BACKGROUND: The Streptococcus pneumoniae urinary antigen test (SPUAT) (Binax Now, USA) was developed for detecting polysaccharide C in urine samples for rapid diagnosis of pneumococcal pneumonia, the most common cause of community-acquired pneumonia (CAP). To validate positive results of these tests, we retrospectively investigated all positive results obtained from the emergency room of a Korean university hospital among patients with suspected CAP. METHODS: One hundred twenty-three positive SPUAT results were abstracted and analyzed from the authors' laboratory information system among the SPUAT results performed from 1,143 pneumonic patients admitted from the emergency room of a university hospital between 2007 and 2008. Medical records, including conventional microbiologic analysis results, were reviewed in detail for all positive test results. RESULTS: Among 123 patients with the positive SPUAT results, 24 patients were excluded due to hospitalization history during the preceding month. Nine of 99 patients (9.1%) with suspected CAP had confirmed pneumococcal pneumonia upon conventional sputum or blood culture. Thirty-five positive results (35.4%) showed other microorganisms upon conventional methods, which might be due to possible cross-reactivity. Among those, 23 positive results were considered bacterial pneumonic agents, and 12 positive results were regarded as urinary tract infection strains or contaminating agents. Fifty-five positive SPUAT results (55.6%) showed negative conventional microbiologic growth, and some positive SPUAT results might be caused by true pneumococcal infection although without cultural evidence. CONCLUSION: Our retrospective study demonstrated that a positive SPUAT result typically does not agree well with conventional culture methods, suggesting that the value of a positive SPUAT result in etiology determination may be limited under practical conditions in a university hospital.
Antigens, Bacterial ; Clinical Laboratory Information Systems ; Emergencies ; Hospitalization ; Humans ; Medical Records ; Pneumococcal Infections ; Pneumonia ; Pneumonia, Pneumococcal ; Retrospective Studies ; Sputum ; Streptococcus ; Streptococcus pneumoniae ; Urinary Tract Infections

BACKGROUND: Ureaplasma urealyticum and Mycoplasma hominis are associated with an increased risk of pregnancy complications, such as preterm birth and premature membrane rupture. The purpose of this study was to determine the isolation rates and antimicrobial susceptibilities of genital mycoplasma in a sample of pregnant women from Jinju, Korea. METHODS: Vaginal swabs were obtained from 258 pregnant women between 2004 and 2008 and tested for the presence of U. urealyticum and M. hominis at Gyeongsang National University Hospital. The identification and antimicrobial susceptibilities of U. urealyticum and M. hominis were determined with a commercially available kit, the Mycoplasma IST2 Kit (bioMe- rieux, Marcy-l'Etoile, France), and evaluated according to standards set by the Clinical and Laboratory Standards Institute (CLSI). RESULTS: U. urealyticum only was detected in 105 specimens (38.6%), while M. hominis only was detected only in 2 specimens (1.8%). Seven specimens (6.7%) were positive both for U. urealyticum and M. hominis. Susceptibilities of U. urealyticum to azithromycin, erythromycin, clarithromycin, and doxycycline were 75.2%, 82.9%, 88.6%, and 88.6%, respectively, while almost all of the isolates were susceptible to josamycin (99.0%) and pristinamycin (100%). The susceptibility of U. urealyticum to ofloxacin and ciprofloxacin was 56.2% and 15.2%, respectively. CONCLUSION: The rate of isolation of genital mycoplasma in pregnant women was 44.2% in Jinju; most of the mycoplasma were U. urealyticum. U. urealyticum and M. hominis were highly resistant to quinolones, but susceptible to josamycin. Therefore, empirical treatment without prior identification and determination of the antimicrobial susceptibility of genital mycoplasma will fail in many cases.
Azithromycin ; Ciprofloxacin ; Clarithromycin ; Doxycycline ; Erythromycin ; Female ; Humans ; Josamycin ; Korea ; Membranes ; Mycoplasma ; Mycoplasma hominis ; Ofloxacin ; Pregnancy Complications ; Pregnant Women ; Premature Birth ; Pristinamycin ; Quinolones ; Rupture ; Ureaplasma ; Ureaplasma urealyticum

