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2.
Ann Lab Med ; 40(1): 63-67, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31432641

RESUMO

As 16S ribosomal RNA (rRNA)-targeted sequencing can detect DNA from non-viable bacteria, it can be used to identify pathogens from clinical samples even in patients pretreated with antibiotics. We compared the results of 16S rRNA-targeted sequencing and culture for identifying bacterial species in normally sterile body fluid (NSBF): cerebrospinal, pericardial, peritoneal and pleural fluids. Over a 10-year period, a total of 312 NSBF samples were evaluated simultaneously using 16S rRNA-targeted sequencing and culture. Results were concordant in 287/312 (92.0%) samples, including 277 (88.8%) negative and 10 (3.2%) positive samples. Of the 16 sequencing-positive, culture-negative samples, eight showed clinically relevant isolates that included Fusobacterium nucleatum subsp. nucleatum, Streptococcus pneumoniae, and Staphylococcus spp. All these samples were obtained from the patients pretreated with antibiotics. The diagnostic yield of 16S rRNA-targeted sequencing combined with culture was 11.2%, while that of culture alone was 6.1%. 16S rRNA-targeted sequencing in conjunction with culture could be useful for identifying bacteria in NSBF samples, especially when patients have been pretreated with antibiotics and when anaerobic infection is suspected.

3.
Medicina (Kaunas) ; 55(10)2019 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-31627324

RESUMO

Background and objectives: The objective of this study was to investigate the clinical significance of isolates from blood stream infection known to be blood culture contaminants in pediatric patients. Materials and Methods: Microbiological reports and medical records of all blood culture tests issued from 2002 to 2012 (n = 76,331) were retrospectively reviewed. Evaluation for potential contaminants were done by reviewing medical records of patients with the following isolates: coagulase-negative Staphylococcus, viridans group Streptococcus, Bacillus, Corynebacterium, Micrococcus, Aerococcus, and Proprionibacterium species. Repeated cultures with same isolates were considered as a single case. Cases were evaluated for their status as a pathogen. Results: Coagulase-negative Staphylococcus had clinical significance in 23.8% of all cases. Its rate of being a true pathogen was particularly high in patients with malignancy (43.7%). Viridans group Streptococcus showed clinical significance in 46.2% of all cases. Its rate of being a true pathogen was similar regardless of the underlying morbidity of the patient. The rate of being a true pathogens for remaining isolates was 27.7% for Bacillus and 19.0% for Corynebacterium species. Conclusions: Coagulase-negative Staphylococcus and viridans group Streptococcus isolates showed high probability of being true pathogens in the pediatric population, especially in patients with underlying malignancy.

4.
Eur J Clin Microbiol Infect Dis ; 38(11): 2113-2120, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31372903

RESUMO

Therapeutic drug monitoring (TDM) of teicoplanin is aimed at minimizing the clinical impact of pharmacokinetic variability; however, its benefits are still being defined. We performed a retrospective study of teicoplanin TDM focusing on the dose-serum concentration relationship and clinical outcomes in a clinical setting. From January 2017 to December 2018, patients receiving teicoplanin ≥ 72 h with TDM were enrolled. Patients were divided into three groups: non-loading (NL) group, low-dose loading (LD) group (loading dose < 9 mg/kg), and high-dose loading (HD) group (≥ 9 mg/kg). Serum teicoplanin trough concentration (Cmin) and adverse events (AEs) were evaluated in each regimen. A subgroup of patients with bacteremia was analyzed to evaluate clinical efficacy. Among 65 patients, 12, 18, and 35 were grouped in NL, LD, and HD, respectively. Achievement rates of Cmin > 20 mg/L within 10 days were significantly different among the groups (25.0%, 38.9%, and 68.6% in the NL, LD, and HD groups, respectively; P = 0.014). Fourteen patients (21.5%) had AEs, and higher Cmin over 10 days (adjusted odds ratio 2.08 per every 20 mg/L increases, 95% CI 1.13-3.84, P = 0.019) and age ≥ 65 years (P = 0.009) were identified as independent risk factors. In the subgroup analysis, HD regimen (P = 0.050) and high mean Cmin over 10 days (P = 0.025) were significantly associated with treatment success. Although HL regimen could achieve Cmin targets and improve clinical outcome during teicoplanin treatment, high Cmin was associated with AEs during treatment. Routine TDM can be helpful to optimize teicoplanin administration.

