제주도에서 브루셀라에 의해 발생한 특발성 세균성 복막염

허상택,조유경,김영리,이근화,윤지완,고관수,박미연,최영실 대한감염학회 2007 Infection and Chemotherapy Vol.49 No.1

Spontaneous bacterial peritonitis is the common infectious disease in liver cirrhosis patients with a fever. Brucellosis is a rare cause of bacterial peritonitis. A case indigenous to a citizen of Jeju, he ate a raw veal of cow four times in last 2 months prior to admission. The gram-negative bacilli were isolated from blood and peritoneal fluid cultures. He was confirmed brucellosis by serologic work- ups. This isolate was confirmed as Brucella abortus by using PCR amplification of 16S ribosomal RNA (rRNA) and omp2. This is the first case of bruellosis that was diagnosed spontaneous bacterial peritonitis in liver cirrhosis patient among native korean citizens. Successful treatment was obtained by using a regimen of doxycycline and gentamicin. Brucella should be suspected as a cause of spontaneous bacterial peritonitis in cirrhotic patients with no response to standard spontaneous bacterial peritonitis treatments. 브루셀라증은 전 세계적으로 발생하는 인수공통 전염병중의 하나로, 국내에서도 해마다 환자가 증가하고 있는 상황이다. 본 증례는 간경화 환자에서 환자의 잘못된 지식을 바탕으로 소 태아 육회를 섭취한 이후 복수와 발열을 주소로 내원한 환자이다. 상기 과거력이 환자의 질환과의 직접적인 연관성을 밝히기는 어려우나 환자의 진단을 추정하는데 도움이 되었으며, 이러한 가능성을 배제하기 위해서라도 국내 유통에 있어서 좀더 적극적인 대체가 필요하다 하겠다. 상기 환자는 브루셀라에 의해 발생한 특발성 세균성 복막염 환자로 제주도에서 발생한 내국인의 첫 증례이기에 문헌 고찰과 함께 보고하는 바이다.

Aspergillus fumigatus에 의한 요추 척추염 1예

허상택,정숙인,김연숙,오원석,조황래,김성민,백경란,송재훈,이남용 대한감염학회 2001 감염 Vol.33 No.2

Aspergillus fumigatus is the most common pathogen causing invasive aspergillosis. Although invasive aspergillosis mainly involves lung, brain, and sinus, Aspergillus fumigatus osteomyelitis of the spine has been reported very rarely. We experienced a case of vertebral Aspergillus osteomyelitis and report it with a review. A 70-year-old women was admitted due to progressive lower back pain, which had begun 1 month before admission. Although she had diabetes and hypertension, no other underlying disease or immune dysfunction was fecund. MRI of spine showed severely destroyeded lumbar spines. Debridement and bone graft was done for correction of unstable spine, and Aspergillus fumigatus wsa grown from surgical specimen. Amphotericin B was given up to total 2 g, and was switched to oral itraconazole maintenance therapy. She is well until now, 120 days after operation. On the other hand, anthracofibrosis due to Mycobac-Terium tuberculosis was found through bronchoscopic study, which was done because of atelectasis in left lower lobe of lung. Therefore she was treated with anti-tuberculous agents also. (Korean J Infect Dis 33: 153∼156, 2001)

제주도에서 브루셀라에 의해 발생한 특발성 세균성 복막염

허상택,조유경,김영리,이근화,윤지완,고관수,박미연,최영실 대한감염학회 2007 감염과 화학요법 Vol.39 No.1

Spontaneous bacterial peritonitis is the common infectious disease in liver cirrhosis patients with a fever. Brucellosis is a rare cause of bacterial peritonitis. A case indigenous to a citizen of Jeju, he ate a raw veal of cow four times in last 2 months prior to admission. The gram-negative bacilli were isolated from blood and peritoneal fluid cultures. He was confirmed brucellosis by serologic work- ups. This isolate was confirmed as Brucella abortus by using PCR amplification of 16S ribosomal RNA (rRNA) and omp2. This is the first case of bruellosis that was diagnosed spontaneous bacterial peritonitis in liver cirrhosis patient among native korean citizens. Successful treatment was obtained by using a regimen of doxycycline and gentamicin. Brucella should be suspected as a cause of spontaneous bacterial peritonitis in cirrhotic patients with no response to standard spontaneous bacterial peritonitis treatments. 브루셀라증은 전 세계적으로 발생하는 인수공통 전염병중의 하나로, 국내에서도 해마다 환자가 증가하고 있는 상황이다. 본 증례는 간경화 환자에서 환자의 잘못된 지식을 바탕으로 소 태아 육회를 섭취한 이후 복수와 발열을 주소로 내원한 환자이다. 상기 과거력이 환자의 질환과의 직접적인 연관성을 밝히기는 어려우나 환자의 진단을 추정하는데 도움이 되었으며, 이러한 가능성을 배제하기 위해서라도 국내 유통에 있어서 좀더 적극적인 대체가 필요하다 하겠다. 상기 환자는 브루셀라에 의해 발생한 특발성 세균성 복막염 환자로 제주도에서 발생한 내국인의 첫 증례이기에 문헌 고찰과 함께 보고하는 바이다.

