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A Case of Rubella Complicated with Hemolytic Anemia.

Joong Sik AUM ; Jin Yong KIM ; Hee Jin CHEONG ; Woo Joo KIM ; Min Ja KIM ; Seung Chull PARK

Korean Journal of Infectious Diseases.1997;29(4):313-316.

Rubella is a viral disease usually characterized by a benign febrile exanthem, manifested with fever, posterior occipital lymphadenopathy and pinkish rash in children. Most cases are recovered without any sequelae. However, it may lead to serious cardiac and ocular congenital malformation and fetal death in pregnant woman. Additionally postnatal rubella can be unusually complicated by encephalitis, meningitis, thrombocytopenic purpura, pneumonia and multiple organ disorder. Especially, hemolytic anemia following postnatally acquired rubella is very rare. Of the world, only twenty cases were reported in Japan during rubella outbreak from 1975 to 1977, and majority were Coombs' positive cases. But no case was reported until now in Korea. Resurgence of rubella has been recognized among adolescents in Korea since 1995. We experienced an adolescent patient with Coombs'-negative hemolytic anemia following rubella infection who has recovered by conservative management. We report the case with a review of literatures.
Adolescent ; Anemia, Hemolytic* ; Child ; Encephalitis ; Exanthema ; Female ; Fetal Death ; Fever ; Humans ; Japan ; Korea ; Lymphatic Diseases ; Meningitis ; Pneumonia ; Pregnant Women ; Purpura, Thrombocytopenic ; Rubella* ; Virus Diseases

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Clinical Characteristics of Mumps in Postpubertal Age.

Joon Sup YEOM ; Yoon Jae MOON ; Eun Sook KIM ; Young Hwa CHOI ; Young Goo SONG ; Eung KIM ; June Myung KIM

Korean Journal of Infectious Diseases.1997;29(4):305-311.

BACKGROUND: Mumps is a generalized viral infection that usually occurs in school-aged children and young adults, characterized by nonsuppurative swelling and tenderness of salivary glands. Mumps in postpubertal person is usually a more severe and commonly associated with extrasalivary gland involvement. This study was undertaken to analyze clinical characteristics of mumps in postpubertal person in Korea. METHODS: Forty-four cases of mumps, diagnosed during March 1983 to February 1995 in Severance hospital, were analyzed retrospectively. RESULTS: Since the end of 1980's, mumps seemed to resurge among postpubertal persons, mainly during the winter and spring. The majority of patients were under 25 years old. Parotitis was developed in all 44 cases. Sixty-five percent of male patient suffered orchitis accompanied by high fever(>38.5degreeCC). Meningitis occurred in 18% of cases. Average hospital stay was 6.3 days. All cases were cured without any sequelae. CONCLUSION: Mumps was more severe and extrasalivary gland involvement was common in postpubertal person than in children. Occurrence of high fever during the course of illness may indicate development of orchitis. Therefore, MMR vaccination should be performed in nonimmunized postpubertal persons. Additionally, booster immunization should be considered in immunized postpubertal persons.
Adult ; Child ; Fever ; Humans ; Immunization, Secondary ; Korea ; Length of Stay ; Male ; Meningitis ; Mumps* ; Orchitis ; Parotitis ; Retrospective Studies ; Salivary Glands ; Vaccination ; Young Adult

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Emergency Debridement with Empirical Antibiotics Treatment for Clinically Diagnosed Vibrio Sepsis.

Kyoung Ai MA ; Sun Min LEE ; Myoung Sung KIM ; Sung Chul HWANG ; Yi Hyeoug LEE ; Gyu Tae SHIN ; Myung Wook KIM ; Kwan KIM ; Myoung Ho HAHN

Korean Journal of Infectious Diseases.1997;29(4):297-303.

