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The First Case of Ganciclovir-Resistant Cytomegalovirus Colitis with a 597-600 Deletion in UL97 Gene after Stem Cell Transplantation in Korea.

Chang Ahn SEOL ; Young Jin KO ; Sung Han KIM ; Mi Na KIM ; Heungsup SUNG ; Je Hwan LEE

Annals of Clinical Microbiology.2015;18(2):64-67. doi:10.5145/ACM.2015.18.2.64

Human cytomegalovirus (CMV) infection has been a major concern in hematopoietic stem cell transplant recipients. Ganciclovir (GCV) resistance results mostly from mutations within the protein kinase UL97 gene. The three hot spots for GCV resistance (codons 460, 520, and 590-607) were well known. We describe a case of GCV-resistant CMV colitis caused by a 597-600 deletion in UL97 after haplo-identical peripheral blood stem cell transplantation (h-PBSCT) in a 46 year-old man with myelodysplastic syndrome. On post-PBSCT day 28, CMV antigenemia turned positive. Treatment of GCV was started and continued for 12 weeks but CMV antigenemia did not respond to the treatment and CMV colitis was worsened. The UL97 showed the in-frame deletion between codons 597 and 600 by direct sequencing. The treatment was switched to foscarnet and the antigenemia test was consecutively negative twice, and clinical symptoms improved. Despite the recovery of the patient from CMV colitis, the patient expired post-PBSCT day 146 from acute liver failure, hepatorenal syndrome and septic shock. This case is a first report of a deletion 597-600 in CMV UL97 in Korea. A 597-600 deletion in UL97 was responsible for the GCV resistance while preserving susceptibility to foscarnet.
Codon ; Colitis* ; Cytomegalovirus* ; Drug Resistance ; Foscarnet ; Ganciclovir ; Hematopoietic Stem Cells ; Hepatorenal Syndrome ; Humans ; Korea ; Liver Failure, Acute ; Myelodysplastic Syndromes ; Peripheral Blood Stem Cell Transplantation ; Protein Kinases ; Shock, Septic ; Stem Cell Transplantation* ; Transplantation

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A Case of Bacteremia Caused by Dialister pneumosintes with Streptococcus anginosus.

Jong Eun PARK ; Hee Jae HUH ; Young Eun HA ; Wook Sung KIM ; Chang Seok KI ; Nam Yong LEE

Annals of Clinical Microbiology.2015;18(2):60-63. doi:10.5145/ACM.2015.18.2.60

Dialister pneumosintes is a nonfermentative, gram-negative anaerobic rod which is considered as a commensal organism of the oral cavity. A 77-year-old man with a history of aortic stenosis was visited to ER for dyspnea and fever. D. pneumosintes and Streptococcus anginosus were isolated from blood culture, and also D. pneumosintes was identified by 16S rRNA-based gene sequencing. This case report is the first case of isolation of D. pneumosintes from blood in Korea, and highlights the usefulness of DNA sequencing to identify pathogens in organism which is difficult to identify by biochemical identification method.
Aged ; Aortic Valve Stenosis ; Bacteremia* ; Dyspnea ; Endocarditis ; Fever ; Humans ; Korea ; Mouth ; Sequence Analysis, DNA ; Streptococcus anginosus*

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A Case of Trichosporon asahii Fungemia with Urinary Tract Infection as a Primary Focus.

Zehwan KIM ; Kyung Eun SONG ; Won Kil LEE

Annals of Clinical Microbiology.2015;18(2):56-59. doi:10.5145/ACM.2015.18.2.56

Since the report of disseminated trichosporonosis in 1970s, several cases of infection by various Trichosporon species in different clinical patients were published. We've isolated a strain of T. asahii from not only blood but also urine. We report 71 year-old male patient with Trichosporon asahii fungemia, who had renal stones. It was identified as T. asahii using conventional method and also confirmed by 18S rRNA gene sequencing. The patient was discharged without any complication, in which case only antibiotic agent was used without any antifungal one.
Fungemia* ; Genes, rRNA ; Humans ; Male ; Trichosporon* ; Trichosporonosis ; Urinary Tract Infections*

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Microbiological Characteristics according to Transudative and Exudative Effusion in Pleural Fluid Culture.

