Evaluation of R-FIND SARS-CoV-2 Neutralizing Antibody ELISA and FREND COVID-19 SP Rapid Fluorescence Immunoassay.

BACKGROUND: Serology testing is useful to determine the past infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: We evaluated the comparative performance of a newly developed neutralizing antibody test (R-FIND SARS-CoV-2 Neutralizing Antibody ELISA, SG Medical, Seoul, Korea) and a rapid fluorescence immunoassay (FREND™ COVID-19 SP, NanoEntek, Hwaseong, Korea) for the detection of SARS-CoV-2 spike protein antibody. They were compared with cPass™ SARS-CoV-2 Neutralization Antibody Detection Kit (Genscript Biotech, Piscataway, NJ, USA) and ADVIA Centaur SARS-CoV-2 Total (COV2T) (Siemens Healthineers, Erlangen, Germany). Forty COVID-19 samples and 80 negative samples were collected after nucleic acid tests. RESULTS: The positive percent agreement (%) of the kit in samples from 6 - 7 days, 8 - 14 days, and 15 - 45 days after symptom onset were as follows: R-FIND (83.3, 76.9, 95.2), cPass (83.3, 69.2, 90.5), FREND (66.6, 84.6, 100), and COV2T (66.6, 69.2, 76.2). The negative percent agreement (%) was 100, 97.5, 92.5, and 100 for R-FIND, cPass, FREND, and COV2T. The total agreement rate between the neutralizing antibody kits (R-FIND and cPass) was 96.7%. FREND showed high agreement with two neutralizing antibody kits (96.7% for R-FIND and 93.3% for cPass). CONCLUSIONS: R-FIND Neutralizing Antibody and FREND COVID-19 SP showed comparable detecting ability to commercial tests.

Multisystem Inflammatory Syndrome in an Adult Following COVID-19 mRNA Vaccination: Successful Treatment With Medium-Dose Steroids and Colchicine.

Multisystem inflammatory syndrome in children and adults (MIS-C/A) was rarely reported as a complication of coronavirus disease 2019 (COVID-19) and potential adverse events following COVID-19 vaccination. Recently, the case definition of MIS-C/A was developed by the Brighton Collaboration Network. However, only a limited number of adult patients with MIS-A following immunization have been reported, and there is still little evidence for adequate treatment. A 57-year-old man presented with fever, headache, vomiting, and hypotension 24 days after receiving the second COVID-19 vaccination with the Pfizer-BioNTech vaccine. According to the Brighton Collaboration Case Definition, the patient met a definitive case of MIS-A after vaccination (level 1 of diagnostic certainty). After administration of medium-dose prednisolone (20 mg/d) with colchicine (1.2 mg/d), all symptoms and signs improved rapidly. The dose of prednisolone was gradually tapered from the third week, and the patient confirmed a full recovery without medication after 8 weeks. This is the first report showing that low-dose steroids in combination with colchicine may be an effective treatment option for MIS-A after vaccination.

Construction of a non-contact community treatment centre for asymptomatic and mildly symptomatic COVID-19 patients during the COVID-19 pandemic.

The explosive outbreak of COVID-19 led to a shortage of medical resources, including isolation rooms in hospitals, healthcare workers (HCWs) and personal protective equipment. Here, we constructed a new model, non-contact community treatment centres to monitor and quarantine asymptomatic and mildly symptomatic COVID-19 patients who recorded their own vital signs using a smartphone application. This new model in Korea is useful to overcome shortages of medical resources and to minimise the risk of infection transmission to HCWs.

Fungal arthritis with adjacent osteomyelitis caused by Candida pelliculosa: a case report.

BACKGROUND: Candida sp. osteoarticular infection is rare and most often due to hematogenous seeding during an episode of candidemia in immunocompromised patients. However, the diagnosis can be delayed in patients with subtle symptoms and signs of joint infection without a concurrent episode of candidemia. CASE PRESENTATION: A 75-year-old woman presented with a three-year history of pain and swelling of the left knee. Candida pelliculosa was detected from the intraoperative tissue when the patient had undergone left total knee arthroplasty 32 months ago, but no antifungal treatment was performed. One year after the total knee arthroplasty, C. pelliculosa was repeatedly isolated from the left knee synovial fluid and antifungal treatment comprising amphotericin B deoxycholate and fluconazole was administered. However, joint infection had extended to the adjacent bone and led to progressive joint destruction. The patient underwent surgery for prosthesis removal and received prolonged antifungal treatment with micafungin and fluconazole. CONCLUSIONS: This case shows that C. pelliculosa, an extremely rare non-Candida albicans sp., can cause fungal arthritis and lead to irreversible joint destruction owing to delayed diagnosis and treatment.

