BACKGROUND: We investigated the species distribution and amphotericin B (AMB) susceptibility of Korean clinical Aspergillus isolates by using two Etests and the CLSI broth microdilution method. METHODS: A total of 136 Aspergillus isolates obtained from 11 university hospitals were identified by sequencing the internal transcribed spacer (ITS) and beta-tubulin genomic regions. Minimal inhibitory concentrations (MICs) of AMB were determined in Etests using Mueller-Hinton agar (Etest-MH) and RPMI agar (Etest-RPG), and categorical agreement with the CLSI method was assessed by using epidemiological cutoff values. RESULTS: ITS sequencing identified the following six Aspergillus species complexes: Aspergillus fumigatus (42.6% of the isolates), A. niger (23.5%), A. flavus (17.6%), A. terreus (11.0%), A. versicolor (4.4%), and A. ustus (0.7%). Cryptic species identifiable by beta-tubulin sequencing accounted for 25.7% (35/136) of the isolates. Of all 136 isolates, 36 (26.5%) had AMB MICs of > or =2 microg/mL by the CLSI method. The categorical agreement of Etest-RPG with the CLSI method was 98% for the A. fumigatus, A. niger, and A. versicolor complexes, 87% for the A. terreus complex, and 37.5% for the A. flavus complex. That of Etest-MH was < or =75% for the A. niger, A. flavus, A. terreus, and A. versicolor complexes but was higher for the A. fumigatus complex (98.3%). CONCLUSIONS: Aspergillus species other than A. fumigatus constitute about 60% of clinical Aspergillus isolates, and reduced AMB susceptibility is common among clinical isolates of Aspergillus in Korea. Molecular identification and AMB susceptibility testing by Etest-RPG may be useful for characterizing Aspergillus isolates of clinical relevance.
Amphotericin B/*pharmacology ; Antifungal Agents/*pharmacology ; Aspergillus/*drug effects/isolation & purification ; DNA, Fungal/chemistry/genetics/metabolism ; Hospitals ; Humans ; Microbial Sensitivity Tests ; Mycoses/diagnosis/microbiology ; Republic of Korea ; Sequence Analysis, DNA ; Tubulin/genetics

BACKGROUND: The incidence of Bacillus cereus bacteremia is increasing, but the identification of Bacillus species remains difficult. Brilliance Bacillus cereus agar (BBC agar; Oxoid, UK) is a new CHROMagar medium that allows selective isolation and identification of B. cereus; however, its clinical usefulness is seldom studied. We evaluated the usefulness of BBC agar to identify B. cereus isolates recovered from blood cultures. METHODS: We analyzed a total of 53 blood isolates that showed a Bacillus-like morphology on Gram staining. All isolates were identified by using both the API Coryne (bioMerieux, France) and API 50CH/B (bioMerieux) systems. They were subsequently subcultured on BBC agar, incubated for 24 hr, and then examined for characteristic blue-green colonies. The clinical characteristics of patients whose isolates were identified as B. cereus were assessed. RESULTS: Of the 53 isolates, 18 were identified as B. cereus by API 50CH/B. With the API 50CH/B system used as gold standard, the sensitivity and specificity for the identification of B. cereus were 100% (18/18) and 100% (35/35), respectively, using BBC agar, and 67% (12/18) and 100% (35/35), respectively, using the API Coryne system. Of the 18 patients with B. cereus bacteremia, 15 showed infectious signs, and 3 had more than 2 blood cultures positive for B. cereus on separate days. CONCLUSIONS: Our study shows, for the first time, that BBC agar, with its good agreement and ease of use, is a valuable alternative to the API 50CH/B system for the presumptive identification of B. cereus isolates from blood cultures.
Adolescent ; Adult ; Agar/chemistry ; Aged ; Bacillus cereus/*isolation & purification ; Bacteremia/*diagnosis/microbiology ; Child ; Child, Preschool ; Chromogenic Compounds/*chemistry ; Culture Media ; Female ; Gram-Positive Bacterial Infections/*diagnosis/microbiology ; Humans ; Infant ; Infant, Newborn ; Male ; Middle Aged ; Reagent Kits, Diagnostic ; Sensitivity and Specificity

