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A Case of Septic Shock Following Catheter-related Infection Caused by Lactococcus lactis subsp. lactis in an Adult.

Tae Won BAE ; Jaehyeon LEE ; Hye Soo LEE ; Yong Gon CHO

Laboratory Medicine Online.2016;6(3):187-190. doi:10.3343/lmo.2016.6.3.187

Lactococcus lactis is a gram-positive cocci used extensively in the dairy industry, but considered an unusual pathogen in humans. Among its five subspecies, L. lactis subsp. lactis in particular has rarely been reported as a pathogen. We report a case of septic shock caused by L. lactis subsp. lactis in an adult patient. A 64-yr-old male patient was admitted to outpatient clinics, with chief complaints of fever and chills for one week after convalescent hospital admission. He had severe ileus requiring surgery. He had a peripherally inserted central catheter from convalescent hospital, which was immediately removed. From two sets of blood and catheter tip cultures, we identified L. lactis subsp. lactis using the Vitek 2 system (bioMerieux Inc., USA), and confirmed this result by 16S rRNA sequencing. The patient was empirically treated with ciprofloxacin, and he recovered and was discharged.
Adult* ; Ambulatory Care Facilities ; Catheter-Related Infections* ; Catheters ; Chills ; Ciprofloxacin ; Fever ; Gram-Positive Cocci ; Hospitals, Convalescent ; Humans ; Ileus ; Lactococcus lactis* ; Lactococcus* ; Male ; Shock, Septic*

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A Rare der(Y)t(Y;1)(q12;q12) in a Patient with Essential Thrombocythemia.

Hyeon Ho LIM ; Jae Lim CHOI ; Bo Ram KIM ; Kwang Sook WOO ; Kyeong Hee KIM ; Jeong Man KIM ; Sung Hyun KIM ; Jin Yeong HAN

Laboratory Medicine Online.2016;6(3):183-186. doi:10.3343/lmo.2016.6.3.183

Among hematologic diseases, structural abnormalities of autosomal chromosomes are well-known, but cases involving the sex chromosomes are uncommon. Duplications of the long arm of chromosome 1 have been reported in several hematologic diseases including myelodysplastic syndrome, myeloproliferative neoplasms, acute myeloid leukemia, acute lymphoblastic leukemia, and Burkitt lymphoma. However, dup(1q) as a der(Y)t(Y;1)(q12;q12) is very rare. Here, we report a case of essential thrombocythemia harboring der(Y)t(Y;1)(q12;q12) with literature review.
Arm ; Burkitt Lymphoma ; Chromosome Aberrations ; Chromosomes, Human, Pair 1 ; Hematologic Diseases ; Humans ; Leukemia, Myeloid, Acute ; Myelodysplastic Syndromes ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Sex Chromosomes ; Thrombocythemia, Essential*

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Comprehensive Analysis of Blood Cultures Using BacT/Alert 3D FA Plus and FN Plus Media.

Jung Hyun BYUN ; Seung Wook KIM ; Eun Ha KOH ; Sunjoo KIM ; Seong Chun KIM

Laboratory Medicine Online.2016;6(3):176-182. doi:10.3343/lmo.2016.6.3.176

BACKGROUND: We prospectively evaluated the performance of blood culture resin media, FA Plus and FN Plus, of the BacT/Alert 3D System (bioMérieux Inc., USA) in a tertiary university-affiliated hospital. METHODS: We obtained 2,994 blood culture sets. The positivity and time to detection (TTD) were compared between FA Plus and FN Plus for clinically significant microorganisms. We then categorized patients into two groups based on antibiotic treatment before blood culture to observe the difference of positivity between two groups. RESULTS: Among 2,994 sets received, 371 (12.4%) yielded 385 clinically significant pathogens. Comparing FA Plus to FN Plus media, lactose non-fermenters (18 vs. 1; P<0.001) and yeasts (15 vs. 0; P<0.001) were recovered at a significantly higher rate using FA Plus, whereas gram-positive cocci (10 vs. 26; P=0.011) and gram-negative anaerobes (0 vs. 10 P=0.002) were isolated at a higher rate using FN Plus. In terms of detection time in FA Plus compared to that in FN Plus, Staphylococcus aureus (13.8 hr vs. 18.1 hr) and gram-positive cocci (14.1 hr vs. 20.3 hr) were detected significantly earlier in FA Plus (each, P<0.001). There was no statistically significant difference in positivity based on prior antibiotic use (13.1%, 65/498) compared to antibiotic naïve patients (12.3%, 306/2,496) (P>0.05). CONCLUSIONS: Complementary detection of microorganisms was observed between FA Plus and FN Plus. Gram-positive cocci including S. aureus grew faster in FA Plus. In addition, the rate of positivity was not affected by prior antibiotic therapy in BacT/Alert 3D resin media.
Gram-Positive Cocci ; Humans ; Lactose ; Prospective Studies ; Sepsis ; Staphylococcus aureus ; Yeasts

