중증 열대열 말라리아 환자의 부검 1 예

김춘관,김성민,백경란,이정원,서연림,송재훈 대한화학요법학회 1997 대한화학요법학회지 Vol.15 No.1

저자들은 아프리카 지역을 여행한 후 중증 열대열 말라리아에 이환되어 뇌형 말라리아, 급성 신부전, 급성 호흡부진 증후군, 범발성 혈관내 응고등 중증 합병증으로 사망하여 부검한 1예를 경험하였기에 이를 문헌 고찰과 함께 보고하는 바이다. As tourism is dramatically increasing, imported infectious diseases pose a serious threat to international travelers. Malaria would be the most important one. Particularly, falciparum malaria can be complicated by cerebral malaria, acute renal failure, acute respiratory distress syndrome, dissenminated intravascular coagulation, severe anemia, and death. We report a fatal case of falciparum malaria after travel to Afrca. A 49-year-old man was admintted to the hospital because of fever, jaundice, and altered mentality. The patient did not take any chemoprophylaxis before and during his stay in Africa. Blood smear was characteristic for falciparum malaria with heavy parasitemia(>50%). Although quinine dihydrochloride was promptly instituted, the patient was complicated by comatous mentality, acute renal failure, adult respiratory distress syndrome, disseminated intravascular coagulation, and refractory hypotension. Despite of intensive care with mechanical ventilator, continuous hemofiltration, the patient expired on the 4th hospital day. Autopsy revealed parasitised red blood cells and malarial pigments in capillaries and small vessels in most organs throughout the entire body.

성인에서 발견된 요붕증과 동반된 랑게르한스 세포 조직구증 1예

김춘관,김광원,이문규,민용기,이명식,고은미,정재훈,안규정,정만표 대한내분비학회 1996 Endocrinology and metabolism Vol.11 No.3

In Langerhans cell histiocytosis, diabetes insipidus is the most common endocrinologic complication. We experienced a case of Langerhans cell histiocytosis, involving pituitary stalk and lung. The patient was a 43 year old male with complaint of polyuria and polydipsia. The water deprivation test was carried out to confirm the diagnosis of diabetes insipidus. We found multiple small cysts and nodules in HRCT of lung, and diagnosed Langerhans cell histiocytosis by transbronchial lung biopsy, The patient was managed conservatively with DDAVP nasal spray. The polyuria,polydipsia was relieved completely. After that, we follow up and observe closely the patients lung and pituitary lesion(J Kor Soc Endocrinol 11:330-335, 1996)

단일한 간종괴로 발현된 간질증 1예

김춘관,이화영,백승운,이풍렬,김재준,고광철,이종철,오영륜,고영혜 大韓消化器病學會 1997 大韓消化器病學會誌 Vol.30 No.5

Ochrobactrum anthropi 패혈증 1예

김춘관,안석진,하경원,현재근,김성민,백경란,이남용,송재훈 대한내과학회 1997 대한내과학회지 Vol.53 No.3S

저자들은 비호지킨씨 림프종으로 항암 치료를 받고 있는 환자에게, 감수성있는 항균제 투여와 중심정맥 카테터를 제거함으로써, 중심정맥 카테터와 관련된 O.anthropi 패혈증을 성공적으로 치료한 1예를 경험하였다. O. anthropi 감염이 세계적으로 드물고, 국내에서는 그 보고가 없었으나, 이 균이 Pseudomonas와 유사해서 동정이 잘못될 수 있으며, 중심정맥 카테터를 가지고 있는 면역 억제된 환자에서 호발됨을 고려해 볼 때, 향후 더 많은 관심을 가져야 할 것이다. Ochrobactrum anthropi is a gram-negative, oxidase producing, non-lactose fermenting bacilli. It was formerly known as CDC Group Vd with confusions in taxonomical classification. Although there have been few reports of O. anthropi infection in English literatures, it may be related to central venous catheter infections, especially in the immunocompromised hosts. We report a case with sepsis due to O. anthropi, who had a central venous catheter and chemotherapy for non--Hodgkin's lymphoma, with review of the literatures. O. anthropi was isolated from blood culture and identified with biochemical tests. We successfully treated the patient with removal of Hickman catheter and antibiotics. To our knowledge, this is the first case of O. anthropi infection in Korea.

