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Comparison of MicroScan and Phoenix Automated Systems for Detection of Extended-Spectrum beta-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae.

Won Young JIN ; Sook Jin JANG ; Young Sook KIM ; Geon PARK ; Dae Soo MOON ; Young Jin PARK

Laboratory Medicine Online.2012;2(1):55-58. doi:10.3343/lmo.2012.2.1.10

The aim of this study was to evaluate the performances of MicroScan (Siemens Healthcare, USA) and Phoenix (Becton Dickinson Diagnostic Systems, USA) automated systems for the detection of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae. ESBL-producers were detected from 18 E. coli strains and 26 K. pneumoniae strains using MicroScan, Phoenix, and double-disk synergy test (DDST). The ESBL types were determined by PCR direct sequencing. ESBL genes were detected in 38 (86.4%) of the 44 test strains. The sensitivities of MicroScan, Phoenix, and DDST were 94.6%, 79%, and 89.5%, respectively. Both MicroScan and Phoenix provided acceptable results for the examination of clinical isolates.
beta-Lactamases ; Delivery of Health Care ; Escherichia ; Escherichia coli ; Klebsiella ; Klebsiella pneumoniae ; Pneumonia ; Polymerase Chain Reaction

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A Case of Plasmodium ovale Malaria Imported from West Africa.

SeJin MOON ; Baek Nam KIM ; Eun Young KUAK ; Tae Hee HAN

Laboratory Medicine Online.2012;2(1):51-54. doi:10.3343/lmo.2012.2.1.9

In Korea, the majority of imported malaria cases are Plasmodium vivax and P. falciparum, but Plasmodium ovale cases are rarely reported. We describe an imported case of P. ovale that was confirmed by peripheral blood smear and nested PCR targeting the small subunit ribosomal RNA (SSU rRNA) gene. A 37-yr-old male had visited the Republic of Ghana in tropical West Africa 3 months ago, and suffered from fever and headache since 2 weeks after his return to Korea. The results of rapid malaria test using SD Malaria Antigen/Antibody Kit (Standard Diagnostics, Korea) were negative, but Plasmodium species was observed in Wright-Giemsa-stained peripheral blood smear. For the evaluation of possible mixed infection and identification of species, we performed a nested PCR targeting the SSU rRNA gene. P. ovale single infection was confirmed by PCR. The sequence analysis of the P. ovale SSU rRNA gene showed that our isolate was P. ovale classic type. We should confirm P. ovale infection for an accurate diagnosis and treatment of imported malaria cases in Korea because the number of travelers to P. ovale-endemic regions has recently increased.
Africa, Western ; Coinfection ; Fever ; Genes, rRNA ; Ghana ; Headache ; Humans ; Korea ; Malaria ; Male ; Plasmodium ; Plasmodium ovale ; Plasmodium vivax ; Polymerase Chain Reaction ; RNA, Ribosomal ; Sequence Analysis

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Chromosomal Abnormalities in Myelodysplastic Syndrome with Near-tetraploidy: A Case Report.

Ha Nui KIM ; Hye Jin LEE ; Myung Han KIM ; Jang Su KIM ; Jin Hyuk YANG ; Soo Young YOON ; Chae Seung LIM ; Kap No LEE

Laboratory Medicine Online.2012;2(1):47-50. doi:10.3343/lmo.2012.2.1.8

Massive hyperdiploidy and tetraploidy are rare cytogenetic abnormalities in myelocytic malignancies, especially in myelodysplastic syndrome (MDS). These abnormalities are known to be associated with leukemogenesis, leukemic transformation and poor prognosis. We report here the first case of MDS with near-tetraploid cytogenetic abnormality in Korea. A 80-yr-old male was diagnosed with refractory anemia with excess blasts-2 (RAEB-2). Bone marrow aspiration smear showed 16% of blasts, which were large sized myeloid blasts with irregular margins and cytoplasmic vacuolation. Cytogenetic analysis of bone marrow cells revealed numercal and structural cytogenetic abnormalities including near-tetraploidy in 8 of 20 metaphases: 45,XY,add(1)(p36.1),del(10)(p11.2),del(11)(q13),-12,-16,der(17)t(11;17) (q13;q21),add(20)(q13.1),+mar[8]/85~90,idemx2[cp8]/46,XY[4]. After chemotherapy with decitabine, he showed pancytopenia during follow-up period and died of sepsis 14 months after the diagnosis.
Anemia, Refractory ; Azacitidine ; Bone Marrow ; Bone Marrow Cells ; Chromosome Aberrations ; Cytogenetic Analysis ; Cytoplasm ; Follow-Up Studies ; Humans ; Korea ; Male ; Myelodysplastic Syndromes ; Pancytopenia ; Prognosis ; Sepsis ; Tetraploidy

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Discerning Trends in Multiplex Immunoassay Technology with Potential for Resource-Limited Settings.

