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Background@#Since the emergence of hypervirulent strains of Clostridioides difficile, the incidence of C. difficile infections (CDI) has increased significantly. @*Methods@#To assess the incidence of CDI in Korea, we conducted a prospective multicentre observational study from October 2020 to October 2021. Additionally, we calculated the incidence of CDI from mass data obtained from the Health Insurance Review and Assessment Service (HIRA) from 2008 to 2020. @*Results@#In the prospective study with active surveillance, 30,212 patients had diarrhoea and 907 patients were diagnosed with CDI over 1,288,571 patient-days and 193,264 admissions in 18 participating hospitals during 3 months of study period; the CDI per 10,000 patientdays was 7.04 and the CDI per 1,000 admission was 4.69. The incidence of CDI was higher in general hospitals than in tertiary hospitals: 6.38 per 10,000 patient-days (range: 3.25–12.05) and 4.18 per 1,000 admissions (range: 1.92–8.59) in 11 tertiary hospitals, vs. 9.45 per 10,000 patient-days (range: 5.68–13.90) and 6.73 per 1,000 admissions (range: 3.18–15.85) in seven general hospitals. With regard to HIRA data, the incidence of CDI in all hospitals has been increasing over the 13-year-period: from 0.3 to 1.8 per 10,000 patient-days, 0.3 to 1.6 per 1,000 admissions, and 6.9 to 56.9 per 100,000 population, respectively. @*Conclusion@#The incidence of CDI in Korea has been gradually increasing, and its recent value is as high as that in the United State and Europe. CDI is underestimated, particularly in general hospitals in Korea.
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Background@#In this study, we aimed to compare the effectiveness and adverse reactions of nirmatrelvir/ritonavir and molnupiravir in high-risk outpatients with coronavirus disease 2019 (COVID-19). @*Methods@#This multicenter prospective observational study evaluated the rate of hospitalization, death, and adverse events within 28 days of oral antiviral agent prescription (molnupiravir, n = 240; nirmatrelvir/ritonavir, n = 240) to 480 nonhospitalized adult patients with COVID-19 from August 2, 2022 to March 31, 2023. @*Results@#Patients receiving molnupiravir had a higher prevalence of comorbidities (85.8% vs. 70.4%; P < 0.001) and a higher Charlson comorbidity index (2.8 ± 1.4 vs. 2.5 ± 1.5; P = 0.009) than those receiving nirmatrelvir/ritonavir. Three patients required hospitalization (nirmatrelvir/ritonavir group, n = 1 [0.4%]; molnupiravir group, n = 2 [0.8%]; P = 1.000). Nirmatrelvir/ritonavir was associated with a higher risk of adverse events than molnupiravir (odds ratio [OR], 1.96; 95% confidence interval [CI], 1.27–3.03), especially for patients aged 65 years and older (OR, 3.04; 95% CI, 1.71–5.39). The severity of adverse events in both groups was mild to moderate and improved after discontinuation of medication. In the molnupiravir group, age ≥ 65 years (OR, 0.43 95% CI, 0.22–0.86) and appropriate vaccination (OR, 0.37; 95% CI, 0.15–0.91) reduced the occurrence of adverse events. @*Conclusion@#The rates of hospitalization and death were low and not significantly different between high-risk patients who received either nirmatrelvir/ritonavir or molnupiravir. Although adverse events were more frequent with nirmatrelvir/ritonavir than with molnupiravir, none were severe. Nirmatrelvir/ritonavir can be safely used to treat COVID-19, while molnupiravir could be considered as an alternative treatment option for high-risk groups.
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Background@#Carbapenem-resistant Acinetobacter baumannii (CRAB) has emerged as an important nosocomial pathogen.The purpose of this study was to determine the effective methods for performing surveillance cultures of CRAB. @*Methods@#Nasal and rectal swabs were obtained concurrently from hospitalized intensive care unit patients colonized with CRAB. All the samples were inoculated in CHROMagar Acinetobacter medium with CR102 (CHROMagar), MacConkey agar medium supplemented with 5 µg/mL imipenem (MCA-IPM), and triptic soy broth medium supplemented with 5 µg/ mL imipenem (TSB-IPM). CRAB detection rates for each sample were compared. @*Results@#The CRAB detection rate in either one of the nasal or rectal swabs from the 37 patients tested were 89.2% (33/37) with the use of CHROMagar, 78.4% (29/37) with the use of MCA-IMP, and 86.5% (32/37) with the use of TSB-IMP. @*Conclusion@#We determined that concurrent use of both nasal and rectal swabs and CHROMagar could be an effective method for CRAB surveillance cultures.