5.
Pediatr Blood Cancer ; 66(12): e27904, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31448550

RESUMO

BACKGROUND: Children with cancer may be at an increased risk of infection with hepatitis B virus (HBV) when levels of hepatitis B antibodies are reduced owing to chemotherapy-induced immunosuppression. This study evaluated the changes in HBV antibody status and HBV infections after chemotherapy in children with acute lymphoblastic leukemia (ALL). PROCEDURE: The data of patients with ALL diagnosed between April 2007 and March 2013 were retrospectively collected. Hepatitis B surface antibody (HBsAb) titers were defined as negative at levels <10 IU/L. The HBsAb titers were individually compared before and after chemotherapy. RESULTS: A total of 88 patients were included in this study. At the time of diagnosis, 32 (36.4%) and 56 (63.6%) patients were HBsAb negative and HBsAb positive, respectively. The 56 HBsAb-positive patients were categorized into two groups, namely, group A with 44 patients (78.6%, 44/56) who became HBsAb negative after chemotherapy, and group B with 12 patients (21.4%) who remained HBsAb positive. On multivariate analysis, lower initial levels of HBsAb titers were associated with HBsAb negativity after chemotherapy (relative risk: 1.003, 95% confidence interval: 1.001-1.006; P = .009). CONCLUSION: This study demonstrated that patients with a low level of prechemotherapy HBsAb titers were likely to become HBsAb negative after chemotherapy. Therefore, evaluation of HBsAb status may be necessary after the completion of chemotherapy in children with ALL.

6.
Korean J Pediatr ; 2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-31163961

RESUMO

The Committee on Infectious Diseases of the Korean Pediatric Society (KPS) recommended immunization schedule for children and adolescents aged 18 years or younger in the 9th (2018) edition of Immunization Guideline. This report provides the revised recommendations made by the committee and summarizes several changes from the 2015 guideline. National immunization program (NIP) launched a human papillomavirus (HPV) immunization for girls aged 12 years in 2016. NIP has also expanded age indication for inactivated influenza vaccine (IIV) to 12 years of age in the 2018-2019 season. Quadrivalent IIVs with a full dose (0.5 mL) are approved for all children of 6 months or older. Recommendations of live attenuated influenza vaccine were removed. For inactivated Japanese encephalitis vaccine (JEV), first two doses are considered as the primary series. Recommendations for use of newly introduced vaccines (diphtheria-tetanus-acellular pertussis/inactivated poliovirus/Haemophilus influenzae type b, 9-valent HPV, new varicella vaccine, new quadrivalent IIV, and attenuated oral typhoid vaccine) were added. Lastly, monitoring system for adverse events following immunization was updated. Other changes can be found in the 9th edition of Immunization Guideline in detail.

8.
Pediatr Int ; 61(7): 688-696, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31107995

RESUMO

BACKGROUND: We investigated the characteristics and clinical outcomes of respiratory syncytial virus (RSV)-related pediatric intensive care unit (PICU) hospitalization and assessed the palivizumab (PZ) prophylaxis eligibility according to different guidelines from Korea, EU, and USA. METHODS: In this multicenter study, children <18 years of age hospitalized in six PICU from different hospitals due to severe RSV infection between September 2008 and March 2013 were included. A retrospective chart review was performed. RESULTS: A total of 92 patients were identified. The median length of PICU stay was 6 days (range, 1-154 days) and median PICU care cost was USD2,741 (range, USD556-98 243). Of 62 patients who were <2 years old at the beginning of the RSV season, 33 (53.2%) were high-risk patients for severe RSV infection. Hemodynamically significant congenital heart disease (22.6%) was the most common risk factor, followed by chronic lung disease (11.3%), neuromuscular disease or congenital abnormality of the airway (NMD/CAA) (11.3%), and prematurity (8.1%). The percentage of patients eligible for PZ prophylaxis ranged from 38.7% to 48.4% based on the guidelines, but only two (2.2%) received PZ ≤30 days prior to PICU admission. The median duration of mechanical ventilation was longer in children with NDM/CAA than in those without risk factors (26 days; range, 24-139 days vs 6 days, range, 2-68 days, P = 0.033). RSV-attributable mortality was 5.4%. CONCLUSIONS: Children <2 years old with already well-known high risks represent a significant proportion of RSV-related PICU admissions. Increasing of the compliance for PZ prophylaxis practice among physicians is needed. Further studies are needed to investigate the burden of RSV infection in patients hospitalized in PICU, including children with NMD/CAA.

