Eggerthella Lenta Bacteremia after Appendectomy in a Healthy Patient / 대한내과학회지

Eggerthella lenta (E. lenta) has been reported to cause bacteremia in patients with gastrointestinal tract disorders or malignancies and in immunocompromised patients. Cases of E. lenta have been increasing with the recent development of testing equipment. The mortality rate due to E. lenta bacteremia is high. The authors report a case of E. lenta bacteremia in an immunocompetent patient.

Eggerthella Lenta Bacteremia after Appendectomy in a Healthy Patient / 대한내과학회지

Eggerthella lenta (E. lenta) has been reported to cause bacteremia in patients with gastrointestinal tract disorders or malignancies and in immunocompromised patients. Cases of E. lenta have been increasing with the recent development of testing equipment. The mortality rate due to E. lenta bacteremia is high. The authors report a case of E. lenta bacteremia in an immunocompetent patient.

Septicemia Caused by Neisseria meningitidis With Decreased Ciprofloxacin Susceptibility: The First Case Report in Korea

No abstract available.

Disseminated Gonococcal Infection Presenting as Bacteremia and Liver Abscesses in a Healthy Adult

Herein, we describe a bacteremia caused by Neisseria gonorrhoeae that presented as liver abscesses. The patient had no risk factors for disseminated gonococcal infection. Periodic fever, skin rashes, and papules were present and the results of an abdominal computed tomography scan indicated the presence of small liver abscesses. The results of blood culture and 16S rRNA sequencing of the bacterial isolates confirmed the presence of N. gonorrhoeae. The patient improved with antibiotic therapy.

Nasal Deformity Due to Tuberculous Chondritis

Tuberculosis (TB) is a common disease worldwide. However, nasal TB is quite rare, and the diagnosis of nasal TB requires a high index of suspicion. The most common symptoms of this unusual presentation are nasal obstruction and nasal discharge. We present a case of nasal TB with involvement of the hard palate presenting with a chronically progressive nasal deformity and ulceration of the hard palate. A biopsy confirmed the diagnosis, and medication for TB was started and the lesions resolved. When a patient presents with chronic ulcerative lesions that do not respond to antibiotic treatment, TB should be included in the differential diagnosis. Biopsy of the lesion can aid in the confirmation of the diagnosis.

A Case of Colon Cancer Associated with Streptococcus gallolyticus Subspecies pasteurianus Bacteremia / 대한내과학회지

Streptococcus Gallolyticus subspecies pasteurianus is a biotype II/2 of Streptococcus bovis. Although there is a clear correlation between Streptococcus bovis bacteremia and the risk of developing colon cancer, the relationship between Streptococcus gallolyticus subspecies pasteurianus bacteremia and colon cancer is not clear. We report a 53-year-old female who initially presented with fever and low back pain. Streptococcus gallolyticus subspecies pasteurianus was isolated in blood cultures, so we performed a colonoscopy and discovered colon cancer.

Epidemiology and Clinical outcomes of Invasive Pulmonary Aspergillosis: A Nationwide Multicenter Study in Korea

BACKGROUND: Invasive pulmonary aspergillosis (IPA) is an important cause of morbidity and mortality in immunocompromised patients. However, few data on clinical characteristics and outcomes of IPA in Korea have been reported. We conducted a nationwide multicenter study in Korea for evaluation of the epidemiology and clinical outcomes of invasive pulmonary aspergillosis. MATERIALS AND METHODS: A retrospective cohort study was conducted in 10 hospitals in Korea. We reviewed all adult patients who met the revised EORTC/MSG definitions between 2008 and 2010. RESULTS: A total of 334 cases, which included proven (26, 8%), probable (159, 48%), or possible (149, 44%) IPA, were identified. Patients with proven or probable IPA were evaluated, and, of these 185 IPA patients, 105 (57%) had neutropenia, 30 (16%) underwent hematopoietic stem cell transplantation, 25 (14%) underwent solid organ transplantation, and 32 (17%) without neutropenia and transplantation received immunosuppressive agents or corticosteroid. Aspergillus spp. were isolated from 42 patients (23%), and positive fungal culture rates from sterile fluid, sputum, and bronchoalveolar lavage fluid (BAL) were 67% (6/9), 21% (32/150), and 20% (9/44), respectively. Results of assays for sensitivity of serum and BAL galactomannan were 84% (155/184) and 89% (25/28), respectively. Amphotericin-B deoxycholate and itraconazole were most commonly administered as a primary therapy in 107 (58%) and 34 (19%) patients, respectively. Of 133 patients (73%) who received salvage therapy after primary antifungal therapy for a median period of six days (IQR 3-12), 82 (62%) patients were treated with voriconazole. Of 185 patients, 82 (44%) died within three months after diagnosis of IPA. CT findings, including small airway lesions and micronodules, ground glass opacities, and pleural effusion and persistent positive galactomannan status showed an independent association with worse outcome, while proven diagnosis of IPA showed an independent association with better outcome. CONCLUSIONS: Microbiologic confirmation of IPA was low in Korea; therefore, many Korean physicians were dependent on the galactomannan assay for microbiologic diagnosis. Primary therapy with Amphotericin-B deoxycholate followed by salvage therapy with voriconazole was the most common antifungal strategy for treatment of patients with IPA in Korea. Overall mortality and IPA-related mortality were comparable with data from Western clinical trials.

