Background: Nasal swabs and saliva samples are being considered alternatives to nasopharyngeal swabs (NPSs) for detecting severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2); however, few studies have compared the usefulness of nasal swabs, NPSs, and saliva samples for detecting SARS-CoV-2 and other respiratory virus infections. We compared the positivity rates and concentrations of viruses detected in nasal swabs, NPSs, and saliva samples using cycle threshold (Ct) values from real-time PCR tests for respiratory viruses. Methods: In total, 236 samples (48 five-rub and 10 10-rub nasal swabs, 96 NPSs collected using two different products, 48 saliva swabs, and 34 undiluted saliva samples) from 48 patients (34 patients with SARS-CoV-2 and 14 with other respiratory virus infections) and 40 samples from eight healthy controls were obtained. The PCR positivity and Ct values were compared using Allplex Respiratory Panels 1/2/3 and Allplex SARS-CoV-2 real-time PCR. Results: NPSs showed the lowest Ct values (indicating the highest virus concentrations); however, nasal and saliva samples yielded positive results for SARS-CoV-2 and other respiratory viruses. The median Ct value for SARS-CoV-2 E gene PCR using nasal swab samples collected with 10 rubs was significantly different from that obtained using nasal swabs collected with five rubs (Ct=24.3 vs. 28.9; P=0.002), but not from that obtained using NPSs. Conclusions Our results confirm that the NPS is the best sample type for detecting respiratory viruses, but nasal swabs and saliva samples can be alternatives to NPSs. Vigorously and sufficiently rubbed nasal swabs can provide SARS-CoV-2 concentrations similar to those obtained with NPSs.

BACKGROUND: From May to July 2015, the Republic of Korea experienced the largest outbreak of Middle East respiratory syndrome (MERS) outside the Arabian Peninsula. A total of 186 patients, including 36 deaths, had been diagnosed with MERS-coronavirus (MERS-CoV) infection as of September 30th, 2015. MATERIALS AND METHODS: We obtained information of patients who were confirmed to have MERS-CoV infection. MERS-CoV infection was diagnosed using real-time reverse-transcriptase polymerase chain reaction assay. RESULTS: The median age of the patients was 55 years (range, 16 to 86). A total of 55.4% of the patients had one or more coexisting medical conditions. The most common symptom was fever (95.2%). At admission, leukopenia (42.6%), thrombocytopenia (46.6%), and elevation of aspartate aminotransferase (42.7%) were observed. Pneumonia was detected in 68.3% of patients at admission and developed in 80.8% during the disease course. Antiviral agents were used for 74.7% of patients. Mechanical ventilation, extracorporeal membrane oxygenation, and convalescent serum were employed for 24.5%, 7.1%, and 3.8% of patients, respectively. Older age, presence of coexisting medical conditions including diabetes or chronic lung disease, presence of dyspnea, hypotension, and leukocytosis at admission, and the use of mechanical ventilation were revealed to be independent predictors of death. CONCLUSION: The clinical features of MERS-CoV infection in the Republic of Korea were similar to those of previous outbreaks in the Middle East. However, the overall mortality rate (20.4%) was lower than that in previous reports. Enhanced surveillance and active management of patients during the outbreak may have resulted in improved outcomes.
Antiviral Agents ; Aspartate Aminotransferases ; Coronavirus Infections* ; Disease Outbreaks ; Dyspnea ; Extracorporeal Membrane Oxygenation ; Fever ; Humans ; Hypotension ; Leukocytosis ; Leukopenia ; Lung Diseases ; Middle East Respiratory Syndrome Coronavirus ; Middle East* ; Mortality ; Pneumonia ; Polymerase Chain Reaction ; Republic of Korea* ; Respiration, Artificial ; Thrombocytopenia