9.
J Infect Chemother ; 25(7): 514-519, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30885457

RESUMO

INTRODUCTION: Respiratory syncytial virus (RSV) is the most common cause of lower respiratory tract infections among infants and young children. The fusion (F) protein of RSV is a major target for monoclonal antibodies and vaccine candidates. We analyzed sequence polymorphisms of the RSV F protein and investigated palivizumab-resistance mutation in clinical isolates from Korean children in post-palivizumab era. METHODS: A review of pediatric patients with RSV infections in Korea from September 2009 to April 2015 was conducted. We performed RSV F gene sequence analysis on positive clinical samples and compared to reference sequences, A2 and 9320. RESULTS: RSV F gene data were obtained from 60 patients (30 RSV-A and 30 RSV-B), of whom 15 (10 RSV-A and 5 RSV-B) received palivizumab. The nucleotide and amino acid identities of the F gene sequence were conserved between RSV isolates and reference strains. There was no significant difference between isolates from patients who received and did not receive palivizumab. One or more amino acid changes were observed in all RSV-A and 26 RSV-B isolates. Twenty-five variations in RSV-A and 17 in RSV-B were noted. One variation within antigenic site II was noted in a RSV-A isolate; D263N with unknown significance was found in a patient without palivizumab prophylaxis. N276S variation adjacent to antigenic site II was observed in 27 RSV-A isolates. However, no known palivizumab-resistant mutations were found in either RSV-A or RSV-B isolates. CONCLUSIONS: The RSV F gene was highly conserved and no known palivizumab-resistant mutants were found in Korean circulating strains.

10.
J Pharm Biomed Anal ; 167: 161-165, 2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30776754

RESUMO

Teicoplanin is a glycopeptide antibiotic used for treatment of severe Gram-positive bacterial infection. The aim of this study was to develop and validate a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for therapeutic drug monitoring (TDM) of teicoplanin and to review our clinical experience. We established an LC-MS/MS method to analyze serum concentration of teicoplanin using simple protein precipitation with a 5 min run time for each sample. The linearity, lower limit of quantitation, detection accuracy, precision, carryover, matrix effect, and extraction recovery were evaluated. From September 2014 to June 2017, a total of 421 serum teicoplanin concentrations was measured in 223 patients. We collected demographic and clinical data, medication history, and laboratory findings through retrospective review of medical records. The LC-MS/MS method was linear for serum teicoplanin concentrations in the range of 12.0-89.0 µg/mL. The intra- and inter-assay precisions were below CV 7.5%. The accuracy was less than ±10% bias. The lower limit of quantification was 0.2 µg/mL. The extraction recovery ranged from 88.8% to 96.6%. Of 421 measurements, 87 (20.7%) were subtherapeutic (< 10 µg/mL), and four (0.9%) were above the toxic threshold (≥ 60 µg/mL). Serum teicoplanin concentration was measured once in 140 patients (63%), and multiple measurements were completed for the others (83 patients, 37%). Intra-patient variability in teicoplanin concentration was found (CV 33%, range 2-94%). Our simple and rapid LC-MS/MS method was successfully applied in TDM of teicoplanin in clinical practice. Such TDM of teicoplanin may be useful for individualized dose adjustment.


Assuntos
Antibacterianos/sangue , Monitoramento de Medicamentos/métodos , Teicoplanina/sangue , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Calibragem , Criança , Cromatografia Líquida , Monitoramento de Medicamentos/instrumentação , Feminino , Humanos , Limite de Detecção , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Espectrometria de Massas em Tandem , Adulto Jovem
11.
Clin Nephrol ; 91(2): 107-113, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30526816

RESUMO

BK virus is a known cause of renal failure in kidney transplant recipients, but there is little data regarding its effect on native kidneys in heart transplant patients. Here, we describe the case of a child who underwent heart transplantation and was later diagnosed with BK virus with multiorgan involvement. This patient was diagnosed with dilated cardiomyopathy at 4 months of age and underwent heart transplantation at the age of 5 years. Before transplantation, the patient suffered from cardiac arrest and fungal pyelonephritis. The patient had no evidence of azotemia. Ten months after transplantation, the patient was diagnosed with diffuse large B-cell lymphoma associated with Epstein-Barr virus infection. She underwent chemotherapy, and later developed azotemia and BK viremia. The findings on renal biopsy were compatible with BK nephropathy. After the biopsy, she was treated with intravenous cidofovir, immunoglobulins, and oral leflunomide. The tacrolimus dose was also reduced. However, the patient's renal function continued to worsen. She developed end-stage renal disease and started peritoneal dialysis. After experiencing a seizure, the patient was found to have positive BK virus polymerase chain reaction in the cerebrospinal fluid. Brain magnetic resonance image revealed a new white matter lesion in the splenium. On immunohistochemistry, there was SV40-positive staining in gastric and heart biopsy specimens. Therefore, BK virus enteropathy and cardiac involvement were suspected. This case suggests that BK virus infection can lead to systemic involvement and can be fatal.
.


