A Case of Vibrio parahaemolyticus Septicemia in a Patient with Liver Cirrhosis / 대한임상미생물학회지

V. parahaemolyticus was isolated from blood culture of a 34-year old female patient with HCV viral hepatitis and liver cirrhosis. V. parahaemolyticus is one of the frequent causative agents of gastrointestinal infection, but rarely causes septicemia. This case is thought to be the 3rd report of V. parahaemolyticus septicemia in Korea.

The Quantitative Evaluation of Optic Ne rve Head of Normal Tension Glaucoma

It is known that optic disc morphology is different between high tension glaucoma[HTG]and normal tension glaucoma[NTG]. We quantitatively evaluated optic nerve head by confocal scanning laser ophthalmoscope [CSLO]to determine if substantial morphological differences between the HTG and the NTG could be identified. 21 patients[21 eyes]in the early NTG and 32 patients[32 eyes]in the early HTG were matched for visual field defect[MD>-10dB].The optic nerve head was evaluated by Heidelberg Retina Tomograph[HRT]and 12parameters provided by HRT were compared between NTG and HTG. The mean age of patients was 56.6 +/-13.6 years in NTG and 48.9 +/-14.7 years in HTG, respectively[p>0.05].Mean MD was -5.4 +/-1.9dB in the NTG, -5.0 +/-2.5dB in the HTG, respectively[p>0.05]. Disc area was slightly lager in the NTG than in the HTG, but the difference did not reach statistical significance[p>0.05].The neuroretinal rim area was significantly larger in the NTG than in the HTG[p<0.05], whereas the mean cup depth was significantly smaller in the NTG than in the HTG[p<0.05].Among the 12 parameters, cup area, rim area, cup volume, mean cup depth, and maximum cup depth in the NTG had significant correlations with CPSD in the visual field index.These findings further support the hypothesis that there may be different mechanisms in the glaucomatous optic nerve damage.

The Effect of Environmental Humidity on LASIK Results

It is known that humidity in the laser room might affect the outcomes of excimer laser refractive surgery. This study evaluated the outcomes of laser in situ keratomileusis (LASIK)according to humidity changes in laser room. Hinged flap was made by SCMD turbokeratome and photoablation was performed by utilizing VISX 20/20 excimer laser system. The differences between targeted refraction and actual refractive error, namely, refractive correction errors (defined by authors)were calculated. We have divided LASIK patients into two groups. Group A consisting of 61 eyes of 31 patients underwent LASIK when laser room humidity was over 70% (average 73%) and Group B includes 49 eyes of 28 patients when laser room humidity was under 40% (average 35%). Each group was broken into two subgroups, that is high myopia (> or= -6 D)and mild to moderate myopia ( or= -6 D)was 1.28+/-1.42 D in the group A (n=46 eyes)and 1.99 +/-1.38 D in the group B (n= 26 eyes). In both groups, the difference between two subgroups was statistically significant and high myopes group B was overcorrected compared with ones in group A (t-test, p0.05). The proper room humidity is critical for LASIK results, particularly in the high myopia (> or= -6 D)because humidity can affect outcomes of LASIK. Therefore, the humidity should be maintained properly for enhancement of surgical outcome predictability in the high myopia.

A Case of Leclercia adecarboxylata Isolated from Dialysate in a Patient with Continuous Ambulatory Peritoneal Dialysis / 대한임상미생물학회지

A 60-year-old male with continuous ambulatory peritoneal dialysis was admitted because of abdominal discomfort and turbid dialysate. He had a history of chronic renal failure due to diabetic nephropathy. His WBC count of perpheral blood was 8,500/mm3 (neutrophil 92%), and that of dialysate was 1,400/mm3 (polymorphonuclear leukocyte 69%, lymphocyte 31%). Pure growth of Leclercia adecarboxylata was isolated from dialysate. The L. adecarboxylata isolate was susceptible to ampicillin, ampicillin/sulbactam, cephalothin, cefoperazone, cefoxitin, cefotaxime, ceftazidime, aztreonam, imipenem, gentamicin, tobramycin, amikacin, tetracycline, trimethoprim- sulfamethoxazole and ciprofloxacin. Cephalothin & amikacin were added into dialysate, and his clinical symptoms and turbidity of dialysate were resolved. L. adecarboxylata has been rarely isolated from clinical specimens. To our knowledge, this is the first report of L. adecarboxylata isolated from clinical specimen in Korea. On review of the world literature, we found only 7 cases of L. adecarboxylata infections. This microorganism has been isolated from lower extremity wounds and sputum as part of a mixed flora in 3 cases and 1 case, respectively, but it was the only microorganism isolated from cultures of blood in 3 cases. These 3 patients with bacteremia due to L. adecarboxylata had severe underlying diseases, and clinical symptoms were developed after invasive procedures. All of the L. adecarboxylata isolates from clinical specimens were susceptible to antimicrobial agents tested, and the responses to antibiotic therapy were excellent. It is difficult to identify this organism because its biochemical reactions are similar to those of Escherichia coli, therefore careful identification is required. And additional studies are necessary to determine the pathogenic potential and route of infection of this organism.

PPrevalence of Staphylococcus aureus Isolates with Decreased Susceptibility to Teicoplanin and Evaluation of Methods for Detection / 감염

BACKGROUND: The purpose of this study was to investigate the prevalence of Stap hylococcus aureus with decreased susceptibility to glycopeptides in Korea and to evaluate the methods for detection. METHODS: From March to May 1998, 106 clinical isolates of S. aureus were collected from patients of the Kosin Medical Center . Antimicrobial susceptibilities for vancomycin and teicoplanin were determined by NCCLS disc diffusion method and the MICs were determined by agar dilution method. Correlation between both results was evaluated. RESULTS: MICs of vancomycin and teicoplanin against S. aureus isolates were 0.5 ~2 microgram/mL and 0.25 ~8 microgram/mL. Some S. aureus isolates showed decreased susceptibility to teicoplanin (MIC 4 microgram/mL, 33 strains; MIC 8 microgram/mL, 1 strain), but none showed decreased susceptibility to vancomycin. A positive correlation was observed between the inhibitory zone diameters of teicoplanin disc and the MICs of teicoplanin(P< 0.0 1). Inhibitory zone diameter differences between vancomycin and teicoplanin discs also showed a positive correlation with the MICs of teicoplanin (P< 0.01). Strains whose inhibitory zone diameters of teicoplanin disc were less than 16 mm, the sensitivity and positive predictive value for the detection of strains with MICs more than 4 microgram/mL were 100 % (34/ 34) and 43% (34/ 79), respectively. In strains with inhibitory zone diameter difference of more than 4 mm, the sensitivity and positive predictive value of detection in MICs of more than 4 microgram/mL were 94 % (32/ 34) and 70 % (32/46), respectively. CONCLUSION: Although S. aureus with intermediate or full resistance to glycopeptides was not isolated in this study, few strains had decreased susceptibility to teicoplanin. We conclude that when the inhibitory zone diameters of teicoplanin disc are less than 16 mm or inhibitory zone diameter difference between vancomycin and teicoplanin discs is more than 4 mm, the presence of S. aureus isolates with decreased susceptibility to teicoplanin should be suspected.