아토피 환자에서 Pharmacia CAP 시스템 검사법과 Auro,Dex(R) Visual,ENSTM 선별 검사법을 이용한 특이 IgE 항체 측정 결과 비교

곽이경 ( Yee Gyung Kwak ),맹선희 ( Sun Hee Maeng ),김희선 ( Hee Sun Kim ),조영주 ( Young Joo Cho ) 대한천식알레르기학회 2003 천식 및 알레르기 Vol.23 No.1

Streptococcus pneumoniae와 Haemophilus influenzae 임상분리주에 대한 Cefditoren의 시험관내 항균력

곽이경 ( Yee Gyung Kwak ),추은주 ( Eun Ju Choo ),박수진 ( Su Jin Park ),이정은 ( Jeong Eun Lee ),정진용 ( Jin Yong Jeong ),최상호 ( Sang Ho Choi ),김남중 ( Nam Joong Kim ),김양수 ( Yang Soo Kim ),우준희 ( Jun Hee Woo ),류지소 ( Ji 대한내과학회 2007 대한내과학회지 Vol.72 No.1

목적: 본 연구에서는 그람양성 및 음성 세균에 대해 광범위한 항균력을 나타내는 것으로 알려진 cefditoren의 임상적 유용성을 평가하기 위해 국내에서 분리된 S. pneumoniae와 H. influenzae 임상균주를 대상으로 cefditoren의 시험관내 항균력을 흔히 임상에서 사용되고 있는 다른 경구용 항균제들과 비교하고자 하였다. 방법: 2000년 1월부터 2004년 3월까지 서울아산병원에서 분리된 S. pneumoniae 120균주와 H. influenzae 80 균주를 대상으로 미국임상검사표준화협회의 방법에 따라 cefditoren과 다른 경구용 항균제에 대한 최소억제농도를 측정하였다. 결과: 모든 S. pneumoniae 균주는 cefditoren 농도 1 μg/mL 이하에서 억제되어 (MIC50/MIC90 0.25/1 μg/mL; range 0.015~1 μg/mL) cefditoren의 감수성 기준을 1 μg/mL로 하였을 때 penicillin에 대한 감수성 여부에 상관없이 모든 균주가 cefditoren에 감수성을 보였다. Penicillin 감수성 균주에서 cefditoren의 MIC (0.015~0.03 μg/mL)는 penicillin 중간 내성 (0.03~0.5 μg/mL) 및 내성 균주 (0.5~1 μg/mL)에 비해 낮았으며, H. influenzae에 대해서는 ampicillin 감수성 및 내성 H. influenzae 모두에서 우수한 항균력을 보였다 (MIC50/MIC90 0.015/0.03 μg/mL; range <0.008~0.03 μg/mL). 결론: Cefditoren은 penicillin이나 ampicillin에 대한 내성 여부에 상관없이 원외 호흡기 감염증의 흔한 원인 균인 S. pneumoniae와 H. influenzae에 대해 우수한 시험관내 항균력을 보였고 따라서 원외 호흡기 감염증 치료를 위한 경구용 항균제로 유용할 것으로 생각된다. Background: The aim of this study was to determine the in vitro activity of cefditoren, an oral third-generation aminothiazolyl cephalosporin, against Streptococcus pneumoniae and Haemophilus influenzae clinical isolates in a tertiary hospital. Methods: We have studied the in vitro activities of cefditoren and other oral antibiotics against 120 S. pneumoniae isolates, including 80 penicillin non-susceptible isolates and 80 H. influenzae isolates from clinical specimens of patients at the Asan Medical Center. Minimal inhibitory concentrations (MICs) were determined by the agar dilution method. Results: All S. pneumoniae strains tested were inhibited by 1 g/mL of cefditoren (MIC50/MIC90 0.25/1 μg/mL; range 0.015~1 μg/mL). The MICs were lower for penicillin-susceptible S. pneumoniae (MIC90 0.015 g/mL) as compared to penicillin-intermediate resistant (MIC90 0.5 g/mL) or penicillin-resistant strains (MIC90 1 μg/mL). Cefditoren was active against all tested H. influenzae strains (MIC50/MIC90 0.015/0.03 μg/mL; range <0.008~0.03 g/mL) and its activity was comparable to levofloxacin and cefixime. Conclusions: Cefditoren had an excellent activity against S. pneumoniae and H. influenzae irrespective of penicillin or ampicillin resistance, respectively. The results of this study suggest that cefditoren is a good choice of an antibiotic to use for empirical oral treatment of community-acquired respiratory tract infections. (Korean J Med 72:68-73, 2007)

