중합효소연쇄반응을 이용한 Chlamydia trachomatis의 검출

서일혜(Yiel Hea Seo),최태열(Tae Yeal Choi) 大韓微生物學會 1995 大韓微生物學會誌 Vol.30 No.2

혈액 및 양수에서 확인된 신생아,산모 리스테리아증

이승현 ( Seung Hyeon Lee ),손동우 ( Dong Woo Son ),심소연 ( So Yeon Shim ),서일혜 ( Yiel Hea Seo ),김석영 ( Suk Young Kim ) 대한주산의학회 2008 Perinatology Vol.19 No.4

Neonatal listeriosis is not uncommon in Western developed countries, and has significant mortality and morbidity. However, its incidence in Asian countries is relatively low and it has rarely been reported in Korea. Once infected, Listeria monocytogenes (L. monocytogenes) can have high mortality and listeriosis in pregnancy may present serious hazards to the fetus and the newborn as sepsis and death through direct infection of the placenta and chorioamnionitis. Because early detection of L. monocytogenes infection is difficult, only high index of suspicion toward this disease can hopefully prompt treatment of this life-threatening perinatal infection. We experienced a case of L. monocytogenes yielded in cultures of blood and amniotic fluid of the newborn and the mother who delivered at 25+1 weeks of gestation because of preterm labor that developed without any specific evidence of infection. We report this case with a brief review of the literature.

급성 관동맥증후군에서 예후평가를 위한 NT-proBNP, troponin 1, hs-CRP의 유용성

오병천 ( Pyung Chun Oh ),한승환 ( Seung Hwan Han ),정욱진 ( Wook Jin Chung ),강웅철 ( Woong Chol Kang ),서일혜 ( Yiel Hea Seo ),엄영실 ( Young Sil Eom ),문찬일 ( Chan Il Moon ),봉정민 ( Jeong Min Bong ),신미승 ( Mi Seung Shin ) 대한내과학회 2009 대한내과학회지 Vol.77 No.2

Background/Aims: Elevated levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), troponin I, and high-sensitivity C-reactive protein (hs-CRP) are each associated with higher rates of death and recurrent myocardial ischemia in patients with acute coronary syndrome (ACS). We evaluated the prognostic value of NT-proBNP and a multi-marker risk approach with the simultaneous assessment of NT-proBNP, troponin I, and hs-CRP in patients with ACS. Methods: We included 277 patients who were admitted for ACS between January and December 2006. We measured NT-proBNP, troponin I, and hs-CRP within 24 hours of the onset of symptoms. Patients were followed for a an of 559 days for cardiovascular events, including death, new myocardial infarction, heart failure, or rehospitalization for ACS. Results: NT-proBNP was the most powerful predictor of clinical outcome among the biomarkers (HR 3.65, 95% CI 2.11-6.30), followed by the peak troponin I and hs-CRP (HR 2.08, 95% CI 1.12-3.87; HR 1.99, 95% CI 1.18-3.37, respectively), but not the baseline troponin I. A multi-marker risk approach with the simultaneous assessment of NT-proBNP, hs-CRP, and peak troponin I was significantly associated with cardiovascular events, especially the presence of three positive biomarkers (adjusted HR 4.20, 95% CI 1.39-12.67). Conclusions: NT-proBNP is the most powerful, independent predictor of clinical outcome among the cardiac biomarkers. Since the peak troponin I level provides more prognostic information than the baseline level, follow-up measurement of troponin I may be warranted for risk stratification. The multi-marker risk approach appears to have better prognostic performance than any marker in isolation. (Korean J 77:200-210, 2009)

증례 : Hafnia alvei에 의해 발생된 부폐렴성 흉수를 동반한 괴사성 폐렴 2예

김유진 ( Yu Jin Kim ),류희정 ( Hee Juang Ryu ),안창혁 ( Chang Hyeok An ),이상표,박정웅,정성환 ( Sung Hwan Jeong ),서일혜 ( Yiel Hea Seo ) 대한내과학회 2005 대한내과학회지 Vol.69 No.-