급성 세균성 부비강염에 대한 Cefpodoxime proxetil의 치료효과

김춘관,이혁,김성민,백경란,동헌종,나동규,송재훈 대한화학요법학회 1998 대한화학요법학회지 Vol.16 No.4

목적 Cefpodoxime proxetil은 새로이 개발된 제3세대 경구용 세팔로스포린 항균제이다. 그람양성과 그람음성균에 넓은 항균력을 가지고 있으며 특히 페니실린 내성 폐렴구균에 중등도로 효과가 있다. 이에 저자들은 시험관 내에서 폐렴구균에 대한 cefpodoxime의 감수성 여부를 조사하고, 급성 세균성 부비강염에 대한 cefopdoxime proxetil의 임상적 효과 및 안전성을 검토하기 위해 이 연구를 시행하였다. 방법 임상 검체에서 분리되어 보관하고 있는 폐렴구균 100 균주를 대상으로 cefodoxime 디스크를 이용하여 항균제 감수성 여부를 조사하였다. 또한 1996년 9월부터 1996년 12월 까지 삼성의료원에 내원한 33명의 급성 세균성 부비강염 환자를 대상으로 cefpodoxime proxetil 200mg을 14 일간 부여하였다. 환자들은 치료를 전후하여 임상 증상 및 증후를 비교하고, 세균검사, 임상 검사, 방사선학적 검사를 시행하였다. 결과 페니실린 감수성 폐렴구균 24균주와 페니실린 중등도 내성 26 균주 모두 cefpodoxime에 감수성이 있었다. 페니실린 내성 폐렴구균 50 균주중 78% 에서 감수성이 있었고 나머지 22%는 내성을 보였다. 임상적 호전을 보인 환자는 전체의 96%였다. 단순 방사선 촬영과 CT를 기초로 판단한 방사선학적 호전율은 69%였다. 약제 부작용은 전체 33명 중 관찰되었고 소화기계 증상과 두통이 각각 2명에서 관찰되었으며, 두통이 발생한 2명은 그 정도가 심하여 투약을 중지하였다. Background : Cefpodoxime proxetil is a new third-generation cephaiosporin. It has 2 broad antibacterial spectrum and shornrs potent antibacterial activity against respiratory pathogens, including Huemophilus in fluenzae, Streptococcus pneumoniae, and Moraxella catarrhalis. Moreover, it has inoderate activity to penicillin-resistant Streptococcus pneumoniue, the incidence of which is increasing worldwidely. Therefore, cefpodoxirne proxetii can be recommended as an empirical antibiotic for treatment of acute bacterial sinusitis. The aim of this study is to reassure In vitro antimicrobial activity of cefpodoxirne to Streptococcus pneumoniae including penicillin-resistant strains and to evaluate the therapeutic efficacy and the safety of cefpodoxiine proxetii in acute bacterial sinusitis. Method : In vitro antimicrobial activities of cefpodoxime to 100 S. pneumoniae isolates from clinical specimens were investigated by disk diffusion method. Clinically. cefpodoxime proxetil mas admmmstered 200 mg twice a day orally for 14 days in 33 patients with acute bacterial smus~tis. The therapeutic efficacy was evaluated by patient's clinical s tom and signs, and by radiologic frndings of simple X-ray of paranasal sinuses and CT. Results : In vitro, penicillin sensitrve(n= 26) and intermediately resistant(n=26) S. pneumontae were all susceptible to cefpodoxime. Among 50 isolates of penicillin resistant s. pneumoruae, 39 strains(78%) were cefpodoxime sensitive and 11 strains(22%) were intermediately resistant to cefodoxime. Clinical symptoms and signs were improved in 32 patients(96%) of the patients. Radiological improvernent were found in 23 patients(69%). During treatment, headache and abdominal discomfort were developed in 2 patients, respectively. Conclusion : Cefpodoxime proxetil was highly effective and safe in treating acute bacterial sinusitis.

외과적 담도계 질환의 임상적 고찰

김춘관(Choon Gwan Kim),윤세영(Se Young Yoon),방창덕(Chang Duck Bang) 대한외과학회 1984 Annals of Surgical Treatment and Research Vol.27 No.5

