Clinical Features and Risk Factors Associated With 30-Day Mortality in Patients With Pneumonia Caused by Hypervirulent Klebsiella pneumoniae (hvKP)

Background@#Reports on metastatic or invasive infections by hypervirulent Klebsiella pneumoniae (hvKP) have increased recently. However, the effects of its virulence on clinical course and outcomes in pneumonia patients have rarely been addressed. We assessed and compared the clinical features of hvKp and classic K. pneumoniae (cKP) strains isolated from patients with pneumonia caused by K. pneumoniae. We also investigated the effects of virulence factors and the K. pneumoniae capsular serotypes K1 and K2 on mortality. @*Methods@#In this retrospective study, we enrolled 91 patients diagnosed as having pneumonia caused by K. pneumoniae and obtained their demographic and clinical data from medical records. We evaluated genes for K1 and K2, antimicrobial susceptibility, and the virulence genes rmpA, iutA, entB, ybtS, kfu, mrkD, and allS. Strains that possessed rmpA and iutA were defined as hvKP (N=39), while the remaining were classified as cKP (N=52).Odds ratio (OR) for the risk factors associated with 30-day mortality was calculated using the binary logistic regression model. @*Results@#The 30-day mortality in all patients was 23.1%; it was 17.9% (7/39) in the hvKP group and 26.9% (14/52) in the cKP group (P = 0.315). Bacteremia (OR = 38.1; 95% confidence interval [CI], 2.5–570.2), altered mental status (OR = 8.8; 95% CI, 1.7–45.0), and respiratory rate > 30 breaths/min (OR = 4.8; 95% CI, 1.2–20.0) were independent risk factors for 30-day mortality in all patients. @*Conclusions@#Our results suggest that hypervirulence determinants do not have a significant effect on 30-day mortality in patients with pneumonia caused by K. pneumoniae.

First Case of Catheter-related Malassezia pachydermatis Fungemia in an Adult

No abstract available.

ABO*B3.01 Found in the A1B3 Phenotype Showing ABO Discrepancy: The First Case in Korea / 대한수혈학회지

B₃ is a rare finding, but it is most common in the B subgroup, which been reported as being 0.025% of the total B group in Koreans. ABO*B3.01 is a specific allele for B₃, a missense mutation with a substituted thymine from cytosine of the 1,054th nucleotide of the ABO*B.01 allele, but rather unexpectedly, it has not been reported in Koreans. We report here the first Korean case of the serological A₁B₃ phenotype with ABO*B3.01, which was confirmed by sequencing of exons 6 and 7 of the ABO gene, found in a pregnant woman.

First Case of Aureimonas altamirensis Bacteremia in Korea

No abstract available.

The Role of the Signal-to-Cutoff Ratio in Automated Anti-HCV Chemiluminescent Immunoassays by Referring to the Nucleic Acid Amplification Test and the Recombinant Immunoblot Assay

BACKGROUND: Following discontinuation of the recombinant immunoblot assay (RIBA), the only available supplementary test for the detection of hepatitis C virus (HCV) is the nucleic acid amplification test (NAAT). However, the NAAT does not adequately detect past HCV. Consequently, it is hard to distinguish between past HCV infection and biological false positivity with an anti-HCV result alone. We assessed the diagnostic performance of two immunoassays: the ARCHITECT anti-HCV chemiluminescent microparticle immunoassay (CMIA; Abbott Diagnostics, Wiesbaden, Germany) and the Access HCV Ab PLUS chemiluminescent immunoassay (CIA; Bio-Rad, Marnes-la-Coquette, France). We also explored an optimized algorithm to determine the anti-HCV results. METHODS: We tested 126,919 patients and 44,556 individuals who underwent a medical checkup. RIBA and NAAT were conducted for samples that tested anti-HCV-positive using CMIA and CIA. We assessed the optimal signal-to-cutoff (S/CO) ratio in HCV-positive samples. RESULTS: In total, 1,035 blood samples tested anti-HCV-positive. Of these, RIBA was positive in 512, indeterminate in 160, and negative in 363 samples. One hundred sixty-five samples were NAAT-positive. Diagnostic sensitivity and positive predictive value (PPV) were 96.7% and 52.1%, respectively, for CMIA, and 94.7% and 72.3%, respectively, for CIA. The optimal S/CO ratio was 5.2 for CMIA and 2.6 for CIA at 95% PPV. In total, 286 samples tested positive in CMIA and 444 in CIA, while 443 samples tested positive in both assays. CONCLUSIONS: It is hard to determine anti-HCV positivity based on the S/CO ratio alone. However, this study elucidated the role of the S/CO ratio by using the NAAT and RIBA.

