임상강좌 : 감염 질환에서 흔히 보는 비특이적 검사 이상의 해석

백경란 ( Kyong Ran Peck ) 대한내과학회 1999 대한내과학회 추계학술대회 Vol.57 No.-

황색포도알균에 의한 감염성 심내막염의 임상적 특성

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)

증례 : 위험인자 없이 자연판막에 발생한 아스페르길루스 심내막염 1예

김영찬 ( Young Chan Kim ),백경란 ( Kyong Ran Peck ),길재숙 ( Jae Sook Kil ),김효송 ( Hyo Song Kim ),권기태 ( Ki Tae Kwon ),박표원 ( Pyo Won Park ),송재훈 ( Jae Hoon Song ) 대한내과학회 2007 대한내과학회지 Vol.73 No.1S

혈관염을 포함한 류마티스 질환에서의 항호중구세포질 항체 양성율

송영욱 ( Yeong Wook Song ),백경란 ( Kyong Ran Peck ) 대한류마티스학회 1994 대한류마티스학회지 Vol.1 No.1

연구 배경: Anti-neutrophil cytoplasmic antibody(ANCA)는 호중구와 단핵구의 세포질내에 존재하는 단백질에 대한 자가항체로, 많은 전신성 괴사성 혈관염 환자들의 진단에 도움이 되는 지표로서 이용이 되고 있고. ANCA가 전신성 혈관염에 비교적 특이적인 항체이어서, 다른 면역학적인 검사와 함께 실시하면 전신성 혈관염과 류마티스 질환을 감별진단하는데 도움이 되는 것으로 알려져 있다. 저자들은 전신성 혈관염 중 우리 나라에 많은 베체트병 타카야수 동맥염에서의 ANCA 양성율과 그 외 여러 류마티스 질환에서의 ANCA 양성율에 대한 조사를 하고자 본 연구를 시행하였다. 방법: 서울대학교병원 내과 류마티스 크리닉에 다니는 활동성 류마티스 질환 및 혈관염성 질환 환자를 대상으로 간접면역형광법을 이용하여 혈청의 ANCA 양성률을 조사하였다. 대상 환자는 총 185명(여자 115명, 남자 70명)이었고, 질환 별로는 전신성홍반성낭창 41예, 류마티스양관절염 31예, 베체트병 50예, 그리고 타카야수 맥염 11예이었다. 그밖에 Henoch-Schonlein 자반증(HSP)과 베게너 육아종증 환자가 각각 1예씩 있었다. 결과: 전신성홍반성낭창 환자 41예 중에서는 2예가 P-ANCA 양성이었고, C-ANCA가 양성인 예는 없었으며, P-ANCA가 양성인 2예는 특별히 혈관염 증상 및 징후가 관찰되지는 않았다. 피부 근염 및 다발성근염 환자 22예 중에서 1예가 P-ANCA 양성이었고 역시 C-ANCA 양성을 보이는 환자는 없었다. 류마티스양관절염 환자 31예, 강직성척추염 환자 9예, 진행성전신경화중 환자 19예는 모두 ANCA 음성이었다. 베체트병, 환자 50예 중 P-ANCA 양성은 2예 있었고, C-ANCA 양성은 없었다. P-ANC가 양성인 2예는 모두 완전형(complete type)으로 구강궤양, 성기궤양, 포도막염 및 피부병변이 있었고, 이중 1예는 혈관염 병변으로 우측 대퇴정맥의 폐쇄소견이 있었다. 타카야수 동맥염 11예와 Henoch-Schonlein 자반증 1예에서 ANCA 양성을 보이는 예는 없었다. 베게너 육아종중 환자 1예는 전형적인 C-ANCA 양성을 보였다(Table 2). 이 환자는 치료 후 관해가 온 다음에는 C-ANCA가 음전되었다. 결론: 이상의 결과로 한국인에 많은 혈관염 및 류마티스질환의 ANCA 검사가 ANCA 양성 혈관염과 다른 류마티스질환을 감별하는데 도움이 될 것으로 사료되었다. Background: Antineutrophil cytoplasmic antibodies (ANCA) are autoantibodies that are specific for proteins in the cytoplasm of neutrophils and monocytes. In the 10 years since their discovery, ANCA have become widely used serological markers for various systemic necrotizing vasculitides, including Wegener`s granulomatosis, polyarteritis nodosa, crescentic glomerulonephritis, and Churg-Strauss syndrome. Rheumatic manifestations (such as arthralgia, myalgia, even frank arthritis) are observed frequently in the group of primary vasculitides. In the group of collagen vascular diseases and the various forms of chronic inflammatory arthritis, vasculitis may severely complicate the course of the disease. Since atypical vasculitic diseases are indistingushable from other rheumatic disorders in the initial period of disease, immunological studies must be performed. We conducted this study for obtaining the seroprevalence of ANCA in rheumatic disorders including vasculitides which are common in Korea. Method: ANCA was detected with indirect immunofluorescent microscopy of alcohol-fixed granulocytes. Results: Total 185 patients were enrolled in this study. There was no patient having C-ANCA except one patient with Wegener`s granulomatosis. Total 5 patients were positive for P-ANCA; 2 of 41 SLE patients, 1 of 22 dermatomyositis/polymyositis patients, 2 of 50 Behcet`s disease patients. All 11 patients with Takayasu`s arteritis were ANCAnegative. These results were similar to those of others. Conclusion: ANCA, as a adjunct to other autoantibodies, will be helpful for differential diagnosis of various vasculitides and rheumatic disorders.

