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A Case of Pyogenic Spondylitis Due to Aggregatibacter aphrophilus.

Kye Hyung KIM ; Namhee KIM ; Kyung Hwa SHIN ; Shine Young KIM ; Chulhun L CHANG ; Jongyoun YI

Annals of Clinical Microbiology.2014;17(3):99-103. doi:10.5145/ACM.2014.17.3.99

Aggregatibacter aphrophilus, a normal component of oral cavity flora, mostly causes infective endocarditis and only rarely causes spondylitis; no spondylitis cases have been previously reported in Korea. We report a case of pyogenic spondylitis due to A. aphrophilus without endocarditis. A 64-year-old man was admitted for back pain lasting 3 weeks. There was severe tenderness on lumbar spines but no fever. Laboratory evaluation showed leukocytosis and elevated C-reactive protein. Blood cultures were negative. Magnetic resonance imaging showed psoas abscess and vertebral inflammation. Pus was obtained by computerized tomography-guided aspiration from the psoas abscess and inoculated into blood culture bottles. After 5 days of incubation, growth was detected: the isolate was a Gram-negative short rod bacteria identified as A. aphrophilus by the automated system; this was confirmed by 16S ribosomal RNA sequencing. There was no evidence of endocarditis in echocardiography and retinal examination. Back pain persisted despite 8 weeks of antibiotic treatment, so vertebral corpectomy was performed. A. aphrophilus, a rare cause of pyogenic spondylitis, can induce spondylitis without endocarditis. If a patient with pyogenic spondylitis shows negative routine bacterial cultures, fastidious organisms such as A. aphrophilus should be suspected and the blood culture bottles could be used.
Aggregatibacter aphrophilus* ; Back Pain ; Bacteria ; C-Reactive Protein ; Echocardiography ; Endocarditis ; Fever ; Humans ; Inflammation ; Korea ; Leukocytosis ; Magnetic Resonance Imaging ; Middle Aged ; Mouth ; Psoas Abscess ; Retinaldehyde ; RNA, Ribosomal, 16S ; Spine ; Spondylitis* ; Suppuration

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Tuberculosis Presenting as a Mediastinal Mass in an Infant.

Namhee KIM ; Hyun Ji LEE ; Jongyoun YI ; Su Eun PARK ; Chulhun L CHANG

Annals of Clinical Microbiology.2017;20(1):17-20. doi:10.5145/ACM.2017.20.1.17

Tuberculosis can occur in various organ systems and may present with diverse manifestations. We report an unusual case of mediastinal tuberculoma in a 3-month-old boy who presented to the hospital after experiencing fever, cough, and progressive pneumonia for two weeks. The chest computed tomography scan indicated a mediastinal mass suggesting lymphoma. However, histological analysis confirmed that the mass was caused by tuberculosis. The present report describes the delayed diagnosis of a disease due to an uncommon presentation. Misdiagnosing unusual cases of tuberculosis results in treatment delays and may lead to an increase in morbidity. Therefore, we suggest that tuberculosis should be included in the differential diagnosis for children presenting with a mediastinal mass, especially in areas with a high prevalence of tuberculosis.
Child ; Cough ; Delayed Diagnosis ; Diagnosis, Differential ; Fever ; Humans ; Infant* ; Lymphoma ; Male ; Mediastinum ; Pneumonia ; Prevalence ; Thorax ; Tuberculoma ; Tuberculosis*

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A Case of Chronic Gordonia otitidis Lung Infection Initially Regarded as Nontuberculous Mycobacterial Lung Disease.

Hyerim KIM ; Yun Seong KIM ; Kye Hyung KIM ; Namhee KIM ; Hyung Hoi KIM ; Chulhun L CHANG ; Jongyoun YI

Annals of Clinical Microbiology.2017;20(1):13-16. doi:10.5145/ACM.2017.20.1.13

The genus Gordonia is one of the mycolic acid-containing aerobic actinomycetes. This genus has 38 named species that are widespread in the natural environment; however, Gordonia species rarely cause human infections. A 76-year-old woman presented with cough and sputum for over 1 year and was suspected of having nontuberculous mycobacterial (NTM) lung disease. An NTM isolate from the sputum was initially identified as Mycobacterium lentiflavum or Mycobacterium genavense by genotypic identification targeting internal transcribed spacer (ITS). However, the isolate was finally confirmed as Gordonia otitidis by sequencing of 16S rRNA, gyrB and secA1 genes. In patients with suspected NTM lung disease, the etiologic agent might be an organism other than NTM such as G. otitidis but still be identified as NTM without sequencing of 16S rRNA or other genes. Especially in case that a possible NTM isolate is identified as M. lentiflavum or M. genavense by the genotypic method targeting ITS, additional genotypic tests such as sequencing of 16S rRNA and other genes would be necessary for more reliable identification.
Actinobacteria ; Actinomycetales ; Aged ; Cough ; Female ; Humans ; Lung Diseases* ; Lung* ; Methods ; Mycobacterium ; Nontuberculous Mycobacteria ; Respiratory Tract Infections ; Sputum