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Clinical Usefulness of a DNA Microarray-based Assay for the Diagnosis of Sexually Transmitted Infections.

Ae Ja PARK ; So Young KIM ; Dong Hee SEO

Laboratory Medicine Online.2016;6(3):171-175. doi:10.3343/lmo.2016.6.3.171

BACKGROUND: Many molecular diagnostic methods have been developed to detect sexually transmitted infections (STI). The STDetect Chip (LabGenomics, Korea) which is a DNA microarray-based tool, newly developed for STI diagnosis in vitro, and the real-time PCR-based Anyplex STI-7 (Seegene, Korea) in clinical use were evaluated using ATCC DNA and clinical samples to determine the clinical usefulness of the STDetect Chip. METHODS: The two methods were compared for consistency, sensitivity, and specificity for 6 pathogens in 300 prospectively selected clinical samples. Analytical sensitivity for ATCC Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma hominis and Trichomonas vaginalis DNA and the effect of mixing bacterial DNA were studied. RESULTS: The consistency of the two methods for clinical samples was superior at more than 0.92 kappa value. The sensitivity and specificity of the STDetect Chip compared with Anyplex STI-7 were 90.5-98.8%, and 95.6-99.6%, respectively. With similar analytical performance for ATCC DNA, the STDetect Chip detected 10(-5) ng/µL of N. gonorrhoeae, 10(-4) ng/µL of C. trachomatis, 10(-6) ng/µL of M. hominis, and 10(-3) ng/µL of T. vaginalis. For the mixture of three bacterial DNAs, less sensitive detection level was observed for T. vaginalis. CONCLUSIONS: The STDetect Chip showed good agreement with the Anyplex STI-7 test and it is considered clinically useful for detecting sexually transmitted pathogens.
Chlamydia trachomatis ; Diagnosis* ; DNA* ; DNA, Bacterial ; In Vitro Techniques ; Mycoplasma hominis ; Neisseria gonorrhoeae ; Oligonucleotide Array Sequence Analysis ; Pathology, Molecular ; Polymerase Chain Reaction ; Prospective Studies ; Sensitivity and Specificity ; Sexually Transmitted Diseases* ; Trichomonas vaginalis

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Nucleic Acid Extraction for the Quantification of Cytomegalovirus and Epstein-Barr Virus.

Heungsup SUNG ; Sang Hyun HWANG ; Young Jin KOH ; Mi Na KIM

Laboratory Medicine Online.2016;6(3):165-170. doi:10.3343/lmo.2016.6.3.165

BACKGROUND: Availability of an international standard will improve the standardization of quantitative PCR (qPCR) for cytomegalovirus (CMV) and Epstein-Barr virus (EBV); however, nucleic acid extraction methods may affect qPCR results. This study was designed to determine whether routine measurement of DNA concentration and purity is required in qPCR for CMV and EBV. In addition, the performance of the automated QIASymphony DSP DNA Mini kit (Qiagen, USA) and the manual QIAamp DNA Blood Mini kit (Qiagen) in extracting DNA from whole blood samples was compared. METHODS: The concentration and purity of 300 extracted DNA samples were determined using a NanoDrop ND-1000 spectrophotometer (Thermo Scientific, USA). A total of 72 and 54 whole blood samples were tested by artus CMV and EBV qPCR (Qiagen), respectively. RESULTS: No correlation was found between DNA concentration and EBV DNA load or between DNA purity and the PCR inhibition measured by ΔCq (the difference between internal control Cq of the sample and that of the negative control). Quantification of CMV and EBV DNA using the two extraction methods showed highly similar results (rho=0.946 and 0.887, respectively). Of the 29 specimens that yielded CMV DNA by both methods, however, 8 specimens (27.6%) yielded higher CMV DNA loads with QIASymphony. CONCLUSIONS: Routine measurement of DNA concentration and purity is not necessary for qPCR of CMV and EBV. The automated QIASymphony outperformed the manual QIAamp Blood Mini kit in extracting CMV and EBV DNA from whole blood samples.
Cytomegalovirus* ; DNA ; Herpesvirus 4, Human* ; Polymerase Chain Reaction

