일개 부산지역 3차 병원에서 관찰한 다제내성 결핵의 실태, 2005~2009

윤늘봄 ( Neul Bom Yoon ),이성우 ( Sung Woo Lee ),박수민 ( Su Min Park ),정일환 ( Il Hwan Jeong ),박소영 ( So Young Park ),한송이 ( Song Yee Han ),이유림 ( Yu Rim Lee ),정진규 ( Jin Kyu Jung ),김준모 ( Joon Mo Kim ),김수영 ( Su You 대한결핵 및 호흡기학회 2011 Tuberculosis and Respiratory Diseases Vol.71 No.2

Background: Although the prevalence of pulmonary tuberculosis has progressively decreased all over the world, drug-resistant tuberculosis is major obstacle in treating tuberculosis. This study was performed to examine the current prevalence and risk factors of drug resistant tuberculosis in a single tertiary hospital in Busan, Korea. Methods: We enrolled 367 patients with active pulmonary tuberculosis on a retrospective basis who had undergone mycobacterium culture and drug sensitivity tests between January 2005 and December 2009. We analyzed all clinical and radiographic parameters to find predictors related to drug resistant tuberculosis. Results: At least one incident of drug resistance was found in 75 (20.4%) patients. Isoniazid (18.8%) was the most frequent resistant drug, followed by rifampin (10.9%), ethambutol (7.1%), streptomycin (4.9%), and fluoroquinolone (2.7%). Resistance to second-line drugs was found in 37 (10.1%) patients. Multidrug resistance and extensively drug resistance was evident in 39 (10.6%) and 4 (1.1%) patients, respectively. Using multiple logistic regression analysis, history of previous treatment including relapse (odd ratio [OR], 11.3; 95% confidence interval [CI], 4.92~ 26.08; p<0.01), treatment failure (OR, 24.1; 95% CI, 5.65~102.79; p<0.01) and an age of below 46 years-old (OR, 3.8; 95% CI, 1.62~8.65; p<0.01) were found to be independent predictors of multidrug resistant tuberculosis. Conclusion: We found that the prevalence of drug resistant tuberculosis was considerably high. A careful consideration for possible drug resistant tuberculosis is warranted in patients with a history of previous treatment or for younger patients.

급성 신부전을 동반한 Churg-Strauss 증후군

정일환 ( Il Hwan Jeong ),남영희 ( Young Hee Nam ),김대철 ( Dae Cheol Kim ),이혜원 ( Hye Won Lee ),윤늘봄 ( Neul Bom Yoon ),엄수정 ( Soo Jung Um ),이수걸 ( Soo Keol Lee ),손춘희 ( Choon Hee Son ) 대한천식알레르기학회 2012 천식 및 알레르기 Vol.32 No.3

Background: Churg-Strauss syndrome is a rare systemic disorder characterized by bronchial asthma, hypereosinophilia and systemic vasculitis. The prevalence and severity of renal involvement in patients with Churg-Strauss syndrome is not well known. We report a rare case of a patient with Churg- Strauss syndrome accompanied by acute renal failure. Case History: A 52-year-old woman with skin rash and generalized edema was admitted to our hospital via the emergency room. She had a 7-year history of bronchial asthma and allergic rhinitis. Laboratory evaluation showed marked eosinophilia, elevated creatinine, and heavy proteinuria. She was positive for anti-neutrophil cytoplasmic antibody. Computed tomography of chest and paranasal sinuses revealed pulmonary infiltration and pansinusitis. Peripheral neuropathy was confirmed and small vasculitis was noted in a skin biopsy specimen. Results: She was diagnosed with Churg-Strauss syndrome and showed rapidly progressive renal insufficiency despite systemic corticosteroid administration. Oilguria was aggravated, and hemodialysis was thereafter started. Despite 2 weeks of continuous hemodialysis, her renal function was not improved. Conclusion: We report a rare case of Churg-Strauss syndrome associated with acute renal failure. A long-term follow- up is needed in Churg-Strauss syndrome patients.