Hafnia alvei는 그람음성 간균으로 위장관에 공생하는 균이며 병원성이 거의 없는 것으로 알려져 있다. H. alvei에 의한 위장관 감염은 많이 알려져 있으나 장외감염은 세계적으로도 드물고 특히 국내 보고는 매우 드물다. 저자들은 H. alvei에 의해 폐감염이 생긴 두개의 증례를 경험하였다. 첫번째 증례는 당뇨병이 있던 37세 남자 환자가 갑자기 발생된 흉통과 호흡곤란을 주소로 내원하여 객담과 기관지세척액, 흉막액 모두에서 H. alvei가 배양되었다. Cefepime 및 levofloxacine 치료로 호전되어 퇴원하였다. 두번째 증례는 당뇨병이 있던 67세 남자 환자가 객혈과 호흡곤란을 주소로 내원하여 객담에서 H. alvei가 배양되어 치료하였으나 패혈증으로 진행되어 사망하였다. H. alvei는 드물기는 하나 기저질환이 있는 환자에서 병원균으로서 중증감염을 일으킬 수 있으므로 주의 및 적극적인 치료를 요한다. Hafnia alvei is gram-negative bacilli that found in gastrointestinal track and rarely considered to be pathogenic. It has been associated with gastroenteritis but extraintestinal H. alvei infection is rarely reported. A 37-year-old man with diabetes mellitus was admitted to our hospital because of pleuritic chest pain and dyspnea. H. alvei was cultured in sputum, bronchial washing, and pleural fluid. The patient was treated with intravenous cefepime and then levofloxacine. A 67-year-old man with diabetes mellitus, hypertension and vesicostomy state was admitted because of blood-tinged sputum. H. alvei was cultured in sputum in twice. The patient was treated with intravenous piperacilline/tazobactam and then imipenem but expired after 25 days due to multiple organ system failure. Although rare, H. alvei may be a potential pathogen in a patient with a chronic underlying illness, there is need to attention and intensive management of H. alvei infection. (Korean J Med 69:S840-S845, 2005)

WOPN을 동반한 급성 괴사성 췌장염 환자에서 내시경적 췌장괴사 제거술 후 발생한 Wernicke Encephalopathy

김민수 ( Min Su Kim ),강은경 ( Eun Kyung Kang ),김수영 ( Su Young Kim ),김지연 ( Ji Yeon Kim ),문송미 ( Song Mi Moon ),서일혜 ( Yiel Hea Seo ),조재희 ( Jae Hee Cho ),박윤수 ( Yoon Soo Park ) 대한췌장담도학회 2016 대한췌담도학회지 Vol.21 No.1

Infected walled-off pancreatic necrosis (WOPN) is dangerous complication of acute pancreatitis. Open necrosectomy and post-operative irrigation of necrotic cavity have been conventional treatment for infected pancreatic necrosis, however, recently minimally invasive techniques such as endoscopic necrosectomy has been regarded as preferred treatment method for infected WOPN. Endoscopic necrosectomy provides a targeted approach with a reduction in the systemic inflammatory response and avoidance of wound complications. Non alcohol related Wernicke encephalopathy is rare disease caused by thiamine deficiency due to intravenous feeding, and presented an encephalopathy, oculomotor dysfunction, gait ataxia. We report herein a case of Wernicke encephalopathy after successful endoscopic necrosectomy for infected WOPN.

증례 : 감염 ; HIV 감염 환자에서 발생한 Ramsay Hunt 증후군 1예

강은경 ( Eun Kyung Kang ),김지연 ( Ji Yeon Kim ),송경환 ( Kyung Hwan Song ),문송미 ( Song Mi Moon ),고광필 ( Kwang Pil Ko ),서일혜 ( Yiel Hea Seo ),박윤수 ( Yoon Soo Park ) 대한내과학회 2016 대한내과학회지 Vol.90 No.2