Hyeun Gyeo LEE ; Gyu Yel HWANG ; Soon Deok PARK ; Young UH ; Juwon KIM ; Kap Jun YOON ; Won Yeon LEE

Annals of Clinical Microbiology.2015;18(2):52-55. doi:10.5145/ACM.2015.18.2.52

A total of 1,132 pleural fluid culture results obtained from October 2012 to July 2014 were analyzed to elucidate the microbiological characteristics according to transudative and exudative pleural fluid. The pleural fluid cultures were performed using aerobic and anaerobic blood culture bottles. The blood and pleural fluid for total protein, lactate dehydrogenase, and glucose measurement were submitted to laboratory at the same time with pleural fluid cultures. The rates for culture positivity, anaerobes isolation, and polymicrobials between transudative and exudative pleural fluid were 5.2% vs. 10.4%, 14.8% vs. 7.8%, and 14.8% vs. 10.9%.
Exudates and Transudates ; Glucose ; L-Lactate Dehydrogenase

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Performance Evaluation of Anyplex plus MTB/NTM and AdvanSure TB/NTM for the Detection of Mycobacterium tuberculosis and Nontuberculous Mycobacteria.

Wonho CHOE ; Ehwa KIM ; Seo Yeon PARK ; Jeong Don CHAE

Annals of Clinical Microbiology.2015;18(2):44-51. doi:10.5145/ACM.2015.18.2.44

BACKGROUND: Polymerase chain reaction (PCR) methods from direct specimen are widely used for the rapid and accurate detection of mycobacteria infection. In this study, we evaluated two domestically developed detection kits for Mycobacterium tuberculosis (MTB) and nontuberculous mycobacteria (NTM) using real-time PCR. METHODS: A total of 348 samples from patients with suspected tuberculosis were tested with real-time PCR over seven months. We performed real-time PCR using the recently developed Anyplex plus MTB/NTM Detection kit (Seegene) with the CFX 96TM Realtime PCR System (Bio-Rad Laboratories) and the conventional AdvanSure TB/NTM real-time PCR kit (LG Life Sciences) with the SLAN Real-time PCR detection system (LG Life Sciences) to evaluate their performance for detecting MTB and NTM. RESULTS: The two real-time PCR systems showed 96.8% concordance rate for MTB-positive, NTM-positive, and negative results. Based on culture results, the sensitivity and specificity for the detection of MTB using PCR were 71.0% and 94.9% for Anyplex plus, and 78.1% and 93.9% for AdvanSure, respectively. For the detection of NTM, the sensitivity and specificity were 33.3% and 98.4% for Anyplex plus, and 51.7% and 97.9% for AdvanSure. Both PCR systems showed high MTB positive results in bronchial washing and sputum samples. CONCLUSION: In detecting MTB and NTM, Anyplex plus MTB/NTM (Seegene) and AdvanSure TB/NTM real-time PCR (LG Life Sciences) showed high concordance rate with each other in all samples. Therefore both detection kits can be used as rapid and reliable detection tool for MTB.
Humans ; Mycobacterium tuberculosis* ; Nontuberculous Mycobacteria* ; Polymerase Chain Reaction ; Real-Time Polymerase Chain Reaction ; Sputum ; Tuberculosis

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Evaluation of Peptide Nucleic Acid Probe-Based Fluorescence In Situ Hybridization for the Detection of Mycobacterium tuberculosis Complex and Nontuberculous Mycobacteria in Clinical Respiratory Specimens.

Seung Hee LEE ; Shine Young KIM ; Hyung Hoi KIM ; Eun Yup LEE ; Chulhun L CHANG

Annals of Clinical Microbiology.2015;18(2):37-43. doi:10.5145/ACM.2015.18.2.37

BACKGROUND: Tuberculosis is globally the most important cause of death from single pathogen. Rapid and accurate identification of mycobacteria is essential for the control of tuberculosis. We evaluated a fluorescence in situ hybridization (FISH) method using peptide nucleic acid (PNA) probes for the differentiation of Mycobacterium tuberculosis complex (MTB) and nontuberculous mycobacteria (NTM) in direct smears of sputum specimens. METHODS: The cross-reactivity of MTB- and NTM-specific PNA probes was examined with reference strains of M. tuberculosis ATCC 13950, Mycobacterium kansasii ATCC 12479, Mycobacterium fortuitum ATCC 6841, several clinical isolates of mycobacteria (Mycobacterium abscessus, Mycobacterium avium, Mycobacterium intracellulare, Mycobacterium gordonae and Mycobacterium chelonae), and 11 frequently isolated respiratory bacterial species other than mycobacteria. A series of 128 sputa (89 MTB culture positive, 29 NTM culture positive, and 10 under treatment culture negative) with grades of trace to 4+ were used to evaluate the performance of the method. RESULTS: The MTB- and NTM-specific PNA probes showed specific reactions with the reference strains of MTB and M. kansasii and clinical isolates of mycobacteria except M. fortuitum ATCC 6841, and no cross-reactivity with other tested bacteria. The PNA probe-based FISH assay for detection of MTB had a sensitivity and specificity of 100%, respectively. The sensitivity and specificity of the NTM-specific PNA probe was 100%. The smear grades of the PNA FISH test were same as with those of the fluorescence AFB stain in 2+ or higher grade. CONCLUSION: Detection and differentiation based on PNA FISH is sensitive and accurate for detecting mycobacteria and for differentiating MTB from NTM in clinical sputum smears.
Bacteria ; Cause of Death ; Fluorescence* ; In Situ Hybridization* ; Mycobacterium ; Mycobacterium avium ; Mycobacterium avium Complex ; Mycobacterium fortuitum ; Mycobacterium kansasii ; Mycobacterium tuberculosis* ; Nontuberculous Mycobacteria* ; Peptide Nucleic Acids ; Sputum ; Tuberculosis

