Serotype Distribution and Antimicrobial Resistance of Invasive and Noninvasive Streptococcus pneumoniae Isolates in Korea between 2014 and 2016

BACKGROUND: Several factors contribute to differences in Streptococcus pneumoniae serotype distribution. We investigated the serotype distribution and antimicrobial resistance of S. pneumoniae isolated between 2014 and 2016 in Korea. METHODS: We collected a total of 1,855 S. pneumoniae isolates from 44 hospitals between May 2014 and May 2016, and analyzed the serotypes by sequential multiplex PCR. We investigated the distribution of each serotype by patient age, source of the clinical specimen, and antimicrobial resistance pattern. RESULTS: The most common serotypes were 11A (10.1%), followed by 19A (8.8%), 3 (8.5%), 34 (8.1%), 23A (7.3%), and 35B (6.2%). The major invasive serotypes were 3 (12.6%), 19A (7.8%), 34 (7.8%), 10A (6.8%), and 11A (6.8%). Serotypes 10A, 15B, 19A, and 12F were more common in patients ≤5 years old, while serotype 3 was more common in patients ≥65 years old compared with the other age groups. The coverage rates of pneumococcal conjugate vaccine (PCV)7, PCV10, PCV13, and pneumococcal polysaccharide vaccine 23 were 11.8%, 12.12%, 33.3%, and 53.6%, respectively. Of the 1,855 isolates, 857 (46.2%) were multi-drug resistant (MDR), with serotypes 11A and 19A predominant among the MDR strains. The resistance rates against penicillin, cefotaxime, and levofloxacin were 22.8%, 12.5%, and 9.4%, respectively. CONCLUSIONS: There were significant changes in the major S. pneumoniae serotypes in the community. Non-PCV13 serotypes increased in patients ≤5 years old following the introduction of national immunization programs with the 10- and 13-polyvalent vaccines.

Early diagnostic value of the antimycoplasma antibody (IgM) in Mycoplasma pneumoniae pneumonia: A single-center study in 2015

PURPOSE: Recently, the incidence of refractory Mycoplasma pneumoniae (MP) pneumonia has increased in Korea. Given that its early diagnosis is helpful in selection of the treatment, this study aimed at investigating the value of the antimycoplasma antibody (IgM) for early diagnosis of MP pneumonia. METHODS: A total of 315 children admitted with MP pneumonia from September 2015 to May 2016 were investigated with the IgM and polymerase chain reaction (PCR) for the diagnosis of MP pneumonia. Specifically, patients were grouped into nonrefractory respiratory MP and refractory MP groups according to their response to macrolide therapy. RESULTS: In the 44 PCR-negative seroconversed children, seroconversed IgM was more frequent in the refractory MP group compared with the nonrefractory respiratory MP group with statistical significance (P<0.001). In the 264 IgM-positive children, the time of antibody reaction was more delayed in the refractory MP group compared to the nonrefractory respiratory MP group with statistical significance (P<0.001). CONCLUSION: This study showed that there was a higher incidence of seroconversed IgM and delayed antibody reaction in the refractory MP group. In children with suspect MP pneumonia, follow-up studies of antibody are necessary, even through initial antibody and PCR showed negative findings. In addition, this result may suggest that the diagnosis of refractory MP pneunomia will be helpful in establishing the strategy of the treatment.

Moxibustion Therapy in Traditional Mongolian Medicine / 中国结合医学杂志

From the medical history of traditional Eastern Asian and Tibetan medicine, the origin and development of moxibustion seems to be closely related to Mongolia. To explore the current clinical practice of moxibustion in Mongolia, we visited a teaching hospital, the Traditional Medical Science, Technology and Production Corporation of Mongolia, in February 2014. Many types of moxibustion are found to be used, and various modalities and methods are practiced based on the principles of traditional Mongolian medicine. In particular, Mongolian drug moxibustion, which uses small butter-warmed bags packed with powdered aromatic herbs instead of moxa cones, is a unique moxibustion technique not found in other countries. In this paper, we introduce the clinical practice of moxibustion, specifically Mongolian drug moxibustion in Mongolia.

