ABSTRACT
BACKGROUND: From May to July 2015, the Republic of Korea experienced the largest outbreak of Middle East respiratory syndrome (MERS) outside the Arabian Peninsula. A total of 186 patients, including 36 deaths, had been diagnosed with MERS-coronavirus (MERS-CoV) infection as of September 30th, 2015. MATERIALS AND METHODS: We obtained information of patients who were confirmed to have MERS-CoV infection. MERS-CoV infection was diagnosed using real-time reverse-transcriptase polymerase chain reaction assay. RESULTS: The median age of the patients was 55 years (range, 16 to 86). A total of 55.4% of the patients had one or more coexisting medical conditions. The most common symptom was fever (95.2%). At admission, leukopenia (42.6%), thrombocytopenia (46.6%), and elevation of aspartate aminotransferase (42.7%) were observed. Pneumonia was detected in 68.3% of patients at admission and developed in 80.8% during the disease course. Antiviral agents were used for 74.7% of patients. Mechanical ventilation, extracorporeal membrane oxygenation, and convalescent serum were employed for 24.5%, 7.1%, and 3.8% of patients, respectively. Older age, presence of coexisting medical conditions including diabetes or chronic lung disease, presence of dyspnea, hypotension, and leukocytosis at admission, and the use of mechanical ventilation were revealed to be independent predictors of death. CONCLUSION: The clinical features of MERS-CoV infection in the Republic of Korea were similar to those of previous outbreaks in the Middle East. However, the overall mortality rate (20.4%) was lower than that in previous reports. Enhanced surveillance and active management of patients during the outbreak may have resulted in improved outcomes.
Subject(s)
Humans , Antiviral Agents , Aspartate Aminotransferases , Coronavirus Infections , Disease Outbreaks , Dyspnea , Extracorporeal Membrane Oxygenation , Fever , Hypotension , Leukocytosis , Leukopenia , Lung Diseases , Middle East Respiratory Syndrome Coronavirus , Middle East , Mortality , Pneumonia , Polymerase Chain Reaction , Republic of Korea , Respiration, Artificial , ThrombocytopeniaABSTRACT
BACKGROUND: Burn wounds lack normal barriers that protect against pathogenic bacteria, and burn patients are easily colonized and infected by Staphylococcus aureus. Toxic shock syndrome (TSS) is a rare but fatal disease caused by S. aureus. A lack of detectable antibodies to TSS toxin-1 (TSST-1) in serum indicates susceptibility to TSS. METHODS: A total of 207 patients (169 men and 38 women; median age, 42.5 yr) admitted to a burn center in Korea were enrolled in this study. The serum antibody titer to TSST-1 was measured by sandwich ELISA. S. aureus isolates from the patients' nasal swab culture were tested for TSST-1 toxin production by PCR-based detection of the TSST-1 toxin gene. RESULTS: One hundred seventy-four (84.1%) patients showed positive results for antibody against TSST-1. All patients aged > or =61 yr (n=28) and <26 months (n=7) were positive for the anti-TSST-1 antibody. S. aureus was isolated from 70 patients (33.8%), and 58.6% of the isolates were methicillin resistant. Seventeen patients were colonized with TSST-1-producing S. aureus. The antibody positivity in these 17 carriers was 88.2%, and the positivity in the non-carriers was 83.7%. CONCLUSIONS: Most burn patients had antibody to TSST-1, and nasal colonization with TSST-1-producing S. aureus was associated with positive titers of anti-TSST-1 antibody. Additionally, patients with negative titers of anti-TSST-1 antibody might be susceptible to TSS.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Young Adult , Antibodies, Bacterial/blood , Bacterial Toxins/genetics , Burns/blood , Enterotoxins/genetics , Enzyme-Linked Immunosorbent Assay , Nasal Cavity/microbiology , Polymerase Chain Reaction , Prevalence , Staphylococcal Infections/epidemiology , Staphylococcus aureus/isolation & purification , Superantigens/geneticsABSTRACT
BACKGROUND: Interferon-gamma assays based on tuberculosis (TB)-specific antigens have been utilized for diagnosing and ruling out latent TB and active TB, but their utility is still limited for TB incidence countries. The aim of this study is to understand the clinical utility of enzyme-linked immunospot (ELISpot) assays among patients with clinically suspected TB and healthy adults in clinical practices and community-based settings. METHODS: The ELISpot assays (T SPOT.TB, Oxford Immunotec, UK) were prospectively performed in 202 patients. After excluding those with indeterminate results, 196 were included for analysis: 41 were TB patients, 93 were non-TB patients, and 62 were healthy adults. RESULTS: The sensitivity and negative predictive values of the T SPOT.TB assays for the diagnosis of TB were 87.8% and 89.1%, respectively, among patients with suspected TB. The agreement between the tuberculin skin test (10-mm cutoff) and the T SPOT.TB assay was 66.1% (kappa=0.335) in all participants and 80.0% (kappa=0.412) in TB patients. Among those without TB (n=155), a past history of TB and fibrotic TB scar on chest X-rays were significant factors that yielded positive T SPOT.TB results. There was a significant difference in the magnitude of T SPOT.TB spot counts between TB patients and non-TB patients or healthy adults. CONCLUSION: The T SPOT.TB assay appeared to be a useful test for the diagnostic exclusion of TB. A positive result, however, should be cautiously interpreted for potential positives among those without active TB in intermediate TB incidence areas.