발열이 동반된 호중구 감소증 환자에서 경험적 치료제로서 cefepime 단독요법과 ceftazidime 단독요법의 효과 비교 연구

이동현,김춘관,고지영,마주락,이가영,천상열,김봉석,노용호 대한화학요법학회 2002 대한화학요법학회지 Vol.20 No.3

발열이 동반된 호중구감소증 환자에서 초기경험적 치료제로서 cefepime은 선택될 수 있다.Cefepime 단독요법은 ceftazidime 단독요법과 비교하여 동등한 임상적 성공률을 보였으나, 향후 더 많은 환자를 대상으로 한 비교연구 및 자료의 보충이 필요하다 하겠다. Background : In view of the recent trend toward monotherapy in the treatment of bacterial infection, we evaluate the clinical efficacy and safety of cefepime versus ceftazidime for the empiric treatment of febrile episodes in cancer patients with chemotherapy-induced neutropenia. METHODS : A prospective, double-blind, randomized study of cefepime 2g every twelve hours and ceftazime 2g every eight hours was performed in 40 adult neutropenic (absolute neutrophil count 〈500/㎣) cancer patients with fever. RESULTS : Forty patients were evaluable. Median duration of neutropenia was 11.5 days in cefepime and 10.5 days in ceftazidime. Treatment was successful in (60%)(12/20) of cefepime-treated patients and (65%)(13/20) of ceftazi야me-treated patients. Overall mortality was 10%(2/20) of cefepime-treated patients and 15% of ceftazidime-treated patients. CONCLUSIONS : Cefepime appears to be as effective as ceftazidime in the initial treatment of febrile episodes in adults cancer patients with chemotherapy-associated neutropenia of modest duration.

면역 부전 환자에서 병발한 급성 황색 포도상 구균에 의한 세균성 식도염 1예

박환양,김춘관,박영배,박재완,김성훈,강정원,문경협,양수현,변종훈 대한감염학회 2001 감염 Vol.33 No.5

Bacterial esophagitis is an uncommon disease and has not been well characterized. Bacterial infection of the esophagus is usually presented as a superimposed infection upon a preexisting viral or fungal esophagitis and most patients are immunocompromised hosts. A 67-year-old man was admitted for retrosternal pain and hematemesis, who had a past history of long-standing diabetes mellitus and end stage renal disease, also had a history of steroid medication. Extensive esophageal ulcerations of the mucosa were visualized by endoscopy. Staphylococcus aureus grew in blood culture. After the 2 weeks of antibiotics treatment, he was successfully recovered without any sequelae. Due to its rarity, this case is herein reported with a review of the corresponding literature. (Korean J Infect Dis 33:360∼363, 2001)

Impact of Community-Onset Methicillin-Resistant Staphylococcus aureus on Staphylococcus aureus Bacteremia in a Central Korea Veterans Health Service Hospital

배은신,김춘관,장정현,성흥섭,최윤미,김미나 대한진단검사의학회 2019 Annals of Laboratory Medicine Vol.39 No.2

Background: No study has examined the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia in Korean veterans’ hospitals. We investigated the microbiological and clinical epidemiology of S. aureus bacteremia at the central Veterans Health Services (VHS) hospital in Korea. Methods: Patients with S. aureus bacteremia were consecutively enrolled from February to August 2015. Bacteremia was classified as hospital-acquired (HA), community-onset healthcare-associated (COHA), or community-acquired (CA). MRSA bacteremia risk factors were analyzed. Species identification, antimicrobial susceptibility, and presence of luk and tst were tested. Staphylococcal cassette chromosome mec (SCCmec) typing, spa sequence typing agr polymorphism typing, and multilocus sequence typing were performed. Biofilm production and δ-hemolysin activity were measured to determine agr function. Results: In total, 60 patients were enrolled (30 HA, 23 COHA, and seven CA bacteremia); 44 (73.3%) had MRSA bacteremia (26 HA, 16 COHA, and two CA). MRSA bacteremia occurred more frequently in non-CA patients and those who had received antibiotic treatment within the past month (P<0.05). The major MRSA strains comprised 24 ST5-agr2-SCCmecII, 11 ST72-agr 1-SCCmecIV, and five ST8-agr1-SCCmecIV strains. Of 26 agr2-SCCmecII strains, including two MSSA strains, 25 were multidrug-resistant, 18 were tst-positive, and 13 were agr-defective, whereas only five of the 18 agr1-SCCmecIV strains were multidrug-resistant, and all were tst-negative and agr-intact. agr1-SCCmecIV and ST8- agr1-SCCmecIV strains were more likely than agr2-SCCmecII strains to be COHA. Conclusions: MRSA was highly prevalent in both COHA and HA bacteremia. The introduction of virulent CA-MRSA strains may be an important cause of increased HA-MRSA bacteremia in VHS hospitals.

신장 이식 후 발생한 Cytomegalovirus 감염

기현균,김춘관,김신우,이혁,김성민,백경란,오하영,송재훈,조재원 대한감염학회 1999 감염 Vol.31 No.4