Elimination of Causative Antibody by Plasma Exchange in a Patient with an Acute Hemolytic Transfusion Reaction / 대한수혈학회지

An ABO-incompatible transfusion is a very rare event but it can cause severe adverse effects, including death. The prognosis is affected by various factors, such as the volume of infusion, underlying diseases, and immunologic state. Until now, however, there has been no consensus regarding the treatment of an ABO-incompatible transfusion except for conservative treatment. A 57 year-old male patient visited the authors' emergency unit with multiple trauma due to a car accident. He had a deep laceration on his left neck accompanied by severe bleeding. Because of his low blood pressure and low hemoglobin level due to bleeding, an emergency transfusion was attempted. Unfortunately, one unit of RBC was transfused incorrectly into the patient due to a clerical error during the identification of the patient. The patient was typed as O, RhD positive; the RBC administered was A, RhD positive. After the transfusion, the patient showed an acute hemolytic transfusion reaction due to gross hematuria. Plasma exchange was attempted and medical treatment with high dose steroid with diuretics was done simultaneously. Two cycles of plasma exchange were done and the patient appeared to recover from the acute adverse effects of the transfusion. The plasma exchange was stopped and medical treatments for the transfusion reactions were maintained for ten days. The patient recovered fully and was discharged after one month. Based on this case, although more studies are necessary for approval as a standard therapy, this case suggests that immediate plasma exchange with medical treatment can be very helpful for eliminating the isoagglutinins in ABO-incompatible transfusions.

Concurrence of e1a2 and e19a2 BCR-ABL1 Fusion Transcripts in a Typical Case of Chronic Myeloid Leukemia

No abstract available.

Measurement Uncertainty in Spine Bone Mineral Density by Dual Energy X-ray Absorptiometry

BACKGROUND: The purpose of this study was to calculate the measurement uncertainty of the process of bone mineral density (BMD) analysis using dual energy X-ray absorptiometry with traceability. METHODS: Between March 2015 and October 2016, among healthy participants in their 20s and 30s, the study included those who had not taken calcium, vitamin D supplements and steroids and were without a history of osteoporosis, osteopenia and diseases related to osteoporosis. Relational expression of the model was established based on Guide to the Expression of Uncertainty in Measurements and Eurachem and the uncertainty from each factor was evaluated. RESULTS: The combined standard uncertainty was 0.015, while the expanded uncertainty was 0.0298. The factor-specific standard uncertainties that occurred in the process of measuring BMD were 0.72% for the calibration curve, 0.9% for the internal quality control (IQC) using Aluminum Spine Phantom, 0.58% for European Spine Phantom (ESP), and 0.9% for the inspector precision (IP). CONCLUSIONS: The combined standard uncertainty of the spine BMD corrected with ESP was 0.015 when measured at one time and targeting one participant. The uncertainties of the accuracy of the IQC and the IP were higher than that of the other factors. Therefore, there will be a need for establishment of protocols to lower these uncertainties.

Rosuvastatin Reduces Blood Viscosity in Patients with Acute Coronary Syndrome

BACKGROUND AND OBJECTIVES: Wall shear stress contributes to atherosclerosis progression and plaque rupture. There are limited studies for statin as a major contributing factor on whole blood viscosity (WBV) in patients with acute coronary syndrome (ACS). This study investigates the effect of statin on WBV in ACS patients. SUBJECTS AND METHODS: We prospectively enrolled 189 consecutive patients (mean age, 61.3±10.9 years; 132 males; ST-segment elevation myocardial infarction, n=52; non-ST-segment elevation myocardial infarction, n=84; unstable angina n=53). Patients were divided into two groups (group I: previous use of statins for at least 3 months, n=51; group II: statin-naïve patients, n=138). Blood viscosities at shear rates of 1 s-1 (diastolic blood viscosity; DBV) and 300 s-1 (systolic blood viscosity; SBV) were measured at baseline and one month after statin treatment. Rosuvastatin was administered to patients after enrollment (mean daily dose, 16.2±4.9 mg). RESULTS: Baseline WBV was significantly higher in group II ([SBV: group I vs group II, 40.8±5.9 mP vs. 44.2±7.4 mP, p=0.003], [DBV: 262.2±67.8 mP vs. 296.9±76.0 mP, p=0.002]). WBV in group II was significantly lower one month after statin treatment ([SBV: 42.0±4.7 mP, p=0.012, DBV: 281.4±52.6 mP, p=0.044]). However, low-density lipoprotein cholesterol level was not associated with WBV in both baseline (SBV: R2=0.074, p=0.326; DBV: R2=0.073, p=0.337) and after one month follow up (SBV: R2=0.104, p=0.265; DBV: R2=0.112, p=0.232). CONCLUSION: Previous statin medication is an important determinant in lowering WBV in patients with ACS. However, one month of rosuvastatin decreased WBV in statin-naïve ACS patients.

