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Modern History of Hansen's Disease in Korea

Infection and Chemotherapy.2020;52(4):647-653. doi:10.3947/ic.2020.52.4.647

Modern history of Hansen's Disease (HD) in Korea begins with nationwide use of the chemotherapeutic agent Diamino Diphenyl Sulphone for the patients in 1955. Definition of the case was different from time to time. Based on World Health Organization (WHO) criteria, Ministry of Health and Welfare (MOHW) reported 4,393 registered patients and same number 4,393 as new cases in 1977. This is the turning point they accepted patient reporting system of WHO, but total number of registered and managed as leprosy patients was 28,029 in 1977, which means the people who needs HD service from government at that time. The number of new cases decreased from 4,393 in 1977, 39 in 1996 to 4 in 2017. Regarding to new cases, it takes 40 years to accomplish from thousands level to below 10. Now we have 166 active cases (registered patients) and reported them as patients to the WHO. Korea Civil Assistance Command invited Dr. RG Cochrane who visited Korea for six weeks to make blue print for eradication of HD in Korea. With his advice and MOHW set HD project and plan for manpower to solve HD problems in 1955. Dr. Joon Lew and his colleagues founded Korean Leprosy Prevention Association in 1947 to combat leprosy, enlighten the public, and solve social problems caused by HD. The Korean Leprosy Prevention Association led by him changed its name to the Korean Leprosy Association in 1956, and grew into the current Korean Hansen Welfare Association. This organization is now playing a leading role in the eradication and management of HD in Korea.

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Persistent Effort to Control Infection after Lung Transplantation in Korea

Su Jin JEONG

Infection and Chemotherapy.2020;52(4):644-646. doi:10.3947/ic.2020.52.4.644

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Causative Pathogens and Antibiotic Resistance in Infectious Arthritis

Ki-Ho PARK

Infection and Chemotherapy.2020;52(4):641-643. doi:10.3947/ic.2020.52.4.641

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Encapsulation of Low Metronidazole Dose in Poly (D,L-lactide-co-glycolide) (PLGA) Nanoparticles Improves Giardia intestinalis Treatment

Neveen Adel MADBOULY ; Hayam NASHEE ; Ashraf Ahmed ELGENDY ; Ibraheem RABEE ; Azza El AMIR

Infection and Chemotherapy.2020;52(4):550-561. doi:10.3947/ic.2020.52.4.550

Background: The present study was designed to investigate the antigiardial efficacy of low metronidazole dose loaded-D.L-lactide-co-glycolide (LMD-PLGA) nanoparticles (NPs) and to compare it with the standard high dose of metronidazole either free (HMD) or loaded on PLGA (HMD-PLGA). Materials and Methods: PLGA NPs were prepared by single emulsification method, metronidazole (MTZ) was loaded in low and high doses. The nanoparticles were evaluated in vivo for mice model. The Giardia intestinalis infected mice were treated by LMD and HMD either free or PLGA NPs loaded, the parasitic load and ployclonal antigiardial serum antibodies (IgG and IgA) were recorded. Histopathological studies on intestinal and liver sections were applied. Results: MTZ-PLGA NPs was successfully prepared with 81.68% encapsulation efficiency and with an average particle size of approximately 228.00 ± 43.19 nm and -32.28 ± 0.07 mV Zeta potential. Experimentally, it was observed that Giardia intestinalis infected animals administered with LMD-PLGA had completely eliminated cyst shedding and trophozoite count compared with Giardia-infected mice. Further, it was found that animals belonging to LMD-PLGA group had significantly reduced levels of antigiardial IgA (0.99 ± 0.05) antibodies in serum compared with Giardia-infected. Histopathologyically, also animals belonging to LMD-PLGA treated group had intact mucosal epithelium lining, and normal villi with no detection of G. intestinalis trophozoites. In addition to the less toxic effect on the liver tissue compared to free HMD, HMD-PLGA and infected-untreated groups using Ishak grading system. Conclusion Our study showed that PLGA nanoparticles could be atrial delivery systems for antigiardial drugs to improve their therapeutic efficacy and minimize their side effects that results from frequent dosing.