Assuntos
Vírus BK , Encefalopatias/virologia , Nefropatias/virologia , Infecções por Polyomavirus/complicações , Infecções Tumorais por Vírus/complicações , Encefalopatias/diagnóstico por imagem , Cardiomiopatia Dilatada/cirurgia , Pré-Escolar , Feminino , Transplante de Coração , Humanos , Imunossupressores/uso terapêutico , Lactente
12.
Ann Lab Med ; 39(2): 176-182, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30430780

RESUMO

BACKGROUND: Real-time PCR is more sensitive than microscopic examination for detecting Pneumocystis jirovecii. We compared the performance of two assays for detecting P. jirovecii DNA: the RealStar Pneumocystis jirovecii PCR Kit 1.0 CE (Altona Diagnostics, Hamburg, Germany) and the AmpliSens Pneumocystis jirovecii (carinii)-FRT PCR kit (InterLabService Ltd., Moscow, Russia). METHODS: We used 159 samples from the lower respiratory tract (112 bronchoalveolar lavage [BAL] fluid, 37 sputum, and 10 endotracheal aspirate [ETA] samples) of non-HIV immunocompromised patients. Nested PCR and sequencing were used to resolve discordant results. The performance of the two assays was evaluated according to clinical categories (clinical Pneumocystis pneumonia [PCP], possible PCP, or unlikely PCP) based on clinical and radiological observations. RESULTS: The positive and negative percent agreement values were 100% (95% confidence interval [CI], 85.4-100%) and 96.6% (95% CI, 90.9-98.9%), respectively, and kappa was 0.92 (95% CI, 0.84-0.99). P. jirovecii DNA load was significantly higher in the clinical PCP group than in the other groups (P<0.05). When stratified by sample type, the positive rate for BAL fluids from the clinical PCP group was 100% using either assay, whereas the positive rate for sputum/ETA samples was only 20%. CONCLUSIONS: The two assays showed similar diagnostic performance and detected low P. jirovecii burden in BAL fluids. Both assays may be useful as routine methods for detecting P. jirovecii DNA in a clinical laboratory setting, though their results should be interpreted considering sample type.


Assuntos
Infecções por Pneumocystis/diagnóstico , Pneumocystis carinii/genética , Reação em Cadeia da Polimerase em Tempo Real/métodos , Líquido da Lavagem Broncoalveolar/microbiologia , DNA Bacteriano/genética , DNA Bacteriano/metabolismo , Erros de Diagnóstico , Humanos , Hospedeiro Imunocomprometido , Infecções por Pneumocystis/microbiologia , Pneumocystis carinii/isolamento & purificação , Kit de Reagentes para Diagnóstico , Doenças Respiratórias/diagnóstico , Doenças Respiratórias/microbiologia , Escarro/microbiologia
13.
Korean J Pediatr ; 61(11): 366-370, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30481995

RESUMO

PURPOSE: Tuberculosis (TB) is one of the most important diseases that cause significant mortality and morbidity in young children. Data on TB transmission from an infected child are limited. Herein, we report a case of disseminated TB in a child and conducted a contact investigation among exposed individuals. METHODS: A 4-year-old child without Bacille Calmette-Guérin vaccination was diagnosed as having culture-proven disseminated TB. The child initially presented with symptoms of inflammatory bowel disease, and nosocomial and kindergarten exposures were reported. The exposed individuals to the index case were divided into 3 groups, namely household, nosocomial, or kindergarten contacts. Evaluation was performed following the Korean guidelines for TB. Kindergarten contacts were further divided into close or casual contacts. Chest radiography and tuberculin skin test or interferon-gamma-releasing assay were performed for the contacts. RESULTS: We examined 327 individuals (3 household, 10 nosocomial, and 314 kindergarten contacts), of whom 18 (5.5%), the brother of the index patient, and 17 kindergarten children were diagnosed as having latent TB infection (LTBI). LTBI diagnosis was more frequent in the children who had close kindergarten contact with the index case (17.1% vs. 4.4%, P=0.007). None of the cases had active TB. CONCLUSION: This is the first reported case of TB transmission among young children from a pediatric patient with disseminated TB in Korea. TB should be emphasized as a possible cause of chronic diarrhea and failure to thrive in children. A national TB control policy has been actively applied to identify Korean children with LTBI.