Sepsis Due to Rhodotorula mucilaginosa in a Patient with Advanced Non-Small Cell Lung Cancer

Rhodotorula species are round to oval-shaped, multilateral budding, encapsulated yeasts that produce urease and do not ferment carbohydrates. Rhodotorula species form characteristic salmon-pink colored colonies owing to carotenoid pigment production. These yeasts form a part of the normal flora of moist skin and are found in the environment. Rhodotorula was traditionally considered a contaminant but is now progressively recognized as a human pathogen, especially in immunocompromised patients with central venous catheters. However, isolation of Rhodotorula species from blood has been very rarely reported in Korea. We report a case of sepsis due to Rhodotorula mucilaginosa infection in a patient who had received chemotherapy and supportive care for non-small cell lung cancer.

Eggerthella lenta Bacteremia after Endoscopic Retrograde Cholangiopancreatography in an End-Stage Renal Disease Patient / 대한임상미생물학회지

Eggerthella lenta is rarely isolated from blood but may occur as an opportunistic pathogen with high morbidity and mortality. We report a case of E. lenta bacteremia after an endoscopic retrograde cholangiopancreatography in an end-stage renal disease patient.

Relationship between Serum Gamma-glutamyltransferase Levels within Reference Intervals and the Prevalence of Metabolic Syndrome and Diabetes Mellitus in Adults

BACKGROUND: This study was conducted to establish reference intervals (RIs) for serum gamma-glutamyltransferase (GGT), and to evaluate the association between serum GGT levels within RIs and the prevalence of metabolic syndrome (MetS) and type 2 diabetes mellitus (DM) in men and women. METHODS: A total of 363 healthy adults (137 men and 226 women) were enrolled for establishing the RIs of serum GGT. A cross-sectional study was conducted with 919 individuals (519 men and 400 women) to evaluate the associations between gender-specific serum GGT RI quartiles and prevalence of MetS and DM. RESULTS: The RIs for serum GGT levels (central 95th percentile ranges) were 9.0-70.6 IU/L and 4.0-31.3 IU/L in men and women, respectively. In men, the odds ratios (ORs) and 95% confidence intervals (CIs) for the prevalence of MetS in 4 serum GGT quartiles (lowest to highest) were 1.0 (reference), 3.6 (0.7-18.0), 8.8 (2.0-39.1), and 17.4 (4.0-75.3), respectively, while the ORs (95% CIs) for the prevalence of DM were 1.0 (reference), 1.0 (0.3-3.0), 1.7 (0.6-4.6), and 2.6 (1.0-6.6), respectively. In women, the corresponding ORs (95% CIs) were 1.0 (reference), 3.3 (0.6-16.6), 5.8 (1.2-27.3), and 18.8 (4.3-82.2) for MetS, respectively, and 1.0 (reference), 1.6 (0.3-9.7), 1.6 (0.3-9.9), and 8.0 (1.7-36.7) for DM, respectively. These significant relationships persisted after adjusting for age, alcohol intake, body mass index, and smoking. CONCLUSIONS: Serum GGT levels, even within RIs, were proportionally associated with prevalence of metabolic syndrome and DM in both men and women. Serum GGT level may be an independent predictor for chronic degenerative diseases.

A Case of Diabetic Foot Ulcer Caused by Arcanobacterium haemolyticum and Streptococcus agalactiae / 대한임상미생물학회지

Arcanobacterium haemolyticum, a aerobic Gram-positive rod, has been described as an unusual pathogen causing soft tissue infections such as pharyngotonsillitis, chronic ulcer and cellulitis. In addition, the microorganism causes deep-seated infection and systemic disease including endocarditis, vertebral osteomyelitis and sepsis in patients with predisposing conditions such as diabetes mellitus. Since colonies and microscopic findings of A. haemolyticum might be confused with those of streptococci and coryneform bacteria, and it is usually isolated with other microorganisms, it is often considered to be normal flora or a contaminant in wound infections, resulting in missed or delayed diagnosis. Streptococcus agalactiae infections in neonates and pregnant women have been well recognized. However, invasive S. agalactiae infections in non-pregnant older adults with chronic medical conditions, particularly diabetes mellitus, are increasing. We report a case of diabetic foot ulcer due to A. haemolyticum and S. agalactiae in an uncontrolled diabetes mellitus patient.