Liver Abscess Caused by Listeria monocytogenes : A Case Report

Listeria monocytogenes has been recognized as a pathogen in elderly and immunecompromised hosts with malignancies, alcohol abuse, diabetes mellitus, transplanted organs, liver cirrhosis, renal failure, or acquired immunodeficiency syndrome (AIDS). In adults, it usually presents as neuromeningeal infection, such as meningitis, meningoencephalitis, or encephalitis, or as primary bacteremia. Involvement of the liver with L. monocytogenes is uncommon. We report on a case of multiple liver abscesses and bacteremia associated with L. monocytogenes in a 67-year-old diabetic female with concomitant active multidrug-resistant pulmonary tuberculosis. Blood cultures were positive for L. monocytogenes. In patients with liver abscess with advanced age or who are immune-compromised, including those with diabetes, clinicians should consider Listeria infection as a differential diagnosis.

Unusual Primary Peritonitis due to Streptococcus pyogenes in a Young Healthy Woman

We describe the first case of primary peritonitis in Korea of a healthy person due to Streptococcus pyogenes. In the absence of comorbid conditions, such as liver cirrhosis, immunosuppression, or nephrotic syndrome, primary peritonitis is uncommon in a young healthy woman. Abdomen computed tomography revealed ascites in the lower abdomen and peritoneal enhancement suggesting peritonitis. In diagnostic laparoscopy, purulent ascites was found in the pelvic cavity but both ovaries and fallopian tubes were intact. There were no intra-abdominal abnormalities such as bowel perforation, appendicitis, or necrosis. The reports of blood culture, ascites culture, and cervical swab culture confirmed S. pyogenes. After use of antibiotics, the patient was cured and discharged without sequelae.

Fatal Necrotizing Fasciitis Due to Streptococcus pneumoniae: A Case Report

Necrotizing fasciitis is known to be a highly lethal infection of deep-seated subcutaneous tissue and superficial fascia. Reports of necrotizing fasciitis due to Streptococcus pneumoniae are exceedingly rare. We report a case of necrotizing fasciitis in a 62-yr-old man with liver cirrhosis and diabetes mellitus. He presented with painful swelling of left leg and right hand. On the day of admission, compartment syndrome was aggravated and the patient underwent surgical exploration. Intra-operative findings revealed necrotizing fasciitis and cultures of two blood samples and wound aspirates showed S. pneumoniae. The patient died despite debridement and proper antimicrobial treatment. To the best of our knowledge, this is the first case of fatal necrotizing fasciitis with meningitis reported in Korea. We also review and discuss the literature on pneumococcal necrotizing fasciitis.

A Case of Pneumococcal Endocarditis Accompanied by Arthritis and Meningitis

Streptococcus pneumoniae is a common cause of pneumonia. S. pneumoniae also had been a frequent cause of infective endocarditis in the past, but its incidence has markedly decreased after the introduction of effective antibiotics. S. pneumoniae is now a rare cause of this invasive and fatal disease, not to mention S. pneumoniae bacteremia with multiple metastatic infections. We report a 74-year-old woman who presented with arthritis and fever and was diagnosed with infective endocarditis accompanied by meningitis and septic arthritis due to S. pneumoniae without pneumonia. After treatment with antibiotics, the patient recovered without complications. Although S. pneumoniae is a rare cause of infective endocarditis with multiorgan involvement, S. pneumonia should be considered as one of the potential pathogens in such cases.

Two Cases of Q Fever Endocarditis

Q fever is a zoonosis caused by Coxiella burnetii, presenting as acute and chronic illness and it has been reported worldwide. Acute Q fever is usually asymptomatic or mild and self-limiting, but infective endocarditis is one of the most serious complications of chronic Q fever and can be fatal. Known risk factors for Q fever endocarditis are valvular heart disease, immunocompromised hosts, and pregnancy. There have been some reports on Q fever in Korea but there exists no report on Q fever endocarditis. We have experienced 2 cases of Q fever with underlying valvular heart disease; both patients came to the hospital for evaluation of prolonged fever. Although Q fever and Q fever endocarditis are rare in Korea, Q fever endocarditis should be considered in the differential diagnosis of patient with infective endocarditis when causative microorganism cannot be identified.

