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Background@#Antimicrobial prescriptions for serious chronic or acute illness nearing its end stages raise concerns about the potential for futile use, adverse events, increased multidrugresistant organisms, and significant patient and social cost burdens. This study investigated the nationwide situation of how antibiotics are prescribed to patients during the last 14 days of life to guide future actions. @*Methods@#This nationwide multicenter retrospective cohort study was conducted at 13 hospitals in South Korea from November 1 to December 31, 2018. All decedents were included in the study. Antibiotic use during the last two weeks of their lives was investigated. @*Results@#A total of 1,201 (88.9%) patients received a median of two antimicrobial agents during the last two weeks of their lives. Carbapenems were prescribed to approximately half of the patients (44.4%) in the highest amount (301.2 days of therapy per 1,000 patient-days).Among the patients receiving antimicrobial agents, 63.6% were inappropriate and only 327 patients (27.2%) were referred by infectious disease specialists. The use of carbapenem (odds ratio [OR], 1.51; 95% confidence interval [CI], 1.13–2.03; P = 0.006), underlying cancer (OR, 1.56; 95% CI, 1.20–2.01, P = 0.047), underlying cerebrovascular disease (OR, 1.88; 95% CI, 1.23–2.89, P = 0.004), and no microbiological testing (OR, 1.79; 95% CI, 1.15–2.73; P = 0.010) were independent predictors for inappropriate antibiotic prescribing. @*Conclusion@#A considerable number of antimicrobial agents are administered to patients with chronic or acute illnesses nearing their end-of-life, a high proportion of which are prescribed inappropriately. Consultation with an infectious disease specialist, in addition to an antimicrobial stewardship program, may be necessary to induce the optimal use of antibiotics.
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BackgroundVaccination has helped to mitigate the COVID-19 pandemic. Ten traditional and novel vaccines have been listed by the World Health Organization for emergency use. Additional alternative approaches may better address ongoing vaccination globally, where there remains an inequity in vaccine distribution. GBP510 is a recombinant protein vaccine, which consists of self-assembling, two-component nanoparticles displaying the receptor-binding domain (RBD) in a highly immunogenic array. MethodsWe conducted a randomized, placebo-controlled, observer-blinded, phase 1/2 trial to evaluate the safety and immunogenicity of GBP510 (2-doses at a 28-day interval) adjuvanted with or without AS03 in adults aged 19-85 years. The main outcomes included solicited and unsolicited adverse events; anti-SARS-CoV-2 RBD IgG antibody and neutralizing antibody responses; T-cell immune responses. FindingsOf 328 participants who underwent randomization, 327 participants received at least 1 dose of vaccine. Each received either 10 g GBP510 adjuvanted with AS03 (n = 101), 10 g unadjuvanted GBP510 (n = 10), 25 g GBP510 adjuvanted with AS03 (n = 104), 25 g unadjuvanted GBP510 (n = 51), or placebo (n = 61). Most solicited adverse events were mild-to-moderate in severity and transient. Higher reactogenicity was observed in the GBP510 adjuvanted with AS03 groups compared to the non-adjuvanted and placebo groups. Reactogenicity was higher post-dose 2 compared to post-dose 1, particularly for systemic adverse events. The geometric mean concentrations of anti-SARS-CoV-2-RBD IgG antibody reached 2163.6/2599.2 BAU/mL in GBP510 adjuvanted with AS03 recipients (10 g/25 g) by 14 days after the second dose. Two-dose vaccination with 10 g or 25 g GBP510 adjuvanted with AS03 induced high titers of neutralizing antibody via pseudovirus (1369.0/1431.5 IU/mL) and wild-type virus (949.8/861.0 IU/mL) assays. InterpretationGBP510 adjuvanted with AS03 was well tolerated and highly immunogenic. These results support further development of the vaccine candidate, which is currently being evaluated in Phase 3. FundingCoalition for Epidemic Preparedness Innovations RESEARCH IN CONTEXTO_ST_ABSEvidence before this studyC_ST_ABSWe searched PubMed for research articles published by December 31, 2021, using the terms "COVID-19" or "SARS-CoV-2," "vaccine," and "clinical trial." In previously reported randomized clinical trials, we found that mRNA vaccines were more immunogenic than adenovirus-vectored vaccines. Solicited adverse events were more frequent and more severe in intensity after the first dose compared to the second dose for adenovirus-vectored vaccines, whereas they increased after the second dose of mRNA or recombinant spike-protein nanoparticle vaccines. Added value of this studyThis is the first human study evaluating the immunogenicity and safety of recombinant SARS-CoV-2 protein nanoparticle with and without adjuvant AS03, designed to elicit functional cross-protective responses via receptor-binding domain (RBD). Both 10 and 25 g of GBP510 with AS03 formulations were well tolerated with an acceptable safety profile. Potent humoral immune responses against the SARS-CoV-2 RBD were induced and peaked by day 42 (14 days after the second dose). In addition, GBP510 adjuvanted with AS03 elicited a noticeable Th1 response, with production of IFN-{gamma}, TNF-, and IL-2. IL-4 was inconsistent and IL-5 nearly inexistent response across all groups. Implications of the available evidenceThe results from this phase 1/2 trial indicate that GBP510 adjuvanted with AS03 has an acceptable safety profile with no vaccine-related serious adverse events. Two-dose immunization with GBP510 adjuvanted with AS03 induced potent humoral and cellular immune responses against SARS-CoV-2.