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Omega 3 Fatty Acids and COVID-19:A Comprehensive Review

Donald HATHAWAY III ; Krunal PANDAV ; Madhusudan PATEL ; Adrian RIVA-MOSCOSO ; Bishnu Mohan SINGH ; Aayushi PATEL ; Zar CHI MIN ; Sarabjot SINGH-MAKKAR ; Muhammad KHAWAR SANA ; Rafael SANCHEZ-DOPAZO ; Rockeven DESIR ; Michael Maher MOURAD FAHEM ; Susan MANELLA ; Ivan RODRIGUEZ ; Alina ALVAREZ ; Rafael ABREU

Infection and Chemotherapy.2020;52(4):478-495. doi:10.3947/ic.2020.52.4.478

The rapid international spread of severe acute respiratory syndrome coronavirus 2 responsible for coronavirus disease 2019 (COVID-19) has posed a global health emergency in 2020. It has affected over 52 million people and led to over 1.29 million deaths worldwide, as of November 13th, 2020. Patients diagnosed with COVID-19 present with symptoms ranging from none to severe and include fever, shortness of breath, dry cough, anosmia, and gastrointestinal abnormalities. Severe complications are largely due to overdrive of the host immune system leading to “cytokine storm”. This results in disseminated intravascular coagulation, acute respiratory distress syndrome, multiple organ dysfunction syndrome, and death. Due to its highly infectious nature and concerning mortality rate, every effort has been focused on prevention and creating new medications or repurposing old treatment options to ameliorate the suffering of COVID-19 patients including the immune dysregulation. Omega-3 fatty acids are known to be incorporated throughout the body into the bi-phospholipid layer of the cell membrane leading to the production of less pro-inflammatory mediators compared to other fatty acids that are more prevalent in the Western diet. In this article, the benefits of omega-3 fatty acids, especially eicosapentaenoic acid and docosahexaenoic acid, including their anti-inflammatory, immunomodulating, and possible antiviral effects have been discussed.

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Clinical Characteristics and Causative Pathogens of Infective Arthritis and Risk Factors for Gram-Negative Bacterial Infections

Yongseop LEE ; Yun Suk CHO ; Yu Jin SOHN ; Jong Hoon HYUN ; Sang Min AHN ; Woon Ji LEE ; Jung Ho KIM ; Hye SEONG ; Junhyoung KIM ; Su Jin JEONG ; Nam Su KU ; Joon Sup YEOM ; Jin Young AHN ; Jun Yong CHOI

Infection and Chemotherapy.2020;52(4):503-515. doi:10.3947/ic.2020.52.4.503

Background: The aim of this study was to describe the clinical and microbiological characteristics of infective arthritis and to analyze risk factors for Gram-negative bacterial infections that cause infective arthritis. Materials and Methods: Patients admitted between 2009 - 2018 with infective arthritis in a single-tertiary hospital were evaluated retrospectively. Results: A total of 181 patients were enrolled in this study. Of them, 135 were native joint infection patients and 46 were prosthetic joint infection patients. The most common site of infective arthritis was the knee (63.6%), followed by the shoulder (17.7%), and the hip (9.9%).The most frequently identified microorganisms were Staphylococcus aureus (51.1%), followed by Streptococci sp. (21.1%), Enterobacteriaceae (8.4%), and coagulase-negative-Staphylococci (CNS;8.4%). Infections due to Gram-negative bacteria and fungi made up 13.7% and 3.2% of all cases, respectively. Additionally, 20% and 4.2% of the cases involved methicillin-resistant S. aureus (MRSA) and MRCNS. We found that bacteriuria, infective arthritis in the hip, and steroid use at admission are independent risk factors for Gram-negative bacterial infections. Conclusion Infective arthritis with methicillin-resistant microorganisms reached up to about 25% in a single-tertiary hospital in Korea. In case of suspected urinary tract infection, infective arthritis of the hip joint, or steroid use at admission time among infective arthritis patients, empirical treatment covering Gram-negative microorganisms can be considered.

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Vancomycin Area under the Curve and Pharmacokinetic Parameters during the First 24 Hours of Treatment in Critically Ill Patients using Bayesian Forecasting

Manat PONGCHAIDECHA ; Dhitiwat CHANGPRADUB ; Kanjana BANNALUNG ; Kajeewan SEEJUNTRA ; Sutthanuch THONGMEE ; Aminta UNNUAL ; Wichai SANTIMALEEWORAGUN