الملخص
Acute gastroenteritis is common infectious disease in community in adults. This work represents an update of ‘Clinical guideline for the diagnosis and treatment of gastrointestinal infections’ that was developed domestically in 2010. The recommendation of this guideline was developed regarding the following; epidemiological factors, test for diagnosis, the indications of empirical antibiotics, and modification of antibiotics after confirming pathogen. Ultimately, it is expected to decrease antibiotic misuse and prevent antibiotic resistance.
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BACKGROUND@#Acute infectious diarrhea (AID) is a commonly observed condition globally. Several studies recommend against the use of empiric antibiotic therapy for AID, except in some cases of travelers' diarrhea. However, many physicians prescribe antimicrobial agents for AID. We aimed to determine the rate of antibiotic use and the associated prescription patterns among adults with AID.@*MATERIALS AND METHODS@#This population-based, retrospective epidemiological study was performed using Korean National Health Insurance claims data from 2016 to 2017. The study population comprised adults (age ≥18 years) who had visited clinics with AID-related complaints. Exclusion criteria were the presence of Crohn's disease, ulcerative colitis, irritable bowel syndrome, and other non-infectious forms of colitis. Patients who underwent surgery during admission were also excluded.@*RESULTS@#The study population comprised 1,613,057 adult patients with AID (767,606 [47.6%] men). Young patients (age 18 – 39 years) accounted for 870,239 (54.0%) of the study population. Overall, 752,536 (46.7%) cases received antibiotic prescriptions. The rate of antibiotic administration tended to be higher among elderly patients (age ≥65 years) than among younger patients (49.5% vs. 46.4%, P <0.001). The antibiotics most frequently prescribed in both monotherapy and combination regimens were fluoroquinolones (29.8%), rifaximin (26.8%), second-generation cephalosporins (9.2%), third-generation cephalosporins (7.3%), trimethoprim/sulfamethoxazole (5.5%), and β-lactam/β-lactamase inhibitors (5.3%). Patients who visited tertiary care hospitals had lower rates of antibiotic therapy (n = 14,131, 41.8%) than did those visiting private clinics (n = 532,951, 47.1%). In total, 56,275 (62.3%) admitted patients received antibiotic therapy, whereas outpatients had lower rates of antibiotic prescription (n = 694,204, 46.0%).@*CONCLUSION@#This study revealed differences between the antibiotics used to treat AID in Korea and those recommended by the guidelines for AID treatment. Multifaceted efforts are necessary to strengthen physicians' adherence to published guidelines.
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BACKGROUND: The emergence of carbapenemase-producing Enterobacteriaceae (CPE) represents a major clinical problem because these bacteria are resistant to most antibiotics. CPE remain relatively uncommon in Korea. We report the prevalence, clinical characteristics, and molecular epidemiology of CPE isolates collected from five university hospitals in Korea. METHODS: Between January and December 2015, 393 non-duplicated isolates that were nonsusceptible to ertapenem were analyzed. Production of carbapenemase, extended-spectrum β-lactamase, and AmpC β-lactamase was determined by genotypic tests. Antimicrobial susceptibility profiles were determined by using an Etest. Clonality of Klebsiella pneumoniae carbapenemase (KPC)-2-producing and oxacillinase (OXA)-232-producing Klebsiella pneumoniae isolates was determined by pulsed-field gel electrophoresis (PFGE). RESULTS: Of the 393 isolates tested, 79 (20.1%) were CPE. Of these 79 isolates, 47 (59.5%) harbored the bla(OXA-232) gene while the remaining isolates carried genes bla(KPC-2) (n=27), bla(IMP-1) (n=4), and bla(NDM-1) (n=1). Among the 24 KPC-2 K. pneumoniae isolates from hospital B, 100% were resistant to carbapenems, 8% to colistin, and 0% to tigecycline. Among the 45 OXA-232 K. pneumoniae at hospital C, 95% were resistant to ertapenem, 68% to imipenem, 95% to meropenem, 10% to colistin, and 24% to tigecycline. PFGE analysis revealed a unique pattern for KPC-2 K. pneumoniae and identified 30 isolates belonging to the dominant pulsotypes (PT)1 and PT2 among 41 OXA-232 K. pneumoniae isolates. CONCLUSIONS: CPE strains are present in Korea, with the majority of K. pneumoniae isolates producing OXA-232 and KPC-2. The prevalence and predominant genotypes of CPE show hospital-specific differences.