14.
Korean J Pediatr ; 61(11): 371-373, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30428645

RESUMO

Scabies is a highly contagious skin infestation caused by the mite, Sarcoptes scabiei var. hominis. Complex responses to scabies mites in the innate, humoral, and cellular immune systems can cause skin inflammation and pruritus. Diagnosis can be challenging because scabies resembles other common skin conditions. We report the first Korean case of scabies in a hematopoietic cell transplant (HCT) recipient, initially suspected of skin graft versus host disease (GVHD). A T-cell acute lymphocytic leukemia patient underwent a sibling-matched allogeneic HCT and developed pruritus after cell engraftment. Treatment for GVHD did not improve the symptoms. He was diagnosed with scabies 30 days after the onset of symptoms.

15.
Artigo em Inglês | MEDLINE | ID: mdl-30448331

RESUMO

BACKGROUND: Fluoroquinolones (FQs) are a popular alternative to trimethoprim-sulfamethoxazole (STX) for Stenotrophomonas maltophilia infections. OBJECTIVES: To compare the effects of FQs and STX on mortality of S. maltophilia infections DATA SOURCES: PubMed and EMBASE STUDY ELIGIBILITY CRITERIA: Clinical studies reporting mortality outcomes of S. maltophilia infections PARTICIPANTS: Patients with clinical infections caused by S. maltophilia INTERVENTIONS: FQ monotherapy in comparison with STX monotherapy METHODS: Systematic review with meta-analysis technique RESULTS: Seven retrospective cohort and seven case-control studies were included. Three cohort studies were designed to compare the two drugs, while others for other purposes. A total of 663 patients were identified, 332 of which were treated with STX (50.1%) and 331 with FQs (49.9%). Three cohort studies were designed to compare the effect of the two drugs, while others for other purposes. Levofloxacin was most frequently used among FQs (187/331, 56.5%), followed by ciprofloxacin (114/331, 34.4%). The overall mortality rate was 29.6%. Using pooled ORs for the mortality of each study, FQ treatment (OR 0.62, 95% CI 0.39-0.99) was associated with survival benefit over STX treatment, with low heterogeneity (I2 = 18%). Specific FQs such as ciprofloxacin (OR 0.44, 95% CI 0.17-1.12) and levofloxacin (OR 0.78, 95% CI 0.48-1.26) did not show significant difference in comparison with STX. In the sub-group analyses of adult and bacteremic patients, significant differences in mortality were not observed between FQs and STX. CONCLUSIONS: Based on a meta-analysis of non-randomized studies, FQs demonstrated comparable effects on mortality of S. maltophilia infection to STX, supporting the use of FQs in clinical S. maltophilia infections. Although the pooled analysis of overall studies favored FQs over STX, the studies included were observational and sub-group analyses of certain FQ agents did not show statistical differences with STX. Randomized clinical studies need to be conducted to address these issues.

16.
J Clin Immunol ; 38(7): 767, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30306363

RESUMO

The original version of this article unfortunately contained a mistake in the 7th author's given name. The correct version is presented above.

17.
Front Immunol ; 9: 2012, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30250467

RESUMO

Background: Cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) is a negative immune regulator on the surface of T cells. In humans, heterozygous germline mutations in CTLA4 can cause an immune dysregulation syndrome. The phenotype comprises a broad spectrum of autoinflammatory, autoimmune, and immunodeficient features. An increased frequency of malignancies in primary immunodeficiencies is known, but their incidence in CTLA-4 insufficiency is unknown. Methods: Clinical manifestations and details of the clinical history were assessed in a worldwide cohort of 184 CTLA4 mutation carriers. Whenever a malignancy was reported, a malignancy-specific questionnaire was filled. Results: Among the 184 CTLA4 mutation carriers, 131 were considered affected, indicating a penetrance of 71.2%. We documented 17 malignancies, which amounts to a cancer prevalence of 12.9% in affected CTLA4 mutation carriers. There were ten lymphomas, five gastric cancers, one multiple myeloma, and one metastatic melanoma. Seven lymphomas and three gastric cancers were EBV-associated. Conclusion: Our findings demonstrate an elevated cancer risk for patients with CTLA-4 insufficiency. As more than half of the cancers were EBV-associated, the failure to control oncogenic viruses seems to be part of the CTLA-4-insufficient phenotype. Hence, lymphoproliferation and EBV viral load in blood should be carefully monitored, especially when immunosuppressing affected CTLA4 mutation carriers.