Subject(s)
Adult , Humans , Cicatrix , Diagnosis , Enzyme-Linked Immunospot Assay , Incidence , Interferon-gamma , Prospective Studies , Skin Tests , Thorax , Tuberculin , TuberculosisABSTRACT
BACKGROUND: The study on bacteremia helps empirically select the proper antibiotics before the results of culture test about causative pathogen. The purpose of this study is to investigate causative pathogen in bloodstream infection, changing aspects based on elapsed time after burn, relationship with other sites and resistance of important causative pathogen against antibiotics through analysis on bacteria isolated from blood culture of patients hospitalized in burn intensive care unit (BICU). MATERIALS AND METHODS: A retrospective study was conducted targeting patients hospitalized in BICU from January 2007 to June 2011. Changes of causative pathogen in bloodstream infection based on elapsed time after injury were analyzed. We would like to examine the relationship between bloodstream infection and infection on other body parts by comparing results of cultures in burn wound site, sputum, urine and catheter tip. Antibiotics resistance patterns of Pseudomonas aeruginosa, Acinetobacter baumannii, Staphylococcus aureus, Enterococcus species, and Klebsiella pneumoniae were studied. RESULTS: A total of 2,337 burn patients were hospitalized in BICU for 54 months. Causative pathogen was cultured in blood cultures from 397 patients (17.0%). P. aeruginosa (169, 30.1%) was the most cultured and A. baumannii (107, 19.0%) and S. aureus (81, 14.4%) were followed. It was confirmed that the relative frequency of A. baumannii tended to get lower as the period got longer after injury, but the relative frequency of K. pneumoniae got higher as the period got longer after injury. With comparison without bacteremia, P. aeruginosa bacteremia showed high probability in which the same bacteria were cultured in wound site, sputum and cathether tip, and A. baumannii bacteremia and candida bacteremia had high probability in sputum, and urine and catheter tip, respectively. 95.9% of P. aeruginosa and 95.3% of A. baumannii showed the resistance against carbapenem. 96.3% of S. aureus was methicillin resistant and 36.2% of Enterococcus species were vancomycin resistant. 75.0% of K. pneumonia were extended-spectrum beta-lactamase (ESBL)-producing bacteria. CONCLUSIONS: Since the highly antibiotic resistant microorganisms were isolated from the patients hospitalized in BICU during early phase, the empirical selection of antibiotics targeting these pathogens should be considered before the results of microbiologic culture test. In addition, use of empirical antifungal agent after 1 week of injury can be considered for patients who have risk factor of fungal infection.
Subject(s)
Humans , Acinetobacter baumannii , Anti-Bacterial Agents , Bacteremia , Bacteria , beta-Lactamases , Burns , Candida , Catheters , Critical Care , Enterococcus , Human Body , Intensive Care Units , Klebsiella pneumoniae , Methicillin Resistance , Pneumonia , Pseudomonas aeruginosa , Retrospective Studies , Risk Factors , Rivers , Sputum , Staphylococcus aureus , VancomycinABSTRACT
We report a rare synchronous presentation of primary lung cancer and adrenal pheochromocytoma. A 59-year-old woman was diagnosed with right upper lobe non-small cell lung carcinoma measuring 2.8 cm and a right adrenal gland mass measuring 3.5 cm, which displayed increased metabolic activity on 18F-fluorodeoxyglucose positron emission tomography-computed tomography. The adrenal lesion was revealed to be asymptomatic. The patient underwent right adrenalectomy and histological examination revealed a pheochromocytoma. Ten days later, right upper lobectomy was performed for lung cancer. This case indicates that incidental adrenal lesions found in cases of resectable primary lung cancer should be investigated.
