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Background: The world encountered the global outbreak of an H1N1 influenza pandemic in 2009. Influenza has accounted for grave outcomes, not only through infectious complications, but also through the exacerbation of underlying chronic diseases. A substantial number of confirmed or probable cases of influenza had been reported during the 2009 H1N1 pandemic in South Korea, but a review of the development of influenza-related complications or the exacerbation of underlying chronic diseases has been absent. This study aims to understand the influence of the 2009 pandemic on the exacerbation of existing cardiopulmonary diseases. Materials and Methods: We surveyed the number of hospitalized patients with a diagnosis of pneumonia, asthma, chronic obstructive pulmonary disease, acute myocardial infarctions, and heart failure during the period of the 2009 H1N1influenza pandemic in a 950-bed teaching hospital in Korea. Three influenza seasons from 2007 to 2009 were compared via a medical records review. Data collection included the number of hospitalizations, patient age, number of deaths from all causes, and underlying medical conditions of fatal patients. Results: The weekly number of cardiopulmonary hospitalizations showed no differences between the 2009 pandemic influenza period and seasonal influenza epidemics (53 and 56 on average, respectively), but the total number of hospitalized patients during the pandemic influenza period was 1481, whereas there were 625 on average for seasonal influenza. The hospitalization rate for patients under five years of age exceeded that of the patients sixty years of age or older in pandemic influenza, and the hospitalization rate of patients twentyfive to fifty-nine during pandemic influenza was significantly higher than that of seasonal influenza outbreaks (P=0.012). On the other hand, the hospitalization rate of the patients sixty years of age or older during the pandemic influenza period significantly fell short of that in past seasonal influenza periods (P<0.001). However, the patients sixty years of age or older had the highest case fatality rate during both periods. The total number of deaths among hospitalized patients with cardiopulmonary diseases in pandemic influenza and seasonal influenza epidemics was 87 and 46 on average, respectively. Weekly fatal cases were 3 and 4. Conclusions: The cardiopulmonary hospitalization rate during the pandemic period outnumbered that of preceding seasonal influenza epidemics by its extended length. But, the virulence or disease severity of the 2009 H1N1 and seasonal influenza seems to be little different. A larger-scale epidemiological investigation is necessary.
Background: Acute transverse myelitis (ATM) refers to inflammation or demyelination across the width of the spinal cord in the absence of pre-existing neurologic disorder. Identifying the cause of transverse myelitis is often challenging, and in many circumstances the cause remains unknown. We report a extremely rare case of ATM caused by herpes simplex virus type 1 infection (HSV-1), which is the first case report in Korea to our knowledge. Case report: A 29-year-old male without remarkable past medical history. presented with febrile sense and oral pain for one weak. Initial body temperature was 37.9℃ and other vital signs were stable. Initial physical examination revealed multiple oral ulcers, and findings on respiratory, cardiac, and abdominal evaluation wereunremarkable. No neurologic deficit was noted. Abnormal laboratory findings included leukocytosis (WBC 10820/μl), elevated C-reactive protein(1.85 mg/dl) and erythrocyte sediment rate (29 mm/hr). On 3rd hospital day, patientcomplained dysethesia in lower extremities and voiding difficulty. Neurologic examination demonstrated grade V- motor weakness in lower extremities. Cerebrospinal fluid(CSF) analysis revealed pleocytosis(WBC 28/mm3, RBC 0/mm3), glucose and rotein in normal range. Spine magnetic resonance imaging noted central T2 high signal intensity from C7 to T10 around gray matter of spinal cord suggesting myelopathy. Blood HSV-1 polymerase chain reaction test was positive. He was diagnosed HSV-1 ATM and treated with intravenous acyclovir for 2 weeks with methylprednisolone for one week. Motor dysfunction was fully recovered, but sensory and autonomic dysfunction remained. The patient was discharged for outpatient follow-up and rehabilitation. Conclusion: This is the first case report of ATM caused by HSV-1 in Korea. Since ATM can bring profound and devastating neurologic sequelae, HSV ATM should be taken into consideration in a patient of HSV infection with neurologic symptoms,apart from other CNS diseases such as Guillain-Barre syndrome or radiculopathy.
