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A Case of Tsutsugamushi Disease Complicated with Adult Respiratory Distress Syndrome and Disseminated Intravascular Coagulopathy.

Hyeon Ok PARK ; Myeong Sook KIM ; Jong Tae BACK ; Yong Ho CHOI ; Dong Hoen YANG ; Kee Won KIM ; Ji Won SUHR ; Suk Young PARK ; Kyung Shick LEE

Korean Journal of Infectious Diseases.1999;31(6):506-509.

Tsutsugamushi disease is an acute febrile illness caused by Orientia tsutsugamushi. It is characterized by fever, myalgia, lymphadenopathy, and rash. And it can be easily diagnosed by characteristic eschar and serologic testing. Nearly all of the patients with tsutsugamushi disease improve with antibiotics such as doxycycline. However, the fatality rate of untreated cases is seven to ten percent. The well-known causes of mortality are respiratory failure associated with pulmonary edema or adult respiratory distress syndrome. We report a case of tsutsugamushi disease complicated with acute respiratory distress syndrome and disseminated intravascular coagulopathy, despite of doxycycline treatment. A 78-year old woman was admitted to the hospital because of fever. Twelve days before admission she had suffered myalgia and some days later she developed a rash. Despite of management at a local clinic, her condition deteriorated and she was transferred to our hospital. On admission she presented with altered consciousness and two eschars on her right arm and right thigh. Under the initial diagnosis of scrub typhus, doxycycline was administered. Her fever subsided with the initiation of doxycycline. However, her hypoxia worsened progressively and she died on the fifth hospital day.
Adult* ; Aged ; Anoxia ; Anti-Bacterial Agents ; Arm ; Consciousness ; Diagnosis ; Doxycycline ; Exanthema ; Female ; Fever ; Humans ; Lymphatic Diseases ; Mortality ; Myalgia ; Orientia tsutsugamushi ; Pulmonary Edema ; Respiratory Distress Syndrome, Adult* ; Respiratory Insufficiency ; Scrub Typhus* ; Serologic Tests ; Thigh

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Invasive Aspergillosis after Solid Organ Transplantation.

Hyun Kyun KI ; Jae Hyun KOH ; Soo Jung KANG ; Shin Woo KIM ; Hyuck LEE ; Sungmin KIM ; Kyong Ran PECK ; Jae Hoon SONG ; Seung Woon PAIK ; Kwang Cheol KOH ; Sang Hoon LEE ; Pyo Won PARK ; Sung Joo KIM ; Jae Won JOH ; Suk Koo LEE

Korean Journal of Infectious Diseases.1999;31(6):500-505.

Solid organ transplantation has been established as an accepted treatment modality for end-stage diseases. Although the prognosis for organ recipients has improved with the development of surgical technical skills and the application of newly developed immunosuppressive agents, opportunistic infections remain the major cause of death in these patients. Invasive aspergillosis is one of the most common fungal infections in solid organ transplantation, and it carries a high mortality rate. In Korea, eight sporadic cases of invasive aspergillosis after kidney or heart transplantation have been reported. Recently, we experienced five cases of invasive aspergillosis after liver or heart transplantation over a four year period. Among these five patients, three died of uncontrollable aspergillosis and one died of heart failure and graft rejection. Early diagnosis and treatment are essential for the improvement of the prognosis for invasive aspergillosis after solid organ transplantation.
Aspergillosis* ; Cause of Death ; Early Diagnosis ; Graft Rejection ; Heart Failure ; Heart Transplantation ; Humans ; Immunosuppressive Agents ; Kidney ; Korea ; Liver ; Mortality ; Opportunistic Infections ; Organ Transplantation* ; Prognosis ; Transplants*

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Detection of ermAM Gene and mefA Gene in Erythromycin-resistant Streptococcus Pyogenes.

Yun Jeong KIM ; Hye Soo LEE ; Sam Im CHOI ; Seon Ju KIM

Korean Journal of Infectious Diseases.1999;31(6):494-499.