BACKGROUND: To evaluate the role of emergency debridement performed in conjunction with an empirical antibiotic therapy in clinically diagnosed, full-blown Vibrio vulnificus sepsis. METHODS: Immediate surgical debridement was performed on 13 out of 15 patients who were clinically diagnosed as having Vibrio vulnificus sepsis. RESULTS: Among 15 patients Vibrio vulnificus was isolated in 8 patients. Underlying diseases were liver cirrhosis (2), chronic alcohol ingestion or chronic liver disease (10), diabetes mellitus (3), gastrectomy (1) and in 4 cases no underlying condition was identified. All patients had skin lesions such as erythema, bulla, vesicle and gangrene. All but one initially showed variable degree of hypotension, thrombocytopenia, hepatic dysfunction, renal failure and mental confusion. Their mean APACHE III score was 84. Immediate survival (within 48hrs) in clinically diagnosed Vibrio sepsis was 80% (12/15) and long term survival rate among them was 66.6%. Forty-eight hour survival rate in bacteriologically confirmed cases of Vibrio vulnificus sepsis was 75%, where their long-term survival was 62.5%. CONCLUSION: In treating full-blown Vibrio vulnificus sepsis, immediate emergency surgical debridement performed in conjunction with the empirical antibiotics gives a possibility to improve both immediate and long term prognosis of the disease.
Anti-Bacterial Agents* ; APACHE ; Debridement* ; Diabetes Mellitus ; Eating ; Emergencies* ; Erythema ; Gangrene ; Gastrectomy ; Humans ; Hypotension ; Liver Cirrhosis ; Liver Diseases ; Prognosis ; Renal Insufficiency ; Sepsis* ; Skin ; Survival Rate ; Thrombocytopenia ; Vibrio vulnificus ; Vibrio*

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The Prognostic Factors in Human Immunodeficiency Virus Infected Patients.

Nam Joong KIM ; Sang Won PARK ; Hong Bin KIM ; Hee Jung CHOI ; Myoung Don OH ; Kang Won CHOE

Korean Journal of Infectious Diseases.1997;29(4):287-295.

BACKGROUND: Human Immunodeficiency Virus (HIV) primarily infects CD4 lymphocyte, resulting in quantitative and qualitative defect of CD4 lymphocyte and eventually AIDS. This study was designed to determine the epidemiologic, cellular, and immunologic markers as possible indicator, of progression to AIDS. METHODS: A total of 115 HIV infected patients enrolled between September 1987 and July 1996 was analyzed. AIDS was defined according to criteria presented by Centers for Disease Control in 1993. The variables considered in the analysis were age, sex, route of transmission, delayed hypersensitivity skin test, WBC counts, hemoglobin, ESR, lymphocyte counts, platelet counts, CD4 lymphocyte counts, CD8 lymphocyte counts, and serum beta2-microglobulin. Predictors of AIDS were determined by multiple logistic regression analysis. RESULTS: Median follow-up duration of study was 12.05 months. Thirty-one subjects were diagnosed as AIDS during the study period. AIDS-defining illness included tuberculosis (23 cases), Pneumocystis carinii pneumonia (6 cases), esophageal candidiasis (6 cases), cytomegalovirus disease (6 cases), cryptococcal meningitis (2 cases), cryptosporidiosis (2 cases), isosporiosis (2 cases), primary central nervous system lymphoma (1 case). On univariate analysis, low hemoglobin, low lymphocyte counts, high platelet counts, high ESR, low CD4 lymphocyte counts, low CD8 lymphocyte counts, and high serum beta2-microglobulin level are associated with progression to AIDS. On multivariate analysis, only the low CD4 lymphocyte counts is associated with increased AIDS hazard. In a group treated with zidovudine, any changes of celluar and immunologic markers during four months following treatment are not associated with progression to AIDS. CONCLUSION: In HIV infected persons, several laboratory markers might predict AIDS when analyzed individually. However, in multivariate analysis, only low CD4 lymphocyte count is an independent predictor of progression to AIDS
Animals ; Biological Markers ; Candidiasis ; CD4 Lymphocyte Count ; Centers for Disease Control and Prevention (U.S.) ; Central Nervous System ; Cryptosporidiosis ; Cytomegalovirus ; Follow-Up Studies ; HIV Infections ; HIV* ; Humans* ; Hypersensitivity, Delayed ; Logistic Models ; Lymphocyte Count ; Lymphocytes ; Lymphoma ; Meningitis, Cryptococcal ; Multivariate Analysis ; Platelet Count ; Pneumonia, Pneumocystis ; Prognosis ; Skin Tests ; Tuberculosis ; Zidovudine

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Clinical Characteristics of Bacteremic Pneumococcal Diseases Due to Penicillin-Resistant Streptococcus pneumoniae.