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Analytical Evaluation of the DiaSys Albumin in Urine/CSF FS Kit for Urine Albumin Measurement Using a JEOL BioMajesty JCA-BM6010/C Analyzer.

Hyun Jeong KIM ; Misuk JI ; Hee Won MOON ; Mina HUR ; Yeo Min YUN

Laboratory Medicine Online.2016;6(2):64-69. doi:10.3343/lmo.2016.6.2.64

BACKGROUND: High albuminuria is defined as albumin excretion of >30 mg/24 hr or an albumin-to-creatinine ratio of 30 mg/g in a random urine sample. We assessed the analytical performance of the Albumin in Urine/CSF FS kit (DiaSys Inc., UK) using a BioMajesty JCA-6010/C analyzer (JEOL Inc., Japan). METHODS: Urine albumin concentrations were measured by the Albumin in Urine/CSF FS kit using a BioMajesty JCA-BM6010/C analyzer. Imprecision, linearity, and carry-over were measured according to the Clinical Laboratory and Standards Institute documents EP10 and EP9. The assay was compared with the ALB-T TQ Gen.2 (Roche, Germany) assay on a Cobas8000 C702 (Roche, Germany), the Tina-Quant Albumin (Roche, Switzerland) assay on a Hitachi7600-210 (Hitachi, Japan), and an Abbott urine albumin assay (Abbott Laboratories, USA) on a TBA 200FR (Toshiba, Japan) using 50 random urine samples. RESULTS: Within-run and total imprecision were 0.551-1.023% and 0.551-1.214%, respectively. Linearity ranged from 6.31 to 30.60 mg/dL, and functional sensitivity was 0.5 mg/dL. Results from the Albumin in Urine/CSF FS kit showed good correlation with the ALB-T TQ Gen.2 (r=0.987) and the Tina-Quant Albumin assays (r=0.991). However, the four assays categorized 18 of 50 urine samples into different albuminuria groups. CONCLUSIONS: Albumin in Urine/CSF FS testing on a BioMajesty JCA-BM6010/C analyzer showed good linearity, functional sensitivity, precision, and correlation with the ALB-T TQ Gen.2 and Tina-Quant Albumin assays. However, because some samples were categorized into different albuminuria groups by the different assays, further studies on the standardization of albuminuria assays are needed.
Albuminuria

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Massive Transfusion Protocols for Pediatric Patients.

Hwan Tae LEE ; Pil Whan PARK ; Yiel Hea SEO ; Jeong Yeal AHN ; Ja Young SEO ; Ji Hun JEONG ; Moon Jin KIM ; Jung Nam LEE ; Gil Jae LEE ; Kyung Hee KIM

Laboratory Medicine Online.2016;6(2):60-63. doi:10.3343/lmo.2016.6.2.60

The number of massive transfusions for pediatric patients has risen owing to the increasing number of complex surgeries and trauma centers. However, as there are only a few studies on pediatric massive transfusion, adult massive transfusion protocols are used for pediatric patients in many hospitals and institutions. Although massive transfusion protocols would improve the outcomes and reduce the received blood products during transfusion, pediatric patients differ from adults in the tolerability to transfusion, incidence of coagulopathy, and mechanisms of injuries. Therefore clinical physicians have requested for a pediatric massive transfusion protocol. Herein, we reviewed pediatric massive transfusion protocols that have been used in various clinical settings. To date, only a few single-center studies with a small number of pediatric patients have been performed. Even though these studies did not show improvement in outcomes such as mortality and side effects, they reported a short preparation time for fresh frozen plasma products and a low coagulopathy rate in pediatric massive transfusion groups. Therefore, large, prospective, multicenter studies are needed to identify the empiric ratio of blood products for improving outcomes of pediatric patients who need massive transfusion.
Adult ; Humans ; Incidence ; Mortality ; Plasma ; Prospective Studies ; Trauma Centers

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Delayed Diagnosis of Atypical Mowat-Wilson Syndrome.

