Changing Epidemiology of Pathogenic Bacteria Over the Past 20 Years in Korea

Background@#The epidemiology of pathogenic bacteria varies according to the socioeconomic status and antimicrobial resistance status. However, longitudinal epidemiological studies to evaluate the changes in species distribution and antimicrobial susceptibility of pathogenic bacteria nationwide are lacking. We retrospectively investigated the nationwide trends in species distribution and antimicrobial susceptibility of pathogenic bacteria over the last 20 years in Korea. @*Methods@#From 1997 to 2016, annual cumulative antimicrobial susceptibility and species distribution data were collected from 12 university hospitals in five provinces and four metropolitan cities in South Korea. @*Results@#The prevalence of Staphylococcus aureus was the highest (13.1%) until 2012 but decreased to 10.3% in 2016, consistent with the decrease in oxacillin resistance from 76.1% in 2008 to 62.5% in 2016. While the cefotaxime resistance of Escherichia coli increased from 9.0% in 1997 to 34.2% in 2016, E. coli became the most common species since 2013, accounting for 14.5% of all isolates in 2016. Pseudomonas aeruginosa and Acinetobacter baumannii rose to third and fifth places in 2008 and 2010, respectively, while imipenem resistance increased from 13.9% to 30.8% and 0.7% to 73.5% during the study period, respectively.Streptococcus agalactiae became the most common pathogenic streptococcal species in 2016, as the prevalence of Streptococcus pneumoniae decreased since 2010. During the same period, pneumococcal penicillin susceptibility decreased to 79.0%, and levofloxacin susceptibility of S. agalactiae decreased to 77.1% in 2016. @*Conclusion@#The epidemiology of pathogenic bacteria has changed significantly over the past 20 years according to trends in antimicrobial resistance in Korea. Efforts to confine antimicrobial resistance would change the epidemiology of pathogenic bacteria and, consequently, the diagnosis and treatment of infectious diseases.

Survey of Point-of-Care Testing Devices for Pre-hospital EMS Equipment of Glucometer on Local Area / 農村醫學 地域保健

Objective@#glucometer is one of POCT(point-of-care testing) devices used by EMS. Accurate measurement value is important for patient decision making. Quality control is necessary for this, but most EMS are still using glucometer without quality control it. Therefore, management status and quality control status of glucometers used by 119 paramedics waswere investigated. @*Methods@#6 and 8 of glucometers and blood glucose test strips were submitted from 4 safety centers in 2010 and 8 safety centers in 2012, respectively. Glucometers submitted by local safety centers were analyzed in 2010 and 2012. The control glucometer, which was well managed at A University Hospital, was assumed to be accurate for at blood glucose measurement. Glucose values of various quality control materials control solutions were measured and analyzed using linear regression and Pearson’s correlation test. Error rates were obtained via error tolerance range required by the 2011 ISO(International Organization for Standardization) guideline. For statistics, Excel and MedCalC programs were used. @*Results@#mong 14 safety centers in the region, 4 centers(28.5%) in 2010 and 8 centers(57.1%) in 2012 submitted 6 and 8 glucometers. In the first evaluation in 2010, 2 out of 6(33.3%) glucometers were untestable due to error, and 45 out of 6(66.683.3%) blood glucose test strips' validity were expired. In the second evaluation in 2012, 1 out of 8(13.5%) glucometers were untestable due to lack of battery, and 2 out of 8(25%) blood glucose test strips' validity were expired. All correlation coefficients were above 0.989 in 2010 and above 0.997 in 2012. Error rates were generally high when using expired blood glucose test strips. @*Conclusion@#Among 119 paramedics’ guideline, quantity and operation status of POCT devices are well managed, but quality control is not. Therefore, it is necessary to add management status and quality control status of POCT devices to the EMS’ field work guideline.