الموضوعات
Aged , Female , Humans , Male , Middle Aged , Anti-Bacterial Agents/pharmacology , Bacterial Proteins/genetics , Drug Resistance, Bacterial , Electrophoresis, Gel, Pulsed-Field , Enterobacteriaceae/drug effects , Enterobacteriaceae Infections/diagnosis , Genotype , Hospitals , Microbial Sensitivity Tests , Prevalence , Republic of Korea/epidemiology , beta-Lactamases/geneticsالملخص
Infection with nontyphoidal Salmonella most often results in self-limited acute gastroenteritis. However, occasionally it causes bacteremia and localized infection requiring antibiotic treatment. A third-generation cephalosporin or fluoroquinolone is often the first choice of antibiotic. However, there has been an increase in nalidixic-acid-resistant nontyphoidal Salmonella with decreased fluoroquinolone susceptibility. Although there have been many cases reported of nontyphoidal Salmonella, no cases of nalidixic-acid-resistant nontyphoidal Salmonella have been reported in Korea. Here, we report on the case of a 61-year-old man with a diagnosis of acute osteomyelitis and periosteal abscess of the femur caused by nalidixic-acid-resistant Salmonella enteritidis. He was treated successfully with prolonged administration of a high-dose of ciprofloxacin and drainage of the abscess.
الموضوعات
Humans , Middle Aged , Abscess , Bacteremia , Ciprofloxacin , Diagnosis , Drainage , Drug Resistance , Femur , Gastroenteritis , Korea , Nalidixic Acid , Osteomyelitis , Salmonella , Salmonella enteritidisالملخص
Since 2001, ten more OXA-48 variants have been identified. Shewanella spp. has been thought to be the original host for OXA-48-like enzymes. These enzymes strongly hydrolyze penicillins and weakly hydrolyze carbapenems, with very weak activity against broad-spectrum cephalosporins. The OXA-48-like genes are always plasmid-borne and have been located in insertion sequences. OXA-48-like carbapenemases have been identified mainly from Turkey, North African countries, the Middle East, and India. Furthermore, the emergence and outbreak of OXA-48-like producers in Korea have been reported recently. Because some OXA-48-like-producing Enterobacteriaceae isolates do not exhibit resistance to broad-spectrum cephalosporins and only decreased susceptibility to carbapenems, their detection can be difficult. Adequate screening and detection methods are required to prevent and control the dissemination of OXA-48-like-producing Enterobacteriaceae.