Infection and Chemotherapy.2020;52(4):573-582. doi:10.3947/ic.2020.52.4.573

Background: Currently, the achievement of the target area under the curve (AUC)/ minimum inhibitory concentration ratio during the first 24 - 48 h of treatment is associated with reduced 30-day mortality and greater microbiological eradication in patients with methicillin-resistant Staphylococcus aureus bacteremia. This study aimed to determine the AUC and pharmacokinetic parameters on the first day of vancomycin administration based on the Bayesian theorem to optimize the dosing regimen in critically ill patients. Materials and Methods: This retrospective study included participants meeting the following criteria: 1) ≥18 years old; 2) receipt of at least one dose of vancomycin; 3) measurement of 2 vancomycin serum concentrations during the first 24 h of treatment; and 4) an intensive care unit admission, mechanical ventilator use, or an Acute Physiology and Chronic Health Evaluation II score >15 points. The AUC on day 1 of treatment and the estimated vancomycin pharmacokinetic parameters were measured using PrecisePK software based on the Bayesian theorem. Results: We obtained 132 vancomycin concentrations from 66 patients. The vancomycin pharmacokinetic parameters were as follows: AUC0-24 , 571.09 (± standard deviation [SD] 188.62) mg/L·h; clearance (CL), 2.97 (± SD 1.81) L/h; volume of distribution (Vd), 50.60 (± SD 13.91) L;elimination rate constant, 0.062 (± SD 0.039) h −1 ; and half-life, 18.19 (± SD 15.96) h. Focusing on the vancomycin loading dose, AUC 0-24 400 - 600 was achieved in 41.7, 46.1, 44.4, and 26.3% of patients with loading doses of <20, 20 – 24.9, 25 – 30, and >30 mg/kg, respectively. Whereas AUC0-24 ≥521 was achieved in 50, 50, 77.8, and 84.2% of patients with loading doses of <20, 20 – 24.9, 25 – 30, and >30 mg/kg, respectively. The CL of vancomycin was correlated with creatinine CL, whereas the Vd of vancomycin was significantly correlated with age and body weight. Conclusion This study revealed that the higher Vd and CL values on the first day of vancomycin therapy were found in critically ill patients. Additionally, a higher vancomycin loading dose (25 – 30 mg/kg) might be required to achieve target of AUC0-24 during early phase of administration for critically ill patients.

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The Outcome of Fungal Pneumonia with Hematological Cancer

Esma EREN ; Emine ALP ; Fatma CEVAHIR ; Tuğba TOK ; Ayşegül Ulu KILIÇ ; Leylagül KAYNAR ; Recep Civan YÜKSEL

Infection and Chemotherapy.2020;52(4):530-538. doi:10.3947/ic.2020.52.4.530

Background: Fungal pneumonia is a common infectious complication of hematological cancer (HC) patients. In this retrospective study, the objective was set to identify the risk factors and outcome of fungal pneumonia in adult HC patients. Materials and Methods: This retrospective study was conducted with adult (>16 years) HC patients from January 2017 and December 2018. Results: During the study period, of 181 patients included 76 were diagnosed with fungal pneumonia. The most common HC was identified as acute myeloid leukaemia (40%). Of the participating patients, 52 (29%) were hematopoietic stem cell transplant (HSCT) recipients.The median age of patients with fungal pneumonia was significantly greater: 57 vs. 48 (odds ratio [OR]: 1.08) and they had longer hospitalization durations (OR: 1.14). Overall, 37 patients (20%) died, and 28-day mortality was significantly greater among patients with fungal pneumonia than without fungal pneumonia (33% vs. 11%). The most significant risk factors for mortality in fungal pneumonia were identified as need of intensive care unit (ICU) (OR: 191.2, P <0.001) and the need of vasopressor support (OR:81.6, P <0.012). ICU-mortality was (88%). Conclusion Fungal pneumonia is a lethal complication in HC patients. Intensive care need is the most important predictive factor for mortality.

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Decision on Chemotherapy amidst COVID-19 Pandemic: A Review and a Practical Approach from Iran

Afshin RAKHSHA ; Samira AZGHANDI ; Farzad TAGHIZADEH-HESARY

Infection and Chemotherapy.2020;52(4):496-502. doi:10.3947/ic.2020.52.4.496

To provide a step-by-step approach to chemotherapy (CTx) in the novel coronavirus disease 2019 (COVID-19) era. The COVID-19 pandemic is the current global issue resulting in vast health implications. Amid the COVID-19 era, special attention must be paid to at-risk groups, including patients with cancer. To our knowledge, there is a paucity of data on the decision for CTx during the pandemic. We herein provide practical recommendations on the CTx of cancer patients over the pandemic based on our experience in an educational hospital. The decision on CTx should be considered to be individualized based on clinical findings. We hope that our experience provides a practical guide for clinical oncologists to deliver more effective cancer care over the COVID-19 pandemic.

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Outbreak associated with Rotavirus G11,P25 in Korea in 2018

Su-Jin CHAE ; Sunyoung JUNG ; Seung-Rye CHO ; Wooyoung CHOI ; Deog-Yong LEE

Infection and Chemotherapy.2020;52(4):616-620. doi:10.3947/ic.2020.52.4.616

We here report the first outbreak caused by rotavirus G11,P[25] in Korea in 2018, representing a case of re-assortment with pig-derived rotavirus. The genotype constellation was identical to the virus identified in Korea in 2012 as G11-P[25] -I12-R1-C1-M1-A1-N1-T1-E1-H1. The infection source was not known exactly but it must be considered infection from swine.

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