Trabecular bone scores in young HIV-infected men: a matched case-control study.

BACKGROUND: Screening for osteoporosis with dual-energy X-ray absorptiometry (DXA) is recommended for male HIV-infected patients only above the age of 50. Recently, trabecular bone score (TBS) has been introduced as a novel tool to assess bone microarchitecture using DXA of the lumbar spine. Few studies have reported TBS values in HIV-infected individuals younger than 50 years of age. This study compared TBS values in young males infected with HIV and matched controls, and investigated the associations between TBS and demographic parameters, clinical parameters, and bone mineral density (BMD) scores. METHODS: A cross-sectional study of BMD and TBS in HIV-infected men (n = 80) aged between 18 and 50 years and age- and sex-matched controls (n = 80) was conducted. RESULTS: The proportion of patients with low BMD (Z-score ≤ - 2) was significantly greater among HIV-infected patients than among matched controls (21.3% [17/80] vs. 8.8% [7/80], p = 0.027). Mean TBS values were significantly lower in HIV-infected patients than in controls (1.41 ± 0.07 vs. 1.45 ± 0.07, p = 0.008). In both groups, TBS values were positively correlated with BMD at the lumbar spine, femoral neck, and total hip (p < 0.001); however, TBS was not correlated with body mass index. In the HIV group, TBS was negatively correlated with the duration of tenofovir disoproxil fumarate(TDF) exposure (p = 0.04). CONCLUSION: Young men infected with HIV had abnormal bone trabecular microarchitecture, as assessed by both TBS and BMD. TBS values were correlated with both BMD and the duration of TDF exposure.

A synbiotic combination of Lactobacillus gasseri 505 and Cudrania tricuspidata leaf extract prevents hepatic toxicity induced by colorectal cancer in mice.

Colorectal cancer (CRC) is known to be a life-threatening disease and commonly leads to metastasis in the liver. Fermented milk acts as an effective carrier for probiotic strains, whose consumption improves host health. Our previous study indicated that fermented milk that included a synbiotic combination of Lactobacillus gasseri 505 (505) and Cudrania tricuspidata leaf extract (CT) resulted in significantly greater anti-oxidative effects than fermented milk without CT. Therefore, we hypothesized that fermented milk containing CT and 505 (FCT) could result in hepatoprotective effects against CRC-induced liver metastasis. Liver inflammation and CRC were induced in male C57BL/6J mice, using azoxymethane/dextran sodium sulfate, and 505, CT, and FCT were administered to the 3 sample-treated 505, CT, and FCT groups, respectively, for 10 wk. The results showed that FCT treatment significantly reduced serum aspartate aminotransferase and alanine aminotransferase concentrations and elevated albumin concentrations. Moreover, the results of histological analysis showed that hepatic steatosis was notably reduced in the FCT group. Among the 3 sample-treated groups, the expression of mRNA associated with enzymes showing anti-oxidative activities, such as superoxide dismutase, catalase, and glutathione reductase, was the highest in the FCT-treated mice. In addition, FCT administration resulted in the greatest anti-inflammatory activity, as inflammatory marker levels (i.e., tumor necrosis factor-α, cyclooxygenase-2, myeloperoxidase, and nuclear factor kappa-light-chain enhancer of activated B cells) were significantly downregulated at the mRNA level and the expression of proteins associated with the nuclear factor kappa-light-chain enhancer of activated B cells and mitogen-activated protein kinase signaling pathways was suppressed by FCT. Therefore, this study demonstrated that fermented milk containing novel synbiotics has the potential to prevent hepatic toxicity induced because of CRC owing to its enhanced anti-oxidative and anti-inflammatory activities.

Prognosis of liver abscess with no identified organism.

