Infection and Chemotherapy.2019;51(4):435-438. doi:10.3947/ic.2019.51.4.435
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Infection and Chemotherapy
2002 (v1, n1) to Present ISSN: 1671-8925
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Infection and Chemotherapy.2019;51(4):427-434. doi:10.3947/ic.2019.51.4.427
The characteristics of cholera epidemics that have occurred in Korea since the country's liberation in 1945 are described. The cholera outbreak in 1946 was the last classical one that occurred in Korea. In the 1960s, El Tor cholera replaced classical cholera worldwide which is characterized by lower volumes of and less frequent diarrhea, a lower case fatality rate, and a higher percentage of people who carry cholera without symptoms. There were 11 cholera epidemics in Korea between 1963 and 2001. Except for 2 patients in 2002, all cases originated from, or were associated with, other countries until 2016. In 2016, cholera was transmitted to three individuals within Korea. The number of cases, the number of deaths, and the case fatality rate decreased markedly after the 1946 cholera epidemic. The highest case fatality rate since 1946 was 9% in 1969, and there have been no deaths due to cholera since 1995. Introduction of infection from outside the country, infection by Vibrio cholerae carrier-residents within the country, and intentional spread were all considered to be possible sources of the initial infection that triggered the epidemics.
Modern History of Tuberculosis in Korea
Infection and Chemotherapy.2019;51(4):414-426. doi:10.3947/ic.2019.51.4.414
Tuberculosis has been a major public health threat in modern Korea. A few reports from the mid-1940s have demonstrated a high prevalence of latent and active tuberculosis infections. The high disease burden urged the newly established government to place a high priority on tuberculosis control. The government led a nationwide effort to control tuberculosis by building dedicated hospitals, conducting mass screening, providing technical and material support for microbiological diagnosis, administering Bacillus Calmette–Guérin vaccination, and improving appropriate antibiotic treatment through public health centers. Such concerted efforts resulted in a gradual decrease in the disease burden of tuberculosis, as demonstrated by National Tuberculosis Prevalence Surveys and notifiable disease statistics. While great progress has been made, new challenges - including an aging population, outbreaks in schools and healthcare facilities, and migration from high-prevalence countries - lie ahead. Here, we review the modern history of tuberculosis in Korea, focusing on epidemiology and public health policies.
Hemorrhagic Fever with Renal Syndrome
Infection and Chemotherapy.2019;51(4):405-413. doi:10.3947/ic.2019.51.4.405
In Korea, hemorrhagic fever with renal syndrome (HFRS) was first reported in a United Nations (UN) soldier stationed in the central front, also known as the “Iron Triangleâ€. In 1976, professor Ho Wang Lee discovered an antigen in the lung and kidney tissues of Apodemus agrarius. In 1980, this novel virus was named Hantaan virus after the Hantaan river. The Old World Hantaviruses, which are usually found in East Asia and Europe, are generally transmitted to humans via the respiratory pathway during dry seasons, usually in late spring and fall. Currently, 300 – 600 cases per year are reported in Korea with a mortality rate of 1 – 2%. The typical clinical course of HFRS is classified into five phases: febrile, hypotensive, oliguric, diuretic, and convalescent. And treatment for HFRS is mostly conservative. A vaccine for the Hantaan virus was developed in 1988 and marketed in 1990. Because HFRS outbreaks mostly occur in regions near the truce line in Korea, vaccination is virtually the only protection against the virus among military personnel working in such regions and local residents. Therefore, proving the effectiveness of the HFRS vaccine and devising efficient vaccination plans have been considered a major task for Korea's health authorities.