BACKGROUND: Burn wounds lack normal barriers that protect against pathogenic bacteria, and burn patients are easily colonized and infected by Staphylococcus aureus. Toxic shock syndrome (TSS) is a rare but fatal disease caused by S. aureus. A lack of detectable antibodies to TSS toxin-1 (TSST-1) in serum indicates susceptibility to TSS. METHODS: A total of 207 patients (169 men and 38 women; median age, 42.5 yr) admitted to a burn center in Korea were enrolled in this study. The serum antibody titer to TSST-1 was measured by sandwich ELISA. S. aureus isolates from the patients' nasal swab culture were tested for TSST-1 toxin production by PCR-based detection of the TSST-1 toxin gene. RESULTS: One hundred seventy-four (84.1%) patients showed positive results for antibody against TSST-1. All patients aged > or =61 yr (n=28) and <26 months (n=7) were positive for the anti-TSST-1 antibody. S. aureus was isolated from 70 patients (33.8%), and 58.6% of the isolates were methicillin resistant. Seventeen patients were colonized with TSST-1-producing S. aureus. The antibody positivity in these 17 carriers was 88.2%, and the positivity in the non-carriers was 83.7%. CONCLUSIONS: Most burn patients had antibody to TSST-1, and nasal colonization with TSST-1-producing S. aureus was associated with positive titers of anti-TSST-1 antibody. Additionally, patients with negative titers of anti-TSST-1 antibody might be susceptible to TSS.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antibodies, Bacterial/*blood ; Bacterial Toxins/genetics/immunology/*metabolism ; Burns/blood/*immunology/*microbiology/pathology ; Child ; Child, Preschool ; Enterotoxins/genetics/immunology/*metabolism ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Infant ; Male ; Middle Aged ; Nasal Cavity/microbiology ; Polymerase Chain Reaction ; Prevalence ; Staphylococcal Infections/epidemiology ; Staphylococcus aureus/isolation & purification/*metabolism ; Superantigens/genetics/immunology/*metabolism ; Young Adult

BACKGROUND: Interferon-gamma assays based on tuberculosis (TB)-specific antigens have been utilized for diagnosing and ruling out latent TB and active TB, but their utility is still limited for TB incidence countries. The aim of this study is to understand the clinical utility of enzyme-linked immunospot (ELISpot) assays among patients with clinically suspected TB and healthy adults in clinical practices and community-based settings. METHODS: The ELISpot assays (T SPOT.TB, Oxford Immunotec, UK) were prospectively performed in 202 patients. After excluding those with indeterminate results, 196 were included for analysis: 41 were TB patients, 93 were non-TB patients, and 62 were healthy adults. RESULTS: The sensitivity and negative predictive values of the T SPOT.TB assays for the diagnosis of TB were 87.8% and 89.1%, respectively, among patients with suspected TB. The agreement between the tuberculin skin test (10-mm cutoff) and the T SPOT.TB assay was 66.1% (kappa=0.335) in all participants and 80.0% (kappa=0.412) in TB patients. Among those without TB (n=155), a past history of TB and fibrotic TB scar on chest X-rays were significant factors that yielded positive T SPOT.TB results. There was a significant difference in the magnitude of T SPOT.TB spot counts between TB patients and non-TB patients or healthy adults. CONCLUSION: The T SPOT.TB assay appeared to be a useful test for the diagnostic exclusion of TB. A positive result, however, should be cautiously interpreted for potential positives among those without active TB in intermediate TB incidence areas.
Adult* ; Cicatrix ; Diagnosis ; Enzyme-Linked Immunospot Assay* ; Humans ; Incidence ; Interferon-gamma* ; Prospective Studies ; Skin Tests ; Thorax ; Tuberculin ; Tuberculosis*

We report a rare synchronous presentation of primary lung cancer and adrenal pheochromocytoma. A 59-year-old woman was diagnosed with right upper lobe non-small cell lung carcinoma measuring 2.8 cm and a right adrenal gland mass measuring 3.5 cm, which displayed increased metabolic activity on 18F-fluorodeoxyglucose positron emission tomography-computed tomography. The adrenal lesion was revealed to be asymptomatic. The patient underwent right adrenalectomy and histological examination revealed a pheochromocytoma. Ten days later, right upper lobectomy was performed for lung cancer. This case indicates that incidental adrenal lesions found in cases of resectable primary lung cancer should be investigated.
Adrenal Glands ; Adrenalectomy ; Electrons ; Female ; Humans ; Lung ; Lung Neoplasms ; Pheochromocytoma