Julian GORDON ; Gerd MICHEL

Laboratory Medicine Online.2013;3(1):62-72. doi:10.3343/lmo.2013.3.1.62

BACKGROUND: In the search for more powerful tools for diagnoses of endemic diseases in resource-limited settings, we have been analyzing technologies with potential applicability. Increasingly, the process focuses on readily accessible bodily fluids combined with increasingly powerful multiplex capabilities to unambiguously diagnose a condition without resorting to reliance on a sophisticated reference laboratory. Although these technological advances may well have important implications for the sensitive and specific detection of disease, to date their clinical utility has not been demonstrated, especially in resource-limited settings. Furthermore, many emerging technological developments are in fields of physics or engineering, which are not readily available to or intelligible to clinicians or clinical laboratory scientists. CONTENT: This review provides a look at technology trends that could have applicability to high-sensitivity multiplexed immunoassays in resource-limited settings. Various technologies are explained and assessed according to potential for reaching relevant limits of cost, sensitivity, and multiplex capability. Frequently, such work is reported in technical journals not normally read by clinical scientists, and the authors make enthusiastic claims for the potential of their technology while ignoring potential pitfalls. Thus it is important to draw attention to technical hurdles that authors may not be publicizing. SUMMARY: Immunochromatographic assays, optical methods including those involving waveguides, electrochemical methods, magnetorestrictive methods, and field-effect transistor methods based on nanotubes, nanowires, and nanoribbons reveal possibilities as next-generation technologies.
Endemic Diseases ; Health Resorts ; Immunoassay ; Immunochromatography ; Nanotubes ; Nanotubes, Carbon ; Nanowires

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Streptococcus dysgalactiae subsp. equisimilis Possessing Lancefield's Group A Antigen.

Jong Ae SON ; Jeong Hwan SHIN

Laboratory Medicine Online.2013;3(1):60-61. doi:10.3343/lmo.2013.3.1.60

No abstract available.
Streptococcus

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Unusually Elevated Serum Insulin Level in a Diabetic Patient during Recombinant Insulin Therapy.

Serim KIM ; Yeo Min YUN ; Mina HUR ; Hee Won MOON

Laboratory Medicine Online.2013;3(1):56-59. doi:10.3343/lmo.2013.3.1.56

Herein, we report a case of unusually elevated serum insulin level as a result of increased anti-insulin antibody (IA)-bound insulin after continuous subcutaneous insulin infusion therapy. Detecting free insulin (unbound IAs) levels after polyethylene glycol pre-treatment could be useful to assess functional insulin levels in diabetic patients receiving insulin therapy. The E170 insulin assay can estimate total insulin (bound IAs and free insulin) levels, but it does not measure the levels of exogenous insulin analogues.
Humans ; Insulin ; Insulin Antibodies ; Polyethylene Glycols

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Prenatal Diagnosis of der(X)t(X;Y)(p22.31;q11.22) in a Male Fetus by Using Array Comparative Genomic Hybridization.

Hyewon KIM ; Eul Ju SEO ; Jin Ok LEE ; Maria HONG ; Jae Yoon SHIM ; Beom Hee LEE

Laboratory Medicine Online.2013;3(1):50-55. doi:10.3343/lmo.2013.3.1.50

Xp/Yq translocations are rare chromosomal rearrangements, and the phe-notype of male carriers varies according to the segment of the Xp region that is deleted. In this case report, we describe a der(X)t(X;Y)(p22.31;q11.22) translocation, detected by conventional cytogenetic analysis, in a male fetus at a gestational age of 16 weeks. Chromosomal analysis of parental blood confirmed that this chromosomal aberration had been maternally inherited. Array comparative genomic hybridization (CGH) analysis of fetal blood further indicated a nullisomy of Xp22.31-pter and a breakpoint between the STS and KAL1 genes. The STS, NLGN4, ARSE, CSF2RA, and SHOX genes are present in the region that was deleted, and are known to be related to conditions such as X-linked ichthyosis, chondrodysplasia punctata, mental retardation, and facial dysmorphism in humans. Prenatal ultrasonographic findings and autopsy results were consistent with Xp22.31-pter deletion phenotypes. Genetic counseling was provided for the mother. The observations from this case study indicate that advanced molecular techniques can provide a more precise prenatal diagnosis of chromosomal anomalies than conventional cytogenetics can.
Autopsy ; Chondrodysplasia Punctata ; Chromosome Aberrations ; Comparative Genomic Hybridization ; Cytogenetic Analysis ; Cytogenetics ; Fetal Blood ; Fetus ; Genetic Counseling ; Gestational Age ; Humans ; Ichthyosis ; Intellectual Disability ; Male ; Mothers ; Parents ; Phenotype ; Prenatal Diagnosis

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Neonatal Alloimmune Thrombocytopenia Caused by Anti-HLA-A2 Alloantibodies Determined by Luminex Single Antigen Bead Assay.