Subject(s)
Female , Humans , Adrenal Glands , Adrenalectomy , Electrons , Lung , Lung Neoplasms , PheochromocytomaABSTRACT
The campaign for proper use of antibiotics in Korea was begun in 2011 by the Korean Society of Infectious Diseases and the Korean Society of Chemotherapy. This article was prepared as a review of worldwide antibiotic campaigns. The European Antibiotic Awareness Day of the European Union and Get Smart: Know When Antibiotics Work, of the USA, are introduced here. These antibiotic campaigns are prepared and organized by government and have partnerships with medical association. The event known as annual awareness day or antibiotic week is held annually and the campaign materials are available online or from printed material. These campaigns have widened the range and depth of activity since the begining of the campaign. Therefore, the Korean antibiotic campaign could obtain some useful suggestions regarding successful conduct of campaign activity from these campaigns.
Subject(s)
Anti-Bacterial Agents , Communicable Diseases , European Union , KoreaABSTRACT
Actinomyces israelii is a normal flora of the oral cavity and gastrointestinal tract, and can cause chronic suppurative granuloma. We report here on a case of tongue actinomycosis. The patient was a 71-year old woman who had undergone surgery for rectal cancer 4 years previously. During the follow-up study using PET-CT, hypermetabolic activities were recognized at the lung hilum, mediastinum and tongue base. Bronchoscopic biopsy sample of the tongue base ulcer revealed histopathologically sulfur granule and aggregations of filamentous bacteria was diagnosed as actinomycosis of the tongue.
Subject(s)
Female , Humans , Actinomyces , Actinomycosis , Bacteria , Biopsy , Follow-Up Studies , Gastrointestinal Tract , Granuloma , Lung , Mediastinum , Mouth , Rectal Neoplasms , Sulfur , Tongue , UlcerABSTRACT
PURPOSE: Pulmonary infiltrates are often encountered in mechanically ventilated burned patients and represent a challenge for pulmonologists and burn intensivists. The etiology is often multiple and empiric therapy is frequently initiated on the basis of clinical diagnosis, which is of uncertain accuracy. This approach can lead to inadequate treatment with increasing the risks of possible adverse events, while potentially reversible causes may be unrecognized. We performed bronchoalveolar lavage (BAL) study to know the causes of lung infiltration in severely burned patients. METHODS: From August 2003 to August 2008, severely burned patients who have been managed in burn intensive care unit (ICU) and shown diffuse lung infiltration during the courses were included prospectively. BAL was used to make the diagnosis of the respiratory infection, with 104> or = organisms considered a positive result. We also analyzed BAL isolates such as fungus, atypical pathogens and virus. RESULTS: Total 50 patients (M 43, F 7) were enrolled. The percent of total body surface area burn was 48.1+/-19.0% and APACHE II score was 10.0+/-5.6. Overall mortality was 64% (32 cases). 44 cases (88%) met criteria for positive BAL culture and 12 cases (24%) of those were combined with alveolar hemorrhage. The frequent bacterial isolates were Acinetobacter species in 19 cases (38%), Pseudomonas aeruginosa in 18 cases (36%) and methicillin-resistant Staphylococcus aureus in 14 cases (28%). Through BAL study, respiratory viruses were isolated in 15 cases (30%), and Legionella pneumonia, Tuberculosis and Pneumocystis pneumonia were reported in one of each (2%). CONCLUSION: BAL seems to be a useful tool for identifying infectious pathogens and may give guidance for adequate choices of antimicrobial agents in severely burned patients with diffuse lung infiltrations.
Subject(s)
Humans , Acinetobacter , Anti-Infective Agents , APACHE , Body Surface Area , Bronchoalveolar Lavage , Burns , Fungi , Hemorrhage , Intensive Care Units , Legionella , Lung , Methicillin-Resistant Staphylococcus aureus , Pneumonia , Pneumonia, Pneumocystis , Prospective Studies , Pseudomonas aeruginosa , Tuberculosis , VirusesABSTRACT
BACKGROUND: In pulmonary infection, serum procalcitonin levels increase rapidly, probably in response to sepsis-related cytokine release from neuroendocrine cells of bronchial epithelium and inflammatory cells. We applied procalcitonin assay in critically ill patients with bacterial pneumonia. MATERIALS AND METHODS: Patients admitted to the intensive care unit (ICU) and show diffuse infiltrations in their chest X-ray were included. Quantitative bronchoalveolar lavage (BAL) culture (> or =10(4) CFU/mL) was performed in all cases on the 5th day of ICU admission. We excluded patients with structural lung disease, non-infectious lung infiltrations, and atypical infections such as Mycobacterium tuberculosis, Pneumocystis jiroveci, and viruses. Serum procalcitonin levels were measured semi-quantitatively by using PCT-Q kit. RESULTS: A total of 28 adult patients (M:F=23:5) were included: 11 (39.3%) medically-ill patients, 7 (25%) surgically-ill patients, and 10 (35.7%) burn patients. Serum procalcitonin level was or =0.5 ng/mL in the remaining half of the cases. Compared to those with serum procalcitonin level of or =0.5 ng/mL had more frequent mechanical ventilation, higher CRP/APACHE II scores/number of organ failure (P or =0.5 ng/mL. CONCLUSIONS: High serum procalcitonin level seems to be closely associated with the severity and poor prognosis in critically ill patients with bacterial pneumonia. However, pneumonia could not be excluded with low level of procalcitonin among ICU patients.