We report a rare case of fungemia due to Exophiala (Wangiella) dermatitidis in a 4-month-old female infant who was admitted to an intensive care unit with sudden infant death syndrome (SIDS). E. dermatitidiswas repeatedly isolated from blood cultures (on the 28th and 32nd day of hospitalization) of the patient, who died on the 44th day of hospitalization. The fungus was identified by its morphological characteristics and DNA sequencing of both the D1/D2 domain and the ITS region of rDNA. To our knowledge, this is the first reported case of E. dermatitidis fungemia in Korea.
DNA, Ribosomal ; Exophiala ; Female ; Fungemia ; Fungi ; Hospitalization ; Humans ; Infant ; Intensive Care Units ; Korea ; Sequence Analysis, DNA ; Sudden Infant Death

We describe here a case of central venous catheter (CVC)-related bacteremia caused by Microbacterium species in a 14-year-old patient, who had received chemotherapy for acute lymphoblastic leukemia. All nine blood cultures obtained from admission day 2 to day 62 yielded the same yellow-pigmented coryneform rod. Both Vitek 2 (bioMerieux, USA) and MicroScan (Dade Behring, USA) identified the isolate as Micrococcus species, and the API Coryne (bioMerieux, France) identified the isolate as Rhodococcus or Brevibacterium species. However, the 16S rRNA gene sequence showed a 99% identity with Microbacterium species. The bacteremia was recurrent or persistent over 60 days despite alternate systemic antibiotic therapy, but blood culture became negative after an addition of teicoplanin lock therapy for eradicating CVC-related bacteremia. This represents the first report of CVC-related Microbacterium bacteremia cured by antibiotic lock therapy in Korea.
Adolescent ; Bacteremia ; Brevibacterium ; Central Venous Catheters ; Genes, rRNA ; Humans ; Micrococcus ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Rhodococcus ; RNA, Ribosomal, 16S ; Teicoplanin

BACKGROUND: Several attempts have been made to expand human NK cells from peripheral blood mononuclear cells (PBMCs). This study examined the selective expansion of NK cells using interleukin 2 (IL-2) plus the K562 cell line, the expression of the NK cell receptors, and the cytotoxic activity. METHODS: The PBMCs from seven healthy volunteers were cultured in a medium containing the IL-2 plus the K562 cell line for 14 days. The expression of the activating and inhibitory receptors on the resting NK cells and the 72 hr-expanded NK cells were analyzed. A flow cytometric cytotoxic assay was used to determined the killing activity of the non-expanded NK cells and the 7 day-expanded NK cells against the K562 target cells. RESULTS: The NK cells from PBMCs expanded 4.5-fold after 7 days, and contained 56.5% CD3-CD56+ cells. The IL-2 or IL-2 plus K562 increased the expression levels of CD158b (MFI, mean florescence intensity), CD158e1/e2 (MFI), and NKp44 (MFI), while it decreased the expression levels of NKp30 (%), CD16 (MFI), and 2B4 (MFI). The non-expanded NK cells lysed 9.0% and 27.6% of the K562 target cells in the 1 : 1 and 5 : 1 effector and target ratio, respectively, and the 7-day expanded NK cells lysed 36.9% and 57.2% of the K562 target cells, respectively. CONCLUSION: The selective expansion of CD3-CD56+ NK cells occurred only during 7 days of culture. IL-2 or IL-2 plus the K562 cells altered the expression of various activating and inhibitory receptors of NK cells, and the cytotoxicity of the expanded NK cells was higher than in the non-expanded cells.
Cell Line* ; Healthy Volunteers ; Homicide ; Humans ; Interleukin-2* ; K562 Cells ; Killer Cells, Natural* ; Receptors, Natural Killer Cell