BACKGROUND: There are limited studies focusing on liver abscess with negative microbiological cultures. This study evaluated the clinical and prognostic differences of patients with culture-negative liver abscess (CNLA) compared to those with a positive culture (CPLA) and compared these factors between K. pneumoniae liver abscess (KLA) and E. coli liver abscess (ELA). METHODS: A retrospective study of the patients who admitted with a liver abscess at two tertiary hospitals in Korea from 2012 to 2016 was performed. RESULTS: Among a total of 402 patients with liver abscess, 61.2% had positive cultures. K. pneumoniae (n = 133) was the most common cause, followed by E. coli (n = 74). Patients with CPLA were significantly older (p = 0.02) and more frequently had cholelithiasis or biliary tract disease (p = 0.001) compared to patients with CNLA. In-hospital mortality (p = 0.63) and recurrence (p = 0.77) were no different between the two groups. The length of hospital stay was significantly longer in patients with CPLA (p = 0.03) compared with those with CNLA. Subgroup analysis for patients who received 3rd generation cephalosporins empirically showed that in-hospital mortality (p = 0.18) and recurrence (p = 0.27) were not also significantly different. Cholelithiasis, or biliary tract disease (p = 0.001), liver disease (p = 0.001), malignancy (p = 0.0001), and ESBL production (p = 0.0001) were found more frequently in patients with ELA compared with those with KLA. CONCLUSIONS: The prognosis of the CNLA patients was similar to that of the CPLA patients, although the length of hospital stay was shorter in the CNLA patients. The epidemiologic and clinical characteristics of the ELA patients are somewhat different than those of the KLA patients.

Significance of Increased Rapid Treatment from HIV Diagnosis to the First Antiretroviral Therapy in the Recent 20 Years and Its Implications: the Korea HIV/AIDS Cohort Study.

From December 2006 to December 2016, 1,429 patients enrolled in the Korea human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) Cohort Study were investigated. Based on the year of diagnosis, the time interval between HIV diagnosis and initiation of antiretroviral therapy (ART) was analyzed by dividing it into 2 years. The more recent the diagnosis, the more likely rapid treatment was initiated (P < 0.001) and the proportion of patients starting ART on the same day of HIV diagnosis was increased in 2016 (6.5%) compared to that in 2006 (1.7%). No significant difference in the median values of CD4+ cell counts according to the diagnosis year was observed. In the past 20 years, the time from the HIV diagnosis to the initiation of ART was significantly reduced. Rapid treatment was being implemented at the HIV diagnosis, regardless of CD4+ cell count. Considering the perspective "treatment is prevention," access to more rapid treatment is necessary at the time of HIV diagnosis.

Predictors for false-negative QuantiFERON-TB Gold assay results in patients with extrapulmonary tuberculosis.

BACKGROUNDS: Extrapulmonary tuberculosis (EPTB) is a heterogeneous disease, and diagnosis is sometimes difficult. We investigated the diagnostic performance of the QuantiFERON-TB Gold assay (QFT-GIT) according to sites of EPTB and predictors for false-negative QFT-GIT results. METHODS: A total of 2176 patients were registered with active TB from January 2012 to December 2016 in Seoul St. Mary's Hospital, a 1200-bed tertiary teaching hospital in Seoul, Korea. We retrospectively reviewed the medical records of 163 EPTB patients who underwent QFT-GIT. RESULTS: False negative QFT-GIT results were found in 28.8% (95% CI 0.22-0.36) of patients with EPTB. In the proven TB group, negative QFT-GIT results were found in 28.6% (95% CI 0.04-0.71) of pleural, 8.3% 0.002-0.38of lymph node, 8.3% (95% CI 0.002-0.38) of skeletal and 5.8% (95% CI 0.001-0.28) of gastrointestinal TB cases. Among probable TB cases, QFT-GIT negative results were identified in 46.2% (95% CI 0.19-0.75) of skeletal, 33.3% (95% CI 10-0.65) of pericardial, 30.8% (95% CI 0.09-0.61) of pleural and 17.2% (95% CI 0.10-0.56) of gastrointestinal TB cases. In the possible TB cases, central nervous system TB (n = 21) was most frequent, and 66.7% (95% CI 0.43-0.85) of those showed QFT-GIT negative results. By multivariate analysis, possible TB was independently associated with false-negative QFT-GIT results (OR 4.92, 95% CI 1.51-16.06, p = 0.008). CONCLUSIONS: Prudent interpretation of QFT-GIT results might be needed according to anatomic site of involvement and diagnostic criteria in patients with high suspicion of EPTB.