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Background@#Coronavirus disease 2019 (COVID-19) is often accompanied by secondary infections, such as invasive aspergillosis. In this study, risk factors for developing COVID-19-associated pulmonary aspergillosis (CAPA) and their clinical outcomes were evaluated. @*Methods@#This multicenter retrospective cohort study included critically ill COVID-19 patients from July 2020 through March 2021. Critically ill patients were defined as patients requiring high-flow respiratory support or mechanical ventilation. CAPA was defined based on the 2020 European Confederation of Medical Mycology and the International Society for Human and Animal Mycology consensus criteria. Factors associated with CAPA were analyzed, and their clinical outcomes were adjusted by a propensity score-matched model. @*Results@#Among 187 eligible patients, 17 (9.1%) developed CAPA, which is equal to 33.10 per 10,000 patient-days. Sixteen patients received voriconazole-based antifungal treatment. In addition, 82.4% and 53.5% of patients with CAPA and without CAPA, respectively, received early high-dose corticosteroids (P = 0.022). In multivariable analysis, initial 10-day cumulative steroid dose > 60 mg of dexamethasone or dexamethasone equivalent dose) (adjusted odds ratio [OR], 3.77; 95% confidence interval [CI], 1.03–13.79) and chronic pulmonary disease (adjusted OR, 4.20; 95% CI, 1.26–14.02) were independently associated with CAPA. Tendencies of higher 90-day overall mortality (54.3% vs. 35.2%, P= 0.346) and lower respiratory support-free rate were observed in patients with CAPA (76.3% vs. 54.9%, P = 0.089). @*Conclusion@#Our study showed that the dose of corticosteroid use might be a risk factor for CAPA development and the possibility of CAPA contributing to adverse outcomes in critically ill COVID-19 patients.
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Background/Aims@#This study aimed to collect information on the opinions of Korean infectious disease (ID) experts on coronavirus disease 2019 (COVID-19) and related issues in preparation for a future outbreak. @*Methods@#A survey was conducted over the course of 5 days (from April 21 to 25, 2020), targeting all adult ID specialists currently in the medical field in South Korea (n = 265). An online-based survey was forwarded via text message and e-mail. Only one response was accepted from each participant. @*Results@#Of these 265 ID specialists gotten to, 132 (49.8%) responded. The highest proportion of the respondents envisaged the current COVID-19 outbreak to end after December 2020 (47.7% for the domestic Korean outbreak and 70.5% for the global pandemic); moreover, 60.7% of them stated that a second nationwide wave is likely to occur between September and December 2020 in South Korea. N95 respirators were considered to be the most important item in hospitals in preparation for a second wave. The most important policy to be implemented at the national level was securing national hospitals designated for the treatment of ID (67.4%). @*Conclusions@#ID experts in South Korea believe that the COVID-19 pandemic may not be easily controlled and that a second nationwide wave is likely to occur in South Korea. Our results indicate that Korean ID specialists believe that a high level of preparation is needed in various aspects, including the procurement of personal protective equipment, to respond efficiently to a second outbreak.