الموضوعات
Carbapenems , Cephalosporins , Enterobacteriaceae , India , Korea , Mass Screening , Middle East , Penicillins , Shewanella , Turkeyالملخص
BACKGROUND/AIMS: Intranasal mupirocin and chlorhexidine bathing are candidate strategies to prevent healthcare-associated infections caused by methicillin-resistant Staphylococcus aureus (MRSA). In Korea, intranasal mupirocin is not available, and mupirocin ointment, an over-the-counter drug, has been used indiscriminately. Furthermore, because it is covered by health insurance, mupirocin is easy to prescribe within hospitals. METHODS: We performed a mupirocin drug utilization review (DUR) within Hallym University Sacred Heart Hospital. Annual use of mupirocin was investigated between 2003 and 2013, and monthly consumption of mupirocin was assessed during the final 2-year period. The DUR focused on August 2012, the period of highest use of mupirocin. Also, we investigated trends in mupirocin resistance in MRSA between 2011 and 2013. RESULTS: Annual consumption of mupirocin increased from 3,529 tubes in 2003 to 6,475 tubes in 2013. During August 2012, 817 tubes were prescribed to 598 patients; of these, 84.9% were prescribed to outpatients, and 77.6% at the dermatology department. The most common indication was prevention of skin infections (84.9%), and the ointment was combined with systemic antibiotics in 62.9% of cases. The average duration of systemic antibiotic administration was about 7.8 days. The rate of low-level mupirocin resistance in MRSA increased from 8.0% to 22.0%, and that of high-level mupirocin resistance increased from about 4.0% to about 7.5%. CONCLUSIONS: Inappropriate use of mupirocin is prevalent. Considering the increase in resistance and the future application of intranasal mupirocin, prophylactic use of mupirocin in dermatology departments should be reconsidered.
الموضوعات
Humans , Administration, Cutaneous , Anti-Bacterial Agents/administration & dosage , Drug Prescriptions , Drug Resistance, Multiple, Bacterial , Drug Utilization Review , Hospitals, University , Inappropriate Prescribing/trends , Methicillin-Resistant Staphylococcus aureus/drug effects , Microbial Sensitivity Tests , Mupirocin/administration & dosage , Ointments , Practice Patterns, Physicians'/trends , Predictive Value of Tests , Republic of Korea , Retrospective Studies , Staphylococcal Skin Infections/diagnosis , Time Factorsالملخص
Haemophilus aphrophilus is an aerobic, gram-negative oropharyngeal bacterium, commonly isolated from cases of HACEK endocarditis. In addition, H. aphrophilus has also been shown to cause invasive bone and joint infections. Although multiple cases of H. aphrophilus endocarditis have been described, no cases of invasive bone and joint infections caused by H. aphrophilus have been reported in Korea. Here we report the case of a 69-year old woman with a diagnosis of vertebral osteomyelitis and spinal epidural abscess with compressive myelopathy caused by H. aphrophilus, in which there was no objective evidence of infective endocarditis. She was successfully treated with intravenous administration of cefotaxime and drainage of the epidural abscess by laminectomy of the T3-7 vertebrae.
الموضوعات
Aged , Female , Humans , Administration, Intravenous , Aggregatibacter aphrophilus , Cefotaxime , Diagnosis , Drainage , Endocarditis , Epidural Abscess , Haemophilus Infections , Haemophilus , Joints , Korea , Laminectomy , Osteomyelitis , Spinal Cord Compression , Spine , Spondylitisالملخص
BACKGROUND: The role of extended-spectrum beta-lactamase (ESBL)-producing or multidrug-resistant (MDR) organisms in patients with sepsis secondary to urinary traction infection (UTI) has not been investigated extensively in the intensive care unit (ICU) setting. METHODS: Patients with UTI sepsis admitted to the ICU were retrospectively enrolled in this study (January 2009-December 2012). We investigated the impact of ESBL-producing and ESBL-negative MDR organisms on hospital outcome. RESULTS: In total, 94 patients were enrolled (median age, 73.0 years; female, 81.9%), and ESBL-producing and ESBL-negative MDR organisms accounted for 20.2% (n = 19) and 30.9% (n = 29), respectively. Both patients with ESBL-producing and ESBL-negative MDR organisms were more likely to experience a delay in adequate antibiotic therapy than those with non-ESBL/non-MDR organisms (p < 0.001 and p = 0.032, respectively). However, only patients with ESBL-producing organisms showed a higher mortality rate (ESBL vs. ESBL-negative MDR vs. non-ESBL/non-MDR, 31.6% vs. 10.3%.vs. 10.9%, respectively). In multivariate analyses, ESBL production was significantly associated with hospital mortality (odds ratio, 11.547; 95micro confidence interval, 1.047-127.373), and prior admission was a significant predictor of ESBL production. CONCLUSIONS: Although both ESBL-producing and ESBL-negative MDR organisms are associated with delayed administration of appropriate antibiotics, only ESBL production is a significant predictor of hospital mortality among patients with UTI sepsis in the ICU setting.