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Effect of Delayed Entry on Time to Detection for the Lactose Nonfermentative Gram-Negative Rods.

Seung Wook KIM ; Jung Hyun BYUN ; Sunjoo KIM

Annals of Clinical Microbiology.2017;20(1):7-12. doi:10.5145/ACM.2017.20.1.7

BACKGROUND: Prolonged transport or poor accessibility of blood culture equipment during night time may cause delayed entry of blood culture bottles. The effect of prestorage conditions on time to detection (TTD) for the blood culture was evaluated for the important gram-negative lactose nonfermentative bacteria. METHODS: Three different clinical isolates of Pseudomonas aeruginosa, Acinetobacter baumannii, Stenotrophomonas maltophilia, and Burkholdera cepacia were diluted to 150 CFU/mL and 15 CFU/mL and inoculated into standard aerobic bottles. These were stored at 25℃ and at 37℃ for 0, 6, 12, 18, and 24 h. They were entered to BacT/Alert 3D Systems (bio-Mérieux Inc.) and TTD was monitored for each condition. RESULTS: At the 150 CFU/mL concentration, P. aeruginosa and A. baumannii showed false-negative for the bottles prestored at 37℃ for 18 h and 24 h, respectively. However, there was no false-negative for S. maltophilia or B. cepacia at any prestorage conditions. There was a significant decrease of TTD for all experimental microorganisms except P. aeruginosa prestored for 24 h either at 25℃ or at 37℃ (P< 0.05). CONCLUSION: Delayed entry may cause false-negative, especially for the high level of bacteremia of P. aeruginosa or A. baumannii when the bottles are stored at 37℃ for ≥18 h. TTD could be reduced by prestorage of the bottles at 37℃ until 12 h without false-negative for nonfermentative bacteria.
Acinetobacter baumannii ; Bacteremia ; Bacteria ; Lactose* ; Pseudomonas ; Pseudomonas aeruginosa ; Sepsis ; Stenotrophomonas maltophilia

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Comparative Evaluation of Multiplex Real-Time PCR Assays for Six Pathogens of Sexually Transmitted Infections.

Hae Sun CHUNG ; Miae LEE

Annals of Clinical Microbiology.2017;20(1):1-6. doi:10.5145/ACM.2017.20.1.1

BACKGROUND: The multiplex real-time PCR assay is a sensitive test for simultaneous detection of various pathogens of sexually transmitted infections (STIs). We evaluated the performance of two multiplex real-time PCR assays for six STI pathogens. METHODS: DNA samples after being used to conduct PCR for STI pathogens were stored below −70℃. Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Mycoplasma genitalium (MG), Mycoplasma hominis (MH), Ureaplasma urealyticum (UU), and Trichomonas vaginalis (TV) were detected by multiplex real-time PCR with GeneFinder STD I (CT/NG/UU)/II (MG/MH/TV) Multiplex Real-time PCR Kits (Infopia, Korea; GeneFinder assay) and Real-Q CT&NG/MH&TV/MG&UU Kits (BioSewoom, Korea; Real-Q assay). Discrepant results were resolved by another multiplex real-time assay, Anyplex II STI-7 Detection (Seegene, Korea). Any two positive results for the assays were considered true positive. RESULTS: Among 81 samples, the GeneFinder assay detected 63 pathogens from 45 cases (16 CT, 2 NG, 6 MG, 20 MH, 18 UU, and 1 TV) and Real-Q assay detected 66 pathogens from 47 cases (16 CT, 2 NG, 8 MG, 20 MH, 19 UU, and 1 TV). For the results of positive cases and negative cases, the overall concordance rate between the two multiplex real-time assays was 93.8% (Kappa=0.87). For each pathogen, the agreement rates of the two assays ranged from 97.5 to 100% (Kappa>0.8). CONCLUSION: There was no significant difference between the results of GeneFinder assay and Real-Q assay. Both multiplex real-time PCR assays can be useful methods for the detection of STI pathogens in clinical laboratories.
Chlamydia trachomatis ; DNA ; Korea ; Mycoplasma genitalium ; Mycoplasma hominis ; Neisseria gonorrhoeae ; Polymerase Chain Reaction ; Real-Time Polymerase Chain Reaction* ; Sexually Transmitted Diseases* ; Trichomonas vaginalis ; Ureaplasma urealyticum

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Two Cases of Medical Device-Related Corynebacterium striatum Infection: A Meningitis and A Sepsis.