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Anaerobic infections have been reported to be responsible for 3–10% of pyogenic liver abscesses in Korea, and reported anaerobes include Fusobacterium, Bacillus fragilis, and Bacteroides melaninogenicus. Parvimonas micra is an anaerobic, Gram-positive, non-spore-forming bacterial species and a constituent of normal flora on skin, vagina, gastrointestinal tract, and oral cavity that can cause opportunistic infections. However, it has only rarely been reported to be a cause of liver abscess; only one such case has been reported in Korea. We experienced a case of concomitant liver and brain abscesses caused by Parvimonas micra in a non-immunodeficient 65-year-old female patient without diabetes or periodontal disease. Parvimonas micra infection was confirmed by blood culture using VITEK® 2 cards and by bacterial 16s ribosomal RNA gene sequencing. We conclude that we should not overlook anaerobes as a cause of liver abscess.
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Idoso , Feminino , Humanos , Bacillus , Bactérias Anaeróbias , Abscesso Encefálico , Encéfalo , Fusobacterium , Trato Gastrointestinal , Coreia (Geográfico) , Abscesso Hepático , Abscesso Hepático Piogênico , Fígado , Boca , Infecções Oportunistas , Doenças Periodontais , Prevotella melaninogenica , RNA Ribossômico 16S , Pele , VaginaRESUMO
Leuconostoc species are Gram-positive coccobacilli and are used in dairy products and are intrinsically resistant to vancomycin. Leuconostoc infections are rare in humans, usually occurring in immune-compromised patients. We describe 6 patients with Leuconostoc bacteremia at Dong-A university hospital between 1990 and 2015. One isolate (L. lactis) was identified to species level using 16S rRNA gene sequencing analysis. All patients had underlying diseases and 5 patients underwent procedures that interrupted the normal integumentary defense. Four patients died within 30 days after being identified as carrying Leuconostoc species.
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Humanos , Bacteriemia , Laticínios , Genes de RNAr , Leuconostoc , Vancomicina , Resistência a VancomicinaRESUMO
BACKGROUND: To elucidate the clinical presentation, antimicrobial susceptibility, and prognostic factors of monomicrobial Aeromonas bacteremia in order to determine the most effective optimal therapy. MATERIALS AND METHODS: We reviewed the medical records of Aeromonas bacteremia patients for the period January 2000 to December 2013 in a retrospective multi-center study. RESULTS: A total of 336 patient records were reviewed, with 242 having community-acquired bacteremia. The major clinical infections were of the hepatobiliary tract (50.6%) and peritonitis (18.5%), followed by primary bacteremia (17.9%). The infections usually occurred in patients with malignancy (42.3%), hepatic cirrhosis (39.3%), or diabetes mellitus (25.6%). High antimicrobial-resistance rates (15.5% for ceftriaxone, 15.5% for piperacillin/tazobactam) were noted. However, resistance to carbapenem and amikacin was only 9.8% and 3.0%, respectively. Aeromonas hydrophila (58.9%) was the most common pathogen, followed by Aeromonas caviae (30.4%). The severity of A. caviae bacteremia cases were less than that of A. hydrophila or Aeromonas veronii bacteremia (P <0.05). A. hydrophila showed higher antimicrobial resistance than did other Aeromonas species (P <0.05). Patients with hospital-acquired bacteremia were more likely to have severely abnormal laboratory findings and relatively high antimicrobial-resistance rates. Mortality was associated with metastatic cancer, shock, delayed use of appropriate antimicrobial agents, increased prothrombin time, and increased creatinine level (P <0.05). CONCLUSIONS: Aeromonas species should be considered one of the causative agents of bacteremia in patients with intra-abdominal infections or malignancies. Although ceftriaxone-resistant Aeromonas bacteremia was not statistically related to mortality in this study, it was associated with severe clinical manifestations and laboratory abnormalities. Appropriate antibiotics, including carbapenem, should be administered early, especially in Aeromonas bacteremia patients with shock and impaired renal function.