Clinical difference between single infection and coinfection with respiratory virus: The 2014 single-center study

PURPOSE: We investigated the clinical difference between single infection and coinfection with respiratory virus in hospitalized children with acute respiratory tract infections. METHODS: We reviewed 727 patients who were admitted with the diagnosis of acute respiratory infection at the Department of Pediatrics, Bundang Jesaeng Hospital between January and December of 2014. Diagnoses were made using the multiplex reverse transcriptase polymerase chain reaction (RT-PCR) assay targeting 16 viruses in nasopharyngeal swabs. Subjects were classified as the single virus infection and coinfection groups. RESULTS: A total of 439 patients were enrolled; 359 (77.2%) under 24 months. Single virus was detected in 279 (63.6%). Coinfection with multiple virus was detected in 160 (36.4%): 126 (28.7%) with 2 viruses, 30 (6.8%), and 4 (0.9%) with 3 to 4 viruses. Viral coinfection was detected in 28 samples (17.5%), with respiratory syncytial virus (RSV) A and rhinovirus being the most dominating combination. There were no clinical differences between the single infection and coinfection groups, except sputum and the frequency of high RSV load. Sputum was significantly more frequent in the coinfection group (P=0.043), and the frequency of high RSV load was significantly higher in the single infection group (P=0.029). Disease severity (high fever, the duration of fever [≥5 days], and the length of hospital stay [≥5 days], O₂ therapy) did not differ significantly between both groups. RSV was a frequent virus of single infection during winter. Coinfection was most common in winter. CONCLUSION: There were no clinical differences between single infection and coinfection, except sputum and the frequency of high RSV load.

A Case of Dengue Fever Complicated by Retinitis

Dengue fever is an acute febrile disease caused by the dengue virus. As the numbers of reported patients with dengue fever are increasing, rare complications associated with dengue fever, such as rhabodomyolysis or meningitis, are increasing in Korea. We describe the case of a Korean male presenting with fever, myalgia, nausea, diarrhea and blurred vision, who as a result of serologic test and fundoscopy, was diagnosed with dengue fever complicated by retinitis. He completely recovered with conservative care.

A Case of Diabetic Ketoacidosis Precipitated by Klebsiella Liver Abscess and Brain Abscess / 대한내과학회지

Diabetes mellitus is a known risk factor for Klebsiella pneumoniae liver abscess, and may be associated with metastatic complications. We report a case of diabetic ketoacidosis (DKA) precipitated by a K. pneumoniae liver abscess and followed by a brain abscess. A 31-year-old man with uncontrolled type 2 diabetes was admitted for DKA. Abdominal and pelvic computed tomography scans showed multiple abscesses in the lung, liver, both kidneys, and prostate gland. The blood culture yielded K. pneumoniae. The patient's condition improved following antibiotic and insulin therapy, and he was discharged. However, he was rehospitalized 10 days after discharge due to a generalized tonic-clonic seizure. Brain magnetic resonance imaging revealed a brain abscess in the right basal ganglia. The patient was given an intravenous injection of antibiotics (vancomycin and carbapenem), and he recovered well with no neurological sequelae.

Lot-to-lot Reagent Variation in Immunoassay: Retrospective Analysis of Daily Quality Control Results / 임상검사와정도관리