Modulating macrophage polarization with divalent cations in nanostructured titanium implant surfaces.

Nanoscale topographical modification and surface chemistry alteration using bioactive ions are centrally important processes in the current design of the surface of titanium (Ti) bone implants with enhanced bone healing capacity. Macrophages play a central role in the early tissue healing stage and their activity in response to the implant surface is known to affect the subsequent healing outcome. Thus, the positive modulation of macrophage phenotype polarization (i.e. towards the regenerative M2 rather than the inflammatory M1 phenotype) with a modified surface is essential for the osteogenesis funtion of Ti bone implants. However, relatively few advances have been made in terms of modulating the macrophage-centered early healing capacity in the surface design of Ti bone implants for the two important surface properties of nanotopography and and bioactive ion chemistry. We investigated whether surface bioactive ion modification exerts a definite beneficial effect on inducing regenerative M2 macrophage polarization when combined with the surface nanotopography of Ti. Our results indicate that nanoscale topographical modification and surface bioactive ion chemistry can positively modulate the macrophage phenotype in a Ti implant surface. To the best of our knowledge, this is the first demonstration that chemical surface modification using divalent cations (Ca and Sr) dramatically induces the regenerative M2 macrophage phenotype of J774.A1 cells in nanostructured Ti surfaces. In this study, divalent cation chemistry regulated the cell shape of adherent macrophages and markedly up-regulated M2 macrophage phenotype expression when combined with the nanostructured Ti surface. These results provide insight into the surface engineering of future Ti bone implants that are harmonized between the macrophage-governed early wound healing process and subsequent mesenchymal stem cell-centered osteogenesis function.

Clinical impact of body mass index on bactibilia and bacteremia.

BACKGROUND: The aim of this study was to evaluate the association between obesity and infected bile or bacteremia in patients with acute calculous cholecystitis. METHODS: Authors analyzed the medical records of 139 patients who had undergone cholecystectomy for the treatment of acute calculous cholecystitis from January 2007 to June 2013 in a single teaching hospital. Association of body mass index (BMI) with bactibilia and bacteremia was assessed using univariate and multivariate analysis. Clinical findings and biliary infection related data were recorded for the following variables: gender, age, alcohol and smoking history, the results of blood and bile cultures, cholesterolosis, diabetes, hypertension, and duration of the hospital stay. RESULTS: The microbial culture rate of bactibilia and bacteremia were 50.4% and 21.6%, respectively. In the univariate analysis, bacteremia was associated with bactibilia (OR: 4.33, p = 0.002). In the multivariate analysis for the risk factors of bactibilia, BMI and bacteremia were related with bactibilia (OR: 0.59, 95% CI: 0.42-0.84, p = 0.003) (OR: 3.32, 95% CI: 1.22-9, p = 0.02). In the multivariate analysis for the risk factors of bacteremia, BMI, bactibilia and age were related with bacteremia (OR: 0.76, 95% CI: 0.59-0.99, p = 0.04) (OR: 3.46, 95% CI: 1.27-9.45, p = 0.02) (OR: 1.05, 95% CI: 1.01-1.09, p = 0.02). CONCLUSION: In this retrospective study, BMI was inversely correlated with bacteremia or bactibilia, which means obese or overweight patients are less likely to be associated with bacteremia or bactibilia in patients with acute calculous cholecystitis.

Risk factors for mortality in patients with Pseudomonas aeruginosa bacteremia; retrospective study of impact of combination antimicrobial therapy.