Drug reaction with eosinophilia and systemic symptoms 증후군의 임상 양상과 혈청 비타민 D 측정치 사이의 연관성

박미란 ( Mi Ran Park ),남영희 ( Young Hee Nam ),정일환 ( Il Hwan Jeong ),이혜원 ( Hye Won Lee ),김용준 ( Yong Jun Kim ),박인철 ( In Chul Park ),조덕송 ( Duk Song Cho ),윤늘봄 ( Neul Bom Yoon ),엄수정 ( Soo Jung Um ),손춘희 ( Choon 대한소아알레르기호흡기학회 1991 소아알레르기 및 호흡기학회지 Vol.1 No.2

Purpose: Vitamin D deficiency (VDD) is widely spread and on the increase throughout the world. Although vitamin D is essential for skeletal mineralization, VDD or vitamin D insufficiency (VDI) has been associated with nonskeletal disorders including cardiovascular disease, cancer, allergic disease and skin disease. However, a few reports showed the association of vitamin D and drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. Thereafter, we evaluated the association between vitamin D and DRESS syndrome. Methods: We conducted a retrospective study on 45 patients with DRESS syndrome. Four hundred and ninty-eight healthy people who visited the health screening center were enrolled in the study as a control group. We investigated the clinical characteristics, the causative drugs and treatments in the patients with DRESS syndrome, and also analyzed the associations with serum 25-hydroxyvitamin D (25(OH)D3). Results: Forty-four patients (97.8%) had low serum vitamin D levels; 21 patients were VDD (serum 25(OH)D3 <10 ng/mL), and 23 patients were VDI (serum 25(OH)D3 10 to 30 ng/mL). There were no significant differences in clinical parameters between two groups. Serum 25(OH)D3 level of the study patients was significantly lower that of the controls (12.3±9.6 ng/mL vs. 17.3±5.5 ng/mL, P<0.001). Serum 25(OH)D3 level showed a significant negative correlation with admission days (r=-0.377, P=0.011). Conclusion: The majority of the patients with DRESS syndrome showed low vitamin D levels. Serum 25(OH)D3 was inversely correlated with admission days. (Allergy Asthma Respir Dis 2013;1:144-150)

감염 ; 폐외 결핵 진단에서 2개의 전혈 인터페론 감마 측정법의 유용성 비교

한송이 ( Song Yee Han ),이혁 ( Hyuck Lee ),정동식 ( Dong Sik Jung ),김경희 ( Kyeong Hee Kim ),우수미 ( Su Mi Woo ),박소영 ( So Young Park ),서정민 ( Jeong Min Seo ),정진규 ( Jin Kyu Jung ),윤늘봄 ( Neul Bom Yoon ),이성우 ( Sung W 대한내과학회 2011 대한내과학회지 Vol.81 No.4