A Case of COVID-19 in a 45-Day-Old Infant with Persistent Fecal Virus Shedding for More Than 12 Weeks

In this report, we describe the case of a SARS-CoV-2 infection (COVID-19) in an infant with mild fever and diarrhea in the absence of respiratory distress. A 45-day-old male infant with COVID-19 was transferred to our pediatric department. He had mild fever and diarrhea at admission. Positive-to-negative nasal swab conversion occurred on the 21st day from the onset of symptoms. However, stool swab positivity persisted during the 6-week admission period and for 7 weeks during follow-up at an outpatient clinic after discharge. Negative conversion in a stool specimen occurred on the 142nd day from the onset of symptoms. This case highlights the potential of fecal virus shedding as an important feature of viral transmission in infants and young children.

Tinea Capitis Caused by Microsporum canis Misdiagnosed as Seborrheic Dermatitis in a 79-Year-Old Woman / 대한의진균학회지

Microspoum canis is a zoophilic dermatophyte that is often transmitted to humans from cats and dogs. It has become one of the most important causative agents in tinea capitis ane kerion celsi. Tinea capitis is uncommon in an adult. Moreover, tinea capitis caused by Microspoum canis is rare in an elderly. The location of the lesion and the clinical course of tinea capitis might have led physicians into misdiagnosis as the seborrheic dermatitis. Therefore, we report this case to emphasize the importance of KOH mount and fungal culture of the skin lesions mimicking seborrheic dermatitis. We report a case of tinea capitis caused by Microspoum canis in a 79-year-old woman. The lesions were manifested by fine scaly erythematous patches on the fronto-vertex scalp for 2 weeks. She was diagnosed as seborrheic dermatitis in local clinic and was treated with topical steroid. However, the lesion was not improved. She kept a cat as a pet. Culture from biopsy specimen on Sabouraud's dextrose agar showed typical cottony colonies of Microspoum canis. The nucleotide sequence of internal transcribed spacer for clinical isolate was identical to that of Arthroderma otae strain ATCC 23828 (GenBank accession number AY213657). She was treated with 200 mg of oral itraconazole daily for 12 weeks. The skin lesions improved after treatment, and recurrence has not been observed.

Majocchi's Granuloma of the Knee Caused by Trichophyton rubrum Presented as Tinea Incognito / 대한의진균학회지

Majocchi's granuloma is a well recognized but uncommon infection of dermal and subcutaneous layers that is caused by fungal organism. It often presents as plaques and papules on areas where trauma is common. Majocchi's granuloma appears usually in immunocompromised patient but can also appear in immunocompetent patient. Tinea incognito appears in various forms of skin diseases, but it is rarely presented as Majocchi's granuloma. We report a case of trichophytic granuloma of the knee caused by Trichophyton(T.) rubrum in a 70-year-old male, who showed a pruritic, 7.0 × 2.0 cm sized, erythematous scaly patches with multiple papules on the right knee for 2 months. Fungal culture of the biopsy specimen grew out typical white cottony colonies of T. rubrum. The nucleotide sequence of internal transcribed spacer for clinical isolate was identical to that of T. rubrum strain ATCC 52013 (GenBank accession number KX092384.1). Histiologic examination showed chronic granulomatous inflammation and fungal elements in the dermis. After one month of itraconazole 200 mg/day and sertaconzole cream treatment, the lesion was completely cleared.

A Clinical and Etiological Analysis of Tinea Incognito Over 10 Years: A Single-Center Experience / 대한의진균학회지

BACKGROUND: Tinea incognito is the dermatophytoses of atypical clinical appearance that is induced by topical and systemic steroid treatment or topical calcineurin inhibitor. OBJECTIVE: The purpose of this study was to investigate the clinical and etiological aspects of tinea incognito. METHODS: In the 10-year-period 2007-2017, we reviewed fifty-one patients with tinea incognito with regards to the age, gender, duration, and associated diseases. The patients with tinea incognito were further evaluated concerning the clinical manifestations and culture of organisms. RESULTS: Age of the tinea incognito was most prevalent in the fifties (23.5%). The male-to-female ratio was 1:1.3. The most common type of infection was tinea corporis (52.9%), followed by tinea faciei (35.3%), tinea manus (5.9%), tinea barbae (3.5%), and tinea cruris (2.0%). The clinical features were to some extent diverse, ranging from eczema-like, seborrheic dermatitis-like, psoriasiform, folliculitis-like, rosacea-like, pyoderma-like, and purpura-like, and discoid lupus erythematosus-like. Trichophyton(T.) rubrum was the most common etiological agent (35.3%), followed by T. mentagrophytes (11.8%), Microsporum(M.) canis (7.8%), T. verrucosum (5.9%), T. erinacei, and M. gypseum (2.0%), respectively. CONCLUSION: Because of the increase in tinea incognito, there is a need for careful mycological examination in patients with tinea incognito.