BACKGROUND: The study on bacteremia helps empirically select the proper antibiotics before the results of culture test about causative pathogen. The purpose of this study is to investigate causative pathogen in bloodstream infection, changing aspects based on elapsed time after burn, relationship with other sites and resistance of important causative pathogen against antibiotics through analysis on bacteria isolated from blood culture of patients hospitalized in burn intensive care unit (BICU). MATERIALS AND METHODS: A retrospective study was conducted targeting patients hospitalized in BICU from January 2007 to June 2011. Changes of causative pathogen in bloodstream infection based on elapsed time after injury were analyzed. We would like to examine the relationship between bloodstream infection and infection on other body parts by comparing results of cultures in burn wound site, sputum, urine and catheter tip. Antibiotics resistance patterns of Pseudomonas aeruginosa, Acinetobacter baumannii, Staphylococcus aureus, Enterococcus species, and Klebsiella pneumoniae were studied. RESULTS: A total of 2,337 burn patients were hospitalized in BICU for 54 months. Causative pathogen was cultured in blood cultures from 397 patients (17.0%). P. aeruginosa (169, 30.1%) was the most cultured and A. baumannii (107, 19.0%) and S. aureus (81, 14.4%) were followed. It was confirmed that the relative frequency of A. baumannii tended to get lower as the period got longer after injury, but the relative frequency of K. pneumoniae got higher as the period got longer after injury. With comparison without bacteremia, P. aeruginosa bacteremia showed high probability in which the same bacteria were cultured in wound site, sputum and cathether tip, and A. baumannii bacteremia and candida bacteremia had high probability in sputum, and urine and catheter tip, respectively. 95.9% of P. aeruginosa and 95.3% of A. baumannii showed the resistance against carbapenem. 96.3% of S. aureus was methicillin resistant and 36.2% of Enterococcus species were vancomycin resistant. 75.0% of K. pneumonia were extended-spectrum beta-lactamase (ESBL)-producing bacteria. CONCLUSIONS: Since the highly antibiotic resistant microorganisms were isolated from the patients hospitalized in BICU during early phase, the empirical selection of antibiotics targeting these pathogens should be considered before the results of microbiologic culture test. In addition, use of empirical antifungal agent after 1 week of injury can be considered for patients who have risk factor of fungal infection.
Acinetobacter baumannii ; Anti-Bacterial Agents ; Bacteremia ; Bacteria ; beta-Lactamases ; Burns ; Candida ; Catheters ; Critical Care ; Enterococcus ; Human Body ; Humans ; Intensive Care Units ; Klebsiella pneumoniae ; Methicillin Resistance ; Pneumonia ; Pseudomonas aeruginosa ; Retrospective Studies ; Risk Factors ; Rivers ; Sputum ; Staphylococcus aureus ; Vancomycin

The campaign for proper use of antibiotics in Korea was begun in 2011 by the Korean Society of Infectious Diseases and the Korean Society of Chemotherapy. This article was prepared as a review of worldwide antibiotic campaigns. The European Antibiotic Awareness Day of the European Union and Get Smart: Know When Antibiotics Work, of the USA, are introduced here. These antibiotic campaigns are prepared and organized by government and have partnerships with medical association. The event known as annual awareness day or antibiotic week is held annually and the campaign materials are available online or from printed material. These campaigns have widened the range and depth of activity since the begining of the campaign. Therefore, the Korean antibiotic campaign could obtain some useful suggestions regarding successful conduct of campaign activity from these campaigns.
Anti-Bacterial Agents ; Communicable Diseases ; European Union ; Korea

Actinomyces israelii is a normal flora of the oral cavity and gastrointestinal tract, and can cause chronic suppurative granuloma. We report here on a case of tongue actinomycosis. The patient was a 71-year old woman who had undergone surgery for rectal cancer 4 years previously. During the follow-up study using PET-CT, hypermetabolic activities were recognized at the lung hilum, mediastinum and tongue base. Bronchoscopic biopsy sample of the tongue base ulcer revealed histopathologically sulfur granule and aggregations of filamentous bacteria was diagnosed as actinomycosis of the tongue.
Actinomyces ; Actinomycosis ; Bacteria ; Biopsy ; Female ; Follow-Up Studies ; Gastrointestinal Tract ; Granuloma ; Humans ; Lung ; Mediastinum ; Mouth ; Rectal Neoplasms ; Sulfur ; Tongue ; Ulcer