Subject(s)
Adult , Humans , Bronchoalveolar Lavage , Burns , Calcitonin , Critical Illness , Epithelium , Intensive Care Units , Lung , Lung Diseases , Mycobacterium tuberculosis , Neuroendocrine Cells , Pneumocystis carinii , Pneumonia , Pneumonia, Bacterial , Prognosis , Protein Precursors , Respiration, Artificial , ThoraxABSTRACT
BACKGROUND: In pulmonary infection, serum procalcitonin levels increase rapidly, probably in response to sepsis-related cytokine release from neuroendocrine cells of bronchial epithelium and inflammatory cells. We applied procalcitonin assay in critically ill patients with bacterial pneumonia. MATERIALS AND METHODS: Patients admitted to the intensive care unit (ICU) and show diffuse infiltrations in their chest X-ray were included. Quantitative bronchoalveolar lavage (BAL) culture (> or =10(4) CFU/mL) was performed in all cases on the 5th day of ICU admission. We excluded patients with structural lung disease, non-infectious lung infiltrations, and atypical infections such as Mycobacterium tuberculosis, Pneumocystis jiroveci, and viruses. Serum procalcitonin levels were measured semi-quantitatively by using PCT-Q kit. RESULTS: A total of 28 adult patients (M:F=23:5) were included: 11 (39.3%) medically-ill patients, 7 (25%) surgically-ill patients, and 10 (35.7%) burn patients. Serum procalcitonin level was or =0.5 ng/mL in the remaining half of the cases. Compared to those with serum procalcitonin level of or =0.5 ng/mL had more frequent mechanical ventilation, higher CRP/APACHE II scores/number of organ failure (P or =0.5 ng/mL. CONCLUSIONS: High serum procalcitonin level seems to be closely associated with the severity and poor prognosis in critically ill patients with bacterial pneumonia. However, pneumonia could not be excluded with low level of procalcitonin among ICU patients.
Subject(s)
Adult , Humans , Bronchoalveolar Lavage , Burns , Calcitonin , Critical Illness , Epithelium , Intensive Care Units , Lung , Lung Diseases , Mycobacterium tuberculosis , Neuroendocrine Cells , Pneumocystis carinii , Pneumonia , Pneumonia, Bacterial , Prognosis , Protein Precursors , Respiration, Artificial , ThoraxABSTRACT
Burn patients are highly susceptible to infection because they are generally immunosuppressed and have open wound of avascular and necrotic tissue. The sources of burn wound infection are the health care workers, the environment and the patients themselves. Protection from cross-contamination, using effective antimicrobial agents, early escharectomy and closure of wound, proper antimicrobial prophylaxis, and frequent evaluation of burn wound are important for preventing burn wound infection.
Subject(s)
Humans , Anti-Infective Agents , Burns , Delivery of Health Care , Wound InfectionABSTRACT
Background: Nosocomial pneumonia in an intensive care unit (ICU) is associated with a high mortality rate. Diagnosing a respiratory tract infection in critically ill patients is still difficult but detailed information for the pathogens is needed to establish an adequate antimicrobial treatment. This study examined the causative organisms and their antimicrobial resistance using bronchoalveolar lavage (BAL) from patients suspected of having pneumonia in the ICU. Methods: From January 2004 to June 2006, ICU patients with diffuse lung infiltration were prospectively enrolled. The BAL was used to diagnose the respiratory infection, with 104 > or = organisms considered a positive result. The most common organisms and their antimicrobial resistances were analyzed from the quantitative BAL cultures in the burn ICU and non-burn ICU. Results: A total 72 patients were included, 35 (M 29, F 6) in the burn ICU and 37 (M 26, F 11) in the non-burn ICU. 27 patients (77.1%) in the burn ICU and 22 patients (59.5%) in the non-burn ICU met the criteria for a positive BAL culture. The major pathogens were Staphylococcus aureus, Acinetobacter species and Pseudomonas aeruginosa. All strains (100%) of Staphylococcus aureus isolated from BAL (9 cases) were methicillin-resistant (MRSA) in the burn ICU, but 5 strains (71.4%, 7 cases) were MRSA in the non-burn ICU. Regarding Pseudomonas aeruginosa, the rate of resistance to amikacin, ciprofloxacin, cefepime, imipenem, ceftazidime, piperacillin/tazobactam in the burn and non-burn ICU ranged from 45.5% to 90% and 25% to 50%, respectively. In addition, the rate of resistance of Acinetobacter species to the above drugs in the burn and non-burn ICU ranged from 81.8% to 100% and 62.5% to 100%, respectively. Conclusions: These results are expected to provide useful guidelines for choosing the effective empirical antimicrobial therapy in patients with lung infiltrations in the burn and non-burn ICU.