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Late Prosthetic Joint Infection and Bacteremia by Bacillus cereus Confirmed by 16S rRNA Sequencing and Hip Joint Tissue Pathology.

Jihye HA ; Yu Jin PARK ; Yee Jeong KIM ; Hyun Cheol OH ; Young Ah KIM

Annals of Clinical Microbiology.2016;19(2):54-57. doi:10.5145/ACM.2016.19.2.54

Bacillus cereus is a widespread organism in nature and a member of the B. cereus group of catalasepositive, aerobic, spore-forming, Gram-positive bacilli. B. cereus found in blood is often dismissed as a contaminant in the absence of repeated isolation from multiple cultures. Soft tissue and bone infection due to B. cereus have been associated with trauma, intravenous drug use, and an immunocompromised state. We report a very late prosthetic joint infection of the hip joint and consequent bacteremia caused by B. cereus, which occurred 13 years after total hip replacement surgery in the absence of recent trauma or intervention.
Arthritis ; Arthroplasty, Replacement, Hip ; Bacillus cereus* ; Bacillus* ; Bacteremia* ; Hip Joint* ; Hip* ; Joints* ; Pathology* ; Prostheses and Implants

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Distribution and Antimicrobial Resistance of Streptococcus pneumoniae at Four University Hospitals in Busan and Gyeongnam.

Si Hyun KIM ; Sae Am SONG ; Jongyoun YI ; Duyeal SONG ; Chulhun Ludgerus CHANG ; Dong Chul PARK ; Sang Hwa URM ; Hye Ran KIM ; Jeong Hwan SHIN

Annals of Clinical Microbiology.2016;19(2):48-53. doi:10.5145/ACM.2016.19.2.48

BACKGROUND: Streptococcus pneumoniae is the most common human pathogen causing community-acquired pneumonia. There is little information on the recent antimicrobial susceptibility patterns of S. pneumoniae in Busan and Gyeongnam of Korea. The aim of this study was to investigate the distribution and antimicrobial resistance of S. pneumoniae at 4 university hospitals in Busan and Gyeongnam. METHODS: We collected and analyzed the antimicrobial susceptibility results of 850 S. pneumoniae strains isolated from regional 4 university hospitals during the last 2 years from July 2013 through June 2015. RESULTS: Among 850 S. pneumoniae strains, 635 strains were isolated from respiratory specimens, followed by blood (N=121), CSF (N=13), and others (N=81). Antimicrobial susceptibility rates to penicillin, cefotaxime and ceftriaxone were 79.4%, 76.6% and 83.6%, respectively. The resistant rates to erythromycin and clindamycin were 80.9% and 68.2%, respectively. The resistant rates to levofloxacin were 9.2%. There were some differences in resistant rates by age groups, years, and specimen types. CONCLUSION: We found the changes of antimicrobial resistance of S. pneumoniae during the last 2 years. It is necessary to monitor the antimicrobial susceptibility of S. pneumoniae regularly for empirical therapy and for early detection of the changes of resistance.
Busan* ; Cefotaxime ; Ceftriaxone ; Clindamycin ; Drug Resistance ; Erythromycin ; Hospitals, University* ; Humans ; Korea ; Levofloxacin ; Penicillins ; Pneumonia ; Streptococcus pneumoniae* ; Streptococcus*

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Molecular Epidemiology and Characterization of Carbapenemase-Producing Enterobacteriaceae Isolated at a University Hospital in Korea during 4-Year Period.