الموضوعات
Female , Humans , Anti-Bacterial Agents , beta-Lactamases , Drug Resistance, Multiple , Hospital Mortality , Intensive Care Units , Mortality , Multivariate Analysis , Retrospective Studies , Sepsis , Urinary Tract , Urinary Tract Infectionsالملخص
BACKGROUND: Hand hygiene compliance has improved significantly through hand hygiene promotion programs that have included poster campaign, monitoring and performance feedback, and education with special attentions to perceived subjective norms. We investigated factors associated with improved hand hygiene compliance, focusing on whether the improvement of hand hygiene compliance is associated with changed perception toward hand hygiene among medical personnel. MATERIALS AND METHODS: Hand hygiene compliance and perceptions toward hand hygiene among medical personnel were compared between the second quarter of 2009 (before the start of a hand hygiene promotion program) and the second quarter of 2012. We assessed adherence to hand hygiene among medical personnel quarterly according to the WHO recommended method for direct observation. Also, we used a modified self-report questionnaire to collect perception data. RESULTS: Hand hygiene compliance among physicians and nurses improved significantly from 19.0% in 2009 to 74.5% in 2012 (P < 0001), and from 52.3% to 91.2% (P < 0.001), respectively. These improvements were observed in all professional status or all medical specialties that were compared between two periods, regardless of the level of the risk for cross-transmission. Hand hygiene compliance among the medical personnel continued to improve, with a slight decline in 2013. Perceptions toward hand hygiene improved significantly between 2009 and 2012. Specifically, improvements were evident in intention to adhere to hand hygiene, knowledge about hand hygiene methods, knowledge about hand hygiene indications including care of a dirty and a clean body site on the same patient, perceived behavioral and subjective norms, positive attitude toward hand hygiene promotion campaign, perception of difficulty in adhering to hand hygiene, and motivation to improve adherence to hand hygiene. CONCLUSIONS: The examined hand hygiene promotion program resulted in improved hand hygiene compliance and perception toward hand hygiene among medical personnel. The improved perception increased hand hygiene compliance. Especially, the perception of being a role model for other colleagues is very important to improve hand hygiene compliance among clinicians.
الموضوعات
Humans , Attention , Compliance , Education , Hand Hygiene , Health Personnel , Intention , Motivation , Quality Improvement , Surveys and Questionnairesالملخص
BACKGROUND: The role of extended-spectrum beta-lactamase (ESBL)-producing or multidrug-resistant (MDR) organisms in patients with sepsis secondary to urinary traction infection (UTI) has not been investigated extensively in the intensive care unit (ICU) setting. METHODS: Patients with UTI sepsis admitted to the ICU were retrospectively enrolled in this study (January 2009-December 2012). We investigated the impact of ESBL-producing and ESBL-negative MDR organisms on hospital outcome. RESULTS: In total, 94 patients were enrolled (median age, 73.0 years; female, 81.9%), and ESBL-producing and ESBL-negative MDR organisms accounted for 20.2% (n = 19) and 30.9% (n = 29), respectively. Both patients with ESBL-producing and ESBL-negative MDR organisms were more likely to experience a delay in adequate antibiotic therapy than those with non-ESBL/non-MDR organisms (p < 0.001 and p = 0.032, respectively). However, only patients with ESBL-producing organisms showed a higher mortality rate (ESBL vs. ESBL-negative MDR vs. non-ESBL/non-MDR, 31.6% vs. 10.3%.vs. 10.9%, respectively). In multivariate analyses, ESBL production was significantly associated with hospital mortality (odds ratio, 11.547; 95micro confidence interval, 1.047-127.373), and prior admission was a significant predictor of ESBL production. CONCLUSIONS: Although both ESBL-producing and ESBL-negative MDR organisms are associated with delayed administration of appropriate antibiotics, only ESBL production is a significant predictor of hospital mortality among patients with UTI sepsis in the ICU setting.