BACKGROUND: Lot-to-lot reagent reproducibility is an important issue in immunoassays. However, there have been no universal criteria for acceptable lot-to-lot reproducibility. We sought to evaluate the inter-lot reagent difference by analyzing the results of various quality control materials during a certain period of time. METHODS: The results of control materials using different reagent lots and same control lots for immunoassays of HBsAg, anti-HBs, alpha-fetoprotein (AFP), ferritin, and CA 19-9 were analyzed. The average value, standard deviation, and coefficient of variation obtained from each reagent lot were calculated and differences in mean control values between two different reagent lots were assessed. We also analyzed the difference between the last control result using one reagent and the first control result using a new reagent. RESULTS: There was no significant difference in control values among reagent lots during this study period in all immunoassays of HBsAg, anti-HBs, AFP, ferritin, and CA 19-9. Some of the reagents showed statistical differences in QC values, but the difference was not considered clinically different. Also, at the time of reagent lot change, there was no significant difference in reagent parallel tests. CONCLUSIONS: Lot-to-lot reagent variation was not significant in immunoassays evaluated in this study. However, this study has been performed during relatively short period by one to three reagent lot changes, parallel testing should be continuously checked at reagent lot changes in each laboratory for continuous quality assurance. These results can be used as basic data for setting the criteria of acceptance on inter-lot difference in reagent parallel tests.

A case of pylephlebitis with Streptococcus viridans and Bacteroides fragilis bacteremia secondary to diverticulitis / 대한내과학회지

Pylephlebitis, a septic thrombophlebitis of the portal vein or one of its tributaries, is a life-threatening complication of intra-abdominal infection. The causes of pylephlebitis include acute diverticulitis, appendicitis, acute cholecystitis, necrotizing pancreatitis, inflammatory bowel disease, and bowel perforation. Although pylephlebitis is an unusual complication of diverticulitis, its morbidity and mortality remain high. Therefore, early diagnosis and initiation of adequate antibiotic therapy is important for improving the long-term prognosis of patients suffering from this rare disease. We report a case of pylephlebitis with Streptococcus viridans and Bacteroides fragilis bacteremia secondary to diverticulitis with a review of the literature.

A Case of Escherichia Coli Empyema Preceded by Acute Pyelonephritis

We experienced a case of acute pyelonephritis which progressed to Escherichia coli bacteremia and later complicated by empyema in a 65-year-old female. She was successfully treated with intravenous antibiotic therapy and percutaneous drainage of empyema.

A Case of Escherichia Coli Empyema Preceded by Acute Pyelonephritis

We experienced a case of acute pyelonephritis which progressed to Escherichia coli bacteremia and later complicated by empyema in a 65-year-old female. She was successfully treated with intravenous antibiotic therapy and percutaneous drainage of empyema.

A Case of Idiopathic CD4+ T-lymphocytopenia Associated with Autoimmune Hemolytic Anemia / 대한혈액학회지

Idiopathic CD4+ T-lymphocytopenia (ICL) is defined by the CDC as depressed numbers of circulating CD4+ T-lymphocytes (<300 cells/microliter or <20% of the total T cells) on more than one determination, with the absence of HIV infection and other known causes of immunodeficiency. The clinical spectrum of ICL ranges from asymptomatic laboratory abnormalities to severe opportunistic infections that mimic the clinical course of human immunodeficiency virus (HIV) infected patients. There are a few reports of ICL associated with different diseases such as Sjogren's syndrome, pulmonary sarcoidosis, Down syndrome or non-Hodgkin's lymphoma. We describe here a 5-year-old male patient with a three-year history of recurrent otitis media and pulmonary infection, and he was without any risk factors for HIV infection; this patient presented with autoimmune hemolytic anemia and was ultimately found to have idiopathic CD4+ T-lymphocytopenia.

UDP-glucuronosyltransferase 1A1 Gene Polymorphism in Severe Neonatal Hyperbilirubinemia