Subject(s)
Humans , Acinetobacter , Amikacin , Bacteria , Bronchoalveolar Lavage , Burns , Ceftazidime , Ciprofloxacin , Critical Illness , Imipenem , Intensive Care Units , Critical Care , Lung , Methicillin Resistance , Methicillin-Resistant Staphylococcus aureus , Mortality , Pneumonia , Prospective Studies , Pseudomonas aeruginosa , Respiratory Tract Infections , Staphylococcus aureusABSTRACT
BACKGROUND: Vancomycin-resistant enterococci (VRE) are multi-drug resistant organisms that have emerged as important nosocomial pathogens in recent years. Patients with burn injury are highly vulnerable to VRE infection. We evaluated the colonization and infection rate of VRE among severe burn patients. MATERIALS AND METHODS: We retrospectively reviewed VRE isolation in a tertiary hospital burn center from January 2000 to December 2003. We analyzed and compared the clinical characteristics of VRE colonized (isolated in rectal swab) and infected patients. We also analyzed the risk factors of mortality in VRE infection group by using univariate and multivariate analyses. RESULTS: VRE was isolated from 104 of severe burn patients. Mean percent of total body surface area of 104 patients was 45.43+/-22.15%. The most commonly isolated VRE was Enterococcus faecium (82.6%). The VRE infection rate of VRE colonization group was 19/93 (20.4%). There were no differences in clinical characteristics, underlying conditions, and isolates species between VRE colonization and infection groups. The mortality rate of VRE infection group was 40%. The risk factors for mortality were bacteremia (P=0.001) and mechanical ventilation (P=0.024) in univariate analysis. However, independent risk factor for death was only VRE bacteremia [odd ratio=32.803, 95% confidence interval (2.884, 373.129), P=0.005] in multivariate analysis. CONCLUSION: Significant portion of severe burn patients with VRE colonization could progress to VRE infection. Severe burn patients with VRE bacteremia have higher risk of death than patients without VRE bacteremia.
Subject(s)
Humans , Bacteremia , Body Surface Area , Burn Units , Burns , Colon , Enterococcus , Enterococcus faecium , Mortality , Multivariate Analysis , Respiration, Artificial , Retrospective Studies , Risk Factors , Tertiary Care Centers , Vancomycin ResistanceABSTRACT
BACKGROUND: Vancomycin-resistant enterococci (VRE) are multi-drug resistant organisms that have emerged as important nosocomial pathogens in recent years. Patients with burn injury are highly vulnerable to VRE infection. We evaluated the colonization and infection rate of VRE among severe burn patients. MATERIALS AND METHODS: We retrospectively reviewed VRE isolation in a tertiary hospital burn center from January 2000 to December 2003. We analyzed and compared the clinical characteristics of VRE colonized (isolated in rectal swab) and infected patients. We also analyzed the risk factors of mortality in VRE infection group by using univariate and multivariate analyses. RESULTS: VRE was isolated from 104 of severe burn patients. Mean percent of total body surface area of 104 patients was 45.43+/-22.15%. The most commonly isolated VRE was Enterococcus faecium (82.6%). The VRE infection rate of VRE colonization group was 19/93 (20.4%). There were no differences in clinical characteristics, underlying conditions, and isolates species between VRE colonization and infection groups. The mortality rate of VRE infection group was 40%. The risk factors for mortality were bacteremia (P=0.001) and mechanical ventilation (P=0.024) in univariate analysis. However, independent risk factor for death was only VRE bacteremia [odd ratio=32.803, 95% confidence interval (2.884, 373.129), P=0.005] in multivariate analysis. CONCLUSION: Significant portion of severe burn patients with VRE colonization could progress to VRE infection. Severe burn patients with VRE bacteremia have higher risk of death than patients without VRE bacteremia.