중족부에 발생한 Mycobacterium abscessus 골수염

천경아,곽이경,서진수,Chun, Kyung-Ah,Kwak, Yee-Gyung,Suh, Jin-Soo 대한족부족관절학회 2011 대한족부족관절학회지 Vol.15 No.1

Non-tuberculous mycobacterium has a wide-spread occurrence in nature, and skin, soft tissue, bone, lung and disseminated infection can be involved. Non-tuberculous mycobacterium infection occurs both in immunocompetent patients without underlying diseases and in immunocompromised hosts. Non-tuberculous mycobactrial osteomyelitis is a rare cause of granulomatous osteomyelitis, and has been previously reported in the sternum, spine, humerus, femur, tibia or metatarsal. Mycobacterium abscessus osteomyelitis is a very rare infection in the foot and only 1 case has been reported. Authors report a case of Mycobacterium abscessus osteomyelitis involving the tarsal and metatarsal bones in a non-immunocompromized middle aged women.

지속성 외래 복막투석환자에서 Kocuria varians에 의해 발생한 재발성 복막염 1예

류우선 ( Woo Sun Rou ),이효근 ( Hyo Keun Lee ),곽이경 ( Yee Gyung Kwak ),한상엽 ( Sang Youb Han ),한금현 ( Kum Hyun Han ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.4

Kocuria species are the normal flora of skin, mucosa and oropharynx, and can be the causative organisms of complications associated with intravenous catheterization, ambulatory peritoneal dialysis, and ventricular shunt. We report a case of relapsing peritonitis by Kocuria varians in a patient undergoing continuous ambulatory peritoneal dialysis (CAPD). A 62 year old woman was admitted to the hospital with a complaint of abdominal pain and a turbid peritoneal dialysate. The patient was treated with a combination of intraperitoneal antibiotics. A culture of the peritoneal dialysate revealed K. varians, and the patient was discharged after she showed improvement with the treatment. Although the organism was sensitive to the administered antibiotics, the patient experienced 2 episodes of peritonitis. This continuing recurrence could be attributed to an insufficient treatment period or biofilm formation. Therefore, the patient underwent further treatment with intraperitoneal antibiotics and showed no recurrence for 1 year thereafter. This is the first report of relapsing peritonitis by K. varians. Although peritonitis caused by rare pathogens has been described recently, K. varians is known to have a low pathogenecity and occurs rarely. The findings in this case emphasize the importance of careful consideration on the rare pathogen and administration of the appropriate antibiotics for a sufficient duration.

심장폐소생술 후 생존한 환자들에서의 급성신부전의 발생과 임상 경과

김현정 ( Hyun Jeong Kim ),송준호 ( Joon Ho Song ),이승우 ( Seoung Woo Lee ),이준희 ( Jun Hee Lee ),곽이경 ( Yee Gyung Kwak ),김은실 ( Eun Sil Kim ),김훈수 ( Hoon Soo Kim ),임희정 ( Hee Jung Lim ),김문재 ( Moon Jae Kim ) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.6