Yoonjoo KIM ; Eun Jee OH ; Yonggoo KIM ; Juyoung LEE ; In Kyung SUNG

Laboratory Medicine Online.2013;3(1):45-49. doi:10.3343/lmo.2013.3.1.45

Neonatal alloimmune thrombocytopenia (NAIT) occurs when maternal alloantibodies react to antigens expressed on fetal platelets, which is mainly platelet-specific alloantigen or HLA, resulting in their immune destruction. Here, we described a patient who suffered from NAIT caused by anti-HLA-A2 antibody. Sera from the mother and the newborn were screened for human platelet antigen-specific antibodies and HLA antibodies by ELISA, and HLA antibodies were detected in both of them. The antibody specificity was identified as anti-HLA-A2 by Luminex single antigen bead assay. HLA typing results showed that patient's father descended HLA-A2 antigen on the patient and the mother was HLA-A2 negative. It is most conceivable that anti-HLA-A2 alloantibody in the mother's sera crossed the placenta and subsequently caused NAIT in the case presented. The patient received platelet concentrates, oral steroid and intravenous globulin and platelet count increased to 120x10(9)/L on the 90th day of life. The Luminex single antigen bead assay used in this case is highly sensitive and specific assay to determine antibody specificity and it is faster and more convenient for routine use in clinical laboratory so that this assay could be useful to diagnose NAIT caused by HLA antibodies and treat such NAIT patients with HLA matched platelet transfusion.
Antibodies ; Antibody Specificity ; Blood Platelets ; Enzyme-Linked Immunosorbent Assay ; Fathers ; Histocompatibility Testing ; HLA-A2 Antigen ; Humans ; Infant, Newborn ; Isoantibodies ; Isoantigens ; Mothers ; Placenta ; Platelet Count ; Platelet Transfusion ; Thrombocytopenia, Neonatal Alloimmune

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A Case of Extremely Elevated Ferritin Levels in a Patient with Fever of Unknown Etiology.

Hyewon KIM ; Yun Ha JANG ; Hee Jung CHUNG ; Woochang LEE ; Sail CHUN ; Won Ki MIN

Laboratory Medicine Online.2013;3(1):40-44. doi:10.3343/lmo.2013.3.1.40

Fever of unknown etiology that occurs along with highly elevated serum ferritin concentrations (>500 ng/mL) is mostly observed in hematologic malignancies and rheumatic diseases such as systemic lupus erythematosus, temporal arteritis, and adult-onset Still's disease (AOSD), among which AOSD is a type of systemic inflammatory disorder with unknown pathophysiology and has very low incidence. AOSD presents with various nonspecific symptoms and signs such as high spiking fever, joint pain, skin rash, and increased leukocytes. Because AOSD is diagnosed after excluding the possibility of other conditions such as neoplasms, infections, and inflammations, diagnosis and treatment are generally delayed. Patients with AOSD often have high serum ferritin levels than those with other conditions, although the underlying mechanism for this is not clearly understood. In addition, decreased proportion of glycosylated ferritin are observed in most patients with AOSD. Therefore a combination of high serum ferritin and a decreased proportion of glycosylated ferritin seems to be important for the differential diagnosis of AOSD that thus may allow early diagnosis of AOSD. Here we report a case of AOSD diagnosed via extremely high serum ferritin levels and decreased glycosylated ferritin proportion.
Arthralgia ; Diagnosis, Differential ; Early Diagnosis ; Exanthema ; Ferritins ; Fever ; Giant Cell Arteritis ; Hematologic Neoplasms ; Humans ; Incidence ; Inflammation ; Leukocytes ; Lupus Erythematosus, Systemic ; Rheumatic Diseases ; Still's Disease, Adult-Onset

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Epidemiology and Resistance Patterns of Bacterial Pathogens in Urinary Tract Infections in the Northern Gyeonggi-do Area during 2007-2011.

Eunyoung OH ; Hyukmin LEE ; Hwan Sub LIM ; Younhee PARK

Laboratory Medicine Online.2013;3(1):34-39. doi:10.3343/lmo.2013.3.1.34

BACKGROUND: Bacteria that cause urinary tract infections (UTIs) are found with different frequencies in different regions; moreover, antibiotic susceptibility can also vary by region. We retrospectively studied and compared the species and antimicrobial susceptibility of bacterial pathogens isolated from patients with UTIs in the northern Gyeonggi-do area. METHODS: We analyzed urine specimens collected from patients who visited the Myongji Hospital between 2007 and 2011. The urine specimens were cultured, and bacteria were identified by biochemical examination with an API kit (bioMerieux Inc., USA). Antimicrobial susceptibility was determined by the disc diffusion method and the Vitek II system (bioMerieux Inc., USA). RESULTS: A total of 11,818 (31.4%) urine specimens were culture positive. The most common species identified were Escherichia coli (37.1%), Klebsiella pneumoniae (7.4%), Enterococcus faecium (6.1%), and Candida spp. (5.5%). The proportion of isolates producing extended-spectrum beta-lactamases significantly increased during the study period. CONCLUSIONS: E. coli, K. pneumoniae, and E. faecium were the 3 most common organisms identified. Of note, however, was the increasing frequency of Pseudomonas spp. and Proteus spp. isolated during the more recent years. Further studies are required from other centers in the northern Gyeonggi-do area.
Bacteria ; beta-Lactamases ; Candida ; Diffusion ; Enterococcus faecium ; Escherichia coli ; Humans ; Klebsiella pneumoniae ; Pneumonia ; Proteus ; Pseudomonas ; Retrospective Studies ; Urinary Tract ; Urinary Tract Infections

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