Sholhui PARK ; Hae Sun CHUNG ; Eui Kyo SEO ; Yeung Chul MUN ; Miae LEE

Annals of Clinical Microbiology.2016;19(1):28-31. doi:10.5145/ACM.2016.19.1.28

Corynebacterium striatum is a commonly isolated contaminant in the clinical microbiology. However, it can be an opportunistic pathogen in immunocompromised and even immunocompetent hosts. The increasing prevalence of C. striatum infection has been associated with immunosuppression and prosthetic devices. We report a case of meningitis with cerebrospinal fluid drainage and a case of catheter-related bloodstream infection caused by C. striatum. The isolates were identified as nondiphtherial Corynebacterium species by VITEK 2 (bioMérieux, France) anaerobe and Corynebacterium card. The final identification by 16S rRNA gene sequencing analysis was C. striatum with 99.7% identity and 99.6% identity with C. striatum ATCC 6940, respectively. Both strains were sensitive to vancomycin and gentamicin, but multidrug-resistant to ciprofloxacin, penicillin, erythromycin and imipenem.
Cerebrospinal Fluid ; Ciprofloxacin ; Corynebacterium* ; Drainage ; Erythromycin ; Genes, rRNA ; Gentamicins ; Imipenem ; Immunosuppression ; Meningitis* ; Penicillins ; Prevalence ; Sepsis* ; Vancomycin

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First Report of Salmonella Serotype Tilene Infection in Korea.

Su Jin CHAE ; Young Sun YUN ; Cheon Kwon YOO ; Gyung Tae CHUNG ; Deog Yong LEE

Annals of Clinical Microbiology.2016;19(1):24-27. doi:10.5145/ACM.2016.19.1.24

Salmonellosis is a common food- and water-borne disease and is also a major zoonosis. Currently, the isolation of rare Salmonella serotypes is increasing every year in Korea. Among them, the Salmonella serotype Tilene was first isolated from two people who visited a hospital located in Andong-si in 2013. Clinical symptoms were weak or non-existent. There was no clear epidemiological connection between the two cases. However, it was assumed that both were independently exposed to a single infectious agent. Perhaps due to their geographical proximity, molecular epidemiological analysis showed the same result between the isolated strains. This serotype has increasingly reported an association with hedgehogs. Recently, the importation of exotic animals, including hedgehogs, as pets has been gradually increasing. Thus, it is recommended that high-risk groups avoid contact with exotic pets.
Animals ; Gyeongsangbuk-do ; Hedgehogs ; Korea* ; Salmonella Infections ; Salmonella*

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An Effective Method of RNA Extraction from Mycobacterium tuberculosis.

Tae Sang OH ; Hee Yoon KANG ; You Sun NAM ; Young Jin KIM ; Eun Kyung YOU ; Min Young LEE ; Sun Young CHO ; Hee Joo LEE

Annals of Clinical Microbiology.2016;19(1):20-23. doi:10.5145/ACM.2016.19.1.20

In the RNA-based study, it is important to extract high-quality RNA. However, RNA extraction from Mycobacterium tuberculosis is problematic due to its thick, waxy cell wall rich in mycolic acid, which renders the cells resistant to lysis. Using TRIzol reagent and several powerful bead-beating steps, a high quantity of RNA was obtained.
Cell Wall ; Mycobacterium tuberculosis* ; Mycobacterium* ; Mycolic Acids ; RNA*

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Prevalence and Antimicrobial Susceptibility of Genital Mycoplasmataceae in Korean Women: Correlation between Phenotypic Test and Resistance Genes.