BACKGROUND: The mechanism of erythromycin resistance of Streptococcus pyogenes results from target modification or active efflux. The purpose of this study was to determine the positive rate of ermAM gene modifying 23S rRNA and that of mefA gene related with efflux for erythromycin-resistant S. pyogenes. METHODS: The minimal inhibitory concentrations (MICs) of erythromycin, azithromycin, clarithromycin, and clindamycin against S. pyogenes were tested by agar dilution method. ermAM and mefA genes were amplified by polymerase chain reaction (PCR) for 32 strains of erythromycin-resistant S. pyogenes. RESULTS: Among the 32 erythromycin-resistant S. pyogenes strains, 20 (62.5%) strains were positive for ermAM gene and 10 (31.1%) for mefA gene. Eighteen (90.0%) out of 20 strains with ermAM gene showed high-level erythromycin resistance (MIC> OR =64 microgram/mL), while all ten strains with mefA gene had low-level erythromycin resistance (MIC< OR =16 microgram/mL). CONCLUSION: Two-thirds of the S. pyogenes strains acquired erythromycin resistance by modification of target site, while the others by active efflux. Each mechanism of resistance is closely associated with range of MICs of erythromycin.
Agar ; Azithromycin ; Clarithromycin ; Clindamycin ; Erythromycin ; Polymerase Chain Reaction ; Streptococcus pyogenes* ; Streptococcus*

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Expression of Eta-1 in Escherichia coli and Production of Monoclonal Antibody.

Sun Myung LEE ; Mee Kyung KIM ; Byung Uk LIM ; Hyeongjin CHO ; Jae Seung KANG

Korean Journal of Infectious Diseases.1999;31(6):487-493.

BACKGROUND: Early T-lymphocyte activation-1 (Eta-1) is a secreted phosphoprotein which regulates a variety of cells involved in the immune and nonimmune systems. It is unique in the sense that it regulates various immune functions, as well as acting as an extracellular matrix protein. The Eta-1 gene has been mapped to the same genetic locus as the Rickettsia resistance gene (Ric), and Eta-1 expression is a part of an early T-dependent response to Orientia tsutsugamushi infection in susceptible hosts. In an initial effort to study Eta-1's mechanism of protection against Orientia tsutsugamushi infection, we attempted to produce Eta-1 in E. coli and to produce monoclonal antibodies against recombinant Eta-1. METHODS: Expression plasmids containing GST-Eta-1 were generated by cloning the polymerase chain reaction-amplified N-and C-terminal Eta-1 fragments into the cloning sites of pGEX-3X. The expressed protein was purified using a GST column and injected into BALB/c mice. Hybridoma clones reactive to Eta-1 were produced and analyzed with ELISA and Western blot. RESULTS: Expression plasmids containing GST-Eta-1 were generated by cloning the polymerase chain reaction-amplified N-and C-terminal Eta-1 fragments into the cloning sites of pGEX-3X. N-and C-terminal fragments of Eta-1 were generated as bacterially expressed GST fusion proteins. However, the expression of full-length Eta-1 was very poor. We immunized BALB/c mice with purified Eta-1 N-terminal fragments. Their spleen cells were used for cell fusion. We obtained two hybridoma cell lines secreting antibodies against Eta-1, but not against GST. Conclusions:We produced Eta-1 protein produced in E. coli. The expression of C-terminal Eta-1 fragments was poor, therefore it appeared that this part of Eta-1 was toxic to E. coli. We obtained monoclonal antibodies which were reactive in ELISA test and Western blot. These monoclonal antibodies could be useful in the analysis of the function of Eta-1 in the pathogenesis of tsutsugamushi disease as well as other diseases.
Animals ; Antibodies ; Antibodies, Monoclonal ; Blotting, Western ; Cell Fusion ; Cell Line ; Clone Cells ; Cloning, Organism ; Enzyme-Linked Immunosorbent Assay ; Escherichia coli* ; Escherichia* ; Extracellular Matrix ; Genetic Loci ; Hybridomas ; Mice ; Orientia tsutsugamushi ; Osteopontin ; Plasmids ; Rickettsia ; Scrub Typhus ; Spleen ; T-Lymphocytes

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Candida Species Isolated from Clinical Specimens and Medical Personnel.