الموضوعات
Female , Humans , Anti-Bacterial Agents , beta-Lactamases , Drug Resistance, Multiple , Hospital Mortality , Intensive Care Units , Mortality , Multivariate Analysis , Retrospective Studies , Sepsis , Urinary Tract , Urinary Tract Infectionsالملخص
Prompt antibiotic treatment reduces the incidence of complications such as liver abscesses, pyelonephritis, and osteomyelitis in patients with typhoid fever. Renal or liver abscesses are especially rare in patients without underlying disease or predisposing factors. The occurrence of both renal and liver abscesses in a patient with typhoid fever has not been reported. Although the prevalence of typhoid fever in Korea has decreased, it is still an important disease owing to increased opportunities for the occurrence of waterborne diseases with climate warming and group feeding, and the increased numbers of tourists and foreigners visiting Korea. We present a patient with no underlying disease or predisposing factors who developed both renal and liver abscesses caused by nalidixic acid-resistant Salmonella typhi after a trip to Nepal. He was treated successfully with percutaneous drainage of the renal abscess and high-dose ciprofloxacin.
الموضوعات
Humans , Abscess , Ciprofloxacin , Climate , Drainage , Drug Resistance , Emigrants and Immigrants , Incidence , Korea , Liver , Liver Abscess , Nalidixic Acid , Nepal , Osteomyelitis , Prevalence , Pyelonephritis , Salmonella , Salmonella typhi , Typhoid Feverالملخص
PURPOSE: Clostridium difficile colitis (CDC) is a nosocomial infection. We attempted to discover the risk factors for the development of CDC in patients admitted to our surgical ward. METHODS: We conducted a retrospective chart review of all patients admitted to our surgical ward between January 2010 and July 2011. CDC was confirmed when toxin A/B or toxin B polymerase chain reaction was detected in the stool and clinical symptoms, such as diarrhea, were present. We divided patients into the CDC and non-CDC groups, and compared the clinical features between the two groups. RESULTS: The rate of CDC occurrence was 0.4% (19/4,720 patients). Univariate analysis showed that colectomy (P < 0.001), hospital stays longer than 10 days (P < 0.001), aged over 55 years (P < 0.001) and transfer from medical ward (P = 0.009) were significant parameters for CDC. Multivariate analysis showed that colectomy (P < 0.001; odds ratio [OR], 8.405; 95% confidence interval [CI], 2.927 to 24.132) and hospital stays longer than 10 days (P = 0.035; OR, 10.253; 95% CI, 1.176 to 89.392) were high risk factors for CDC occurrence in the surgical ward. CONCLUSION: The risk factors for CDC in a surgical ward could be colectomy and a long duration of hospitalization. Therefore, clinicians should consider the possibility of CDC when patients undergo colectomy, are admitted for a long time, and have postoperative diarrhea.
الموضوعات
Aged , Humans , Clostridium , Clostridioides difficile , Colectomy , Colitis , Cross Infection , Diarrhea , Hospitalization , Length of Stay , Multivariate Analysis , Odds Ratio , Polymerase Chain Reaction , Retrospective Studies , Risk Factorsالملخص
BACKGROUND: Surgical site infection (SSI) is prominent among the total incidence of healthcare-associated infections, and is a major contributing factor in the trend of increasing medical costs. There have been numerous efforts to analyze the conditions and causes of SSI for the purpose of prevention. In this study of SSI development after gastric surgery, we evaluated the prevalence of specific pathogens and compared the clinical characteristics observed between gram-positive (GPB) and gram-negative bacteria (GNB). MATERIALS AND METHODS: We conducted a retrospective study of patients who developed SSI within 30 days after gastric surgery at 13 clinics in Korea, between January 2007 and December 2008. Only those cases of SSI which included confirmed pathogen were included in this study. RESULTS: Among the 121 patients who developed SSI, GPB were observed in 32 patients and 36 cases, and GNB were isolated in 32 patients and 36 cases. Methicillin resistant Staphylococcus aureus (MRSA) was the most frequently isolated pathogen in this analysis. There were no differences observed between the GPB and GNB group in terms of baseline characteristics, patient or procedure related risk factors, or factors associated with prophylactic antibiotics. CONCLUSIONS: In the previous studies of the occurrence of SSI after gastric surgery, it was reported that the majority of observed pathogens were enteric GNB. Further studies of the incidence of SSI after gastric surgery, particularly those related to MRSA infection, are necessary.
