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폐렴 구균(Streptococcus pneumoniae)에 의한 척수 경막외 농양 1예
이지영,위유미,손경목,기현균,문치숙,오원섭,백경란,송재훈 대한감염학회 2004 감염과 화학요법 Vol.36 No.6
폐렴구균은 보통 폐렴이나 뇌막염을 일으키는 균으로 척수 경막외 농양을 일으키는 경우는 매우 드물다. 본 저자들은 폐렴 구균에 의한 척수 경막 외 농양을 경험하여 보고하는 바이다. 과거 건강했던 36세 남자 환자로 사다리에서 낙상한 후 요통 및 고열, 신경학적 이상으로 내원하여 자기 공명 촬영 결과 척수 경막 외 농양으로 진단받고 항균제 투여와 함께 응급 수술을 시행하였다. 농 배양 결과 페니실린 감수성인 폐렴 구균이 분리 되었고, 수술 요법과 항생제 투여 후 농양은 치유되었으나 신경학적 이상은 호전 없는 상태로 타원으로 전원되었다. Pneumonia and meningitis are the most frequent manifestations of pneumococcal infections. Pneumococcal spinal epidural abscesses have been rarely reported. Spinal epidural abscess by Streptococcus pneumoniae has been diagnosed among the patients with diabetes mellitus, alcoholism, corticosteroid therapy, intravenous drug use, chronic renal failure, AIDS, and history of spinal surgery. Recently, we experienced a case of pneumococcal spinal epidural abscess after spinal trauma. A 36-year-old male patient was admitted with back pain, fever, and paraplegia which occurred 5 days after the trauma. Spine MRI revealed spinal epidural abscess at the level from T2 to T9. He was treated with antimicrobial agents and surgical exploration for spinal epidural abscess. Pus culture grew S. pneumoniae which was susceptible to penicillin. Despite early surgical treatment, neurologic sequelae remained. Considering the high mortality and morbidity of pneumococcal spinal epidural abscess, early diagnosis and aggressive treatment including surgical intervention and antibiotics therapy should be implemented immediately.
급성 백혈병 환자에서 발생한 감염 양상의 분석(1986~1992)
박선양,오명돈,김양수,백경란,김병국,최강원,김성민 대한감염학회 1993 감염 Vol.25 No.3
Infection is a major complication and potentially life-threatening in patients with acute leukemia. The patients require prompt broad-spectrum antibiotics therapy when fever develops. One of the keys to successful patient management is the recognition of institutional trends of the spectrum of infections and infecting microorganisms. So we evaluated 138 patients with acute leukemia and blastic crisis of chronic myelogenous leukemia admitted to Seoul National University Hospital from July 1986 to June 1992. The results are following: 1) Total number of febrile episodes was 224 and 60% of them occurred after chemotherapy. 2) Microbiologically-defined infection, clinically-defined infection, and unexplained fever accounted for 28%, 45%, 27% of the febrile episodes respectively. 3) Fifty-eight percent of microbiologically-defined infections were caused by gram-negative bactria, and 36% were gram-positive bacteria. There was a tendency to a greater proportion of gram (+) organisms than that of the last study (p>0.1). Escherichia coli was the most common organism, and coagulase-negative staphylococci, Pseudomonas aeruginosa, Klebsiella pneumoniae were common in decreasing order. 4) Pneumonia was the most common type of infection, followed by skin and soft tissue infection, perianal infection, gingivitis and primary septicemia. 5) Seventy-two percent of total infections improved with therapy and this success rate was higher than that of the last study(p<0.001).