목 적 : 심장폐소생술은 교육병원 입원 환자의 1-2%에서 발생하며 그 소생율은 약 10-40%로 보고되고 있다. 저자 등은 심장폐소생술 시행 후 급성신부전의 발생 빈동와 이들 환자들에서의 경과 및 예후에 미치는 영향에 대해 알아보고자 하였다. 방 법 : 1999년 1월부터 2001년 2월까지 2년간 인하대학교 인하병원 응급실에서 도착 직후 심장폐소생술을 시행한 환자 68명 중 소생술 후 생존한 환자 24명을 대상으로 임상 경과에 대한 후향적 분석을 하였다. 결 과: 연구에 포함된 생존 환자들 (n=24)의 평균 연령은 62±14세, 남녀 비는 20:4였다. 급성신부전은 8명 (33%)에서 발생하였으며, 급성신부전의 발생군 (n=8)과 비발생군 (n=16) 사이에 연령, 성별, 원인질환, 심폐정지의 종류와 유의한 차이는 없었다. 신부전 발생군은 내원 당시 검사실 소견상 크레아틴키아제가 유의하게 높았고, 심장폐소생술 시행기간이 길었으며, 에피네프린 사용량이 많았다 (p<0.05). 심장폐소생술 후 24시간 동안 급성신부전 발생군은 평균 동맥압이 낮고 시간당 소변량이 적으면서, 도파민 투여량은 많았고, 모두 에피네프린의 연속적 주입을 요하였다(p<0.05), 신부전 발생군은 혈청 크레아티닌이 심장폐소생술 후 24시간 시점에서 유의하게 상승되어 있었으며 (p<0.05), 사망환자는 (n=7) 평균 2.3土0.8일만에 평균 혈청 크레아티닌 2.8±1.7 ㎎/dL로 사망하였고 투석을 요한 경우는 없었다. 급성신부전의 발생군과 비발생군의 평균 입원기간은 4.4±2.8, 14.0±11.5일, 생존 퇴원율은 12.5, 75%로 생존율에 유의한 차이를 보였다 (p<0,05). 결 론 : 이상의 결과로, 심장폐소생술을 시행 받은 환자에서 급성신부전은 심장폐소생술 후 불안정한 혈역학 상태를 보인 환자들에서 이차적으로 타나났고 사말율이 높았다. 따라서 심장폐소생술 후 신부전의 발생은 사망을 예측할 수 있는 인자이나, 독립적인 사망 원인으로 작용하지는 않는 것으로 추정된다. Background s The purpose of the study was to evaluate the prevalence, related factors, and outcome of acute renal failure (ARF) developed in the patients who survived following a cardiac arrest. Methods : A respective analysis of medical records was underwent in 24 patients who survived among 68 patients receiving cardiopulmonary resuscitation (CPR) at the emergency center of Inha-hospital, Sungnam, Korea, from January 1999 to February 2001. Clinical factors before, during and after CPR were compared and contrasted between the patients who manifested ARF after CPR and those who did not. Results; ARF occurs at 33% following CPR. ARF group, showed high baseline creatine kinase (CK) level, longer duration of resuscitation, and larger dosages of epinephrine usage during CPR. During 24 hours after CPR, mean arterial pressure and hourly urine output were significantly lower and dopammine was administered significantly higher in ARF group. Among them seven patients died in 2.3±0.8 hospital day with a mean serum creatinine of 2.8 1.7 ㎎/dL. None required renal replacement therapy in ARF group. Mean admission durations were 4.4 2.8 and 14.0 11.5 days. Survival rate was 12.5% in ARF group, which was significantly low compared to 75% in non-ARF group. Conclusion : In spite of high mortality rate in ARF group, ARF by itself was not a direct cause of death. We suggest that the development of ARF is a predicting but not a causative factor of death in the survivors following CPR.