Two Cases of Q Fever Endocarditis

Q fever is a zoonosis caused by Coxiella burnetii, presenting as acute and chronic illness and it has been reported worldwide. Acute Q fever is usually asymptomatic or mild and self-limiting, but infective endocarditis is one of the most serious complications of chronic Q fever and can be fatal. Known risk factors for Q fever endocarditis are valvular heart disease, immunocompromised hosts, and pregnancy. There have been some reports on Q fever in Korea but there exists no report on Q fever endocarditis. We have experienced 2 cases of Q fever with underlying valvular heart disease; both patients came to the hospital for evaluation of prolonged fever. Although Q fever and Q fever endocarditis are rare in Korea, Q fever endocarditis should be considered in the differential diagnosis of patient with infective endocarditis when causative microorganism cannot be identified.

Septic Shock due to Vibrio alginolyticus in a Cirrhotic Patient: The First Case in Korea

We describe a case of septic shock due to Vibrio alginolyticus presenting with fever and bilateral leg pain. Despite intensive management with antibiotics and inotropic agents, the patient died from septic shock 1 day after hospitalization. V. alginolyticus was isolated from both leg wounds and a blood culture. To the best of our knowledge, this is the first reported case of V. alginolyticus bacteremia in Korea.

Risk Dactors for Death in Patients with Staphylococcus aureus Bacteremia

BACKGROUND: Staphylococcus aureus is a common cause of severe infection and frequently results in death or disability. We investigated potential risk factors influencing clinical outcome in S. aureus bacteremia (SAB). MATERIALS AND METHODS: Our study is based on retrospective chart review for episodes of SAB from 168 patients, identified between January 2003 and December 2005. Twenty patients were excluded: 2 patients with infective endocarditis and 18 patients with metastatic lesions. Demographic, underlying diseases, sources of SAB, antimicrobial therapy, laboratory, and microbiologic characteristics were identified. Outcome was classified as death or survival 12 weeks after onset of SAB. RESULTS: A total of 97 patients had survived and 51 patients died 12 weeks after the onset of SAB. Death group was older (66.4+/-13.6 vs. 59.4+/-14.9 years, P=0.007) and had higher Acute Physiology and Chronic Health Evaluation II system score (17.5+/-6.3 vs. 13.5+/-5.1, P<0.001) and the acute physiology score (11.1+/-5.5 vs. 8.0+/-4.3, P<0.001). Patients with nosocomial SAB (36 (70.6%) vs. 49 (50.5%), P=0.03] and ineradicable primary source of SAB [46 (90.2%) vs. 66 (68.0%), P=0.005] were more vulnerable to death. Multivariate analysis shows that hospital acquisition [adjusted odds ratio (OR)=2.93], ineradicable primary source (adjusted OR=5.74) and high APACHE II score (adjusted OR=1.22) lead to higher mortality rate from SAB. CONCLUSION: Our study shows hospital acquisition, ineradicable primary source, and high APACHE II score are the risk factors related to death from SAB. On the other hand, methicillin resistance or initially ineffective antimicrobial therapy is not much correlated with mortality rate from SAB.

Risk Dactors for Death in Patients with Staphylococcus aureus Bacteremia

BACKGROUND: Staphylococcus aureus is a common cause of severe infection and frequently results in death or disability. We investigated potential risk factors influencing clinical outcome in S. aureus bacteremia (SAB). MATERIALS AND METHODS: Our study is based on retrospective chart review for episodes of SAB from 168 patients, identified between January 2003 and December 2005. Twenty patients were excluded: 2 patients with infective endocarditis and 18 patients with metastatic lesions. Demographic, underlying diseases, sources of SAB, antimicrobial therapy, laboratory, and microbiologic characteristics were identified. Outcome was classified as death or survival 12 weeks after onset of SAB. RESULTS: A total of 97 patients had survived and 51 patients died 12 weeks after the onset of SAB. Death group was older (66.4+/-13.6 vs. 59.4+/-14.9 years, P=0.007) and had higher Acute Physiology and Chronic Health Evaluation II system score (17.5+/-6.3 vs. 13.5+/-5.1, P<0.001) and the acute physiology score (11.1+/-5.5 vs. 8.0+/-4.3, P<0.001). Patients with nosocomial SAB (36 (70.6%) vs. 49 (50.5%), P=0.03] and ineradicable primary source of SAB [46 (90.2%) vs. 66 (68.0%), P=0.005] were more vulnerable to death. Multivariate analysis shows that hospital acquisition [adjusted odds ratio (OR)=2.93], ineradicable primary source (adjusted OR=5.74) and high APACHE II score (adjusted OR=1.22) lead to higher mortality rate from SAB. CONCLUSION: Our study shows hospital acquisition, ineradicable primary source, and high APACHE II score are the risk factors related to death from SAB. On the other hand, methicillin resistance or initially ineffective antimicrobial therapy is not much correlated with mortality rate from SAB.