BACKGROUND: Whether the combination of antimicrobial therapy is a factor in mortality in Pseudomonas aeruginosa bacteremia remains to be elucidated. This study investigated the risk factors for mortality in P. aeruginosa bacteremia patients and the influence of adequate antimicrobial therapy and combination therapy on clinical outcomes. METHODS: This retrospective study analyzed data of 234 patients with P. aeruginosa bacteremia at a 1,200-bed tertiary teaching university hospital in South Korea between January 2010 and December 2012. Factors associated with mortality were determined. Mortality was compared in patients with adequate empirical and targeted combination therapy, and monotherapy, and inappropriate therapy. RESULTS: A total of 141 (60.3%) patients were given appropriate empirical antibiotic treatment (combination therapy in 38 and monotherapy in 103). Among 183 patients (78.2%) who finally received appropriate targeted treatment, 42 had combination therapy and 141 had monotherapy. The percentage of patients receiving empirical combination therapy was slightly, but not significantly higher, in the survivor group than in the nonsurvivor group (17.0% [31/182] vs. 13.5% [7/52], p = 0.74). A similar tendency was demonstrated for targeted combination therapy (19.8% [36/182] vs. 11.5% [6/52], respectively; p = 0.31). However, in a subgroup analysis of data from patients (n = 54) with an absolute neutrophil count less than 500/mm3, the patients who had appropriate empirical or targeted combination therapy showed better outcomes than those who underwent monotherapy or inappropriate therapy (p < 0.05). Mechanical ventilation (odds ratio [OR], 6.93; 95% confidence interval [CI], 2.64-18.11; p = 0.0001), the use of a central venous catheter (OR, 2.95; 95% CI, 1.35-6.43; p = 0.007), a high Acute Physiology and Chronic Health Evaluation II score (OR, 4.65; 95% CI, 1.95-11.04; p = 0.0001), and presence of septic shock (OR, 2.91; 95% CI, 1.33-6.38; p = 0.007) were independent risk factors for 14-day mortality. CONCLUSIONS: Disease severity was a critical factor for mortality in our patients with P. aeruginosa bacteremia. Overall, combination therapy had no significant effect on 14-day mortality compared with monotherapy. However, appropriate combination therapy showed a favorable effect on survival in patients with febrile neutropenia.

Liver abscess due to Klebsiella pneumoniae: risk factors for metastatic infection.

INTRODUCTION: Klebsiella pneumoniae-associated liver abscess (KPLA) is often accompanied by extrahepatic complications. We investigated the clinical features and outcomes of patients with and without metastatic infections and compared the 2 groups. METHODS: We retrospectively reviewed the medical records of 161 patients with KPLA who were admitted to 2 tertiary referral hospitals in Korea. RESULTS: In total, 9.9% had a metastatic infection. The most commonly involved distant sites were the eyes (n = 7) and the lungs (n = 6). In multivariate analysis, diabetes mellitus as an underlying disease (odds ratio (OR) 2.30, 95% confidence interval (CI) 1.05-9.51; p = 0.03) and a platelet count < 80,000/mm(3) (OR 11.60, 95% CI 2.53-53.26; p = 0.002) were associated with metastatic infection. Extended-spectrum beta-lactamase (ESBL) production was not observed in K. pneumoniae from patients with metastatic infection, whereas 3.4% of the bacteria in patients without metastatic infection had ESBL production. However, this difference was not statistically significant (p = 0.45). The in-hospital mortality rate was not significantly different (0% vs. 2.8%; p = 0.52). By multivariate analysis, the Acute Physiology and Chronic Health Evaluation II (APACHE II) score was independently associated with mortality among patients with KPLA (OR 1.5, 95% CI 1.12-2.00; p = 0.006). CONCLUSIONS: Clinicians must be aware of potential metastatic infections in patients with KPLA, especially if they have diabetes mellitus and thrombocytopenia. The APACHE II score was predictive of mortality in patients with KPLA.

The Impact of Body Mass Index as a Predictive Factor of Steatocholecystitis.

BACKGROUND/AIMS: Obesity is a chronic inflammatory condition and is strongly linked to raised levels of pro-inflammatory factors and may lead to fatty infiltration of multiple internal organs including the gallbladder and liver, causing organ dysfunction. This study was performed to evaluate the relationship between body mass index (BMI) and acute and chronic cholecystitis, and cholecystitis and cholesterolosis. We investigated the clinical implications of BMI as a predictive factor of cholesterol associated cholecystitis. METHODS: This retrospective study covered the period from January 2007 to December 2011, we included 1,158 patients who had cholecystectomy. We excluded patients with gallbladder cancer, adenomyomatosis, and cholesterolosis without cholecystitis. Finally, we investigated the data of a total of 1,109 patients with cholecystitis. Laboratory test results and clinical data such as age, sex, BMI, height, weight and underlying diseases were examined. We retrospectively investigated acute and chronic cholecysti tis, cholesterol polyps, and other gallbladder diseases such as gallbladder cancer and adenomyomatosis according to the histopathologic findings. RESULTS: There was a significant difference of BMI between patients with cholecystitis with cholesterolosis and without cholesterolosis (P = 0.001). Among patients who had cholecystitis with cholesterolosis, the BMI was 25.2 kg/m2. Among patients with cholecystitis without cholesterolosis, the average BMI was 24.3 kg/m2. Weight, systolic blood pressure, platelet count, glucose, triglyceride, and LDL-cholesterol were different between the groups above (P < 0.05). However, there was no significant difference in BMI between acute and chronic cholecystitis (P = 0.05). CONCLUSIONS: BMI was associated with steatocholecystitis. However, we cannot predict whether cholecystitis is acute or chronic according to the BMI. We suggest that BMI can be used as one of the predictive factors of steatocholecystitis for obese patients.