전신성경화증/전신홍반루푸스/쇼그렌증후군 중복증후군

박보형 ( Bo Hyoung Park ),박원 ( Won Park ),이용환 ( Yong Hwan Lee ),김성수 ( Sung Soo Kim ),김훈수 ( Hoon Soo Kim ),곽이경 ( Yee Gyung Kwak ),송정수 ( Jung Soo Song ) 대한류마티스학회 2002 대한류마티스학회지 Vol.9 No.2

Overlap syndrome is a combination of major features of more than one rheumatic disease present in the same patient and often defined by a specific serologic test. Overlap syndrome consistent with systemic sclerosis (SSc) and systemic lupus erythematosus (SLE) has been reported in a few cases. Overlap syndrome with SSc and SLE combined with Sjogren`s syndrome (SS) is rarely reported worldwide. In Korea, this is the first case report. A 33 year-old female visited our rheumatology clinic complaining of Raynaud`s phenomenon. She was diagnosed as SSc 6 years ago. Clinical and laboratory finding revealed that she has affected by SLE. She also complained dry mouth and dry eye. Finally, she was diagnosed as overlap syndrome consistent with SSc and SLE combined with SS. The authors report a case of overlap syndrome consistent with SSc, SLE, and SS with relevant literatures.

억제제 내성 TEM β-lactamase

곽이경,우준희 대한감염학회 2003 감염과 화학요법 Vol.35 No.6

국내 Epstein-Barr 바이러스 일차감염의 임상적 특성

김백남,곽이경,문치숙,김의석,박상원,이창섭 대한감염학회 2007 감염과 화학요법 Vol.39 No.6

In this study, the clinical features of 264 patients of primary Epstein-Barr virus (EBV) infection between the years of 2002-2006 were evaluated retrospectively. The median age of the patients was 6 years old (0-69), and the hospitalization rate was 78.0%. Fever (83.3%) and sore throat (50.4%) were the most common symptoms. Cervical lymphadenopathy (71.2%), tonsillitis (51.1%), splenomegaly (26.1 %), hepatomegaly (25.8%), rash (10.2%) and jaundice (1.5%) were observed. Cervical lymphadenopathy was less frequent in older age groups. The annual number of primary EBV infections according to the age group during the study period did not change significantly in this study.

2009년 인플루엔자 대유행 중 인플루엔자 진료소 방문자의 연령 분포 변화

김백남,곽이경,문치숙,김연숙,김의석,배인규,염준섭,이창섭,허지안 대한감염학회 2010 감염과 화학요법 Vol.42 No.2

The pandemic influenza (H1N1 2009) virus, after being introduced in Korea in April, 2009, spread rapidly nationwide in mid-2009. This study was conducted to characterize trend in age distribution of visitors to Flu-clinics during the pandemic. Demographic, clinical and laboratory data of visitors to flu clinic from Week 36 to 52 (August 30 to December 26) of 2009 were retrieved and collected from electronic databases at 9 hospitals. Visitors 0-6, 7-12, 13-18, 19-29, 30-64, and 65 years or more of age were classified into group I to VI, respectively. A total of 107,467 visitors were seen at Flu-clinics for a 17-week study period. Of those, 32,485 were laboratory-confirmed. Antivirals were prescribed for 62,533 visitors. Numbers of visits, prescriptions of antivirals, and laboratory-confirmed cases of the pandemic influenza (H1N1 2009) peaked at Week 44. A large number of visits by group II and III were followed by those of group I and V, especially around the peak. Numbers of visits by group VI were lowest in all hospitals. In some hospitals, higher number of visits lasted longer in children than in adults while vice versa in other hospitals depending on the location. In summary, the pandemic influenza (H1N1 2009) was presumed to peak in late October and involved majorly children and students in Korea. Unique age distribution of visitors to flu clinic was observed in some hospitals.