RHS는 안면신경 무릎신경절에 수두대상포진바이러스(varicellar zoster virus)가 감염되어 있다가 얼굴과 귀에 분지되어 있는 감각 분지로 재활성화되어 발생한다. 전형적인 3가지 증상인 얼굴마비, 귀 통증, 외이도와 귓바퀴의 소수포성 발진이 나타나면 RHS라고 진단한다. 본 증례는 사람면역결핍바이러스 환자에서 RHS 진단과 치료의 국내 첫 보고이다. 40세 남자가 우측 귀 통증과 귀가 멍멍한 느낌을 주소로 내원하였다. 입원 직후 우측 얼굴의 말초 신경마비, 이루, 두통, 혀의 우측 운동 장애가 나타났으며 우측 외이도와 귓바퀴에 소수포성 발진이 관찰되었다. 입원 10일째 청력저하를 호소하였으며 고막 천공이 관찰되었다. 말초혈액 검사에서 사람면역결핍바이러스(HIV) 항체가 양성으로 도출되었고 확진 검사 양성이 확인되었다. CD4 T cell은 281/μL였다. 치료는 valacyclovir와 steroid를 투여하고 highly active antiretroviral therapy를 시행하였으며 안면마비를 포함한 증상은 치료 후호전되었으나 청력저하는 호전이 없었다. Ramsay Hunt syndrome is caused by reactivation of the varicella zoster virus in the geniculate ganglion of the sensory branch in the face and ears. It is characterized by peripheral facial palsy, ear pain, and vesicles in the auditory canal and auricle. We report on a first case of Ramsay Hunt syndrome in a patient with human immunodeficiency virus in Korea. The patient, a 40-year-old male, first presented with otalgia and ear fullness. On admission, he had right facial palsy of the peripheral type, otorrhea, headache, limited tongue movement, and right auricle vesicular eruptions. He had positive human immunodeficiency virus antibody and Western blot tests. His CD4 T cell count was 281/μL. The patient was treated with valacyclovir and steroid with highly active antiretroviral therapy. His symptoms and facial palsy improved with treatment. (Korean J Med 2016;90:169-172)

영아에서의 침습 B군 사슬알균 감염증 및 혈청형 분석: 2개 대학병원 연구

조혜경 ( Hye-kyung Cho ),남혜나 ( Hye Na Nam ),조혜정 ( Hye Jung Cho ),손동우 ( Dong Woo Son ),조용균 ( Yong Kyun Cho ),서일혜 ( Yiel-hea Seo ),김예진 ( Yae-jean Kim ),은병욱 ( Byung Wook Eun ) 대한소아감염학회 2017 Pediatric Infection and Vaccine Vol.24 No.2

목적: 침습 B군 사슬알균(group B streptococcus [GBS]) 감염증에서 분리된 균의 혈청형과 임상적 특징의 관계를 분석하고자 하였다. 방법: 가천대 길병원과 삼성서울병원에 입원한 GBS 감염 환자 데이터를 후향적으로 수집하고 슬라이드 응집법으로 혈청형을 정하였다. 결과: 총 37명 중 만삭아 22명, 미숙아 15명이었고, 조발형 15명(40.5%), 지발형 19명(51.4%), 늦은 지발형 3명(8.1%)이었다. 조발형이 미숙아에서 더 많이 발생하였다(P =0.17). 임상 양상은 균혈증(70.3%)이 가장 흔했고, 수막염, 화농관절염 순이었다. 혈청형 분석이 가능했던 24 균주 중 III형이 가장 흔했고 (41.7%), V (16.7%), Ia, Ib, II (각각 12.5%), non-typeable (4.2%)였다. III형은 만삭아에서 더 많았던 반면, V형은 미숙아에서 더 흔했다. 페니실린 내성균은 없었고 에리트로마이신과 클린다마이신 내성은 각각 64.9%였다. 결론: GBS는 미숙아와 만삭아에게 모두 중요한 병원체이며 혈청형 분포에서도 미숙아와 만삭아 간에 차이가 있을 수 있다. 조발형 질환의 발생을 과소평가하지 않고 적절한 예방 대책을 마련하기 위해 미숙아를 포함한 GBS 질환의 전국적인 역학을 감시하는 것이 필요하다. Purpose: This study was aimed at analyzing the serotypes of group B streptococcus (GBS) isolated from Korean infants with invasive disease and evaluating their association with disease manifestation. Methods: Data were retrospectively collected from invasive GBS infections at Gachon University Gil Medical Center from January 2006 to June 2012 and at Samsung Medical Center from April 2010 to November 2012. Serotypes were determined by slide agglutination test. Results: A total of 37 cases were identified, which included 22 full-term infants and 15 preterm infants. Fifteen cases (40.5%) were early-onset, 19 (51.4%) was late-onset, and three (8.1%) was very late-onset. Early-onset diseases among preterm infants were higher than those among full-term infants (60.0% [9/15] vs. 27.3% [6/22], P =0.17). The most common manifestation was bacteremia (70.3%), followed by meningitis and septic arthritis. Among 24 isolates retrievable for serotyping, serotype III (41.7%) was most common, followed by V (16.7%), Ia, Ib, and II (12.5%, respectively), and non-typeable (4.2%). Serotype III was more common in isolates from full-term infants (10/22) than from preterm infants (0/15), whereas serotype V was more common in isolates from preterm infants (4/15) than from full-term infants (0/22) (P =0.002). No penicillin-resistant strain was detected, and resistance to erythromycin and clindamycin were both 64.9%. Conclusions: GBS is an important pathogen in both preterm and full-term infants, and serotype distribution of GBS causing invasive diseases can differ between preterm and full-term infants. It is necessary to monitor the nationwide epidemiology of GBS diseases, including in preterm infants, in order to prepare preventive measures without underestimating early-onset diseases.

