002;16(1):59-61
A small number of cases of bacterial endophthalmitis due to Streptococcus pyogenes, a Gram positive organism, have previously been reported. In this case, rapidly progressive Streptococcus pyogenes endophthalmitis was developed five years after cataract surgery which had been. The previous cataract surgery was combined with intraocular lens implantation by trans-scleral suspension technique. Treatment included enucleation and intravenous antibiotic injection. In this case of delayed Streptococcus pyogenes endophthalmitis after extracapsular cataract extraction. It seems probable that progressive erosion of the suture material resulted in exogenous endophthalmitis.
Aged
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Antibiotics, Combined/therapeutic use
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Case Report
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Cataract Extraction/*adverse effects
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Endophthalmitis/drug therapy/*microbiology
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Eye Infections, Bacterial/drug therapy/*etiology
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Female
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Human
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Lens Implantation, Intraocular/adverse effects
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Streptococcal Infections/drug therapy/*etiology
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Streptococcus pyogenes/*isolation & purification
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Treatment Outcome
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Vitreous Body/microbiology
9.Predictors of vancomycin-resistant enterococcus (VRE) carriage in the first major VRE outbreak in Singapore.
Kok-Soong YANG ; Yuke-Tien FONG ; Heow-Yong LEE ; Asok KURUP ; Tse-Hsien KOH ; David KOH ; Meng-Kin LIM
Annals of the Academy of Medicine, Singapore 2007;36(6):379-383
INTRODUCTIONUntil recently, vancomycin-resistant enterococcus (VRE) infection or colonisation was a rare occurrence in Singapore. The first major VRE outbreak involving a 1500-bed tertiary care institution in March 2005 presented major challenges in infection control and came at high costs. This study evaluates the predictors of VRE carriage based on patients' clinical and demographic profiles.
MATERIALS AND METHODSStudy patients were selected from the hospital inpatient census population during the VRE outbreak (aged 16 years or more). Clinical information from 84 cases and 377 controls were analysed.
RESULTSSignificant predictors of VRE carriage included: age>65 years Odds ratio (OR), 1.98; 95% CI (confidence interval), 1.14 to 3.43); female gender (OR, 2.15; 95% CI, 1.27 to 3.65); history of diabetes mellitus (OR, 1.94; 95% CI, 1.14 to 3.30), and staying in a crowded communal ward (OR, 2.75; 95% CI, 1.60 to 4.74). Each additional day of recent hospital stay also posed increased risk (OR, 1.03; 95% CI, 1.01 to 1.04).
CONCLUSIONElderly diabetic females with prolonged hospitalisation in crowded communal wards formed the profile that significantly predicted VRE carriage in this major hospital-wide outbreak of VRE in Singapore. It is imperative that active VRE surveillance and appropriate infection control measures be maintained in these wards to prevent future VRE outbreaks.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Case-Control Studies ; Cross Infection ; drug therapy ; epidemiology ; microbiology ; Disease Outbreaks ; Enterococcus ; drug effects ; Enterococcus faecalis ; isolation & purification ; Enterococcus faecium ; isolation & purification ; Female ; Humans ; Infection Control ; Male ; Medical Audit ; Middle Aged ; Risk Factors ; Singapore ; epidemiology ; Streptococcal Infections ; drug therapy ; epidemiology ; Vancomycin ; pharmacology ; therapeutic use ; Vancomycin Resistance
10.Septic Pylephlebitis as a Rare Complication of Crohn's Disease.
A Ri SHIN ; Chang Kyun LEE ; Hyo Jong KIM ; Jae Jun SHIM ; Jae Young JANG ; Seok Ho DONG ; Byung Ho KIM ; Young Woon CHANG
The Korean Journal of Gastroenterology 2013;61(4):219-224
Thrombophlebitis of the portal venous system (PVS) with superimposed bacterial infection (septic pylephlebitis) is an extremely rare complication of Crohn's disease (CD), and therefore diagnosis of septic pylephlebitis is difficult without high clinical suspicion. A 16-year old male patient who was diagnosed with CD 3 months earlier was admitted with recurrent fever and abdominal pain. CD activity had been well controlled with conventional medical treatment during a follow-up period. Abdominal contrast-enhanced computed tomography showed massive thrombosis in the PVS without evidence of intra-abdominal infection, and blood cultures were positive for Streptococcus viridians. There was no evidence of deep vein thrombosis or pulmonary thromboembolism, and all laboratory tests for thrombophilia were normal. Based on these findings, the patient was diagnosed with septic pylephlebitis complicated with CD, and was successfully treated with intravenous antibiotic therapy combined with anticoagulation. This case suggests that early comprehensive evaluation is crucial for immediate diagnosis and proper treatment of septic pylephlebitis in patients with CD who present with fever and abdominal pain of unknown origin, even with stable disease activity and absence of other intra-abdominal infections.
Adolescent
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Anti-Bacterial Agents/therapeutic use
;
Anticoagulants/therapeutic use
;
Colonoscopy
;
Crohn Disease/complications/*diagnosis
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Humans
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Male
;
Phlebitis/complications/*diagnosis
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Portal Vein/radiography
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Sepsis/*diagnosis/microbiology
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Streptococcal Infections/diagnosis/drug therapy
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Thrombosis/drug therapy/radiography
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Tomography, X-Ray Computed
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Viridans Streptococci/isolation & purification