쯔쯔가무시병에서 가피의 위치와 복장과의 관계

김백남,곽이경,문치숙,김의석,박상원,이창섭 대한감염학회 2006 감염과 화학요법 Vol.38 No.6

목적 : 쯔쯔가무시병의 예방을 위하여 위험지역에서 긴소매 윗옷을 입고 바지 끝을 양말 속에 넣는 것이 권장되고 있다. 이러한 예방조치의 효용성을 알아보기 위하여 우리는 쯔쯔가무시병에서 가피의 위치와 신발과 복장과의 관계를 살펴보았다. 재료 및 방법 : 2005년 10-12월 사이 6개 병원에서 전형적인 임상양상, 가피의 존재, 혈청검사 결과로 쯔쯔가무시병이 의심되거나 확진된 159명의 성인을 대상으로 가피의 위치, 추정 감염일, 야외활동, 당시 착용한 신발과 복장 등 을 조사하였다. 결과 : 혈청검사는 5명에서 시행되지 않았고 99명이 양성이었으며, 가피는 142명에서 발견되었다. 몸의 두 군데에서 발견된 6명을 제외한 136명 중 82명(60.3%)에서 가피는 하반신(아랫배, 엉덩이, 서혜부, 생식기, 넓적다리, 종아리)에 있었다. 감염일이 추정가능하고 가피가 1개만 있는 44명을 대상으로 하였을 때, 가피가 하반신에서 발견된 17명에서 슬리퍼를 신거나 맨발인 경우는 5명이었으나 상반신에 있는 27명 중에는 아무도 없었다(P=0.006). 바지아랫단을 양말 속에 집어 넣은 4명 중 1명은 하반신에서 3명은 상반신에서 가피가 발견되었다. 42명이 긴 소매 윗옷을 입었는데, 이중 16명은 하반신에서 26명은 상반신에서 가피가 발견되었다(P=1.00). 결론 : 쯔쯔가무시병 환자에서 신발을 신지 않거나 발이 잘 보호되지 않았을 때 가피는 하반신에 더 잘 생겼다. 바지 아랫단의 처리방법이나 긴 소매 윗옷의 착용은 가피의 위치와 통계적으로 유의한 연관관계는 발견되지는 않았다. 그러나 표본수가 적고 유충의 침범경로에 영향을 줄수 있는 다른 요인이 있기 때문에 가피의 위치와 연관관계가 없다고 이 연구에서 단정할 수는 없다. 따라서 쯔쯔가무시병의 예방을 위한 실용적인 권고를 위해서는 더 많은 연구가 필요하다. Background:Wearing a long-sleeved shirt and tucking the pants legs into the socks is recommended to prevent scrub typhus. This study investigated associations between the location of eschar and the type of clothes and shoes to evaluate the efficacy of these protective measures. Materials and Methods:One-hundred and fifty nine patients in whom scrub typhus was confirmed or suspected based on the typical clinical manifestations, presence of eschar, or positive results of serologic tests at 6 Korean hospitals from October to December 2005 were included in this study. We collected the information on the location of eschar, presumed exposure date to chiggers, and the clothes and shoes which they had worn. Results:Serologic tests were positive in 99 patients. Eschars were observed in 142 patients and 6 of them exhibited more than 2 eschars. Eighty-two (60.3%) of 136 patients with a single eschar had an eschar on the lower half of the body. Of the 44 patients whose exposure date could be estimated, and who had only a single eschar, 5 of the 17 patients with eschars in the lower half of their bodies, and none of the 27 patients with eschars in the upper half of their bodies went barefoot or wore open footware (P=0.006). Only 4 patients tucked the pants into their socks, and an eschar was found in the lower half in one patient, and in the upper half of the body in the other 3 patients. Of 42 patients who wore long-sleeved shirts, eschars were found in their lower bodies in 16, and on their upper bodies in 26 (P=1.00). Conclusion:When the feet were not protected properly with shoes, eschars were found more frequently on the lower half of the body than on the upper half. Wearing a long-sleeved shirt or tucking the pants legs into the socks was not found to be significantly correlated to the location of eschars. Further studies involving larger samples are necessary for the development of practical guidelines of protective measures to prevent scrub typhus.