Sunyoung AHN ; Ji Yeon SUNG ; Hyunsoo KIM ; Myung Sook KIM ; Younjee HWANG ; Sori JONG ; Younghee SEO ; Eunjin HA ; Eun Suk PARK ; Jun Yong CHOI ; Dongeun YONG ; Kyungwon LEE

Annals of Clinical Microbiology.2016;19(2):39-47. doi:10.5145/ACM.2016.19.2.39

BACKGROUND: Carbapenemase-producing Enterobacteriaceae (CPE) has been increasingly reported worldwide in the past 10 years, which is an important infection control concern. Since the epidemiology and characteristics of these CPEs vary according to institutes, we aimed to characterize CPEs in a university hospital during the recent 4 years. METHODS: From October 2011 to September 2015, CPE isolates from clinical specimens and hospital surveillance cultures were collected. Carbapenem resistance was confirmed by disk diffusion method and Minimal Inhibitory Concentration (MIC) was determined by agar dilution method. Carbapenemase production was tested by double disk test using aminophenylboronic acid and dipicolic acid. PCR and sequence analysis were performed to detect bla(KPC), bla(IMP-1), bla(VIM-2), bla(NDM-1)-like genes and bla(OXA-48) gene. Pulsed-field gel electrophoresis (PFGE) and Multilocus sequence typing (MLST) were conducted for KPC-producing Klebsiella pneumoniae isolates. RESULTS: Twenty-five isolates (11%) of CPE were identified among 222 carbapenem-resistant Enterobacteriacae isolates during the study period. The most prevalent CPE was KPC-producing K. pneumonia and others were IMP-1, VIM-2, NDM-1 type and OXA-48 producing CPEs. Most of these CPEs showed resistance to carbapenems with variable MICs. The sequence types (STs) of KPC-producing K. pneumoniae were ST307 and ST11. The PFGE of ST11 and ST307 showed clonality in each group suggesting the possibility of in-hospital outbreak. CONCLUSION: The prevalence of CPE has been increasing. In our institute, KPC-producing K. pneumoniae was the most frequently isolated CPE in the recent 4 years. CPE including KPC producers can easily transfer their resistance. Therefore continuous monitoring and more intensified infection control for CPE should be considered.
Academies and Institutes ; Agar ; Carbapenems ; Diffusion ; Drug Resistance, Bacterial ; Electrophoresis, Gel, Pulsed-Field ; Enterobacteriaceae* ; Epidemiology ; Infection Control ; Klebsiella pneumoniae ; Korea* ; Methods ; Molecular Epidemiology* ; Multilocus Sequence Typing ; Pneumonia ; Polymerase Chain Reaction ; Prevalence ; Sequence Analysis

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Evaluation of the Usefulness of MacConkey Agar and Colistin-Nalidixic Acid Blood Agar for Body Fluids, Peritoneal Fluid, and Wound/Abscess Specimens.

Jayoung KIM ; Sung Il CHO ; Yong Kyun KIM ; Yeon Joon PARK

Annals of Clinical Microbiology.2015;18(1):1-6. doi:10.5145/ACM.2015.18.1.1

BACKGROUND: Most clinical microbiology laboratories in Korea have difficulty in following the recommendations of the clinical procedure handbook for culture of body fluid and wound/abscess specimens. We evaluated the usefulness of MacConkey (MAC) and colistin-nalidixic acid blood agar (CNA) for the isolation of pathogens from these specimens. METHODS: A total of 1,508 clinical specimens [144 peritoneal fluid, 241 body fluids (19 bile, 70 joint fluid, 6 pericardial fluid, 104 pleural fluid, and other fluids in 42 cases) and 1,123 wound/abscess] were inoculated onto basic media [Blood agar plate (BAP), chocolate agar or BAP with streaking of Staphylococcus aureus] and simultaneously inoculated onto MAC and CNA. The pathogens isolated by basic media and by additional use of MAC and/or CNA were compared. RESULTS: With basic media, 885 isolates from 588 specimens were detected, and by additional use of MAC and CNA, an additional 27 isolates from 24 specimens and an additional 128 isolates from 112 specimens were isolated, respectively. Compared to the basic media, by adding MAC, an additional 233.3%, 38.5% and 4.5% of gram-negative bacteria were isolated from peritoneal fluids, body fluid and wound/abscess, respectively, and by adding CNA, an additional 106.7%, 45.0%, and 20.7% of gram-positive bacteria/ yeast were isolated, respectively. The isolates detected by additional use of MAC were mainly Enterobacteriaceae (77.0%), and those detected by CNA were S. aureus (21.1%), Coagulase-negative Staphylococcus spp. (20.3%), Enterococcus spp. (16.4%), Streptococcus spp. (10.2%) and yeasts (16.4%). CONCLUSION: For peritoneal fluid and body fluid specimens, additional use of MAC plus CNA seems necessary for detection of pathogens. For wound/abscess, additional use of CNA will be cost effective.
Agar* ; Ascitic Fluid* ; Bile ; Body Fluids* ; Cacao ; Enterobacteriaceae ; Enterococcus ; Gram-Negative Bacteria ; Joints ; Korea ; Staphylococcus ; Streptococcus ; Yeasts

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