A Clinical and Etiological Analysis of Subcutaneous Mycoses / 대한의진균학회지

BACKGROUND: There have been many studies about sporotrichosis in Korean dermatological literature. However, a few studies have reported on subcutaneous mycoses other than sporotrichosis. OBJECTIVE: The purpose of this study was to investigate the clinical and etiological aspects of subcutaneous mycoses. METHODS: In the 20-year-period 1996-2015, we reviewed seventeen patients with subcutaneous mycoses with in regards to the age, gender, occupation, trauma history and associated diseases. The patients with subcutaneous mycoses were further evaluated concerning the clinical manifestations, histopathology, culture of organisms and treatment. RESULTS: Age of the subcutaneous mycosis was most prevalent in the sixties (35.2%). The male-tofemale ratio was 1:1.8. Most patients were farmers (52.8%), although preceding trauma was noted in seven patients (41.2%). The most common skin lesion was erythematous plaque (58.7%), followed by abscess, ulcer, papule and nodule. The most frequently involved area was upper extremities (58.8%), followed by face, and lower extremities. Hyalohyphomycosis was the most common infection in 6 cases (35.2%), followed by sporotrichosis (5 cases, 29.4%), chromoblastomycosis (4 cases, 23.5%), phaeohyphomycosis (2 cases, 11.8%). Sporothrix species was the most common etiological agent (29.4%), followed by Fonsecaea (23.5%), Scedosporium (17.6%), Exophiala (11.8%), Fusarium, Paecilomyces, and Cephalotheca (5.9%), respectively. Most patients responded well to therapy. CONCLUSION: Because of the increase in subcutaneous mycoses other than sporotrichosis, there is a the need for careful mycological examination in patients with subcutaneous mycoses.

A Case of Toenail Onychomycosis Due to Aspergillus terreus / 대한의진균학회지

Onychomycosis is caused by dermatophytes usually, but some species of nondermatophytic molds and yeasts are also associated with invasion of nails. Aspergillus(A.) terreus is a nondermatophytic mold which is opportunistic filamentous fungus in all environments. We report a case of onychomycosis caused by A. terreus in a 60-year-old male. The patient showed brownish yellow discoloration with hyperkeratotic change on the distal and lateral portion of both toenails. Direct microscopic examination of scraping on the potassium hydroxide preparation revealed septate hyphae and repeated cultures on Sabouraud's dextrose agar showed the velvety, cinnamon brown colonies. Biseriate and compactly columnar phialides that cover upper vesicle with conidial structure were shown in the slide culture. The DNA sequence of internal transcribed spacer (ITS) region of clinical sample was 99% match to that of A. terreus strain ATCC 20542 (GenBank accession number GU256759.1). We confirmed A. terreus by KOH mount, colony, light microscopic morphology and DNA sequence analysis. The patient was treated with 200 mg oral itraconazole daily and topical 5% amorolfine nail lacquer for 3 months.