목적: QuantiFERON-TB GOLD (QFT-G)와 QuantiFERON-TB GOLD in tube (QFT-IT) 검사는 주로 활동성 폐결핵 또는 잠복결핵의 진단과 관련되어 연구되어져 왔으나, 폐외 결핵의 진단과 유용성은 아직 잘 밝혀지지 않은 상태이다. 본 연구는 폐외 결핵 환자에서 QFT-G와 QFT-IT의 진단적 유용성에 대해 비교 분석하였다. 방법: 2007년 6월부터 2010년 8월까지 임상적으로 폐외결핵이 의심되어 QFT-G, QFT-IT 검사를 한 환자 각각 56명과 48명을 대상으로 하였다. QFT-G와 QFT-IT의 민감도, 특이도, 양성예측도, 음성예측도와 QFT-IT의 cut-off value를 통하여 진단적 유용성을 분석하였다. 결과: 폐외 결핵으로 진단된 환자는 55명(53%)이었고 QFT-IT의 민감도, 특이도, 양성예측도, 음성예측도는 96%, 42%, 62%, 91%이었으며, QFT-G는 81%, 52%, 68%, 68%이었다. 감염부위에 따른 검사 결과 또한 민감도, 음성예측도에서 QFT-IT가 QFT-G보다 더 높은 결과를 보였다. 본 연구에서 cut-off value는 기존에 권고하고 있는 cut-off value의 범위 안에 포함되었다(0.30-0.45 IU/mL, sensitivity 95.8%, specificity 41.7%). 결론: QFT-IT는 M.tuberculosis 감염의 진단에 있어서 QFT-G보다 높은 민감도와 음성예측도를 보이며, 특이도에 있어서는 유사한 결과를 보여 새로운 IGRA방법으로서 폐외결핵의 진단을 더 강화시킬 수 있는 가능성을 보여주었다. Background/Aims: The QuantiFERON-TB Gold (QFT-G) and QuantiFERON-TB Gold in tube (QFT-IT) assays have been studied primarily for the use of diagnosing active pulmonary tuberculosis (TB) or latent TB. The clinical usefulness of these assays for the detection of active extrapulmonary (EP) TB has not been fully defined. The aim of this study was to compare the diagnostic value of these two interferon-gamma assays for EP-TB. Methods: From June 2007 to August 2010, we evaluated the usefulness of QFT-G (n=56) and QFT-IT (n=48) in patients (n=104) with suspected EP-TB. The diagnostic sensitivity, specificity, postive predictive value (PPV), and negative predictive value (NPV) of QFT-G and QFT-IT, and the cut-off value of QFT-IT were analyzed. Results: EP-TB was diagnosed in 55 (53%) patients. The overall sensitivity, specificity, PPV, and NPV of the QFT-IT assay were 96%, 42%, 62%, and 91%, respectively, and those of the QFT-G test were 81%, 52%, 68%, and 68%, respectively. In subgroup analyses according to infection site, the sensitivity and NPV of QFT-IT were higher than those of QFT-G. Analysis confirmed that the manufacturer`s recommended test cut-off value fell within our cut-off value range (0.30-0.45 IU/mL; 95.8% sensitivity, 41.7% specificity). Conclusions: The QFT-IT assay showed superior sensitivity and NPV, and equivalent specificity, as comparison with the QFT-G test for the detection of Mycobacterium tuberculosis infection. The logistic benefits of the QFT-IT test format should facilitate the diagnosis of EP-TB. (Korean J Med 2011;81:478-486)

Drug reaction with eosinophilia and systemic symptoms 증후군의 임상 양상과 혈청 비타민 D 측정치 사이의 연관성

박미란 ( Mi Ran Park ),남영희 ( Young Hee Nam ),정일환 ( Il Hwan Jeong ),이혜원 ( Hye Won Lee ),김용준 ( Yong Jun Kim ),박인철 ( In Chul Park ),조덕송 ( Duk Song Cho ),윤늘봄 ( Neul Bom Yoon ),엄수정 ( Soo Jung Um ),손춘희 ( Choon 대한소아알레르기호흡기학회 2013 Allergy Asthma & Respiratory Disease Vol.1 No.2

Purpose: Vitamin D deficiency (VDD) is widely spread and on the increase throughout the world. Although vitamin D is essential for skeletal mineralization, VDD or vitamin D insufficiency (VDI) has been associated with nonskeletal disorders including cardiovascular disease, cancer, allergic disease and skin disease. However, a few reports showed the association of vitamin D and drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. Thereafter, we evaluated the association between vitamin D and DRESS syndrome. Methods: We conducted a retrospective study on 45 patients with DRESS syndrome. Four hundred and ninty-eight healthy people who visited the health screening center were enrolled in the study as a control group. We investigated the clinical characteristics, the causative drugs and treatments in the patients with DRESS syndrome, and also analyzed the associations with serum 25-hydroxyvitamin D (25(OH)D3). Results: Forty-four patients (97.8%) had low serum vitamin D levels; 21 patients were VDD (serum 25(OH)D3 <10 ng/mL), and 23 patients were VDI (serum 25(OH)D3 10 to 30 ng/mL). There were no significant differences in clinical parameters between two groups. Serum 25(OH)D3 level of the study patients was significantly lower that of the controls (12.3±9.6 ng/mL vs. 17.3±5.5 ng/mL, P<0.001). Serum 25(OH)D3 level showed a significant negative correlation with admission days (r=-0.377, P=0.011). Conclusion: The majority of the patients with DRESS syndrome showed low vitamin D levels. Serum 25(OH)D3 was inversely correlated with admission days. (Allergy Asthma Respir Dis 2013;1:144-150)