Two Cases of Anti-Jka Whose Reactivity Was Disappeared after Enzyme Treatment / 대한수혈학회지

We report on two cases of anti-Jka, whose reactivity disappeared on an antibody identification test using enzyme-treated red cells. One of two patients was a 72-year-old female with cirrhosis of the liver and colon cancer, and the other was a 55-year-old female with known MDS and incomplete Behcet's disease. Results of an antibody identification test using a LISS/Coombs gel card (DiaMed AG) showed negative to one positive with red cells having the Jka antigen; however, all reactions using the enzyme-treated cells showed negative results, which was unexpected. The patients' RBC phenotype was Jk(a-b+). We obtained positive results in reactions of enzyme-treated Jka+ cells and EDTA using a patient's serum and proved that the cause of the negative reaction might be complement-related.

Bacteremia Detected by a Peripheral Blood Smear in a Pediatric Surgical Patient with Thrombocytopenia / 대한임상미생물학회지

Microscopic examination of peripheral blood smear (PBS) for detection of microorganisms is simple method that can be used for doctors to confirm the septicemia more swiftly and to select more specific therapy. But it is unusual to find microorganisms in PBS. We report a case of gram negative bacteremia diagnosed by PBS in a severe thrombocytopenic pediatric surgical patient. A 6-month and 2 week old baby with cyanosis was diagnosed congenital heart diseases such as transposition of great arteries, atrial septal defect, and patent ductus arteriosus. The infant underwent surgical operations and the postoperative platelet count progressively decreased in spite of transfusion of multiple platelet concentrates. We performed routine examination of a PBS for evaluation of severe thrombocytopenia. The PBS revealed severe thrombocytopenia, leukopenia with left shifted and some extracellular bacilli. Toxic granulations, toxic vacuoles and some bacilli were observed in the neutrophils. The bacilli were identified as Pseudomonas aeruginosa and Serratia marcescens in blood culture. To our knowledge, this is the second case of bacteremia diagnosed by PBS before the positive blood culture in Korea. We suggest that a PBS is useful for the rapid detection of organisms in cases of septicemia with severe thrombocytopenic pediatric surgical patient.

Molecular Genetic Analysis of the Ryanodine Receptor Gene (RYR1) in Korean Malignant Hyperthermia Families / 대한진단검사의학회지

BACKGROUND: Malignant hyperthermia (MH) is genetically heterogeneous, with mutations in the gene encoding the skeletal muscle ryanodine receptor (RYR1) at 19q13.1 accounting for up to 80% of the cases. However, the search for known and novel mutations in the RYR1 gene is hampered by the fact that the gene contains 106 exons. We aimed to analyze mutations from the entire RYR1 coding region in Korean MH families. METHODS: We investigated seven affected MH individuals and their family members. The entire RYR1 coding region from the genomic DNA was sequenced, and RYR1 haplotyping and mutational analysis were carried out. RESULTS: We identified nine different RYR1 mutations or variations from seven Korean MH families. Among these, five previously reported mutations (p.Gly248Arg, p.Arg2435His, p.Arg2458His, p.Arg2676Trp, and p.Leu4838Val) and four novel variations of unknown significance (p.Arg2508Cys, p.Met4022Val, p.Glu2669Lys, and p.Ala4295Val) were identified. In two families, two variations (R2676W & M4022V, R2435H & A4295V, respectively) were identified simultaneously. Four of the observed nine mutations or variations were located outside the hotspot region of RYR1 mutations. CONCLUSIONS: These data indicate that RYR1 is a main candidate gene in Korean MH families, and that comprehensive screening of the entire coding sequence of the RYR1 gene is necessary for molecular genetic investigations in MH-susceptible individuals, owing to the presence of RYR1 mutations or variations outside of the hotspot region.

A Case of Vancomycin-Induced Thrombocytopenia / 대한혈액학회지

Immune thrombocytopenia is a rare complication associated with vancomycin. A 76-year-old male patient who was treated with vancomycin experienced severe thrombocytopenia and refractoriness as a result of platelet transfusion. Vancomycin-dependent antibodies in his thrombocytopenic serum were detected by flow cytometric analysis. The mechanism of thrombocytopenia is probably related to immunological destruction, as strongly suggested by its association with a specific drug-dependent anti-platelet antibody.