백경란 ( Kyong Ran Peck ),송재훈 ( Jae Hoon Song ),김은석 ( Eun Seok Kim ),주은정 ( Eun Jeong Joo ),하영은 ( Young Eun Ha ),위유미 ( Yu Mi Wi ),정혜숙 ( Hae Suk Cheong ),이진서 ( Jin Seo Lee ),강철인 ( Cheol In Kang ),정두련 ( Doo 대한내과학회 2009 대한내과학회지 Vol.76 No.3
Background/Aims: The risk factors and clinical outcome of infective endocarditis (IE) have changed over the past few decades. Recently, the incidence of Staphylococcus aureus IE (SAIE) has increased. We investigated the clinical and microbiological characteristics and clinical outcomes of SAIE. Methods: All patient cases that were diagnosed as IE according to the modified Duke criteria in Samsung Medical Center during the period of January 1995 to December 2006 were reviewed retrospectively. The clinical and microbiological characteristics of patients with SAIE were compared to those of non-SAIE patients with IE. Results: We enrolled 304 patients with IE. Of these, 240 cases were IE culture-positive, including 73 cases of SAIE. The mean age of patients with SAIE was 48.15±19.87 years, with male patients accounting for 71.2% of our study group. Congenital heart disease (8.2%) was less common among SAIE patients. Hospital-acquired IE was significantly more common in SAIE than in non-SAIE cohorts (p<0.05). Surgical treatment was performed in 33 cases (45.2%). Valvular regurgitation with heart failure was the most frequent cause of surgery (39.3%). Twenty-three cases exhibited complications, including extra cardiac embolization (16.4%) and heart failure (5.6%). Fever persisting for a period longer than seven days was more common among those in the SAIE group. Twelve patients (16.4%) died and four patients (5.4%) were discharged without hope of improvement. The in-hospital mortality rate was higher among SAIE patients (17.3%) compared to that among non-SAIE patients (11%), although this comparison was not statistically distinct (p>0.05). Methicillin resistance and non-surgical treatment were significant risk factors for in-hospital mortality. Conclusions: SAIE is more strongly associated with systemic embolization, persistent fever, and longer hospital stays compared to non-SAIE. Further studies are warranted to evaluate adequate treatment and to improve the outcome of patients with SAIE. (Korean J Med 76:329-337, 2009)
백경란,배현주,신형식,오명돈,정문현,최강원 대한감염학회 1991 감염 Vol.23 No.4
We reviewed 27 patients with candidemia who were admitted to the SNUH from January 1981 to June 1990. The observed results were as follows. 1) The range of age was from 17 to 69 years and the median age was 49 years. Male to Female ratio was 15:12. 2) The underlying diseases were acute leukemia in 10, solid tumor in 4, nononcologic disease in 13. 3) The predisposing factors associated with candidemia were antibiotic therapy(100%), central venous catheter insertion(70%), cytotoxic chemotherapy(37%), neutropenia(33%), preceding surgery(33%), corticosteroid therapy(15%) and hyperalimention(11%). 4) Infecting species were C.albicans in 9 cases, C.tropicalis in 9, C. parasilosis in 4, C. guilliermondii in 2, C.glabrata in 2 and C.lusitaniae in 1. Infecting species were C. tropicalis in 6 of 9 cases with neutropenia, and C.albicans in 4 of 6 cases with preceding abdominal surgerv. 5) The serum specimens from 12 patients were examined for circulating Candida protein antigen with Cand-Tec. One case had a antigen titer of 1:8, 2 cases 1:4, and 7 cases 1:2. 6) In 7 patients with invasive candidasis, involved organs were lung in 3 cases, kidney in 2 cases, spleen in 2 cases, and liver, heart, CNS, retina and skin in 1 case respectively. 7) Overall mortality was 30%. In 14 patients who received amphotericin B therapy, 3 patients expired. Two patients who received fluconazole therapy were cured. Six patients were cured only with the correction of predisposing factors. Five patients who were presented with septic shock at the onset of candidemia expired without specific antifungal therapy.
백경란,오명돈,김병국,최강원 대한감염학회 1992 감염 Vol.24 No.4
Hepatosplenic candidiasis is a distinct clinical variant of candidiasis in immunocompromised patients. It has become a major problem in the patients with acute leukemia, whose disease is in remission after successful induction chemotherapy. Manifestations of disease at the time when hepatic involvement is documented are localized to the liver and/or spleen. Patients with focal hepatosplenic candidiasis have fever unresponsive to antimicrobial therapy, prominent gastrointestinsl symptoms and signs, elevated levels of alkaline phosphatase, and hepatosplenic defects noted on abdominal US or CT. Histopathologic demonstration of Candida organisms in tissue specimens is necessary for a definite diagnosis. Cultures taken from involved tissues are often negative. Response to conventional therapy with amphotericin B is poor, and this form of candidiasis often persists after months of therapy. We report three cases of hepatosplenic candidiasis in leukemic patients, and review clinical, laboratory, radiologic findings, and treatment of hepatosplenic candidiasis in the medical literatures.