MCR1 and KPC2 Co-producing Klebsiella pneumoniae Bacteremia: First Case in Korea
Infection and Chemotherapy.2019;51(4):399-404. doi:10.3947/ic.2019.51.4.399
Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-KP) has been disseminating nationwide due to clonal spread and is taking a serious action at the national level in Korea. The mobilized colistin resistance (MCR1) gene confers plasmid-mediated resistance to colistin and is known to be capable of horizontal transfer between different strains of a bacterial species. We have experienced a fatal case of the patient who developed MCR1-possessing, ST307/Tn4401a[blaKPC2] K. pneumonia bacteremia in the community of non-capital region after being diagnosed as pancreatic cancer with multiple liver metastases and treated in the capital region. The ST307/Tn4401a[blaKPC2] K. pneumonia was the most commonly disseminated clone in Korea. Our strain is the first MCR1 and KPC2 co-producing K. pneumonia in Korea and our case is the critical example that the multi-drug resistant clone can cause inter-regional spread and the community-onset fatal infections. Fortunately, our patient was admitted to the intensive care unit on the day of visit, and the contact precaution was well maintained throughout and KPC-KP was not spread to other patients. The high risk patients for KPC-KP need to be screened actively, detected rapidly and preemptively isolated to prevent outbreak of KPC-KP. Inter-facility communications are essential and the nationwide epidemiologic data of KPC-KP should be analyzed and reported regularly to prevent spread of KPC-KP. The prompt identification of species and antimicrobial susceptibilities for successful treatment against KPC-KP should be emphasized as well.
Infection and Chemotherapy.2019;51(4):393-398. doi:10.3947/ic.2019.51.4.393
By comparing the data of prospectively and retrospectively enrolled cohorts, we evaluated whether the prospective cohort represented all patients in the retrospective cohort. The prospectively enrolled subjects were older and had lower CD4+ T cell counts, higher viral load. In addition, the initial antiretroviral treatment regimen of the prospective cohort consisted of less integrase strand transfer inhibitor-containing regimens. The 20-year survival rate was 51.8% in the prospective cohort and 84.6% in the retrospective cohort, respectively (P = 0.844). This study suggests the prospective cohort study may not represent all patients.
Infection and Chemotherapy.2019;51(4):386-392. doi:10.3947/ic.2019.51.4.386
Invasive fungal diseases (IFDs) are a leading cause of infection-related-mortality after allogeneic hematopoietic stem cell transplantation (HSCT). In this prospective pilot study, we investigated the use of bedside lung ultrasound (US) in IFD management. Ten consecutive hematological patients, who developed pulmonary IFD after HSCT, were included in the study. Standard computed tomography scan and lung US were performed at IFD diagnosis and 10 days after antifungal treatment. The lung US demonstrated a high sensitivity in the detection of lung lesions at IFD diagnosis and in the follow-up examinations. It is of potential clinical relevance for IFD management in hematological patients.
Infection and Chemotherapy.2019;51(4):376-385. doi:10.3947/ic.2019.51.4.376
BACKGROUND:
Recent data suggests the inoculum effect of methicillin-susceptible Staphylococcus aureus (MSSA) against beta-lactam antibiotics and their association with functionality or genotypic variation of agr locus.
METHODS:
MSSA blood isolates were collected at a tertiary care hospital in Korea from June 2014 to December 2017. The functionality of the agr operon was measured by δ-hemolysin assays. Multiplex PCR was performed to determine the agr genotype. The cefazolin minimum inhibitory concentrations (MICs) at a high inoculum concentration (~5 × 10ⷠCFU/ml) were compared to the MICs at a standard inoculum concentration (~5 × 10ⵠCFU/ml) to identify strains with the cefazolin inoculum effect (CIE). The DNA sequencing of blaZ gene was performed to classify the blaZ genotype.
RESULTS:
Among the 195 MSSA blood isolates, agr genotype I was most common (68.2%), followed by type III (16.4%), type IV (9.2%), and type II (6.2%). Sixty-seven (34.3%) MSSA isolates had dysfunctional agr, but neither CIE nor blaZ genotype was associated with dysfunctional agr. The MSSA with agr type III genotype exhibited significantly higher CIE positivity (agr III 43.8% vs. non-agr III 5.5%, P <0.01) and erythromycin/clindamycin resistance. In the subgroup analysis of type A blaZ possessing MSSA, almost all of the agr III MSSA isolates exhibited CIE, while only 20% of non-agr III isolates had CIE (P <0.01).
CONCLUSION
In MSSA blood isolates, CIE might be associated with agr genotype rather than with dysfunctional agr.
Infection and Chemotherapy.2019;51(4):365-375. doi:10.3947/ic.2019.51.4.365
BACKGROUND:
The intestinal microbiota plays an important role in the pathogenesis of Clostridioides difficile-associated diarrhea, and regional and racial characteristics influence the microbiome composition and diversity. We investigated the intestinal microbiome characteristics of patients with C. difficile colitis (CD+) compared to those of patients with colitis not due to C. difficile (CD−), patients with vancomycin-resistant enterococci (VRE) colonization, and healthy controls, in Korea.