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Animais , Humanos , Aeromonas caviae , Aeromonas hydrophila , Aeromonas , Amicacina , Antibacterianos , Anti-Infecciosos , Bacteriemia , Ceftriaxona , Creatinina , Diabetes Mellitus , Cobaias , Infecções Intra-Abdominais , Coreia (Geográfico) , Cirrose Hepática , Prontuários Médicos , Mortalidade , Peritonite , Tempo de Protrombina , Estudos Retrospectivos , Fatores de Risco , ChoqueRESUMO
Although a decrease in acquired immunodeficiency syndrome (AIDS)-related mortality has been documented in highly active antiretroviral therapy (HAART) era, there are no published data comparing specific causes of death between pre-HAART and HAART era in Korea. Mortality and cause of death were analyzed in three treatment periods; pre-HAART (1990-1997), early-HAART (1998-2001), and late-HAART period (2002-2011). The patients were retrospectively classified according to the treatment period in which they were recruited. Although mortality rate per 100 person-year declined from 8.7 in pre-HAART to 4.9 in late-HAART period, the proportion of deaths within 3 months of initial visit to study hospital significantly increased from 15.9% in pre-HAART to 55.1% in late-HAART period (P < 0.001). Overall, 59% of deaths were attributable to AIDS-related conditions, and Pneumocystis pneumonia (PCP) was the most common cause of death (20.3%). The proportion of PCP as cause of death significantly increased from 8.7% in pre-HAART to 31.8% in late-HAART period (P < 0.001). Despite of significant improvement of survival, there was still a high risk of early death in patients presenting in HAART era, mainly due to late human immunodeficiency virus (HIV) diagnosis and late presentation to care.
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Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome da Imunodeficiência Adquirida/mortalidade , Terapia Antirretroviral de Alta Atividade , Causas de Morte/tendências , Infecções por HIV/tratamento farmacológico , Estimativa de Kaplan-Meier , Pneumonia por Pneumocystis/mortalidade , República da Coreia , Estudos RetrospectivosRESUMO
Scrub typhus is a mite-borne bacterial infection of humans that is caused by Orientia tsutsugamushi, which causes generalized vasculitis. The disease may involve the tissues of any organ system but no case with involvement of the lower gastrointestinal tract has been reported. We report a case of a 39-year old Korean male with enterocolitis of severe scrub typhus, of which the serotype was Ikeda strain. The patient was admitted to hospital with fever, abdominal pain and shock. He developed multi organ failure and frequent watery diarrhea. Abdominal computed tomography revealed diffuse edematous thickening of the entire small and colon with inflammation. Three days after admission, the antibody to O. tsutsugamushi was reported to be 1:320. He improved with doxycycline and azithromycin, and the persistent watery diarrhea stopped at 24 hours. This study shows that scrub typhus should be considered when the small and large intestine are affected. For the genotype of O. tsutsugamushi in Korea, additional studies of the impact of changes in the vector distribution on the genotype distribution will be needed.
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Humanos , Masculino , Dor Abdominal , Azitromicina , Infecções Bacterianas , Colo , Diarreia , Doxiciclina , Enterocolite , Febre , Genótipo , Inflamação , Intestino Grosso , Coreia (Geográfico) , Trato Gastrointestinal Inferior , Orientia tsutsugamushi , Tifo por Ácaros , Choque , Entorses e Distensões , VasculiteRESUMO
Chronic active Epstein-Barr virus (CAEBV) infection is characterized by persistent infectious mononucleosis-like symptoms, an unusual pattern of Epstein-Barr virus (EBV) antibodies, detection of the EBV genome in affected tissues or peripheral blood, and chronic illness that cannot be attributed to any other known disease. This is the first reported Korean case of an immunocompetent adult with CAEBV-associated interstitial pneumonitis. A 28-year-old female was admitted with a fever that persisted for 3 weeks. She had multiple lymphadenopathy, hepatosplenomegaly, pancytopenia, and elevated serum aminotransferase levels. Serology for antibodies was positive and chest computed tomography showed diffuse ground glass opacities in both lungs. Histopathology of the lung tissue showed lymphocyte infiltration, and EBV DNA was detected in those lymphocytes using in situ hybridization with an EBV-encoded RNA probe. After 1 month of hospitalization, she improved without specific treatment.