Jae Hoon SONG ; Doo Ryeon CHUNG ; Eun Ok KIM ; Yang Soo KIM ; Jun Hee WOO ; Sungmin KIM ; Kyong Ran PECK ; Hyuck LEE ; Nam Yong LEE ; Ji So RYU ; Chik Hyun PAI

Korean Journal of Infectious Diseases.1997;29(4):277-285.

BACKGROUND: The emergence of penicillin-resistant Streptococcus pneumoniae (PRSP) poses serious therapeutic problem in clinical practice, especially in cases with bacteremia or meningitis. METHODS: To investigate clinical characteristics of bacteremic pneumococcal diseases due to PRSP, we retrospectively analyzed 41 cases with documented bacteremic diseases seen in a tertiary care hospital between 1989 and 1994. RESULTS: Agar dilution test of 41 strains isolated showed that 68.3% of S. pneumoniae were PRSP [high-level resistance(R) 56.1%, intermediate resistance (I) 12.2%]. High-level resistant strains were not susceptible to other beta-lactam agents, whereas isolates of penicillin-susceptible S. pneumoniae (PSSP) were uniformly susceptible to all beta-lactam agents. Predominant serogroup of PRSP were 19, 23, and 6. Bacteremic diseases caused by PRSP included pneumonia (22), meningitis (5), peritonitis (3), acute otitis media (2), acute tonsillitis (2), endocarditis (1), pyelonephritis (1), and primary bacteremia (5). Children were more likely to be infected with PRSP with high-level or intermediately resistant strains than were adults (P=0.0001), but no differences were seen between PRSP and PSSP regarding sex, previous antibiotic history, previous hospitalization, and underlying immunocompromised conditions. Most cases were community-acquired (R 78.3%, I 60%, S 61.5%). Fatality rates of patients infected with PRSP were not different significantly from PSSP (22.6% vs. 30%). However, most fatal cases had underlying immunocompromised conditions. CONCLUSION: PRSP is widely prevalent in Korea and shows resistance to most antibiotics. It causes community-acquired bacteremic diseases with poor outcomes, but there was no difference in mortality between patients infected with PRSP and PSSP. Pediatric age was the only risk factor for penicillin resistance.
Adult ; Agar ; Anti-Bacterial Agents ; Bacteremia ; Child ; Endocarditis ; Hospitalization ; Humans ; Korea ; Meningitis ; Mortality ; Otitis Media ; Palatine Tonsil ; Penicillin Resistance ; Peritonitis ; Pneumonia ; Pyelonephritis ; Retrospective Studies ; Risk Factors ; Streptococcus pneumoniae* ; Streptococcus* ; Tertiary Healthcare ; Tonsillitis

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Prevalence of TEM- and SHV-type Beta-lactamase gene in Escherichia coli and Klebsiella pneumoniae in Korea.

So Hee SOHN ; Dae Jun LEE ; Chang In KIM ; Jung Min KIM ; Hyun Joo PAI

Korean Journal of Infectious Diseases.1997;29(4):271-276.