PURPOSE: TATA box mutation/polymorphism in the promoter region of the bilirubin uridinediphosphoglucuronate glucuronosyltransferase 1A1 (UGT-1A1) gene is known to be an etiology of hyperbilirubinemia. This study examined if a TATA box mutation/polymorphism in UGT-1A1 gene promoter could be associated with the development of severe early neonatal jaundice in Korean infants. METHODS: Thirty-nine neonatal jaundice patients and 40 controlled infants were analyzed for UGT-1A1 promoter genotypes by using DNA sequencing. RESULTS: The homozygote for (TA)7TAA mutation was not found in this study. Comparison of the prevalence of UGT-1A1 promoter (TA)7TAA heterozygotes revealed no difference between the group with jaundice and the controlled group (15.4% vs. 10%). The peak bilirubin level was higher and the onset of jaundice was earlier in the jaundice group with (TA)7TAA heterozygote compared to the jaundice group without (TA)7TAA heterozygote (23.2+/-1.0 mg/dL vs. 19.7+/-2.4 mg/dL, P=0.004, 5.0+/-1.5 days vs. 8.3+/-4.1 days, P= 0.057). CONCLUSION: The results of this study showed that TATA box polymorphism in UGT-1A1 gene promoter did not increase the prevalence of severe early neonatal jaundice in Korean infants.

Analysis of Turnaround Time for Packed Red Blood Cell Delivery by Laboratory Information System: Shortening of Turnaround Time Through Quality Improvement Program / 임상검사와정도관리

BACKGROUND: As transfusion service is linked directly with patient's life and is often a race against time, efforts to shorten the turnaround time (TAT) for every step of transfusion process from blood request to blood transfusion are important. We introduce our experience for analysis and shortening of the packed red blood cell delivery time through quality improvement program for 2 years. METHODS: From January 2003 to December 2004, we evaluated the mean TAT for each step of transfusion process in Bundang Jesaeng General Hospital using the computerized laboratory information system which is capable of recording the exact times of blood request (request), specimen reception (reception), crossmatch completed (preparation), and blood issue (issue). We analyzed the turnaround time of packed red blood issued and notified the obtained data to transfusion-related workers and changes in TATs during the period were evaluated according to the type and place of request. RESULTS: Mean TAT from request to issue was significantly decreased from 174.4 minutes in 2003 to 126.7 minutes in 2004 (p<0.01). TAT from request to reception and TAT from preparation to issue were significantly decreased. No significant difference was observed according to type of request. Mean TAT was different according to place of request, with the operating and recovery room showing the shortest mean TAT from request to issue. CONCLUSIONS: Our computerized TAT data helps us to understand each steps of transfusion process. Continuous monitoring of TAT and periodic publicity to clinical staff and nurse can shorten the mean TAT.

Analysis of Simultaneous Positivity to Multiple Allergens on MAST CLA Test / 대한진단검사의학회지

BACKGROUND: Allergic patients showing a simultaneously positive reaction to multiple allergens are frequently found. The purpose of this study was to analyze the pattern of simultaneously positive results to the allergens of MAST CLA Korean inhalant and food panels. METHODS: From March 2004 to March 2005, we analyzed the results of the MAST CLA allergy test performed at Bundang Jesaeng General Hospital. During this period, 1, 421 inhalant panels and 331 food panels were tested. RESULTS: Mite-farinae (40.3%) and mite-pterony (34.8%) specific IgE were the most frequently detected in the inhalant panel and also in the food panel. Simultaneously positive rates to two or more allergens were 41.9% (595/1421) in the inhalant panel and 32.3% (107/331) in the food panel. Allergens with a highly positive rate (Mite-f, Mite-p, house dust) were frequently detected simultaneously with other allergens, and allergens known to have cross-reactivity showed simultaneously positive results among themselves (i.e. among various pollen allergens; among allergens associated with the pollen-food syndrome; among grain allergens; among milk and cheese; among fungi allergens; among house dust mites and house dust; among cockroach, crab and shrimp; and among cat and dog). CONCLUSIONS: Simultaneous positivity on the MAST CLA allergy test can be found frequently among various allergens, especially allergens with cross-reactivity. More advanced techniques using recombinant allergens may be needed for further analysis of this finding.