18.
Yonsei Med J ; 59(8): 1004-1007, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30187709

RESUMO

Bronchiectasis is a chronic disease characterized by airway infection and inflammation, leading to permanent dilation of the bronchi. Evaluation of underlying etiology is important in managing young bronchiectasis patients with recurrent infections caused by unusual pathogens. The signal transducer and activator of transcription 1 (STAT1) protein plays a key role in STAT signaling and immune system regulation. Heterozygotes for gain-of-function (GOF) alleles of the STAT1 gene usually display autosomal dominant chronic mucocutaneous candidiasis (CMC) and a wide range of clinical features, such as bronchiectasis. Here, we report on a patient with CMC and bronchiectasis with various types of infections who carried a pathogenic variant of the STAT1 gene. The 24-year-old female presented with recurrent respiratory bacterial and nontuberculous mycobacterial infections complicated by severe bronchiectasis and CMC. Whole-exome sequencing revealed a c.800C>T (p.Ala267Val) heterozygous mutation in the STAT1 gene. Further analysis by Sanger sequencing of STAT1 from the patient and her parents revealed the patient had a de novo occurrence of the variant. This is the first report of a Korean patient with a GOF pathogenic variant in STAT1. Physicians should be aware of the existence of this variant as a genetic factor associated with CMC and bronchiectasis complicated by recurrent infection.


Assuntos
Bronquiectasia/complicações , Bronquiectasia/genética , Candidíase Mucocutânea Crônica/genética , Mutação com Ganho de Função , Infecções Respiratórias/microbiologia , Fator de Transcrição STAT1/genética , Sequenciamento Completo do Exoma/métodos , Bronquiectasia/imunologia , Candidíase Mucocutânea Crônica/imunologia , Candidíase Mucocutânea Crônica/microbiologia , Feminino , Humanos , Mutação , Polimorfismo de Nucleotídeo Único , República da Coreia , Fator de Transcrição STAT1/metabolismo , Transdução de Sinais , Adulto Jovem
19.
Emerg Infect Dis ; 24(9): 1768-1770, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30124412

RESUMO

We recently observed the emergence of fluconazole-resistant Candida parapsilosis bloodstream isolates harboring a Y132F substitution in Erg11p in South Korea. These Y132F isolates had a higher propensity to cause clonal transmission than other fluconazole-resistant isolates and persisted within hospitals for several years, as revealed by microsatellite typing.

20.
J Clin Immunol ; 38(7): 757-766, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30151618

RESUMO

PURPOSE: We aimed to report our single-center experience of allogeneic hematopoietic cell transplantation (HCT), which has been the only curative option for certain patients with lethal primary immunodeficiencies (PIDs). METHODS: We summarized the results of HCT performed for patients with PIDs for 11 consecutive years from 2006 to 2016 at Samsung Medical Center, Seoul, Korea. Twenty-six patients with PIDs received HCT. Most had chronic granulomatous disease (42.3%), Wiskott Aldrich syndrome (15.4%), or severe combined immunodeficiency (11.5%). RESULTS: Nine patients (34.6%) received HCT during the former half period and 17 patients (65.4%) during the latter half period. Donor types were categorized as: matched sibling donor (n = 5), unrelated donor (n = 17), and familial mismatched donor (FMMD) (n = 4). Unrelated HCT and FMMD transplantation were increasingly performed in the latter half period compared to the first (5 vs. 16, P = 0.034). Five patients experienced initial engraftment failure, but all of them were eventually engrafted after additional HCTs. The 3-year probability of overall survival was 72.0%. Seven patients (26.9%) died, and the causes of death were bacterial sepsis (n = 4), pneumonia (n = 1), chronic graft-versus-host disease (GVHD) (n = 1), and diffuse alveolar hemorrhage (n = 1). Two patients with bacterial sepsis and a patient with pneumonia also had chronic GVHD. Unrelated HCT and use of methotrexate were associated with poor outcome. Complete chimerism was attained in 85.0% at 1 year after HCT. CONCLUSION: PID candidates have been increasingly identified for allogeneic HCT in Korea, and the majority of them could be cured by HCT. Establishment of a systematic registry of PID patients for HCT is needed.

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