Herpes Zoster in Children and Adolescents: A 10-year Retrospective Study at a Single Institution / 대한피부과학회지

BACKGROUND: Studies on herpes zoster have been extensively reported in Korea. However, few reports have dealt with herpes zoster in children and adolescents. OBJECTIVE: The purpose of this study was to investigate the epidemiological features and clinical characteristics of herpes zoster in children and adolescents. METHODS: During a 10-year period (2005~2014), 95 herpes zoster patients, aged 18 years and younger, were evaluated in regard to the annual, monthly, and seasonal incidences; the age distribution; and the gender ratio. The children and adolescents with herpes zoster were further assessed on the accompanying symptoms, dermatomal distribution, associated diseases, treatments, and complications. RESULTS: Among all the patients with herpes zoster, 2.41% were children and adolescents. The highest incidence was in summer (35.8%). The age group of 10 to 14 years had the highest incidence (40.0%). The male to female ratio was 1.4:1. The common accompanying symptoms were pain (77.9%) and pruritus (22.1%). The most common dermatomal distribution was the thoracic dermatome (50.5%), followed by the cervical (21.1%), the trigeminal (16.8%), the lumbar (7.4%) and the sacral (4.2%) dermatomes. Associated diseases including atopic dermatitis, bronchial asthma, allergic rhinitis, chronic sinusitis, and epilepsy were observed in 23.2%. There was no case with immunosuppression. The most common complication was secondary bacterial infection (5.2%), followed by herpes zoster ophthalmicus or herpes zoster generalisatus (4.2%), Ramsay Hunt syndrome (2.1%), meningitis and recurrent herpes zoster (1.1%). No patient developed postherpetic neuralgia. CONCLUSION: Herpes zoster is rare and relatively mild in healthy immunocompetent children and adolescents. Pruritus was observed in some pediatric patients, but there was no occurrence of postherpetic neuralgia.

Cutaneous Sporotrichosis Presenting as Clinical Feature of Facial Cellulitis in an Adult

No abstract available.

Kerion Celsi Caused by Trichophyton rubrum in an Elderly / 대한의진균학회지

Kerion celsi is a severe inflammatory type of tinea capitis that presents as a boggy mass studded with broken hairs, oozing purulent material from follicular orifices. This infection is caused most commonly by zoophilic or geophilic pathogens. Trichophyton(T.) rubrum is an anthropophilic dermatophyte that is found all over the world. It has become one of the most important causative agents in tinea unguium and tinea pedis. But, kerion celsi caused by T. rubrum is rare. Kerion celsi is uncommon in adult. We report a case of kerion celsi caused by T. rubrum in a 72-year-old woman. She presented with localized tender erythematous plaques with pustules with oozing purulent material on the frontal scalp. A fungal culture from tissue of the lesions was grown on Sabouraud's dextrose agar and showed typical whitish cottony colonies of T. rubrum. The nucleotide sequence of internal transcribed spacer region for clinical isolate was identical to that of T. rubrum strain UZ1588_14 (GenBank accession number KP326579.1). She was treated with 200 mg of oral itraconazole daily for 3 months. The skin lesions improved 1 month after treatment, and recurrence has not been observed.

Kerion Celsi Caused by Trichophyton verrucosum in an Adult / 대한피부과학회지

No abstract available.

Tinea Capitis Caused by Trichophyton rubrum in a 81-Year-Old Woman / 대한의진균학회지

Trichophyton(T.) rubrum is an anthropophilic dermatophyte that is found all over the world. It has become one of the most important causative agents in tinea pedis and onychomycosis. But tinea capitis caused by T. rubrum is rare. Tinea capitis is uncommon in an adult. We report a case of tinea capitis caused by T. rubrum in an 81-year-old woman. She presented with localized asymptomatic well-demarcated thick scaly erythematous patches on the fronto-vertex scalp for 6 months. She was diagnosed as seborrheic dermatitis in local clinic and was treated with topical steroid. However, the lesion was not improved and spreading. Culture from scalp lesion of patient was grown on Sabouraud's dextrose agar and showed typical whitish cottony colonies of T. rubrum. She was treated with 200 mg of oral itraconazole daily for 8 weeks. The skin lesions improved 8 weeks after treatment, and recurrence has not been observed.