포스타 전시 발표 : 감염, 알레르기, 류마티스 ; Aspergillus tracheobronchitis 3례

허상택,손준성,신상엽,정숙인,김연숙,오원섭,김성민,백경란,송재훈 대한내과학회 2001 대한내과학회 추계학술대회 Vol.61 No.-

First Case of Necrotizing Fasciitis Caused by Skermanella aerolata Infection Mimicking Vibrio Sepsis

허상택,권기태,유정래,최지영,이근화,고관수 대한진단검사의학회 2018 Annals of Laboratory Medicine Vol.38 No.6

The genus Skermanella, comprising gram-negative, motile, and pigmented bacteria, was first described in 1999 [1]. However, human infections caused by Skermanella have not been reported to date [2, 3]. Here, we present a case of necrotizing fasciitis caused by Skermanella sp. This study was exempted by the Institutional Review Board of Jeju National University Hospital (IRB No: JNUH 2018-04-005). A 76-year-old man with a 13-year history of hypertension and a 6-year history of diabetes mellitus was transferred to a tertiary-care hospital (Jeju National University Hospital, Jeju, Korea) from a local clinic after experiencing pain in the left lower limb and hypotension for one day. The patient resided in a rural area and had consumed fresh fish at a Japanese restaurant, five days prior to the appearance of his presenting symptoms. On admission, his vital signs were as follows: blood pressure, 66/50 mmHg; pulse rate, 105/minutes; respiratory rate, 31/minutes; and body temperature, 38.7°C. On physical examination, his mental status was alert,

The First Case of Catheter-related Bloodstream Infection Caused by Nocardia farcinica

허상택,고관수,권기태,류성열,배인규,오원섭,송재훈,백경란 대한의학회 2010 Journal of Korean medical science Vol.25 No.11

Nocardia farcinica is an emerging pathogen in immunocompromised hosts. Even though several species of Nocardia have been reported as causative pathogens of catheter-related blood stream infections (CRBSI), CRBSI caused by N. farcinica has not been reported. A 70-yr-old man with a tunneled central venous catheter (CVC) for home parenteral nutrition was admitted with fever for two days. Norcardia species was isolated from the blood through CVC and peripheral bloods and identified to N. farcinica by 16S rRNA and rpoB gene sequence analyses. This report emphasizes the rapid and correct identification of causative agents in infectious diseases in the selection of antimicrobial agents and the consideration of catheter removal.

Myositis due to Cryptococcus neoformans in a Diabetic Patient

허상택,배인규,박진용,김선주 대한임상미생물학회 2009 Annals of clinical microbiology Vol.12 No.3

We report a rare case of cryptococcal myositis with dissemination to lung in a 66-year-old diabetic woman who had no apparent risk factors for cryptococcal disease. She visited the hospital with a continuous pain in the right thigh and fever despite of treatment with antibiotics. She developed a localized lung infiltration. Crytococcus neoformans was isolated from the abscess of the right thigh and confirmed by molecular identification with DNA sequence analysis. Biopsy of the involved lung showed numerous budding yeasts consistent with Cryptocococcus species. The patient was successfully treated with surgical drainage and systemic antifungal agents.