BACKGROUND: Resistance to beta-lactams in E. coli is mostly via acquisition of plasmid-mediated beta-lactamase gene. Among the plasmid-mediated beta-lactamases, TEM-1 beta-lactamase is by far the most prevalent among ampicillin-resistant E. coli. The prevalence of TEM-1 or TEM-2 ranged from 61% to 98% across the surveys. Klebsiella species generally have class A chromosomal beta-lactamases, which differ greatly from the class C types. Most K. pneumoniae isolates have chromosomally mediated SHV-1 beta-lactamase in most surveys. There has been only one report of prevalence and types of beta-lactamases in E. coli and K. pneumoniae in Korea. We performed this study to determine the prevalence and types of beta-lactamases in E. coli and K. pneumoniae isolated in Korea. METHODS: Ampicillin resistance was determined by disk diffusion test (E. coli) and agar dilution method (K. pneumoniae). Fifty five isolates of E. coli and 92 isolates of K. pneumoniae which were derived from patients in 2 university hospitals in Korea during 1996 were tested by TEM- and SHV-specific PCR. RESULTS: The ampicillin resistance rate in E. coli and K. pneumoniae was 82% and 94.6%, respectively. TEM-type beta-lactamase gene was found in 53% of E. coli isolates. 93.5% of K. pneumoniae isolates was found to have SHV-type beta- lactamase gene. CONCLUSION: In Korea TEM-type beta-lactamase gene was most prevalent in E. coli, but its prevalence rate was relatively low compared with those in other country. For K. pneumoniae, the isolates with SHV type beta-lactamase gene were predominant.
Agar ; Ampicillin Resistance ; beta-Lactamases* ; beta-Lactams ; Diffusion ; Escherichia coli* ; Escherichia* ; Hospitals, University ; Humans ; Klebsiella pneumoniae* ; Klebsiella* ; Korea* ; Penicillinase ; Pneumonia ; Polymerase Chain Reaction ; Prevalence*

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Epidemiological and Clinical Analysis of Influenza and Viruses Isolation during Winter of 1996-1997 .

Nam Yong KEE ; Chang Seok KI ; Su Jeong KIM ; Yong Wha LEE ; Gyu Young JEONG ; Sang Il LEE ; Jee Hee KIM

Korean Journal of Infectious Diseases.1997;29(4):263-270.

BACKGROUND: Although influenza has been a leading cause of global morbidity and mortality, we have few data regarding the epidemiological and clinical characteristics of influenza activity in Korea. Since an outbreak of influenza was recognized during winter of 1996-1997, we analyzed the epidemiological and clinical features of influenza activity in the hospital setting. METHODS: All clinical specimens requested for isolation of influenza virus at Samsung Medical Center from October 1996 to April 1997 were included. Mardin- Darby canine kidney (MDCK) cell line was used for virus culture. Isolated viruses were confirmed with immunostain followed by subtyping. The demographic and clinical characteristics of the patients were reviewed retrospectively. RESULTS: Ninety-eight influenza viruses were isolated from 461 patients (21.3%). Influenza A and B virus was isolated from 58 (54 children and 4 adults) and 40 pediatric patients, respectively. One of 31 influenza A viruses were confirmed as A/Wuhan/359/95-like strain and 5 of 12 influenza B viruses were confirmed as B/Guangdong/8/97-like strains. Two distinctive peaks of influenza activity were recognized and the most common age of patients was less than 1 year for influenza A, and 3 to 5 years for influenza B. Common lower respiratory infections were pneumonia followed by croup, bronchiolitis and laryngitis. CONCLUSION: We analyzed the epidemiological and clinical features of influenza activity during winter of 1996-1997. Although this study was performed not in the community but in the hospital setting, the morbidity caused by influenza may not be low in Korea. Therefore, nationwide surveillance for influenza activity is warranted.
Bronchiolitis ; Cell Line ; Child ; Croup ; Epidemiology ; Herpesvirus 1, Cercopithecine ; Humans ; Influenza A virus ; Influenza B virus ; Influenza, Human* ; Kidney ; Korea ; Laryngitis ; Mortality ; Orthomyxoviridae ; Pneumonia ; Respiratory Tract Infections ; Retrospective Studies

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A Case of Vancomycin-resistant E. faecium Peritonitis in Patient with Continuous Ambulatory Peritoneal Dialysis.

