Effect of Early Plasma Exchange on Survival in Patients with Severe Fever with Thrombocytopenia Syndrome: A Multicenter Study.

Despite a high mortality rate, no specific treatment for severe fever with thrombocytopenia syndrome (SFTS) has been established. This study compared the clinical outcomes of SFTS patients treated with plasma exchange (PE group) with those who were not treated (non-PE group) at nine Korean hospitals between May 2013 and August 2015. A total of 53 SFTS patients were included: 24 (45.3%) PE cases and 29 (54.7%) non-PE cases. The overall in-hospital mortality rate was 32.1% (17/53). The in-hospital mortality rate of the PE group did not differ from that of the non-PE group (29.3% vs. 34.5%, p=0.680). Of the 24 PE cases, 16 (66.7%) were treated with PE within 7 days of symptom onset (early PE group). The early PE group survived longer than the non-PE group (mean 28.4 days vs. 22.6 days, p=0.044). Multivariate analysis showed an inverse association between early PE implementation and 30-day mortality (adjusted hazard ratio 0.052, 95% confidence interval 0.004-0.678, p=0.024). The results of this study suggest that early PE implementation may have a beneficial effect on the clinical outcome of SFTS patients.

First case of Bartonella quintana endocarditis in Korea.

Since microbial gene sequencing was utilized for etiologic diagnosis of culture-negative endocarditis, cases of Bartonella endocarditis have been reported in various countries. Herein we report the first case of Bartonella quintana endocarditis, which was confirmed for the first time in Korea by 16S rRNA gene sequencing from the excised valve. A 75-yr-old woman was hospitalized due to dyspnea. Echocardiography demonstrated large oscillating vegetation at the aortic valve. Blood culture was negative. She underwent valve replacement and sequencing of the 16S rRNA gene from excised valve identified Bartonella quintana. She was successfully treated with combined use of ceftriaxone and gentamicin.

First report of vancomycin-intermediate resistance in sequence type 72 community genotype methicillin-resistant Staphylococcus aureus.

Vancomycin-intermediate resistance has not been previously reported among sequence type 72 (ST72) methicillin-resistant Staphylococcus aureus (MRSA) isolates of SCCmec type IV (ST72-MRSA-IV), which are distinctive community genotype strains in Korea. We report the first case of vancomycin treatment failure due to development of vancomycin-intermediate resistance in infection caused by an ST72-MRSA-IV isolate.

Clinical predictors of community-genotype ST72-methicillin-resistant Staphylococcus aureus-SCCmec type IV in patients with community-onset S. aureus infection.

OBJECTIVES: Community-genotype methicillin-resistant Staphylococcus aureus (MRSA) clones have emerged in the community worldwide and recently have been spreading into the hospitals. To identify predictors of sequence type 72-MRSA-SCCmec type IV (ST72-MRSA-IV) in patients with community-onset (CO) S. aureus infection, a case-control study was conducted among CO S. aureus infections, including healthcare-associated infections. METHODS: Eighty-four patients with CO infections caused by ST72-MRSA-IV strains in Korea between 2007 and 2009 were selected as cases. Members of the control group were those with CO methicillin-susceptible S. aureus infections and they were matched by the admission date in a 1 : 1 ratio. RESULTS: The most common type of infection was skin and soft tissue infection in both groups (48.8% versus 52.4%), followed by pneumonia. Female sex (OR 2.55, 95% CI 1.30-5.04), severe sepsis or septic shock (OR 3.05, 95% CI 1.09-8.55), prior hospitalization within the previous year (OR 2.18, 95% CI 1.10-4.32) and surgical site infection (SSI) (OR 4.63, 95% CI 1.38-15.59) were associated with ST72-MRSA-IV infections in multivariate analyses. CONCLUSIONS: Female sex, SSI, severe sepsis or septic shock and prior hospitalization within the previous year were predictors of ST72-MRSA-IV among patients with CO S. aureus infection.

Repeated isolation of Pseudomonas aeruginosa isolates resistant to both polymyxins and carbapenems from 1 patient.

Emergence of polymyxin resistance in carbapenem-resistant isolates is a great concern in clinical settings because it may mean the end of treatment options against Gram-negative bacterial infections. Polymyxin-nonsusceptible and -susceptible Pseudomonas aeruginosa isolates resistant to carbapenems and harboring bla(IMP-6) were alternatively isolated from a patient. In vitro antimicrobial susceptibility testing, multilocus sequence typing, and pulsed-field gel electrophoresis were performed. Metallo-ß-lactamase genes such as bla(IMP), bla(VIM), bla(SPM), bla(GIM), and bla(SIM) and bla(OXA-50) were detected by polymerase chain reaction. Sequences of 2-component systems, PmrAB and PhoPQ, were also determined. All showed ST235 and the same pulsotype. Amino acid substitutions were identified in PmrB and PhoP from polymyxin-nonsusceptible isolates. Colistin exposure might be associated with the recovery of polymyxin-nonsusceptible isolates in this patient.

Invasive paranasal mucormycosis with peripheral eosinophilia in an immunocompetent patient.

A 53-year-old healthy patient was admitted with unilateral nasal obstruction of one month duration which was suspected to be a malignancy because of mass-like finding on radiology and peripheral eosinophilia. The biopsy of the involved sinus showed tissue invasion by aseptate hyphae suggestive of a zygomycete and tissue infiltration of eosinophilia. He was diagnosed as invasive paranasal mucomycosis and treated with complete endoscopic sinus surgery and amphotericin B deoxycholate. Paranasal symptoms with peripheral eosinophilia might be a presentation of invasive fungal sinusitis.

Isolated cerebellar reversible leukoencephalopathy syndrome in a patient with end stage renal disease.

We report an adult end-stage renal disease patient with only cerebellum involvement of reversible posterior leukoencephalopathy syndrome (RPLS). A 37-year-old woman, diagnosed as chronic glomerulonephritis, was admitted to our hospital with progressive visual disturbance and severe headache. MRI revealed hyperintense signal intensity changes restricted in the cortex and subcortical white matter of the cerebellum. With appropriate control of blood pressure and intracranial pressure, her symptoms were improved and complete resolution of previous hyperinternse lesion was shown on MRI after the 19th day of admission. This is first case of isolated cerebellar involvement of RPLS without other cerebral involvement in an adult.