Q열로 진단된 불명열 3예

허상택 ( Sang Taek Heo ),박미연 ( Mi Yeoun Park ),최영실 ( Young Sill Choi ),오원섭 ( Won Sup Oh ),고관수 ( Kwan Soo Ko ),백경란 ( Kyong Ran Peck ),송재훈 ( Jae Hoon Song ) 대한내과학회 2008 대한내과학회지 Vol.74 No.1

Q열은 국내에서도 드물지 않은 질환으로 생각되며, 조기에 진단하지 못하는 경우에 심내막염이나 혈관염 등의 만성 Q열로 진행하여 사망에 이를 수 있다. 물론 급성 Q열은 비특이적 증상에서 폐렴이나 간염 소견으로 내원하는 환자가 대부분이나 발열의 원인이 확실한 경우 원인균이 밝혀지지 않아도 Q열의 혈청학적 의뢰를 요하는 경우는 흔하지 않다. 하지만 발열을 주소로 내원한 환자들에 대하여 상기 증례들처럼 불명열의 경우 가축이나 이들의 부산물에 접촉력이 있는 경우 뿐만 아니라 특별한 접촉력이나 직업력이 없더라도 불명열로 내원한 환자들의 감별진단에서 Q열의 가능성을 고려하여 혈청학적 검사 및 핵형 분석을 시행해야 하겠다. 향후 국내에서도 사람뿐만 아니라 가축에서의 대규모의 역학적 조사가 추가적으로 필요할 것으로 생각된다. Q fever is an orthozoonotic infection caused by Coxiella burnetii, which was recently reclassified from the order Rickettsials to the order Legionellales. Although Q fever is usually mild and self-limiting, it may be manifested as a serious disease, such as pneumonia, endocarditis, or meningoencephalitis. We describe three separate cases of acute Q fever, which were diagnosed by an indirect micro-immunofluorescence assay (MIFA) test and DNA amplification (PCR). Three adult patients were admitted between December 2004 and August 2006 because of a fever of greater than three weeks duration. Only one patient had contact history with a dog. Of the three patients, two patients had myalgia, headache, skin rash, lymphadenopathy, and hepatosplenomegaly. Although all sets of blood cultures were negative, anti-phase II antibody titers by using an indirect MIFA (IgG 1:512-1,024 and IgM 1:320) were markedly increased in sera from all of three patients. Concomitant PCR assays also demonstrated the presence of OMP com1 for C. burnetii in blood from all of the three patients. Two patients had complete resolution of symptoms and signs with a two-week course of doxycycline, while one patient had spontaneous defervescence. Although the incidence of Q fever is not well known yet in Korea, it should be considered in the differential diagnosis of patients with fever of unknown origin. (Korean J Med 74:100-105, 2008)

제주지역에서 발생한 중증열성혈소판감소증후군 4예

허상택 ( Sang Taek Heo ),천민석 ( Min Seok Cheon ),김재왕 ( Jae Wang Kim ) 대한피부과학회 2014 대한피부과학회지 Vol.52 No.3

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease caused by a novel SFTS bunyavirus (SFTSV), a member of the genus Phlebovirus in the family Bunyaviridae. SFTSV is believed to be transmitted by Haemaphysalis longicornis. Common symptoms of SFTS include high fever, vomiting, diarrhea, thrombocytopenia, leukocytopenia, and multi-organ failure with an average case-fatality rate of 12∼30%. In 2009, SFTS was firstly reported in China. In 2013, 27 cases of SFTS were documented in Korea, and 6 cases were confirmed on Jeju Island. Although the pathogenesis and transmission mode of SFTS remain unclear, SFTS is now considered endemic in East Asia. Accordingly, SFTS needs to be differentiated from scrub typhus, leptospirosis, and hemorrhagic fever with renal syndrome. We here report 4 cases of SFTS preceded by a tick bite, which were in need of a differential diagnosis of scrub typhus. (Korean J Dermatol 2014;52(3):173∼177)

Secondary Syphilis with Nodular Vasculitis Mimicking Behçet’s Disease

조재민,허상택,김재왕,김진석,유정래,김유찬 대한감염학회 2013 Infection and Chemotherapy Vol.45 No.4

Although, erythema nodosum is a common skin manifestation associated with syphilis, nodular vasculitis is a rare feature. Here,we describe a case of a 22-year-old, human immunedeficiency virus negative, non-immunocompromised man who developedrecurrent oral and scrotal ulcers with nodular lesions of the lower extremitie. Behçet’s disease was initially suspected, however,his serologic test for syphilis was positive, and he was thus diagnosed with secondary syphilis, with a skin biopsy showing nodularvasculitis. The patient was treated with benzathine penicillin, and the skin lesions disappeared after treatment.