BACKGROUND: The erythromycin (EM) resistance rates and emm genotypes of Streptococcus pyogenes could vary by geographical location and study period. The purpose of this study, involving a large number of children, was to determine EM resistance rate and its resistance mechanism of S. pyogenes, and to compare these results with those of previous studies performed at the same area. METHODS: Throat cultures were taken from 2,351 healthy children of four elementary schools from October through December, 2004 in Jinju. A total of 328 strains of S. pyogenes were isolated. Antimicrobial susceptibility test was performed by the agar dilution method against six antimicrobial agents. The phenotypes of EM resistance were evaluated by the double-disk diffusion test and the frequency of ermB and mefA genes was determined by polymerase chain reaction. RESULTS: Resistance rates of S. pyogenes to EM, clindamycin and tetracycline were 9.8%, 8.8% and 18.3%, respectively. Almost all isolates were susceptible to ofloxacin, levofloxacin and chloramphenicol. Constitutive resistance (CR) was observed in 87.5%, M phenotype in 9.4%, and inducible resistance only in 3.1%. The ermB and mefA genes were present in 90.6% and 9.4% of the isolates, respectively. CONCLUSION: The resistance rate to EM of S. pyogenes was 9.8% in 2004, which was a large drop from the 51% shown in 2002. CR with the ermB gene was predominant, suggesting that most of the EM resistant isolates have a high level of resistance.
Agar ; Anti-Infective Agents ; Child ; Chloramphenicol ; Clindamycin ; Diffusion ; Erythromycin* ; Genotype ; Gyeongsangnam-do* ; Humans ; Levofloxacin ; Ofloxacin ; Pharynx ; Phenotype ; Polymerase Chain Reaction ; Streptococcus pyogenes* ; Streptococcus* ; Tetracycline

BACKGROUND: T typing has been used as a screening test for epidemiologic studies of group A streptococci (GAS) infections or carriers, and M typing has been performed for virulence studies. However, M typing is difficult to perform in routine laboratories. Recently, genotyping of the emm gene, which encodes the M protein, has become available. We investigated which T antigen is closely associated with a certain emmgenotype. METHODS: GAS were collected from the children in Jinju who were asymptomatic carriers (N=349) or had acute pharyngitis (N=122) during the 3 year-period from 2002 through 2004. T typing was performed by a slide aggulutination, and emmgenotyping by PCR and DNA sequencing. RESULTS: More than 90% of T1, T3, T6, T12, T25, and T5/27/44 antigens were associated with emm1, emm3, emm6, emm12 and 22, emm75, and emm44/61 genotypes, respectively; however, other T antigens, such as T2, T4, T7, T11, and B3264, were not associated with any particular emm genotypes. CONCLUSION: Several T antigens are so closely associated with particular emm genotypes that one could predict emmgenotypes based on the result of T typing.
Antigens, Viral, Tumor* ; Child ; Epidemiology ; Genotype* ; Gyeongsangnam-do ; Humans ; Mass Screening ; Pharyngitis ; Polymerase Chain Reaction ; Sequence Analysis, DNA ; Streptococcus pyogenes ; Virulence