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Adulto , Feminino , Humanos , Doença Crônica , Infecções por Vírus Epstein-Barr/complicações , Herpesvirus Humano 4 , Imunocompetência , Pneumopatias/etiologia , Doenças Pulmonares Intersticiais/etiologiaRESUMO
BACKGROUND/AIMS: The QuantiFERON-TB Gold (QFT-G) and QuantiFERON-TB Gold in tube (QFT-IT) assays have been studied primarily for the use of diagnosing active pulmonary tuberculosis (TB) or latent TB. The clinical usefulness of these assays for the detection of active extrapulmonary (EP) TB has not been fully defined. The aim of this study was to compare the diagnostic value of these two interferon-gamma assays for EP-TB. METHODS: From June 2007 to August 2010, we evaluated the usefulness of QFT-G (n = 56) and QFT-IT (n = 48) in patients (n = 104) with suspected EP-TB. The diagnostic sensitivity, specificity, postive predictive value (PPV), and negative predictive value (NPV) of QFT-G and QFT-IT, and the cut-off value of QFT-IT were analyzed. RESULTS: EP-TB was diagnosed in 55 (53%) patients. The overall sensitivity, specificity, PPV, and NPV of the QFT-IT assay were 96%, 42%, 62%, and 91%, respectively, and those of the QFT-G test were 81%, 52%, 68%, and 68%, respectively. In subgroup analyses according to infection site, the sensitivity and NPV of QFT-IT were higher than those of QFT-G. Analysis confirmed that the manufacturer's recommended test cut-off value fell within our cut-off value range (0.30-0.45 IU/mL; 95.8% sensitivity, 41.7% specificity). CONCLUSIONS: The QFT-IT assay showed superior sensitivity and NPV, and equivalent specificity, as comparison with the QFT-G test for the detection of Mycobacterium tuberculosis infection. The logistic benefits of the QFT-IT test format should facilitate the diagnosis of EP-TB.
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Humanos , Interferon gama , Linfadenite , Mycobacterium tuberculosis , Sensibilidade e Especificidade , Espondilite , Tuberculose , Tuberculose PulmonarRESUMO
The incidence of imported malaria has been increasing in Korea. We reviewed data retrospectively to evaluate the epidemiology, clinical features, and outcomes of imported malaria from 1995 to 2007 in a university hospital. All patients diagnosed with imported malaria were included. Imported malaria was defined as a positive smear for malaria that was acquired in a foreign country. A total of 49 patients (mean age, 35.7 year; M : F = 38 : 11) were enrolled. The predominant malarial species was Plasmodium falciparum (73.5%), and the most frequent area of acquisition was Africa (55.1%), followed by Southeast Asia (22.4%) and South Asia (18.4%). Fourteen-patients (30.6%) suffered from severe malaria caused by P. falciparum and 1 patient (2.0%) died of multiorgan failure. Most of the patients were treated with mefloquine (79.2%) or quinine (10.2%); other antimalarial agents had to be given in 13.2% treated with mefloquine and 44.4% with quinine due to adverse drug events (ADEs). P. falciparum was the most common cause of imported malaria, with the majority of cases acquired from Africa, and a significant number of patients had severe malaria. Alternative antimalarial agents with lower rates of ADEs might be considered for effective treatment instead of mefloquine and quinine.
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Adulto , Animais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Antimaláricos/efeitos adversos , Coreia (Geográfico)/epidemiologia , Malária Falciparum/tratamento farmacológico , Plasmodium falciparum/efeitos dos fármacos , Estudos Retrospectivos , ViagemRESUMO
BACKGROUND/AIMS: The prevalence of malignancies associated with human immunodeficiency virus (HIV) is rapidly increasing. The aim of the present study was to identify clinical features associated with malignancies in South Korean patients infected with HIV. METHODS: From January 1990 to June 2007, we reviewed an electronic database containing pathological reports obtained from HIV-infected patients and then retrospectively analyzed a total of 27 malignancy cases treated at four different institutions. RESULTS: Among 683 patients infected with HIV, malignant diseases were diagnosed in 27 cases (4.0%). Twenty-five of these patients were male, and the median age was 48 (range; 24-76). At the time of diagnosis, the median CD4+ lymphocyte count was 42/uL (range 3-339). Acquired immune deficiency syndrome (AIDS)-defining malignancies were diagnosed in 13 patients (48%) and non-AIDS-defining malignancies were diagnosed in 14 patients (52%). Two patients each were diagnosed with AIDS-defining and non-AIDS-defining malignancies during the pre-highly active anti-retroviral therapy (HARRT) period. In contrast, 11 patients (48%) and 12 patients (52%) were diagnosed with AIDS-defining and non-AIDS-defining malignancies during the HARRT period, respectively. Among AIDS-defining malignancies, non-Hodgkins lymphoma was the most frequently observed (9/13), followed by Kaposi's sarcoma (4/13). Among the 9 patients with non-Hodgkins lymphoma, diffuse large B-cell lymphoma was most common (5/9), followed by primary CNS lymphoma (3/9) and Burkitt's lymphoma (1/9). Gastrointestinal (GI) malignancies [i.e., gastric cancer (3/14), rectal cancer (3/14), and esophageal cancer (1/14)] and hepatocellular carcinoma (3/14) were the most commonly observed among the non-AIDS-defining malignancies. Other observed non-AIDS-defining malignancies were thyroid cancer (1/14), tonsillar cancer (1/14), angiosarcoma (1/14), and eccrine cancer (1/14). Finally, median CD4+ lymphocyte counts at the time of diagnosis were significantly different (18 vs. 114/uL, p=0.001) between AIDS-defining malignancies and non-AIDS-defining malignancies. CONCLUSIONS: Malignancies were diagnosed in 4.0% of patients infected with HIV. This study showed similar rates of incidence between AIDS-defining and non-AIDS-defining malignancies. Non-Hodgkins lymphoma was the most frequently observed malignancy, whereas GI malignancies and hepatocellular carcinoma were common among non-AIDS-defining malignancies.