PURPOSE: Pulmonary infiltrates are often encountered in mechanically ventilated burned patients and represent a challenge for pulmonologists and burn intensivists. The etiology is often multiple and empiric therapy is frequently initiated on the basis of clinical diagnosis, which is of uncertain accuracy. This approach can lead to inadequate treatment with increasing the risks of possible adverse events, while potentially reversible causes may be unrecognized. We performed bronchoalveolar lavage (BAL) study to know the causes of lung infiltration in severely burned patients. METHODS: From August 2003 to August 2008, severely burned patients who have been managed in burn intensive care unit (ICU) and shown diffuse lung infiltration during the courses were included prospectively. BAL was used to make the diagnosis of the respiratory infection, with 104> or = organisms considered a positive result. We also analyzed BAL isolates such as fungus, atypical pathogens and virus. RESULTS: Total 50 patients (M 43, F 7) were enrolled. The percent of total body surface area burn was 48.1+/-19.0% and APACHE II score was 10.0+/-5.6. Overall mortality was 64% (32 cases). 44 cases (88%) met criteria for positive BAL culture and 12 cases (24%) of those were combined with alveolar hemorrhage. The frequent bacterial isolates were Acinetobacter species in 19 cases (38%), Pseudomonas aeruginosa in 18 cases (36%) and methicillin-resistant Staphylococcus aureus in 14 cases (28%). Through BAL study, respiratory viruses were isolated in 15 cases (30%), and Legionella pneumonia, Tuberculosis and Pneumocystis pneumonia were reported in one of each (2%). CONCLUSION: BAL seems to be a useful tool for identifying infectious pathogens and may give guidance for adequate choices of antimicrobial agents in severely burned patients with diffuse lung infiltrations.
Acinetobacter ; Anti-Infective Agents ; APACHE ; Body Surface Area ; Bronchoalveolar Lavage ; Burns ; Fungi ; Hemorrhage ; Humans ; Intensive Care Units ; Legionella ; Lung ; Methicillin-Resistant Staphylococcus aureus ; Pneumonia ; Pneumonia, Pneumocystis ; Prospective Studies ; Pseudomonas aeruginosa ; Tuberculosis ; Viruses

BACKGROUND: In pulmonary infection, serum procalcitonin levels increase rapidly, probably in response to sepsis-related cytokine release from neuroendocrine cells of bronchial epithelium and inflammatory cells. We applied procalcitonin assay in critically ill patients with bacterial pneumonia. MATERIALS AND METHODS: Patients admitted to the intensive care unit (ICU) and show diffuse infiltrations in their chest X-ray were included. Quantitative bronchoalveolar lavage (BAL) culture (> or =10(4) CFU/mL) was performed in all cases on the 5th day of ICU admission. We excluded patients with structural lung disease, non-infectious lung infiltrations, and atypical infections such as Mycobacterium tuberculosis, Pneumocystis jiroveci, and viruses. Serum procalcitonin levels were measured semi-quantitatively by using PCT-Q kit. RESULTS: A total of 28 adult patients (M:F=23:5) were included: 11 (39.3%) medically-ill patients, 7 (25%) surgically-ill patients, and 10 (35.7%) burn patients. Serum procalcitonin level was <0.5 ng/mL in half of the cases (14/28) and > or =0.5 ng/mL in the remaining half of the cases. Compared to those with serum procalcitonin level of <0.5 ng/mL, patients with serum procalcitonin level of > or =0.5 ng/mL had more frequent mechanical ventilation, higher CRP/APACHE II scores/number of organ failure (P<0.05), and showed increased tendency for death (P=0.052). Positive bacterial BAL cultures were noted in 17 cases (60.7%). Of these, 7 cases (41.2%) showed serum procalcitonin level > or =0.5 ng/mL. CONCLUSIONS: High serum procalcitonin level seems to be closely associated with the severity and poor prognosis in critically ill patients with bacterial pneumonia. However, pneumonia could not be excluded with low level of procalcitonin among ICU patients.
Adult ; Bronchoalveolar Lavage ; Burns ; Calcitonin ; Critical Illness ; Epithelium ; Humans ; Intensive Care Units ; Lung ; Lung Diseases ; Mycobacterium tuberculosis ; Neuroendocrine Cells ; Pneumocystis jirovecii ; Pneumonia ; Pneumonia, Bacterial ; Prognosis ; Protein Precursors ; Respiration, Artificial ; Thorax