الموضوعات
Humans , Gram-Negative Bacteria , Gram-Positive Bacteria , Incidence , Korea , Methicillin Resistance , Methicillin-Resistant Staphylococcus aureus , Prevalence , Retrospective Studies , Risk Factors , Staphylococcus aureusالملخص
Acute human immunodeficiency virus (HIV) syndrome develops in 40 to 90% of new HIV-1 infections. In Korea, recent increases in HIV-1 infection rates suggest that the number of patients experiencing acute HIV syndrome will also increase. Furthermore, it has been reported that aseptic meningitis occurs in 24% of patients with acute HIV syndrome. The inclusion of acute HIV syndrome in the differential diagnosis of aseptic meningitis is crucial; however, few reports of acute HIV syndrome presenting as aseptic meningitis in Korea exist. Here we report a case of aseptic meningitis in a patient who received early antiretroviral therapy after a diagnosis of acute HIV syndrome.
الموضوعات
Humans , Diagnosis, Differential , HIV , HIV Infections , HIV-1 , Korea , Meningitis , Meningitis, Asepticالملخص
Acute human immunodeficiency virus (HIV) syndrome develops in 40 to 90% of new HIV-1 infections. In Korea, recent increases in HIV-1 infection rates suggest that the number of patients experiencing acute HIV syndrome will also increase. Furthermore, it has been reported that aseptic meningitis occurs in 24% of patients with acute HIV syndrome. The inclusion of acute HIV syndrome in the differential diagnosis of aseptic meningitis is crucial; however, few reports of acute HIV syndrome presenting as aseptic meningitis in Korea exist. Here we report a case of aseptic meningitis in a patient who received early antiretroviral therapy after a diagnosis of acute HIV syndrome.
الموضوعات
Humans , Diagnosis, Differential , HIV , HIV Infections , HIV-1 , Korea , Meningitis , Meningitis, Asepticالملخص
The epidemiology of Group B streptococcal disease has been changing. Since the 1990s, early-onset neonatal and maternal peripartum infections have decreased, due to the administration of prophylactic intrapartum antibiotics. On the other hand, invasive Group B streptococcal infections have increased in nonpregnant adults, especially in elderly persons and in those with chronic immunosuppressive diseases, such as diabetes mellitus, liver cirrhosis, and malignancies. Although infective endocarditis is an uncommon manifestation of invasive Streptococcus agalactiae infection, it usually leads to cardiac surgery, due to heart failure associated with rapid valve destruction and the formation of emboli. Several cases of endocarditis due to S. agalactiae have appeared in the literature, but there have been few reports in Korea. We present a case of S. agalactiae infective endocarditis in an elderly patient with advanced gastric cancer, successfully treated with intravenous antibiotics and cardiac surgery.
الموضوعات
Adult , Aged , Humans , Anti-Bacterial Agents , Diabetes Mellitus , Endocarditis , Endocarditis, Bacterial , Hand , Heart Failure , Korea , Liver Cirrhosis , Peripartum Period , Stomach Neoplasms , Streptococcal Infections , Streptococcus , Streptococcus agalactiae , Thoracic Surgeryالملخص
The epidemiology of Group B streptococcal disease has been changing. Since the 1990s, early-onset neonatal and maternal peripartum infections have decreased, due to the administration of prophylactic intrapartum antibiotics. On the other hand, invasive Group B streptococcal infections have increased in nonpregnant adults, especially in elderly persons and in those with chronic immunosuppressive diseases, such as diabetes mellitus, liver cirrhosis, and malignancies. Although infective endocarditis is an uncommon manifestation of invasive Streptococcus agalactiae infection, it usually leads to cardiac surgery, due to heart failure associated with rapid valve destruction and the formation of emboli. Several cases of endocarditis due to S. agalactiae have appeared in the literature, but there have been few reports in Korea. We present a case of S. agalactiae infective endocarditis in an elderly patient with advanced gastric cancer, successfully treated with intravenous antibiotics and cardiac surgery.