Neutropenic enterocolitis is an acute life-threatening, necrotizing inflammation of cecum and terminal ileum often seen in leukemia and lymphoma during periods of prolonged or severe neutropenia. It has been also referred to as necrotizing enterocolitis, ileocecal syndrome, or typhlitis (from the Greek word typhlon meaning cecum). The pathophysiology of the neutropenic enterocolitis is unknown but is believed to be multifactorial. The clinical symptoms of neutropenic enterocolitis are nonspecific including fever, abdominal pain (often right lower quadrant), abdominal distension, diarrhea, bloody stools, nausea, and vomiting. So acute appendicitis is should be included in the differential diagnosis. The early signs and symptoms are nonspecific and it may rapidly lead to intestinal perforation. The definite management of neutropenic enterocolitis is contrversial. but the prognosis is likely to be good with early diagnosis and proper management. We report one case of neutropenic enterocolitis in acute myelogenous leukemia with literature review.
Abdominal Pain ; Appendicitis ; Cecum ; Diagnosis, Differential ; Diarrhea ; Early Diagnosis ; Enterocolitis, Necrotizing ; Enterocolitis, Neutropenic* ; Fever ; Ileum ; Inflammation ; Intestinal Perforation ; Leukemia ; Leukemia, Myeloid, Acute* ; Lymphoma ; Nausea ; Neutropenia ; Prognosis ; Typhlitis ; Vomiting

A 63-year-old man was placed on hemodialysis for the end-stage of renal disease secondary to renal artery stenosis. He was also regularly given epoetin, subcutaneously, for anemia associated with his renal disease. Rapidly progressing erythropoietin (EPO) resistant anemia and reticulocytopenia developed after 1 year of hemodialysis. The patient required frequent red blood cell transfusions. The bone marrow examination demonstrated selective erythroid hypoplasia. A detailed search for the cause of the erythroblastopenia revealed nothing, with the exception of anti-EPO antibodies (Ab). Pure red cell aplasia (PRCA) was suspected due to the anti-EPO Ab. With the immunosuppressive agent and change to the epoetin-therapy, the patient recovered his hemoglobin and reticulocyte counts. Particular attention should be paid for the possibility of PRCA due to anti-EPO Ab in patients undergoing rHuEPO therapy, with an unexplained recombinant human erythropoietin (rHuEPO) resistant anemia, especially via the subcutaneous route.
Anemia ; Antibodies* ; Bone Marrow Examination ; Erythrocyte Transfusion ; Erythropoietin ; Humans ; Middle Aged ; Red-Cell Aplasia, Pure* ; Renal Artery Obstruction ; Renal Dialysis* ; Reticulocyte Count

BACKGROUND: Streptococcus pyogenes is the most common bacterial cause of acute pharyngitis in children. The resistance rate and phenotype distribution of S. pyogenes could be different by geo-graphical locations and study periods. The purpose of this study was to determine the minimal inhibitory concentration (MIC), resistance rate to antimicrobial agents, and association of erythromycin (EM) resistance phenotype with resistance to tetracycline (TC) among S. pyogenes isolated in Jinju, Korea. METHODS: A total of 223 isolates of S. pyogenes were obtained from pediatric pharyngitis patients and asymptomatic carriers during the period from November 2001 to May 2002. Antibiotic susceptibility test was performed by the agar dilution and the disk diffusion methods against eight antimicro-bial agents. The phenotypes of EM resistance were determined by the double-disk diffusion test. RESULTS: Resistance rates of S. pyogenes to EM, clindamycin (CC), and TC were 48.9%, 22.0% and 29.6%, respectively. MIC(50) and MIC(90) were 0.25 mg/L and > or =256 mg/L of EM, < or =0.06 mg/L and > or =256 mg/L of CC, and < or =0.5 mg/L and 64 mg/L of TC respectively. Almost all isolates were suscep-tible to penicillin, ampicillin, ofloxacin, levofloxacin and chloramphenicol. The M phenotype (55.0%) was slightly more common than the constitutive resistance (45.0%); the inducible resistance pheno-type was not detected. All strains of constitutive resistance phenotype were highly resistant to TC (MIC higher than 32 mg/L), while only 3.3% of M phenotype strains was resistant to TC. CONCLUSIONS: Almost all S. pyogenes isolated in the Jinju area were susceptible to penicillin, ampi-cillin, ofloxacin, levofloxacin and chloramphenicol, but resistance rates of S. pyogenes to EM, CC and TC were relatively high. This study showed that the EM phenotypes are associated with resistance to TC.
Agar ; Ampicillin ; Anti-Infective Agents ; Child ; Chloramphenicol ; Clindamycin ; Diffusion ; Erythromycin ; Gyeongsangnam-do ; Humans ; Korea ; Levofloxacin ; Ofloxacin ; Penicillins ; Pharyngitis ; Phenotype* ; Streptococcus pyogenes* ; Tetracycline Resistance ; Tetracycline*