이식 환자의 감염 예방

하영은 ( Young Eun Ha ),백경란 ( Kyong Ran Peck ) 대한내과학회 2013 대한내과학회지 Vol.84 No.2

Opportunistic infections are major causes of morbidity and mortality in hematopoietic stem-cell transplant and solid organ transplant recipients. The epidemiology and incidence of opportunistic infections in those patients have been dramatically changed with use of potent immunosuppressive agents as well as routine prophylaxis against various microorganisms such as common bacterial pathogens, fungi, cytomegalovirus, Pneumocystis jirovecii, and so on. Because transplant recipients are at the greatest risk for infection during early phase (1-3 months) after transplant, safe and effective prevention strategies should be implemented in this period. Moreover, beyond early phase, recipients are often susceptible to infections due to prolonged immunosuppressive therapy for graft rejection or chronic graft-versus-host diseases. Therefore, clinicians should assess a recipient`s risk of infection on the basis of concomitant graft function, intensity of immunosuppression, and other factors that may contribute to susceptibility to infections. We discussed infection prevention strategies among recipients of hematopoietic stem-cell and solid organ transplantation against various opportunistic pathogens. Vaccinations should also be recommended for pre-transplant candidates and post-transplant recipients for the best prevention of infections. (Korean J Med 2013;84:168-178)

요로감염에 관여하는 카테터 내 박테리아의 Quorum Sensing 관련 autoinducer 합성 유전자의 발현분석

이미혜,서필수,이지열,백경란,이상섭,Lee, Mi-Hye,Seo, Pil-Soo,Lee, Ji-Youl,Peck, Kyong-Ran,Lee, Sang-Seob 한국미생물학회 2006 미생물학회지 Vol.42 No.4