Antifungal Susceptibility Testing with Etest for Candida Species Isolated from Patients with Oral Candidiasis

BACKGROUND: The necessity of performing antifungal susceptibility tests is recently increasing because of frequent cases of oral candidiasis caused by antifungal-resistant Candida species. The Etest (BioMerieux, Marcy l'Etoile, France) is a rapid and easy-to-perform in vitro antifungal susceptibility test. OBJECTIVE: The purpose of this study was to determine the minimal inhibitory concentrations (MICs) of antifungal agents by using the Etest for Candida species isolated from patients with oral candidiasis. METHODS: Forty-seven clinical isolates of Candida species (39 isolates of Candida albicans, 5 isolates of C. glabrata, and 3 isolates of C. tropicalis) were tested along with a reference strain (C. albicans ATCC 90028). The MIC end points of the Etest for fluconazole, itraconazole, voriconazole, and amphotericin B susceptibility were read after the 24-hour incubation of each isolate on RPMI 1640 agar. RESULTS: All Candida isolates were found susceptible to voriconazole and amphotericin B. However, all five isolates of C. glabrata were resistant to itraconazole, among which two isolates were also resistant to fluconazole. CONCLUSION: This study revealed that the Etest represented a simple and efficacious method for antifungal susceptibility testing of Candida species isolated from oral candidiasis patients. Therefore, voriconazole and amphotericin B should be recommended as effective alternatives for the treatment of oral candidiasis.

Cutaneous Infection Due to Mycobacterium abscessus / 대한피부과학회지

No abstract available.

A Case of Toenail Onychomycosis Due to Aspergillus sydowii Infection / 대한의진균학회지

Onychomycosis is caused by dermatophytes usually, but some species of nondermatophytic molds and yeasts are also associated with invasion of nails. Aspergillus sydowii is a nondermatophytic mold which is opportunistic filamentous fungus in all environments. We report a case of onychomycosis caused by A. sydowii in a 65-year-old male. The patient showed yellowish discoloration with hyperkeratotic change on the distal and lateral portion of both great toenails. Direct microscopic examination of scraping on the potassium hydroxide preparation revealed dichotomous septate hyphae and repeated cultures on Sabouraud dextrose agar showed the same blue green velvety colonies. Biseriate phialides that cover entire vesicle with conidial structure resembling Penicillium were shown in the slide culture. The DNA sequence of internal transcribed spacer (ITS) region of clinical sample was 99% match to that of A. sydowii strain XWSFJJ1 (GenBank accession number FJ461692). We confirmed A. sydowii by KOH mount, colony, light microscopic morphology and DNA sequence analysis. The patient was treated with 250 mg oral terbinafine daily and topical 5% amorolfine nail lacquer for 3 months.

A Clinical and Mycological Study of Onychomycosis in the Elderly Over 10 Years (2001-2010) / 대한의진균학회지

BACKGROUND: As the life expectancy has risen globally because of the advance of medicine, onychomycosis in the elderly has been increasing with higher concerns over nails. Onychomycosis has been studied quite extensively, however, few reports on onychomycosis in a geriatric Korean population have been available. OBJECTIVE: The purpose of this study was to investigate the clinical features of onychomycosis in the elderly compared with other age groups and to identify the etiological agents during 10-year period. METHODS: A total of 629 patients over 65 years of age had been diagnosed with onychomycosis during a 10-year period (2001-2010). The etiological agents were identified by cultures on Sabouraud's dextrose agar with and without cycloheximide. Nondermatophytic molds and yeasts were considered as pathogens, if the identical fungal elements were observed at the initial direct microscopy and repeatedly in specimen-yielding cultures at a follow-up visit. RESULTS: The 629 elderly patients represented 22.1% of all onychomycosis patients. Toenails were involved in 567 (90.1%) patients; fingernails in 39 (6.2%); both toenails and fingernails in 23 (3.7%). The ratio of male to female was 1.01:1. Associated systemic diseases were found in 327 (52.0%) cases. Distal and lateral subungual onychomycosis (80.2%) was the most common clinical type of onychomycosis, followed by TDO (10.7%), SWO (6.2%) and PSO (2.9%). TDO was increasing significantly in the elderly. Organisms causing onychomycosis were dermatophytes (76.5%), yeasts (14.3%) and nondermatophytic molds (9.2%). The most common cause of onychomycosis in the elderly was Trichophyton rubrum. Nondermatophytic molds were more frequently responsible for onychomycosis in the elderly. CONCLUSION: Onychomycosis has been increased in the elderly and there are many differences from other age groups in aspects of clinical features, associated diseases and etiologic agents. Therefore, we suggest the need of a careful mycological examination in the elderly patients with onychomycosis.