Jong Hee SHIN ; Woo Hyun LIM ; Dong Hyeon SHIN ; Soon Pal SUH ; Dong Wook RYANG

Korean Journal of Infectious Diseases.1999;31(6):481-486.

BACKGROUND: The frequency of bloodstream infection by Candida species has dramatically increased in recent years. Many of bloodstream infections caused by candida arise from an endogenous source of mucosal colonization, as well as exogenously from the hospital environment. We analyzed the prevalence of Candida species isolated from blood cultures, and compared it to those of all other clinical specimens, and those of the hospital environment. METHODS: Identification of Candida species was performed on isolates from blood cultures (159 strains), from cultures of clinical specimens other than bloods (1,609 strains) and from cultures of the hospital environment (30 strains). All candida isolates were recovered between January 1997 and June 1998 at Chonnam University Hospital. Candida surveillance cultures of the hands and nares of 77 medical personnel were performed using CHROMagar Candida. RESULTS: Among the Candida species isolated from the blood cultures, C. parapsilosis was the most frequently isolated (35.2%), followed by C. albicans (29.6%), C. glabrata (9.4%), and C. tropicalis (8.8%). The Candida species frequently isolated from clinical specimens other than bloods were C. albicans (52.6%), C. glabrata (19.1%), and C. tropicalis (15.3%). While C. parapsilosis was not frequently isolated from clinical specimens other than blood (3.4%), it was the most frequent Candida species isolated from the hands of medical personnel. Sixteen (20.8%) out of 77 medical personnel were found to harbor C. parapsilosis on their hands. CONCLUSION: These results suggest that it is possible that most of the Candida species causing bloodstream infections are from mucosal colonized strains, but that C. parapsilosis may be acquired from exogenous sources.
Candida* ; Candidemia ; Colon ; Hand ; Jeollanam-do ; Prevalence

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Comparison of Pulsed-field Gel Electrophoresis, Amplified Fragment Length Polymorphism, and Infrequent Restriction Site-Polymerase Chain Reaction for Molecular Typing of Escherichia coli and Staphylococcus aureus Strains.

Sang Il KIM ; Jin Hong YOO ; Yoon Kyung CHO ; Dong Gun LEE ; Seong Heon WIE ; Jung Hyun CHOI ; Yang Ree KIM ; Wan Shik SHIN ; Moon Won KANG

Korean Journal of Infectious Diseases.1999;31(6):474-480.

BACKGROUND: Pulsed-field gel electrophoresis (PFGE) has been regarded a standard method for genotyping in epidemiologic studies. However, it is tedious and time-consuming to perform. Two alternative genotyping methods have recently been developed using the polymerase chain reaction (PCR):amplified fragment length polymorphism (AFLP) and infrequent restriction site-polymerase chain reaction (IRS-PCR). These methods have not yet been applied yet to common pathogens such as Staphylococcus aureus. The purpose of this study was to determine the applicability of AFLP and IRS-PCR for the genotyping of E. coli and S. aureus isolates. METHODS: We performed PFGE, AFLP, and IRS-PCR on clinical isolates of E. coli (n=27) and S. aureus (n=30). We assessed each method in terms of discriminatory power, quality, and efficiency. RESULTS: In E. coli, the discriminatory powers of IRS-PCR and AFLP were comparable to that of PFGE. PFGE discerned 24 (88.8%) out of 27 strains, IRS-PCR discerned 22 (81.5%) out of 27, and AFLP discerned 25 (92.6%) out of 27. In the case of S. aureus, PFGE discerned 27 (90%) out of 30 strains, while both IRA-PCR and AFLP discerned 12 (40%) out of 30. The test-ing took four days to complete with PFGE, two days with AFLP, and was completed within one day with IRS-PCR. IRS-PCR showed better resolution than both PFGE and AFLP. CONCLUSION: In cases of E. coli, AFLP and IRS-PCR could be good alternatives for epidemiologic typing, as they offer better efficiency and comparable discriminatory power to PFGE. On the other hand, IRS-PCR and AFLP do not seem to be suitable for the strain-to-strain differentiation of S. aureus.
Electrophoresis, Gel, Pulsed-Field* ; Escherichia coli* ; Escherichia* ; Hand ; Molecular Typing* ; Polymerase Chain Reaction ; Staphylococcus aureus* ; Staphylococcus*

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Cryptococcal Meningitis in 25 Non-AIDS Patients.