Jiyoung CHANG ; Jin Kyung YU ; Changeun SONG ; In Yang PARK ; Yeon Joon PARK

Annals of Clinical Microbiology.2016;19(1):13-19. doi:10.5145/ACM.2016.19.1.13

BACKGROUND: While 7.6% of cultured genital Mycoplasmataceae was identified as Ureaplasma urealyticum, most of them were Ureaplasma parvum (80.3%). This is the first study differentiating between these two species. We investigated the prevalence and antimicrobial resistance of genital Mycoplasmataceae in Korean women. METHODS: A total of 150 specimens submitted to the laboratory for culture of M. hominis and Ureaplasma spp. were included. Detection and antimicrobial susceptibility tests were performed with the Mycoplasma IST2 kit (bioMérieux, France). The identification of Ureaplasma spp. was performed by PCR, and mutations in drug resistance genes were investigated by PCR and sequencing. RESULTS: In total, 66 specimens (44.0%) were positive for genital Mycoplasmatacea: U. parvum, 53 (80.3%); U. urealyticum, 5 (7.6%); M. hominis, 2 (3.0%); mixed infection, 6 (9.1%). Susceptibilities of Ureaplasma spp. to erythromycin, azithromycin, clarithromycin, and doxycycline were 86.0%, 80.7%, 98.2%, and 94.7%, respectively. The susceptibility of Ureaplasma spp. to ofloxacin and ciprofloxacin was 47.4% and 17.5%, respectively. The S83L mutation was found in the ParC subunit of the ofloxacin-resistant (5/7, 71.4%) and the ciprofloxacin-resistant isolates (7/14, 50.0%). One M. hominis isolate showed resistance to erythromycin, azithromycin, and clarithromycin but susceptibility to josamycin, pristinamycin, fluoroquinolones, and tetracyclines. CONCLUSION: The prevalence of genital Mycoplasmataceae in Korean women was 44.0%; most of them were identified as U. parvum. As more than 10% of Ureaplasma spp. showed non-susceptibility to erythromycin and azithromycin (15.5%, 20.7%), a susceptibility test is needed prior to use of these antibiotics. Further study is needed about the clinical features of infections caused by U. urealyticum vs. U. parvum and their associated resistance mechanisms.
Anti-Bacterial Agents ; Azithromycin ; Ciprofloxacin ; Clarithromycin ; Coinfection ; Doxycycline ; Drug Resistance ; Erythromycin ; Female ; Fluoroquinolones ; Humans ; Josamycin ; Mycoplasma ; Mycoplasmataceae* ; Ofloxacin ; Polymerase Chain Reaction ; Prevalence* ; Pristinamycin ; Tetracyclines ; Ureaplasma ; Ureaplasma urealyticum

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Increase of Clostridium difficile in Community; Another Worrisome Burden for Public Health.

Young Ah KIM ; John Hoon RIM ; Min Hyuk CHOI ; Heejung KIM ; Kyungwon LEE

Annals of Clinical Microbiology.2016;19(1):7-12. doi:10.5145/ACM.2016.19.1.7

BACKGROUND: Increasing rates of Clostridium difficile infection (CDI) have been reported mainly in Europe and North America; however, only limited reports have originated in Korea. The current epidemiology of CDI in the community could help to understand the outpatient healthcare environment and to extend infection control measures to outpatient settings. METHODS: C. difficile isolates in NHIS Ilsan Hospital from 2012 to 2014 were included in this study. Clinical characteristics, acquisition types, and previous antimicrobial therapy were obtained via Electronic Medical Records. C. difficile culture was performed only in unformed stool. Toxin was positive by enzyme-linked fluorescent immunoassay (ELFA) in 247 specimens. In addition, toxin B and binary toxin gene were detected by PCR in 57 specimens. CDI was defined by toxigenic C. difficile isolation in unformed stool. RESULTS: In the previous 3 years, 251 unduplicated C. difficile cases have been detected; 168 healthcare facility- associated hospital onset (HCFA-HO), 45 healthcare facility-associated community onset (HCFA-CO), and 38 community-associated (CA). Toxin positive rates by ELFA for toxin A&B were HCFA-HO 50.6% (84/166), HCFA-CO 41.9% (18/43), and CA 42.1% (16/38). Toxin positive rate by PCR for tcdB were HCFA-HO 62.9% (22/35), HCFA-CO 69.2% (9/13), and CA 100% (9/9). No binary toxin (cdtA/cdtB) was detected in 57 cases. CONCLUSION: Community-associated CDI may be underestimated in Goyang province, Korea, especially by commonly used ELFA toxin assay. The spread of community-associated CDI should be recognized as an increasing burden of public health.
Clostridium difficile* ; Clostridium* ; Community-Acquired Infections ; Delivery of Health Care ; Electronic Health Records ; Epidemiology ; Europe ; Humans ; Immunoassay ; Infection Control ; Korea ; North America ; Outpatients ; Polymerase Chain Reaction ; Public Health*

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