Chronic renal failure induces cell death in rat hippocampal CA1 via upregulation of alphaCaMKII/NR2A synaptic complex and phosphorylated GluR1-containing AMPA receptor cascades

BACKGROUND: N-methyl-D-aspartate (NMDA) and alpha-amino-3-hydroxy-5-methyl-isoxazole-4-propinoic acid (AMPA) receptors bound to postsynaptic density-95 (PSD-95) and alpha isoform of calcium/calmodulin-dependent protein kinase II (alphaCaMKII) is fundamentally involved in the regulation of working memory. The aim of present study was to investigate the alterations of NMDA and AMPA receptors responsible for hippocampal synaptic dysfunction and selective neuronal cell death after chronic renal failure (CRF) which may be associated with impairment of working memory. METHODS: Altered interactions between NMDA and AMPA receptors and PSD-95 and alphaCaMKII were analyzed in the cornu ammonis (CA) 1 and CA3/dentate gyrus (DG) subfields of the uremic rat hippocampi using the immunoblotting and immunoprecipitation methods. RESULTS: Uremia induced by CRF produced necrotic cell death and decreased neuronal nucleoli protein levels in the hippocampal CA1 subfield, but not in the CA3/DG subfields. The CA1 subfields of CRF rats exhibited significant decreases and increases, respectively, in the expressions of PSD-95/NR2B and alphaCaMKII/NR2A synaptic complex. Moreover, increased phosphorylation of glutamate receptor type 1 (GluR1) AMPA receptor at ser831 was observed in the CA1 subfield after CRF. CONCLUSION: These hippocampal CA1 neuronal vulnerability may be responsible for memory dysfunction after CRF as mediated by an increase in NR2A-containing NMDA receptors bound to alphaCaMKII and subsequent activation of GluR1-containing AMPA receptors caused by the phosphorylation of GluR1 at ser831.

A Case of Localized Skin Infection Due to Scedosporium apiospermum Diagnosed by DNA Sequencing of the Internal Transcribed Spacer Region / 대한의진균학회지

Scedosporium apiospermum is an asexual state of Pseudallescheria boydii which has been isolated from soil, sewage, and decaying vegetation. It can cause cutaneous infections by traumatic implantation of the contaminant due to penetrating injury. This ubiquitous fungus cause not only mycetoma, but also infections of variety of body sites including the skin. The localized skin infection due to this organism is much rare than mycetoma. We report a case of cutaneous S. apiospermum infection occurred in 80-year-old male. The skin lesion was manifested by a 8.0 x 4.0 cm-sized erythematous plaque with pustules and crusts on the dorsum of right hand. The fungal culture from the biopsy specimen on Sabouraud's dextrose agar showed white to gray colored cottony colonies of S. apiospermum. The nucleotide sequence of internal transcribed spacer for clinical isolate was identical to that of S. apiospermum strain IHEM 23829. The patient was treated with oral fluconazole for 3 months.

Tinea Barbae Caused by Trichophyton verrucosum / 대한의진균학회지

Tinea barbae is a dermatophyte infection of the bearded areas of the face and neck. The incidence of tinea barbae has decreased as improved sanitation. We report a case of tinea barbae in a 58-year-old-man, who presented with relatively well-defined erythematous pustular plaque on the upper lip. A fungal culture from tissue of the lesions was grown on Sabouraud dextrose agar and showed typical Trichophyton verrucosum. The nucleotide sequence of internal transcribed spacer for clinical isolate was identical to that of Trichophyton verrucosum strain ATCC 10695. The patient was treated with oral itraconazole for 3 months. The skin lesions improved 3 months after treatment, and recurrence has not been observed.