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Humanos , Masculino , Síndrome da Imunodeficiência Adquirida , Linfoma de Burkitt , Carcinoma Hepatocelular , Eletrônica , Elétrons , Neoplasias Esofágicas , Hemangiossarcoma , HIV , Incidência , Contagem de Linfócitos , Linfoma , Linfoma de Células B , Linfoma não Hodgkin , Prevalência , Neoplasias Retais , Estudos Retrospectivos , Sarcoma de Kaposi , Neoplasias Gástricas , Neoplasias da Glândula Tireoide , Neoplasias TonsilaresRESUMO
BACKGROUND/AIMS: Toxoplasmic encephalitis (TE) is one of the most common causes of focal brain lesions, which complicate the course of acquired immunodeficiency syndrome (AIDS). There is wide geographic variation in the prevalence of toxoplasma infection. This study was performed to characterize toxoplasma infection in human immunodeficiency virus (HIV)-infected patients in South Korea. METHODS: We retrospectively examined the incidence and clinical characteristics of TE in 683 HIV-infected patients who were enrolled between 1990 and 2008 at four university hospitals in Busan, Korea. We also assessed the seroprevalence of IgG antibodies to Toxoplasma gondii, risk factors for toxoplasma seropositivity, and seroconversion rates during the course of HIV infection. RESULTS: Among 683 HIV-infected patients, six (0.9%) patients were diagnosed with TE. The incidence of TE was 0.34 per 100 person-years (py) during the study period. Of the 414 patients who had undergone serological examinations for Toxoplasma gondii, 35 (8.5%) patients were seropositive. Univariate analysis showed that the risk factors associated with toxoplasma seropositivity included increased age, heterosexual transmission, marriage, and a history of overseas residence (p<0.05). Of these factors, a history of overseas residence was a significant risk factor in a multivariate analysis (p<0.05). A total of 95 patients who were seronegative on their initial screen showed serial toxoplasma IgG antibodies (mean duration of follow-up, 2.1 years). Among these patients, only two (2.1%) acquired IgG antibodies to Toxoplasma gondii during the follow-up period. CONCLUSIONS: The seroprevalence of anti-toxoplasma IgG antibodies in HIV-infected patients in Korea was 8.5%. A history of overseas residence was a significant risk factor for toxoplasma seropositivity. The incidence of TE was 0.34/100 py, which is lower than that reported in other countries. Toxoplasma seroconversion was also uncommon (2.1%).
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Humanos , Síndrome da Imunodeficiência Adquirida , Anticorpos , Encéfalo , Encefalite , Seguimentos , Heterossexualidade , HIV , Infecções por HIV , Hospitais Universitários , Imunoglobulina G , Incidência , Coreia (Geográfico) , Casamento , Análise Multivariada , Prevalência , República da Coreia , Estudos Retrospectivos , Fatores de Risco , Estudos Soroepidemiológicos , ToxoplasmaRESUMO
BACKGROUND/AIMS: Tuberculous meningitis is a common, occasionally fatal infectious disease of the central nervous system. We evaluated the diagnostic validity of weighted diagnostic index scores (WDIS), which have been suggested to aid in the diagnosis of adult patients with tuberculous meningitis, on the basis of simple clinical and laboratory findings. METHODS: The microbiological and clinical data of adult patients with either tuberculous or bacterial meningitis were reviewed retrospectively. Diagnostic validity and WDIS cut-off values were evaluated by receiver operating characteristic (ROC) curve analysis. RESULTS: A total of 77 cases were included: 47 with tuberculous meningitis and 30 with bacterial meningitis. For the diagnosis of tuberculous meningitis, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of WDIS suggested by Thwaites (cut-off value of < or =4) were 100, 90, 94 and 100%, respectively. Based on ROC curve analysis (area under ROC curve=0.993), a cut-off value of < or =3 was most appropriate for the diagnosis of tuberculous meningitis. The sensitivity and specificity of WDIS with a cut-off value of < or =3 were 100 and 93.3%, respectively. CONCLUSIONS: Our study demonstrated that WDIS are highly predictable and acceptable for the early diagnosis of tuberculous meningitis in Korea, based on our analysis of clinical and laboratory findings. A cut-off value of < or =3 showed the best diagnostic validity.