BACKGROUND: Statins reduce mortality of patients with coronary artery disease. However, many trials have excluded patients with ischemic heart failure. Statins may have other beneficial effects besides cholesterol lowering, such as anti-inflammatory properties and improvement of endothelial function. The aim of this study was to determine the effects of statin therapy in acute myocardial infarction (AMI) patients with left ventricular (LV) dysfunction. METHODS: We studied 202 patients with AMI with LV dysfunction [ejection fraction (EF) below 40%] between January 2001 and June 2002. The patients were divided into two groups: Group I (n=106, 60.8 +/- 10.3 years, male 71.7%) who were treated with simvastatin and Group II (n=96, 60.9 +/- 10.4 years, male 78.1%) who were not treated with simvastatin. RESULTS: At six-month after percutaneous coronary intervention (PCI), LVEF was more improved in Group I than in Group II (30.8 +/- 10.0% to 42.4 +/- 10.7% vs 31.9% to 38.9%, p=0.042). The levels of total cholesterol, triglyceride and low density lipoprotein-cholesterol were more decreased and the level of high density lipoprotein-cholesterol was more increased in Group I than in Group II. The levels of C-reactive protein, fibrinogen, white blood cell and monocyte count were more decreased in Group I than in Group II. During one-year clinical follow-up, statin therapy was associated with a significant reduction in mortality (1.9% vs 7.5%, p=0.048), restenosis rate (25.7% vs 43.1%, p=0.033) and repeat PCI rate (25.7% vs 43.1%, p=0.033). The event-free survival rate was higher in Group I than in Group II (79.8% vs 57.0%, p=0.001). CONCLUSION: Statin therapy improves LV systolic function and decreases mortality, restenosis and repeat PCI in the AMI with LV dysfunction.
C-Reactive Protein ; Cholesterol ; Coronary Artery Disease ; Disease-Free Survival ; Fibrinogen ; Follow-Up Studies ; Heart Failure ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors* ; Inflammation ; Leukocytes ; Male ; Monocytes ; Mortality ; Myocardial Infarction* ; Percutaneous Coronary Intervention ; Simvastatin ; Triglycerides ; Ventricular Dysfunction, Left*

BACKGROUND AND OBJECTIVES: The level of cardiac specific troponin (cTn) may be important in patients with acute coronary syndrome (ACS), but with normal electrocardiography (ECG). SUBJECTS AND METHODS: Three hundred and nineteen patients (61+/-11 years, M:F=212:107), with ACS and normal ECG, who underwent a diagnostic coronary angiogram (CAG), between July 2000 and June 2001, were analyzed according to their cTn level. The clinical characteristics, initial CAG findings and major adverse cardiac events (MACE), during a one-year clinical follow-up, were compared between positive and negative cTn groups. RESULTS: Of the enrolled patients, 191 had a negative cTn (group A, 61+/-10 years, M:F=131:60), and 128 a positive cTn (group B, 60+/-11 years, M:F=81:47), and 176 (55.2%) were shown to have significant coronary artery stenosis on CAG. There were no significant differences in risk factors between the two groups. The mean left ventricular ejection fraction was 64+/-9%, and was lower in group B than in group A (59+/-10% vs. 67+/-7%, p<0.05). cTn positivity was associated with the percentage of significant coronary artery stenosis present (88% vs. 32%, p<0.05), a smaller minimal luminal diameter (1.09+/-0.44 mm vs. 2.68+/-0.33 mm, p<0.05) and a larger diameter of stenosis (68+/-6% vs. 44+/-6%, p<0.05). A multi-vessel lesion was more common in group B than in group A (58.3% vs. 30.3%, p<0.05). During the one-year follow-up period, 36 patients developed MACE, resulting in 3 deaths, 7 acute myocardial infarctions and 34 patients with restenosis. MACE was observed in 9 patients of group A and in 27 of group B (4.7% vs. 21.1%, p<0.05). CONCLUSION: The troponin levels are valuable for the early diagnosis, and prediction of the long-term prognosis, in patients with ACS and a normal ECG.
Acute Coronary Syndrome* ; Angina, Unstable ; Constriction, Pathologic ; Coronary Disease ; Coronary Stenosis ; Early Diagnosis ; Electrocardiography* ; Follow-Up Studies ; Humans ; Myocardial Infarction ; Phenobarbital ; Prognosis ; Risk Factors ; Stroke Volume ; Troponin*