본 연구에서는 신경인성 방광으로 요도 카테터를 유치하고 있는 환자의 카테터로부터 카테터 내 요로감염(Catheter-Associate Urinary Tract Infection; CA-UTI)에 관여하는 박테리아인 Escherichia coli, Pseudomonas aeruginosa 그리고 Staphylococcus aureus를 순수 분리, 동정하였다. 이 균주들을 대상으로 하여 quorum sensing mechanism을 규명하는 기초 연구로 각 균주의 quorum sensing 신호물질인 autoinducer (AIs)를 합성하는 유전자의 mRNA 발현을 확인하고, 정략분석 하였다. 각 세 균주를 단일과 세 균주의 혼합으로 24시간, 30일 동안 배양하며 일정 시간 간격으로 sample을 얻었다. 이 중 24시간 배양한 sample을 가지고 reverse transcription polymerase chain reaction (RT-PCR)을 수행하여 각 AIs 합성 유전자가 발현되는 최초 박테리아 밀도를 확인하였다. 단일배양에서 E. coli와 S. aureus의 AIs 합성 유전자(ygaG와 luxS)의 mRNA가 발현되는 최초 박테리아 밀도는 $2.4{\times}20^5$ CFU/ml, $5.4{\times}10^6$ CFU/ml 이었으며 P. aeruginosa의 rhlI와 lasI의 경우 $6.9{\times}10^4$ CFU/ml로 나타났다. 세 균주의 혼합배양에서 ygaG와 luxS의 mRNA가 발현되는 최초 박테리아 밀도는$7.3{\times}10^5$ CFU/ml, $1.6{\times}10^7$ CFU/ml이었으며 rhlI와 lasI의 경우 $2.1{\times}10^5$ CFU/ml로 나타났다. 또한 30일 배양한 sample의 RT-PCR 결과, 배양초기부터 각 AIs 합성 유전자들의 mRNA가 30일 동안 일정한 양만큼 지속적으로 발현됨을 확인하였다. Real-time RT-PCR을 이용한 AIs 합성 유전자의 mRNA 발현을 정량 분석한 결과 각 균주에서 단일배양보다 혼합배양시 AIs 합성 유전자의 발현이 더 많았다. 가장 많은 발현량의 차이를 보인 경우 E. coli ygaG의 mRNA 발현량은 단일배양보다 세 균주의 혼합배양시 최고 약 30배 이상이 증가하였고, P. aeruginosa rhlI의 경우 단일배양보다 혼합배양시 최고 약 40배, P. aeruginosa lasI의 경우 최고 약 250배 그리고 S. aureus luxS의 경우는 단일배양보다 혼합배양시 최고 약 5배 이상 mRNA 발현량이 증가하였다. 또한 세 균주의 4가지 유전자 중 P. aeruginosa의 rhlI와 lasI의 mRNA가 가장 많은 양으로 발현됨을 확인하였다. The most biofilm forming bacteria in catheter, Esctherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus were isolated and identified from a patient's catheter occuring catheter-associated urinary tract infection (CA-UTI). We examined mRNA expression and its quantification of AIs synthetic genes encoding signal substance of quorum sensing from each bacterial species in order to elucidated quorum sensing mechanism. Both pure cultures for each bacterial strains and a mixed cultures with three were grown for 24 hr and 30 days. Initial densities to be able to detect mRNA expression oil single strains culture were shown at $2.4{\times}10^5$ CFU/ml, $5.4{\times}10^6$ CFU/ml of E. coli for ygaG and S. aureus for luxS, and at $6.9{\times}10^4$ CFU/ml of P. aeruginosa for rhlI and lasI. Also, in mixed culture of three, initial cell densities of mRNA expression were appear to at $7.3{\times}10^5$ CFU/ml, $1.6{\times}10^7$ CFU/ml of E. coli for ygaG and S. aureus for luxS, and at $2.1{\times}10^5$ CFU/ml of P. aeruginosa for rhlI and lasI. Each AIs synthetic gene was expressed in initial cell density and the mRNA expression of the genes were detected continously during 30 days. And then, the quantification of mRNA expression level of ygaG, rhlI, last, and luxS which were related AIs synthesis was done each time point by real-time RT-PCR. Interestingly, the mRNA levels of ygaG, rhlI, lasI, and luxS from the mixed culture was higher than those from each single strain culture. In the case of E. coli ygaG, the amount of transcript from the mixed culture was at least 30 times for that from single culture. In the case of P. aeruginosa rhlI and lasI, the amount of transcript from the mixed culture was at least 40 times and 250 times for that from single strain culture. In the case of S. aureus luxS, the amount of transcript from the mixed culture was at least 5 times for that from single strain culture. And specially, the mRNA expression of rhlI and lasI of P. aeruginosa showed the highest efficency among four AIs synthetic genes.

한국인의 Epstein-Barr Virus 항체 양성률 변화양상에 대한 분석: 단일기관 연구

김수경,최준식,김동섭,강철인,정두련,백경란,강은숙,김예진,Kim, Su Kyung,Choi, Joon-Sik,Kim, Dongsub,Kang, Cheol-In,Chung, Doo Ryeon,Peck, Kyong Ran,Kang, Eun-Suk,Kim, Yae-Jean 대한소아감염학회 2020 Pediatric Infection and Vaccine Vol.27 No.2