Tae Hyo KIM ; Hyun Jung KIM ; Hye Jung HA ; Hwi Jong KIM ; Young Mi CHOI ; Jung Ill YANG ; Soo Jin KIM ; Un Sil JEON ; Se Ho CHANG ; Soon Ill CHUNG

Korean Journal of Infectious Diseases.2000;32(3):256-258.

Enterococcus is a normal flora of the gastrointestinal or genitourinary tract. With the increased use of vancomycin and third generation cephalosporins, vancomycin-resistant enterococci (VRE) have become one of the major nosocomial pathogens in USA and Europe since 1986. In Korea, patients with VRE infection or colonization were increasingly reported recently and VRE may become a serious nosocomial pathogen in the near future. So we report a case of vancomycin-resistant E. faecium peritonitis in a patient on continuous ambulatory peritoneal dialysis.
Cephalosporins ; Colon ; Enterococcus ; Europe ; Humans ; Korea ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis* ; Vancomycin

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A Case of Pichia ohmeri Fungemia Related to the Central Venous Catheter.

Jin Han LEE ; Choon Kwan KIM ; Hu Seok LEE ; Jin Su KIM ; Min Jung KIM ; Oh Young CHUNG ; Jong Ryul KIM ; Mi Jin SO ; Buyng Ju NA ; Yong Kyun CHO ; Kuyi Rae LEE ; Myung Hee LEE ; Young Ho RHO

Korean Journal of Infectious Diseases.2000;32(3):252-255.

Pichia ohmeri is a very rare pathogen of human infection. To date, two cases of P. ohmeri infection were reported worldwide. We have experienced a case of catheter-related P. ohmeri fungemia. The patient had been admitted due to cerebrovascular accident in rehabilitation center since August 1998. He had been bedridden due to previous cerebrovascular accident and undergone several episodes of nosocomial infection. Multiple antimicrobial agents had been used with central venous catheter for parenteral nutrition. On February 1999, he had developed fever and dyspnea. Vancomycin and imipenem were administered empirically and central venous catheter was removed on the impression of central venous catheter related infection. Blood culture and catheter tip culture grew P. ohmeri. He developed septic shock and finally led to death before the administration of amphotericin B.
Amphotericin B ; Anti-Infective Agents ; Catheters ; Central Venous Catheters* ; Cross Infection ; Dyspnea ; Fever ; Fungemia* ; Humans ; Imipenem ; Parenteral Nutrition ; Pichia* ; Rehabilitation Centers ; Shock, Septic ; Stroke ; Vancomycin

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A Case of Severe Community-acquired Pneumonia due to Pseudomonas aeruginosa in a Healthy Adult.

Tae Yong KIM ; Ee Seok KIM ; Nam Joong KIM ; Sun Hee LEE ; Myoung Don OH ; Kang Won CHOE

Korean Journal of Infectious Diseases.2000;32(3):248-251.

Pseudomonas aeruginosa pneumonia is characteristically found as a hospital-acquired infection in patients with underlying medical disorders. Few cases of community acquired P. aeruginosa pneumonia have been reported in individuals without underlying diseases. We report a case of P. aeruginosa pneumonia in a healthy 33-year-old man. He visited our hospital because of fever, non-productive cough, and pleuritic chest pain. On physical examination, the breathing sounds were decreased on the right lower lung field. The chest radiograph showed lobar consolidations with a cavity on the right upper lung field. Blood cultures and a pleural fluid culture yielded P. aeruginosa. Despite aggressive management including antibiotics and mechanical ventilation, he died 26 hours after the onset of symptoms. P. aeruginosa should be included in the differential diagnosis of severe community-acquired pneumonia.
Adult* ; Anti-Bacterial Agents ; Chest Pain ; Cough ; Diagnosis, Differential ; Fever ; Humans ; Lung ; Physical Examination ; Pneumonia* ; Pseudomonas aeruginosa* ; Pseudomonas* ; Radiography, Thoracic ; Respiration, Artificial ; Respiratory Sounds ; Sepsis

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