증례 : 감염 ; 수술 후 발생한 Corynebacterium Striatum 복강 내 감염

최현석 ( Hyun Seok Choi ),김주승 ( Ju Seung Kim ),정을식 ( Eul Sik Jung ),김애진 ( Ae Jin Kim ),정한 ( Han Jung ),박윤수 ( Yoon Soo Park ),서일혜 ( Yiel Hea Seo ) 대한내과학회 2012 대한내과학회지 Vol.82 No.4

Corynebacterium striatum is an aerobic, Gram-positive bacillus that is part of the resident flora of skin and mucosal membranes. C. striatum is usually considered a non-pathogenic contaminant, although infective endocarditis and respiratory infection, and less frequently arthritis and meningitis, due to C. striatum have been reported. C. striatum has been particularly associated with catheter-related infections and infections following conditions that resulted in disruption of the skin barrier in both immunocompromised and immunocompetent hosts. We describe a case of post-operative intra-abdominal infection caused by the rare pathogen, C. striatum. (Korean J Med 2012;82:516-519)

급성 골수성 백혈병에서 AML1 / ETO 융합유전자와 예후

조은경(Eun Kyung Cho),정은경(Eun Kyung Jung),안정렬(Jeong Yeal Ahn),임도윤(Do Yoon Lim),경선영(Sun Young Kyung),주기탁(Ki Tak Ju),방수미(Soo Mee Bang),서일혜(Yiel Hea Seo),신동복(Dong Bok Shin),이재훈(Jae Hoon Lee) 대한내과학회 2001 대한내과학회지 Vol.61 No.6

N/A Background: The t (8;21) (q22;q22), which produces the fusion gene AML1/ETO, is associated with relatively good prognosis and, in particular, with a good response to cytosine arabinoside. Analysis of t (8;21) positive leukemic blasts has shown characteristic morphological and immunological features. We performed this study to investigate the incidence of AML1/ETO rearrangement in adult AML, especially in M2 subtype, to make a comparison of morphologic, immunophenotypic and clinical characteristics between AML1/ETO rearrangement positive and negative group in patient with AML and to analyze the correlation with other biological parameters. Methods: From May 1995 to Sep. 2000, fifty-nine patients with AML including twenty-nine AML-M2 were studied. RNAs were extracted from leukemic cells and reverse transcriptase mediated polymerase chain reaction (RT-PCR) for AML1/ETO fusion transcript was done. Chromosome study, immunophenotypic, and clinical characteristics were analysed and statistical analysis was done. Results: The male to female ratio was 32:27 in AML and 17:12 in AML-M2. The median age was 43 years (range 14-86) in AML and 43 years (range 14-77) in AML-M2. The incidence of AML1/ETO fusion transcripts was 22.0% in AML and 44.8% in AML-M2. The morphologic finding of bone marrow in AML-M2 showed higher incidence of Auer rods, large blast with prominent golgi and abnormal granules in AML1/ETO positive patients. There was no significant difference of immunophenotype. AML patients with AML1/ETO rearrangement had a tendency of higher complete remission rate (81.8% vs 56.6%, p=0.13). The overall survival (median 82.2 weeks vs 34.4 weeks, p=0.02) and progression free survival (median 50.9 weeks vs 20.4 weeks, p=0.02) of AML1/ETO positive group were longer than those of negative group in AML. AML-M2 patients with AML1/ETO rearrangement had also a tendency of longer overall survival and progression free survival, although there was no significant difference between both group (median OS 82.4 weeks vs 15.6 weeks, p=0.07, median PFS 50.9 weeks vs 16.0 weeks, p=0.09). Conclusion: Our data suggest that AML1/ETO rearrangement is detected frequently in AML, especially M2, and is a favorable prognostic factor. Thus, molecular diagnostic approaches should be used routinely to identify patients with this genetic subtype of AML.(Korean J Med 61:650-659, 2001)

다중 중합효소연쇄반응 및 제한효소 RFLP를 이용한 마이코박테리아의 동정

서일혜,김완,안정열,금동극 대한감염학회 1999 감염 Vol.31 No.2