Purpose: Epstein-Barr virus (EBV) infection is related to infectious mononucleosis or nasopharyngeal cancer, and its epidemiology may change according to the socioeconomic development of communities. This study aimed to evaluate the recent epidemiology of EBV seropositive rate in Korea. Methods: We retrospectively reviewed EBV serology test results obtained from a part of clinical care at Samsung Medical Center, Seoul, South Korea, from January 2000 to December 2017. Results: The EBV seropositive rate in 26,527 subjects during the study period was 81.0% (21,485/26,527): 44.4% (2,716/6,122) in subjects aged 0-9 years, 75.8% (2,077/2,739) in those aged 10-19 years, and 94.5% (16,692/17,666) in those aged ≥20 years. The EBV seropositive rate decreased from 89.4% (8,592/9,616) in 2000-2008 to 76.2% (12,893/16,911) in 2009-2017 (P<0.001). Especially, the EBV seropositive rate in subjects aged 0-19 years significantly decreased from 2000-2008 to 2009-2017 (0-9 years, 62.8% [1,172/1,866] in 2000-2008 and 36.3% [1,544/4,256] in 2009-2017; 10-19 years, 83.8% [745/858] in 2000-2008 and 70.8% (1,332/1,881) in 2009-2017) (P<0.001). Conclusions: The EBV seropositive rate in children has decreased in the last 20 years. As the age of patients with primary EBV infection increased, there is a need for interest in clinical manifestation, such as infectious mononucleosis, in adolescents and young adults.

증례 : 순환기 ; 폐렴간균에 의한 감염성 대동맥류와 동반된 내인성 안내염 1예

오세훈 ( Se Hoon Oh ),이미래 ( Mi Rae Lee ),백경란 ( Kyong Ran Peck ),강세웅 ( Se Woong Kang ),최연현 ( Yeon Hyeon Choe ),김영욱 ( Young Wook Kim ),김덕경 ( Duk Kyung Kim ) 대한내과학회 2010 대한내과학회지 Vol.78 No.3

감염성 대동맥류는 세균성 감염에 의한 동맥벽의 미란과 파괴로 생긴 동맥류를 말한다. 그 원인 병원체로는 그람 양성균, 그람 음성균, 진균, 항산균 등이 있다. 폐렴막대균은 비뇨생식기계 감염, 지역사회 폐렴, 간농양, 내인성 안내염 등을 흔하게 발병시키나 감염성 동맥류의 원인으로는 드물다. 최근 들어, 특히 동부 아시아 지역에서 폐렴막대균으로 인한 간농양의 발생과 이에 동반된 내인성 안내염의 보고가 증가하고 있는 추세이지만 아직까지 폐렴막대균 감염성 동맥류 A mycotic aneurysm is a localized, irreversible arterial dilatation resulting from destruction of the vessel wall by infection. Pathogens causing mycotic aneurysms include Gram-positive and -negative bacteria, mycobacteria, and fungi. Klebsiella pneumoniae

감염성 심내막염 환자에서 16S rRNA 유전자 염기서열 분석을 통한 Gemella 동정 2예

손경목 ( Kyung Mok Sohn ),고관수 ( Kwan Soo Ko ),김정 ( Jeong Kim ),이지영 ( Ji Young Rhee ),오원섭 ( Won Sup Oh ),백경란 ( Kyong Ran Peck ),송재훈 ( Jae Hoon Song ) 대한내과학회 2006 대한내과학회지 Vol.70 No.5

증례 : 비장티푸스성 살모넬라 감염으로 인한 감염성 거짓동맥류와 합병증 1예

서윤 ( Yun Seo ),하영은 ( Young Eun Ha ),성기익 ( Ki Ick Sung ),강철인 ( Cheol In Kang ),백경란 ( Kyong Ran Peck ),송재훈 ( Jae Hoon Song ),정두련 ( Doo Ryeon Chung ) 대한내과학회 2012 대한내과학회지 Vol.83 No.2

저자들은 대동맥활에 발생하고 종격동, 흉강, 심장막에 광범위한 화농성 합병증을 동반한 비장티푸스성 살모넬라 감염에 의한 감염성 거짓 동맥류 1예를 경험하고 치료하였기에 보고하는 바이다. Non-typhoidal Salmonella infections, which rarely present with multiple complications, are predominantly seen in immunocompromised patients, In particular, non-typhoidal Salmonella infections presenting with more than two complications are extremely rare, Here, we report a case of an infected pseudoaneurysm in the aortic arch caused by a non-typhoidal Salmonella species complicated by pleural empyema, pericarditis, pericardial empyema, and mediastinitis, To our knowledge, this is the first such case report in Korea.