Concentrations of Blood Vitamin A, C, E, Coenzyme Q10 and Urine Cotinine Related to Cigarette Smoking Exposure / 대한진단검사의학회지

BACKGROUND: In smokers, smoking causes many disease entities including cancers, chronic pulmonary diseases and cardiovascular diseases. Passive smoking is also accepted as a carcinogen and its adverse health effects are emphasized. We measured blood vitamin A, C, E (alpha-, beta- and gamma-tocopherol), coenzyme Q10 and urine cotinine concentrations in nonsmokers and smokers. METHODS: Twenty-one healthy nonsmokers and 24 healthy smokers were included in this study. Smoking status was assessed with a self-reported questionnaire. Plasma was analyzed for coenzyme Q10 and serum for vitamin A, C, E using HPLC (Agilent Technologies Inc., USA) and random urine for cotinine using LC/tandem mass spectrometry (Applied Biosystems Inc., Canada). RESULTS: Smokers had significantly lower serum concentrations of vitamin C than nonsmokers (P=0.0005). No significant differences in concentrations of serum vitamin A, E, and plasma coenzyme Q10 were observed. Smokers had highly elevated urine cotinine levels (1,454+/-903 ng/mL). In 16 (76.2%) of 21 nonsmokers, urine cotinine was detected (3.25+/-4.08 ng/mL). The correlations between urine cotinine and blood antioxidants levels were not found. Neither, the correlation between smoking status and blood antioxidants & urine cotinine was found. CONCLUSIONS: This study shows that smokers had significantly lower vitamin C levels among nonenzymatic antioxidants, namely, vitamin A, C, E and coenzyme Q10. High detection rate of urine cotinine in nonsmokers show the seriousness of passive smoking exposure, therefore more social efforts should be directed to reduce passive smoking exposure.

A Double Mutation of the Ryanodine Receptor Type 1 Gene in a Malignant Hyperthermia Family with Multiminicore Myopathy

BACKGROUND AND PURPOSE: At least 100 Ryanodine receptor type 1 (RYR1) mutations associated with malignant hyperthermia (MH) and central core disease (CCD) have been identified, but 2 RYR1 mutations accompanying multiminicore myopathy in an MH and/or CCD family have been reported only rarely. METHODS: Fifty-three members of a large MH family were investigated with clinical, histopathologic, RYR1 mutation, and haplotyping studies. Blood creatine kinase (CK) and myoglobin levels were also measured where possible. RESULTS: Sequencing of the entire RYR1 coding region identified a double RYR1 mutation (R2435H and A4295V) in MH/CCD regions 2 and 3. Haplotyping analysis revealed that the two missense heterozygous mutations (c.7304G>A and c.12891C>T) were always present on a common haplotype allele, and were closely cosegregated with histological multiminicores and elevated serum CK. All the subjects with the double mutation showed elevated serum CK and myoglobin, and the obtained muscle biopsy samples showed multiminicore lesions, but only two family members presented a late-onset, slowly progressive myopathy. CONCLUSIONS: We found multiminicore myopathy with clinical and histological variability in a large MH family with an unusual double RYR1 mutation, including a typical CCD-causing known mutant. These results suggest that multiminicore lesions are associated with the presence of more than two mutations in the RYR1 gene.

Impact of Visceral Fat on the Metabolic Syndrome and Nonalcoholic Fatty Liver Disease

Visceral fat has been reported to be associated with nonalcoholic fatty liver disease (NAFLD) and the metabolic syndrome (MetS). We assessed the prevalence of both NAFLD and the MetS, measured visceral fat thickness VFT), and estimated the physical activity indexes of 224 relatively healthy hospital workers. We also investigated the associations between both VFT and physical activity index and each of NAFLD and the MetS. The MetS was diagnosed according to the guidelines outlined by the Adult Treatment Panel III, and NAFLD was diagnosed by ultrasonography. Subjects with hepatitis B and C infections and those reporting moderate alcohol consumption were excluded from the study. The prevalence of the MetS was 11.6% and that of NAFLD was 41.5%. Many subjects with the MetS had NAFLD (73.1%), and some subjects with NAFLD (20.4%) also had several components of the MetS (p=0.001). VFT was significantly increased by both the addition of components of the MetS and the severity of NAFLD (p<0.001). In addition, VFT was independently associated with NAFLD (odds ratio [OR], 1.10; 95% confidence interval [CI], 1.02-1.19) in subjects with more than 2 components of the MetS. In contrast, habitual physical activity was reversely associated with NAFLD (OR, 0.29; 95% CI, 0.10-0.87). In conclusion, an increased visceral fat content and reduced physical activity could be not only biological markers but also therapeutic targets in the treatment of NAFLD and the MetS.