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Adulto , Humanos , Sistema Nervoso Central , Doenças Transmissíveis , Diagnóstico Precoce , Coreia (Geográfico) , Meningites Bacterianas , Estudos Retrospectivos , Curva ROC , Sensibilidade e Especificidade , Tuberculose MeníngeaRESUMO
Waldenstrom macroglobulinemia, which is characterized by elevation of serum monoclonal IgM paraprotein, has recently been responsible for the treatment of purine analogues. Fludarabine, one of purine analogues, has been associated with autoimmune hemolytic anemia in patient with chronic lymphocytic leukemia. However, autoimmune hemolytic anemia after fludarabine treatment for Waldenstrom macroglobulinemia has not been reported. We experienced a case of autoimmune hemolytic anemia after fludarabine treatment for Waldenstrom macroglobulinemia. In this case, hemolytic anemia with positive direct Coombs' test occurred at 20 months after the first administration of fludarabine, relapsed at 5 days after re-administration. This anemia responded to steroid therapy. Autoimmune hemolytic anemia associated with fludarabine therapy can be severe and fatal, especially if a patient is re-treated with this drug after a previous episode of hemolytic anemia.
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Humanos , Anemia , Anemia Hemolítica , Anemia Hemolítica Autoimune , Teste de Coombs , Imunoglobulina M , Leucemia Linfocítica Crônica de Células B , Macroglobulinemia de WaldenstromRESUMO
The group G streptococcal endocarditis is a rare form of infective endocarditis when present, and it is associated with serious neurological complications. Also, endogenous endophthalmitis due to group G streptococcal endocarditis has rarely been reported, and usually leads to total loss of vision. We report a case of group G streptococcal endocarditis which presented clinically as endophthalmitis unrelated to trauma or surgery in a 85-year-old diabetic man.
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Idoso de 80 Anos ou mais , Humanos , Endocardite , EndoftalmiteRESUMO
Prosthetic vascular graft infection (PVGI) is a relatively uncommon complication of peripheral vascular surgery and although rare, is the most severe complication in reconstructive vascular surgery. The early diagnosis of this complication can reduce the mortality. We report a case of aorto-femoral bypass graft infection, which was diagnosed by Tc-99m HMPAO WBC scan, complicated with infective endocarditis. A 60-year-old man had been operated with aortofemoral bypass graft because of aortojejunal fistula due to abdominal aortic aneurysm. Nine months later, he was admitted with fever of two months' duration. On echocardiolography, aortic regurgitation and vegetation were observed, and then he was diagosed with infective endocarditis. He was treated with antibiotics for 6 weeks. Recurrent bacteremia of unknown origin persisted despite antibiotic therapy. Multiple microorganisms were separately isolated from the blood cultures. He complained of intermittent right groin pain. Imaging study (CT, MRI, US) showed no definite evidence of graft infection. However, Tc-99m HMPAO WBC scan demonstrated uptake in the aortofemoral bypass graft site. The patient underwent emergent aortofemoral graft removal with axillobifemoral bypass and right femoropopliteal bypass.
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Humanos , Pessoa de Meia-Idade , Antibacterianos , Aneurisma da Aorta Abdominal , Insuficiência da Valva Aórtica , Bacteriemia , Diagnóstico Precoce , Endocardite , Febre , Fístula , Virilha , Imageamento por Ressonância Magnética , Mortalidade , Tecnécio Tc 99m Exametazima , TransplantesRESUMO
The group G streptococcal endocarditis is a rare form of infective endocarditis when present, and it is associated with serious neurological complications. Also, endogenous endophthalmitis due to group G streptococcal endocarditis has rarely been reported, and usually leads to total loss of vision. We report a case of group G streptococcal endocarditis which presented clinically as endophthalmitis unrelated to trauma or surgery in a 85-year-old diabetic man.