Association between obesity and cancer risk in adults with HIV in Korea.

INTRODUCTION: This study aimed to investigate the association between obesity and cancer risk as well as site-specific cancer risks in adults with HIV using a nationwide health screening database in Korea. METHODS: Of the 16,671 adults with a new diagnosis of HIV from 2004 to 2020, 456 incident cancer cases and 1814 individually matched controls by sex, year of birth, year of HIV diagnosis, and follow-up duration (1 : 4 ratio) were included in this nested case-control study. The association between obesity (BMI ≥25 kg/m 2 ) and cancer risks was estimated and presented as odds ratios (ORs) and 95% confidence intervals (95% CIs). RESULTS: Of the 456 cancer incident cases, there were 146 AIDS-defining cancer cases and 310 non-AIDS-defining cancer cases. Compared with nonobese adults with HIV, obese adults with HIV were at higher risk of non-AIDS-defining cancer (OR = 1.478, 95% CI = 1.118-1.955). Otherwise, the overall risk of AIDS-defining cancer (OR = 0.816, 95% CI = 0.520-1.279) and each type of AIDS-defining cancer (Kaposi sarcoma and non-Hodgkin's lymphoma) were not high in obese adults with HIV. Of the specific types of non-AIDS-defining cancers, obesity was associated with an increased risk of colorectal cancer (OR = 3.090, 95% CI = 1.110-8.604) and liver, bile duct, and pancreatic cancers (OR = 2.532, 95% CI = 1.141-5.617). CONCLUSION: Obesity, which is one of the important health concerns in HIV management, was associated with an increased risk of non-AIDS-defining cancer but not AIDS-defining cancer.

Prevention of Cytomegalovirus Infection in Solid Organ Transplant Recipients: Guidelines by the Korean Society of Infectious Diseases and the Korean Society for Transplantation.

Cytomegalovirus (CMV) is the most important opportunistic viral pathogen in solid organ transplant (SOT) recipients. The Korean guideline for the prevention of CMV infection in SOT recipients was developed jointly by the Korean Society for Infectious Diseases and the Korean Society of Transplantation. CMV serostatus of both donors and recipients should be screened before transplantation to best assess the risk of CMV infection after SOT. Seronegative recipients receiving organs from seropositive donors face the highest risk, followed by seropositive recipients. Either antiviral prophylaxis or preemptive therapy can be used to prevent CMV infection. While both strategies have been demonstrated to prevent CMV infection post-transplant, each has its own advantages and disadvantages. CMV serostatus, transplant organ, other risk factors, and practical issues should be considered for the selection of preventive measures. There is no universal viral load threshold to guide treatment in preemptive therapy. Each institution should define and validate its own threshold. Valganciclovir is the favored agent for both prophylaxis and preemptive therapy. The evaluation of CMV-specific cell-mediated immunity and the monitoring of viral load kinetics are gaining interest, but there was insufficient evidence to issue recommendations. Specific considerations on pediatric transplant recipients are included.

Work-related infectious diseases among Korean workers compensated under the Industrial Accident Compensation Insurance Law, 2006-2011.