Risk factors for staphylococcal bacteremia in patients undergoing hemodialysis using dual lumen catheters / 대한내과학회지

BACKGROUND/AIMS: Risk factors for infection in patients undergoing hemodialysis during dual lumen catheterization have not been adequately defined. We investigated risk factors associated with Staphylococcal bacteremia (SB) in patients undergoing hemodialysis using a catheter. METHODS: Patients undergoing hemodialysis with a catheter were categorized into either the SB group (n=43) or control group (n=44). Data on patient demographics, the presence of underlying diseases, antibiotic use, APACHE II scores, and laboratory findings were collected retrospectively. RESULTS: Patients in the SB group tended to be older, and underwent dialysis upon admission more frequently, as compared with controls. In addition, the SB group had higher APACHE II scores, BUN, and lower creatinine levels upon admission, as compared with the control group. A multivariate analysis showed that dialysis upon admission was a risk factor for SB in patients undergoing hemodialysis using a catheter. Patients with Staphylococcus aureus bacteremia (SAB) also tended to be older and showed a higher incidence of both dialysis upon admission and antibiotic therapy prior to catheterization, as compared with the control group. Patients with SAB also had higher APACHE II scores, BUN and creatinine levels upon admission. Antibiotics prior to catheterization, higher creatinine levels, and dialysis upon admission were all independent risk factors for SAB. Patients with methicillin-resistant SB had lower albumin and creatinine levels than those with methicillin-susceptible SB. The incidences of catheterization in the general ward or ICU and antibiotic therapy prior to catheterization were both higher in the methicillin-resistant SB group. Catheterizations in the general ward or ICU and antibiotic therapy prior to catheterization were both independent risk factors for methicillin-resistant SB. CONCLUSIONS: In patients undergoing hemodialysis with a catheter, dialysis upon admission was an independent risk factor for SB. Additionally, antibiotic therapy prior to dual lumen catheterization was a risk factor for methicillin-resistant SB.

A Case of Gastric Schwannoma in a Male Patient / 대한소화기내시경학회지

Gastric schwannoma that originates from nerve sheath comprises about 0.2% of all gastric tumors and 4% of all benign gastric tumors. It is difficult to precisely diagnose gastric schwannoma via endoscopic biopsy or imaging studies. A 57-year-old male was referred to our hospital from a private clinic for further evaluation of a gastric tumor-mass that was diagnosed by gastroscopy. Gastroscopy and endoscopic ultrasonography showed a submucosal mass larger than 3 cm in size at the low body of the stomach. That the mass had malignant potential could not be excluded because of its size and shape. The patient underwent subtotal gastrectomy. The tumor cells showed immunoreactivity to S-100 protein. This submucosal tumor was diagnosed as a gastric schwannoma on the basis of these findings. Gastric schwannoma is known to occur more frequently in females than males. This is the first reported case of gastric schwannoma that's occurred in a Korean male patient.

A Case of Streptococcus pyogenes Pneumonia with Rhabdomyolysis

We describe a case of Streptococcus pyogenes pneumonia in a 63-year-old man presenting with rhabdomyolysis and acute renal failure. The patient completely recovered following treatment with mechanical ventilation, continuous venovenous hemodiafiltration, and intravenous antimicrobial agents.

Acute Pyogenic Sacroiliitis Caused by Staphylococcus aureus without Predisposing Conditions

Pyogenic sacroiliits is a rare disease and the diagnosis is difficult because of unawareness of the disease and nonspecific symptoms and signs mimicking septic hip, iliopsoas muscle abscess and herniation of intervertebral disk. There are some predisposing factors related to the disease like trauma, pregnancy, intravenous drug abuse and infection of other systems such as skin, genitourinary system and heart. Staphylococcus aureus is the most common causative bacteria. Here we describe a case of 27-year-old woman presented with acute onset of back and left buttock pain. Bone scintigraphy revealed increased uptake at left sacroiliac joint and computed tomography of the pelvis showed left sacroiliitis with left iliacus and iliopsoas abscess. There was no history of usual predisposing conditions. S. aureus was grown from blood cultures and the patient improved with 2 weeks of intravenous cefazolin followed by 4 weeks of oral clindamycin treatment.