Shin Woo KIM ; Sook In JUNG ; Yeon Sook KIM ; Hyeon Kyun KI ; Choon Kwan KIM ; Sungmin KIM ; Kyoung Ran PECK ; Nam Yong LEE ; Jae Hoon SONG

Korean Journal of Infectious Diseases.1999;31(6):467-473.

BACKGROUND: Cryptococcal meningitis is an opportunistic infection common among patients with AIDS. Because of the low incidence of cryptococcal meningitis in Korea, there have been insufficient data on the clinical features of cryptococcal meningitis in non-AIDS Korean patients, particularly in patients with liver cirrhosis (LC). We evaluated the clinical manifestations of cryptococcal meningitis in non-AIDS patients admitted at the Samsung Medical Center and assessed the relationship between LC and cryptococcal meningitis. METHODS: The medical records of 25 non-AIDS patients with cryptococcal meningitis admitted between May 1995 and March 1999 were reviewed. Cryptococcal meningitis was confirmed by positive culture of CSF or compatible clinical features plus a positive cry-ptococcal latex test. The mean age of the 25 patients was 55 years and the median duration of follow-up was 95.5 days. Underlying conditions were:use of immunosuppressants (including steroids) (47.8%), LC (34.8%), diabetes mellitus (34.8%), malignancy (17.4%), alcoholism (8.7%), and none (21.7%, five patients). RESULTS: There were no differences in the clinical manifestations between the LC and non-LC groups, with the exception of mental deterioration, which was more frequent in patients with LC than without LC (P= 0.026). The outcomes were:complete cure in six cases, cure with sequelae in five, and treatment failure in ten. The crude and attributable mortality rates of cryptococcal meningitis were 62.5% (15/24) and 50.0% (12/24), respectively. LC was a significant risk factor for a poor survival rate among patients with cryptococcal meningitis (OR:3.25, 95% CI, 1.02~10.40) (P=0.045). CONCLUSION: In Korea, liver cirrhosis is an important risk factor for cryptococcal meningitis and an attributable factor for its high mortality. Because it is possible to confuse mental obtundation in cirrhotic patients with that of hepatic encephalopathy, cryptococcal meningitis should be considered in any patients with altered consciousness and liver cirrhosis.
Alcoholism ; Consciousness ; Cryptococcosis ; Diabetes Mellitus ; Follow-Up Studies ; Hepatic Encephalopathy ; Humans ; Immunosuppressive Agents ; Incidence ; Korea ; Latex ; Liver Cirrhosis ; Medical Records ; Meningitis, Cryptococcal* ; Mortality ; Opportunistic Infections ; Risk Factors ; Survival Rate ; Treatment Failure

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A case of arthritis of hip joint caused by salmonella typhi.

Kyung Sik KO ; Hwan Jo SUH

Korean Journal of Infectious Diseases.1992;24(1):71-75.

No abstract available.
Arthritis* ; Hip Joint* ; Hip* ; Salmonella typhi* ; Salmonella*

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Unusual case report as imported sparganosis.

Kyung Sik KO ; Hyung Keun CHUNG ; Myung Jae PARK ; Hwan Jo SUH ; Jung Youl CHUN ; Kyung Nam RYU ; Hyun Jong YANG ; You Jung CHO ; Yung Han PAIK

Korean Journal of Infectious Diseases.1992;24(1):65-69.

No abstract available.
Sparganosis*

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Fatal staphylococcal endocarditis complicated with systemic septic emboli.

Joong Won KIM ; Sun Ho CHANG ; Jun Hee WOO ; So Yong JIN ; Dong Hwa LEE

Korean Journal of Infectious Diseases.1992;24(1):55-63.

No abstract available.
Endocarditis*

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