Distribution of Alleles and Clinical Manifestation in Patients with Progressive Ataxia Caused by Trinucleotide Repeat Expansion / 대한진단검사의학회지

BACKGROUND: Trinucleotide repeat (TNR) expanded disorders represent a novel class of human mutations, which are characterized by abnormal elongation of the triplet repeat sequence in the human genome and is caused by heritable DNA instability. The aim of this study is to determine the relative frequency, distribution of alleles, and the clinical manifestation of TNR expanded disorders in Korean patients with progressive ataxia. METHODS: A total of 76 clinical specimens that were suspicous of hereditary cerebellar ataxia were submitted from January 1999 to August 2001 and tested for TNR expanded disorders by PCR analysis. RESULTS: Spinocerebellar ataxia (SCA) type 1 was the most common hereditary ataxia (5.3%), while SCA2, SCA3, SCA6, SCA7, and dentatorubral and pallidoluysian atrophy (DRPLA) represented 2.6%, 3.9%, 2.6%, 2.6%, and 1.3% of progressive ataxia patients, respectively. This result is different from previous reports concerning Caucasian, Chinese and Koreans. CONCLUSIONS: This study may provide the basis for the study of TNR expanded disorders in Korean patients. To elucidate the prevalence and frequencies of mutation types in Koreans, a large scale study should be performed.

Evaluation of In-house Lymphocyte Panel of 72 Wells for the Identification of HLA Antibody Specificity / 대한임상병리학회지

BACKGROUND: To detect anti-human leukocyte antigen(HLA) class I alloantibodies in patients awaiting solid organ transplantation, panel reactive antibody(PRA) test using complement-dependent lymphocytotoxicity(CDC) has been used. The enough size of lymphocyte panel in PRA test enables the identification of HLA antibody specificities. So we made lymphocyte panel of 72 wells to evaluate the usefulness comparing with 36 wells screening panel. METHODS: A total of 55 sera(positive 20, negative 25, quality control materials provided by "International Cell Exchange" program of UCLA Tissue Typing Laboratory 10), which had been tested for PRA using 36 wells screening panel, were re-tested using newly produced 72 wells lymphocyte panel. RESULTS: The results of the 25 negative sera were same except one serum, which might be due to non-specific reaction. The %PRA values of the 20 positive sera using 36 wells screening panel were distributed into 1-10%(n=4), 10-50%(n=9), 50-80%(n=5), and 80-100%(n=2). Using lymphocyte panel of 72 wells, %PRA values of 20 positive sera showed no difference(p=0.61) from that of 36 wells and we could not identify the specificity of HLA antibodies for the 10 sera, which previously had not been identified with 36 wells screening panel. But we additionally or newly identified the specificity of HLA antibodies in 4 positive sera and 2 quality control materials. CONCLUSION: Identification of HLA antibodies was not much improved using a PRA test with 72 lymphocyte panel and therefore 36 lymphocyte panel is considered to be enough to screen the HLA antibodies. However the increase of the size of lymphocyte panel is expected to resolve the difficulty, caused by linkage disequilibrium, for the identification of HLA antibody specificity.

Evaluation of Precision Q.I.D(R) Glucose Testing System / 대한임상병리학회지

BACKGROUND: Self-monitoring blood glucose devices are widely used for self-monitoring and point-of-care testing (POCT) in the management of diabetic patients. We performed the present study to evaluate the performance of Precision Q.I.DR Blood Glucose Testing System using electochemical detection techique. METHODS: Precision Q.I.DR was evaluated for linearity, precision, comparison of method, and the effect of sample volume, hematocrit concentration, reapplication, operator, and application methods. RESULTS: Precision Q.I.DR revealed good linearity in glucose concentration ranging from 40 mg/dL to 550 mg/dL (r2=0.9874). In the precision study, within-run and total-run CVs were within 10%. Excellent correlation was found between Precision Q.I.DR and Hitachi 7070 (y = 1.0332 x, r = 0.9195). Sample volume, reapplication, operator, and application method did not produce significant effect on the test result. Over- or underestimation of glucose values was found with the change of hematocrit concentration. CONCLUSIONS: Precision Q.I.DR showed good linearity, precision, and correlation with reference method. No significant effect of testing procedure or operator was found. Precision Q.I.DR provided rapid and reliable result of blood glucose and seems appropriate for clinical use in the management of diabetic patients.