MATERIALS AND METHODS:
We collected stool samples from 24, 18, 11 and 13 subjects within CD+, CD−, VRE and healthy control groups, respectively. The microbial communities were evaluated by 454-pyrosequencing of bacterial 16s rRNA.
RESULTS:
The species richness and microbial diversity were significantly lower in the CD+ group compared to those in healthy controls, but not compared to those in CD− and VRE groups. Phylum-level analysis showed that the proportion of Actinobacteria in the CD+ group was significantly lower than in the healthy control, but was unchanged compared to that in CD− and VRE groups. At the genus level, compared to the healthy group, the CD+ group showed significantly lower proportions of Blautia, Bifidobacterium, Faecalibacterium et al. Compared to the VRE group, the CD+ group showed a significantly higher proportion of Anaerostipes.
CONCLUSIONS
We could identify the intestinal microbiome characteristics of Koreans with C. difficile colitis. It might help to develop microbiome based diagnostic and treatment modalities.
Infection and Chemotherapy.2019;51(4):355-364. doi:10.3947/ic.2019.51.4.355
BACKGROUND:
Healthcare workers (HCWs) have a high risk of tuberculosis (TB) infection. Since August 2017, Korea has mandated the testing of latent TB infection (LTBI) and recommended treatment from HCWs at medical institutions. However, the acceptance/completion rate and adverse events of LTBI treatment have not been analyzed.
MATERIALS AND METHODS:
From February to August 2017, we conducted a retrospective study at a referral university hospital in Korea, to screen the interferon-gamma release assay (IGRA) tests conducted for all HCWs for detecting and treating LTBI. HCWs diagnosed with LTBI were offered a 9-month isoniazid (9H), 3-month isoniazid/rifampin (3HR), or 4-month rifampin regimen. We investigated the acceptance/completion rate, adverse events, and causes of discontinuation or change in LTBI medication. A major adverse event was one wherein a patient had any adverse event ≥grade 3 causing LTBI treatment interruption.
RESULTS:
Of the 1,538 HCWs, 1,379 underwent IGRA testing for LTBI. Among them, 13.6% (187/1,379) tested positive and 73.3% (137/187) received treatment. The overall completion rate was 97.8% (134/137). HCWs were significantly more likely to complete first-line therapy with 3HR than with 9H (91.4% vs. 76.7%, P = 0.02). The most common major adverse event was hepatotoxicity (n = 7), followed by thrombocytopenia (n = 1) and anaphylactic shock (n = 1). Hepatotoxicity and hepatotoxicity (≥ grade 2) were more frequent in 9H than in 3HR (39.5% vs. 17.2%, P = 0.006 and 18.6% vs. 3.7%, P = 0.005, respectively). The median time to hepatotoxicity was 96 days (interquartile range, 20 – 103 days).
CONCLUSION
Completion of first-line therapy for LTBI is more likely with 3HR than with 9H. This might be related to the development of hepatotoxicity after around 3 months of treatment. Anaphylactic shock and platelet count should be carefully monitored in those receiving rifampin-containing regimens.
Country
Republic of Korea
Publisher
Korean Society of Infectious Diseases
ElectronicLinks
http://www.icjournal.org/Editor-in-chief
Dong-Gun Lee
ksinfect@naver.com
Abbreviation
Infect Chemother
Vernacular Journal Title
감염과화학요법
ISSN
2093-2340
EISSN
2092-6448
Year Approved
2007
Current Indexing Status
Currently Indexed
Start Year
Description
Infection & Chemotherapy (Infect Chemother) is an international, peer-reviewed, and open-access journal. Infect Chemother publishes editorials, review articles, original articles, practice guidelines, case reports, brief communications, and correspondences covering a wide range of clinical descriptions in infectious diseases, public health issues, microbiology including emerging resistance, parasitology and immunity to microbes, current and novel treatments, and the promotion of optimal practices for diagnoses and treatments. The scope of the journal is to link basic and clinical research in the field of infectious diseases and antimicrobial therapy based on the evidence. Infect Chemoter is an official publication of the Korean Society of Infectious Diseases and Korean Society of Chemotherapy. The journal is published quarterly (March, June, September, and December) in print and open-access online (http://www.icjournal.org).
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