BACKGROUND AND OBJECTIVES: The purpose of the study was to evaluate the usefulness of cardiac troponin as a marker for the detection of minor myocardial injury following percutaneous coronary interverntion (PCI). SUBJECTS AND METHODS: In 79 patients who underwent successful PCI under the diagnosis of stable angina, serum creatinine kinase MB isoenzyme (CK-MB), cardiac troponin T (cTnT), and cardiac troponin I (cTnI) were measured before and at 6, 12 and 24 hours after PCI, and the angiographic findings and procedural characteristics of PCI were compared between the elevated and the normal enzyme groups. RESULTS: Abnormal values of one or more markers following PCI were observed in 17 patients (22%) ; 11 after stenting and 6 after balloon angioplasty alone. The frequency of abnormal cTnI levels was 19% and was significantly higher than that of CK-MB (6%, p < 0.01). No significant differences in target vessel number, target artery, ACC/AHA type, TIMI flow, stenting, time and number of ballooning, maximal inflation pressure or balloon diameter and length were observed between the two groups. Small side branch occlusions developed in 23% of the elevated enzyme group and in 3% of the normal enzyme group. CONCLUSION: Minor myocardial injury can be detected by cTnI and is observed frequently in patients with stable angina following PCI. A small side branch occlusion is related with elevated cTnI.
Angina Pectoris ; Angina, Stable ; Angioplasty, Balloon ; Arteries ; Coronary Disease ; Creatinine ; Diagnosis ; Humans ; Inflation, Economic ; Percutaneous Coronary Intervention* ; Phosphotransferases ; Stents ; Troponin I ; Troponin T ; Troponin*

PURPOSE: Radiation-induced chromosomal damage and apoptosis were compared in human lymphocytes. MATERIALS AND METHODS: Peripheral lymphocytes from 10 normal volunteers (6 males, 4 females, age range 23~41 years) were irradiated by gamma rays from a cell irradiator. Doses of irradiation were 0 (control), 0.18, 2, 5, 10, 20 and 25 Gy. Irradiated lymphocytes were examined by metaphase analysis for chromosomal aberrations and by flow cytometry for apoptosis. RESULTS of both studies were compared according to dose. RESULTS: Number of dicentric and ring chromosomes (D+R) was 0.5+/-0.53 at baseline, which was significantly increased after radiation according to the dose. The fraction of cells showing annexin V-fluore-scein isothiocyanate uptake was 0.55+/-0.39%, which increased to 3.58+/-1.85% by 2 Gy irradiation, and then decreased. The fraction of cells showing propidium iodide (PI) uptake was 0.52+/-0.12%, which significantly increased according to dose (upto 15.64+/-5.99% by 20 Gy irradiation). D+R and PI uptake were well correlated (r=0.84, p<0.001). CONCLUSION: Radiation-induced chromosomal aberration was correlated to nuclear uptake of PI, a marker of late apoptosis.
Apoptosis* ; Chromosome Aberrations* ; Female ; Flow Cytometry ; Gamma Rays ; Healthy Volunteers ; Humans* ; Lymphocytes* ; Male ; Metaphase* ; Propidium ; Radiation Injuries ; Ring Chromosomes

BACKGROUND: Human papillomavirus (HPV) is a small double-stranded DNA virus. Of HPV, type 16 and 18 are associated with high risk in the development of cervical cancer. In order to evaluate HPV infections, several HPV typing and detection methods have been developed. The aim of this study was to compare the detection rates of HPV 16 and 18 by polymerase chain reaction (PCR), in situ hybridization(ISH), and PCR in situ in uterine cervical cancers. METHODS: PCR, ISH and PCR in situ were performed for the detection of HPV DNA in fifty-one formalin fixed, paraffin embedded blocks of uterine cervical cancer tissues. Twenty uterine cervical specimens from patients with uterine myomas were used as controls. RESULTS: The detection rates of HPV 16 and HPV 18 in cervical cancers were 56.9% (29/51) and 45.1% (23/51) by PCR, 9.8% (5/51) and 5.9% (3/51) by ISH, 17.6% (9/51) and 11.8% (6/51) by PCR in situ, respectively. In control group, the detection rate of HPV 16 and 18 by PCR were 10% (2/20) and 5% (1/20), but HPV was not detected by both ISH and PCR in situ. CONCLUSION: PCR was the most sensitive method for the detection of HPV. However, PCR in situ was more informative fort the specific detection and cell localization of HPV DNA.
DNA ; Formaldehyde ; Human papillomavirus 16 ; Human papillomavirus 18 ; Humans* ; In Situ Hybridization* ; Leiomyoma ; Paraffin ; Polymerase Chain Reaction* ; Uterine Cervical Neoplasms*