BACKGROUND: Korea has no surveillance system for work-related infectious disease. However, these diseases are compensated by the Korea Workers' Compensation & Welfare Service (KCOMWEL). OBJECTIVES: To understand the nature and distribution of compensated occupational infectious diseases in Korea. METHODS: We used the KCOMWEL electronic database to analyze compensated cases of work-related occupational infectious disease. We reviewed and confirmed diagnoses excluding denied claims, secondary infections, dermatoid diseases, duplicated cases and those with missing information. We calculated the distribution of work-related infectious disease in Korea by occupation, calendar year, gender, age, and employment duration, as well as the annual compensated claim rates (per million). RESULTS: We included 1,062 compensated cases of work-related infectious disease. The most common was scrub typhus (n = 567, 53.4%), followed by tuberculosis (n = 227, 21.4%), viral hepatitis (n = 55, 5.2%), and viral influenza (n = 53, 5.0%). A sudden increase in scrub typhus was observed in 2009. Unskilled laborers, including short-term contract workers in public sectors, were most commonly affected by these diseases, followed by health care professionals. CONCLUSIONS: Workers employed in forestry care in the public sectors and in hospitals were most vulnerable to infections. Proper surveillance systems to monitor infectious diseases among vulnerable working groups and improved prevention measures are needed.

Economic Burden of Cancer for the First Five Years after Cancer Diagnosis in Patients with Human Immunodeficiency Virus in Korea.

This study aimed to estimate the medical cost of cancer in the first five years of diagnosis and in the final six months before death in people who developed cancer after human immunodeficiency virus (HIV) infection in Korea. The study utilized the Korea National Health Insurance Service-National Health Information Database (NHIS-NHID). Among 16,671 patients diagnosed with HIV infection from 2004 to 2020 in Korea, we identified 757 patients newly diagnosed with cancer after HIV diagnosis. The medical costs for 60 months after diagnosis and the last six months before death were calculated from 2006 to 2020. The mean annual medical cost due to cancer in HIV-infected people with cancer was higher for acquired immunodeficiency syndrome (AIDS)-defining cancers (48,242 USD) than for non-AIDS-defining cancers (24,338 USD), particularly non-Hodgkin's lymphoma (53,007 USD), for the first year of cancer diagnosis. Approximately 25% of the cost for the first year was disbursed during the first month of cancer diagnosis. From the second year, the mean annual medical cost due to cancer was significantly reduced. The total medical cost was higher for non-AIDS-defining cancers, reflecting their higher incidence rates despite lower mean medical costs. The mean monthly total medical cost per HIV-infected person who died after cancer diagnosis increased closer to the time of death. The estimated burden of medical costs in patients with HIV in the present study may be an important index for defining healthcare policies in HIV patients in whom the cancer-related burden is expected to increase.

Rate of and Risk Factors for Loss to Follow Up in HIV-Infected Patients in Korea: The Korea HIV/AIDS Cohort Study.

BACKGROUND: Owing to antiretroviral therapy (ART), acquired immune deficiency syndrome (AIDS)-related mortality has significantly decreased. Retaining in care is an essential step for human immunodeficiency virus (HIV) care cascade. This study investigated the incidence of and risk factors for loss to follow-up (LTFU) in Korean people living with HIV (PLWH). MATERIALS AND METHODS: Data from the Korea HIV/AIDS cohort study (including prospective interval cohort and retrospective clinical cohort) were analyzed. LTFU was defined as not visiting the clinic for more than 1 year. Risk factors for LTFU were identified using the Cox regression hazard model. RESULTS: The study enrolled 3,172 adult HIV patients (median age, 36 years; male 92.97%). The median CD4 T cell count at enrollment was 234 cells/mm3 (interquartile range [IQR]: 85 - 373) and the median viral load at enrollment was 56,100 copies/mL (IQR: 15,000 - 203,992). The total follow-up duration was 16,487 person-years, and the overall incidence rate of LTFU was 85/1,000 person-years. In the multivariable Cox regression model, subjects on ART were less likely to have LTFU than subjects not on ART (hazard ratio [HR] = 0.253, 95% confidence interval [CI]: 0.220 - 0.291, P <0.0001). Among PLWH on ART, female sex (HR = 0.752, 95% CI: 0.582 - 0.971, P = 0.0291) and older age (>50: HR = 0.732, 95% CI: 0.602 - 0.890; 41 - 50: HR = 0.634, 95% CI: 0.530 - 0.750; 31 - 40: HR = 0.724, 95% CI: 0.618 - 0.847; ≤30: reference, P <0.0001) were associated with high rate of retention in care. The viral load at ART initiation ≥1,000,001 (HR = 1.545, 95% CI: 1.126 - 2.121, ≤10,000: reference) was associated with a higher rate of LTFU. CONCLUSION: Young and male PLWH may have a higher rate of LTFU, and an increased rate of LTFU may induce virologic failure.