BACKGROUND: Chlamydia pneumoniae can cause chronic inflammation in the arterial wall. C. pneumoniae infection has been investigated as a new risk factor for acute myocardiac infarction (AMI), afatal outcome of coronary artery occlusion. METHODS: IgG and IgM for C. pneumoniae using micro-immunofluorescence were evaluated in 80 AMI patients and 46 controls without coronary arterial disease. RESULTS: Chronic infection, defined by equal or higher than 1: 32 titers of IgG of C. pneumoniae, was observed in 51.3% (41/80) in AMI and 17.4% (8/46) in controls (P<0.05). None of the subjects showed acute infection, defined by equal or higher than either 1: 16 of IgM or 1: 512 of IgG of C. pneumoniae. CONCLUSIONS: Chronic C. pneumoniae infection was significantly more common in AMI patients compared to the controls.
Chlamydia* ; Chlamydophila pneumoniae ; Coronary Vessels ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Infarction* ; Inflammation ; Pneumonia ; Risk Factors

BACKGROUND: Hyperhomocysteinemia can be treated and is more preventable compared to the classical risk factors such as age, sex, smoking, obesity, diabetes mellitus, hypertension and hyperlipidemia. METHODS: Serum homocysteine levels were analyzed with fluorescence polarized immunoassay (IMx, Abbott Diagnostics) for 63 patients with acute myocadiac infarction (AMI) and 43 controls who did not have coronary arterial disease from 1997 to 1998. Medical records were reviewed to compare the classical risk factors between the two groups. RESULTS: The mean homocysteine level of AMI was 9.3 +/-5.3 micronmol/L, which is slightly lower than 9.8+/-5.8 micronmol/L in the control group (P>0.05). Other risk factors were not significantly different between the two groups with the exception of serum cholesterol level. CONCLUSIONS: It is concluded that hypercholesterolemia is an important risk factor for AMI, while serum homocysteine level is not, as far as this study goes. Well planned follow up studies are needed to establish the degree to which homocysteine is a risk factor for AMI.
Cholesterol ; Diabetes Mellitus ; Fluorescence ; Homocysteine* ; Humans ; Hypercholesterolemia ; Hyperhomocysteinemia ; Hyperlipidemias ; Hypertension ; Immunoassay ; Infarction* ; Medical Records ; Obesity ; Risk Factors* ; Smoke ; Smoking

Familial hemophagocytic lymphohistiocytosis (FHL) is a fatal illness with a median life expectancy of 2 months if not treated. However, with the recent employment of allogeneic bone marrow transplantation in the treatment of FHL, even complete cure might be anticipated. We report here a case of prolonged remission following autologous peripheral blood stem cell transplantation (Auto-PBSCT) which was first attempted for FHL in Korea. A 4-month-old girl presented with high fever and a huge hepatosplenomegaly. Bone marrow examination revealed the proliferation of both non-malignant histiocytes engulfing red blood cells and lymphocytes. Her brother died at the age of 18 months showing quite similar manifestations. A diagnosis of FHL was made. Following 8 courses of chemotherapy with multiple drugs, Auto-PBSCT was performed. She has been well without any evidence of disease over 8 months of post- transplant period. This case illustrates that it might be worth trying Auto- PBSCT in the treatment of FHL.
Bone Marrow Examination ; Bone Marrow Transplantation ; Diagnosis ; Drug Therapy ; Employment ; Erythrocytes ; Female ; Fever ; Histiocytes ; Humans ; Infant* ; Korea ; Life Expectancy ; Lymphocytes ; Lymphohistiocytosis, Hemophagocytic* ; Peripheral Blood Stem Cell Transplantation* ; Siblings