Mi Ae JANG ; Yu Jung JUNG ; Dong Kyu JIN ; Jeehun LEE ; Eun Hae CHO ; Ja Hyun JANG ; Chang Seok KI

Laboratory Medicine Online.2016;6(2):57-59. doi:10.3343/lmo.2016.6.2.57

No abstract available.
Delayed Diagnosis*

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Interferon-gamma Release Assay Using Pericardial Fluid and Peripheral Blood for the Diagnosis of Tuberculous Pericarditis: A Case Report.

Kyung Sun PARK ; Hyung Doo PARK ; Chang Seok KI ; Nam Yong LEE ; Sung A CHANG ; Eun Suk KANG

Laboratory Medicine Online.2014;4(2):116-121. doi:10.3343/lmo.2014.4.2.116

Here, we report a case in which the rapid diagnosis of tuberculous pericarditis was made using Mycobacterium tuberculosis (MTB)-specific interferon-gamma release assay on peripheral blood and pericardial effusion. Acid-fast bacilli staining, mycobacterial culture, and nucleic acid amplification targeting MTB using pericardial fluid were negative. However, elevated adenosine deaminase (ADA) activity in pericardial fluid and interferon-gamma release assay positivity in both pericardial fluid and peripheral blood indicated the presence of tuberculous pericarditis. After anti-tuberculous and steroid treatment, the patient's clinical symptoms improved, and pericardial effusion has not reoccurred.
Adenosine Deaminase ; Diagnosis* ; Interferon-gamma Release Tests* ; Interferon-gamma* ; Mycobacterium tuberculosis ; Pericardial Effusion ; Pericarditis, Tuberculous*

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Acute Megakaryoblastic Leukemia with CD41a-/CD61-/CD42a+ Blasts in an Infant with Down Syndrome.

Kiwoong KO ; Min Jung KWON ; Mi Ae JANG ; Seung Tae LEE ; Hee Yeon WOO ; Hyosoon PARK ; Sun Hee KIM

Laboratory Medicine Online.2014;4(2):112-115. doi:10.3343/lmo.2014.4.2.112

Infants with Down syndrome have increased incidences of transient abnormal myelopoiesis (TAM) and acute leukemia, which are usually associated with acute megakaryoblastic leukemia (AMKL). A 5-day-old girl with Down syndrome was diagnosed with TAM; 4 months later, acute leukemic transformation was suspected. Bone marrow (BM) examination was performed, and the infant was diagnosed with acute leukemia (80% blasts). Although BM aspirates showed the presence of megakaryocytic blasts with cytoplasmic blebs, flow cytometry analysis revealed that they were negative for cells with CD41a and CD61 immunophenotypes. Further analysis revealed that the megakaryocyte-related marker CD42a was positive in 57% of blasts. Morphologic and immunophenotypic features are required to establish the lineage of megakaryocytic blasts, which are necessary for diagnosing AMKL. As most cases of AMKL were positive for CD41 and/or CD61 markers, their presence was evaluated during routine analysis. In order to identify the immunophenotypic features of AMKL in an infant with Down syndrome, we performed additional flow cytometry for CD42a, one of the megakaryocytic markers, and were able to assist in the early diagnosis of AMKL, as well as to use CD42a as an effective follow-up marker.
Blister ; Bone Marrow ; Cytoplasm ; Down Syndrome* ; Early Diagnosis ; Female ; Flow Cytometry ; Follow-Up Studies ; Humans ; Incidence ; Infant* ; Leukemia ; Leukemia, Megakaryoblastic, Acute* ; Myelopoiesis

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