Common manifestations of pneumococcal infection are otitis media, sinusitis, pneumonia, meningitis, and infrequently,brain abscess, endocarditis, and bone and joint infection can develop. Spinal epidural abscess caused by S. pneumoniae are rarely described. We report a rare case of pneumococcal spinal epidural abscess in an immunecompetent person, in which causative pathogen was confirmed by positive blood culture in the context of relevant clinical setting. A previously healthy 75 year-old woman presented with febrile sense and lower back pain. Physical examination was unremarkable with the exception of tenderness in lower lumbar spine, bilateral costovertebral angles. No neurological abnormal finding was noted. Initial vital sign showed no fever, but the patient was taking NSAIDs. Laboratory test revealed leukocytosis and elevated ESR (102 mm/hr) and CRP (28.56 mg/dl). Chest x-ray finding was unremarkable. Magnetic resonance imaging of spine confirmed epidural abscess extending from spinal level L3 to S1. Meanwhile patient complained left shoulder pain and MRI was taken which revealed septic arthritis at glenohumeral joint. Blood cultures were positive for S. pneumoniae with intermediate antibiotic resistance to penicillin(MIC:0.25). On 22nd hospital day, decompressive surgery was performed. Intraoperative pus culture showed no growth. The patient was diagnosed S. pneumoniae epidural abscess and septic arthritis with bacteremia. On 8th hospital day, in regard to culture result, intravenous penicillin G 20milion IU was given and maintained for 7 days, then was changed to cefotaxime due to failure of defervescence with concern for drug fever. Because of persistent fever, cefotaxime was switched to levofloxacin considering cross-reactivity of cephalosporin with penicillin, and maintained afterwards. After near 2 months of antibiotic therapy, interval regression of epidural abscess was found in MRI. Patient was discharged with oral levofloxacin for outpatient follow-up. S. pneumoniae is a virulent and invasive eorganism, one should remind that S. pneumoniae can be implicated in potentially devastating invasive infections, such as epidural abscess.
Staphylococcus lugdunensis is a member of coagulase-negative staphylococci (CoNS) which is uncommon microbial culture isolate with virulent potency. Despite CoNS are usual skin commensals and often regarded as contaminant or colonizer when isolated from cultures of clinical specimens, clinical course and microbiological characteristics of Staphylococcus lugdunensis may resemble those of Staphylococcus aureus rather than other CoNS. Invasive infectious diseases such as infective endocarditis, peritonitis, skin and soft tissue infection, vascular prosthetic infection,septicemia, osteomyelitis have been described to be associated with Staphylococcus lugdunensis. We report the first case of psoas abscess caused by Staphylococcus lugdunensis in Korea. A 45-year old woman presented to a community hospital with fever and right flank pain. On admission date, her body temperature was 37.8℃, laboratory test revealed white blood cell count of 18950 cells/μl (90.7% neutrophils), ESR of 77 mm/hr, CRP of 22.86 mg/dl. Abdomen-pelvic CT scan was obtained, which illuminated 12x5cm sized right-sided psoas abscess. Percutaneous abscess drainage was performed and culture from the drained fluid isolated oxacillin-sensitive Staphylococcus lugdunensis. Initial antimicrobial therapy, intravenous ceftriaxone plus metronidazole, was maintained for 15 days. Defervescence and normalization of leukocytosis and CRP level was achieved, and the patient was placed on oral ciprofloxacin. After 9 days of administration of oral ciprofloxacin, patient was transferred to a tertiary teaching hospital due to prolonged treatment and for further management. Cefazolin was administrated intravenously. On 26th day of total antibiotics therapy, interval reduction of size of abscess was noted on CT. The patient was discharged for outpatient follow-up with oral ciprofloxacin and rifampicin in consideration of antibiotic sensitivity and tissue penetration. To our best knowledge, this is the very first case report of Staphylococcus lugdunensis psoas abscess in Korea.
Background: Teicoplanin is a glycopeptide antibiotic that is widely used in clinical practice for the treatment of infections caused bydrug-resistant Gram-positive bacteria. The aim of this study was to analyze plasma teicoplanin concentrations to determine the percentageof patients in whom therapeutic concentrations of teicoplanin were achieved in clinical practice. Materials and Methods: The plasma teicoplanin concentrations of hospitalized patients receiving treatment at a teaching hospitalwere retrospectively analyzed. The target level was defined as a plasma teicoplanin concentration of 10 mg/L or greater, since thiswas generally regarded as the lower limit of the optimal concentration range required for the effective treatment of a majority of infections. Results: Patients with sub-optimal (< 10 mg/L) plasma teicoplanin concentrations constituted nearly half of the total study population. The majority of these patients received the recommended loading dose, which were three 400 mg doses administered every12 hours. Sub-group analysis showed a trend that the group receiving loading dose was more likely to reach the optimal teicoplaninconcentration. Conclusions: The data revealed that a significant proportion of patients in clinical practice achieved only sub-optimal teicoplaninconcentrations, which emphasizes the importance of the mandatory use of loading dose and routine therapeutic drugmonitoring. Treatment reassessment and simulation of individual dose regimens may also be necessary to achieve optimal drugconcentrations.
The novels of Park, Wahn-Seo have witnessed the reality and hidden background of the world surrounding our lives, reminded us that we are the ones causing all these irrational contradictions in the world and eventually implying that we are both the parties to the crime and the victims at the same tune. The significance is found in her grasp on the problems that have been ignored and left underneath the surface of our conscious. This thesis is approaching the critical features appearing in her work with her unique technique. The summary of this study is as fallows. Her unique technique of writing is to picturize her autobiographical experiences In repeated manner: It is like factorizing the dynamic moments of our age. Such writing style reflects her interest in the critical situation of her own the reality of and the overall society surrounding her. For her personal wounds in heart and the destructive realities causing such wounds, her novels are the way of activating both 'revenge' and 'healing' : in the mode of her writing In the mode of 'revenge' and 'healing' is her narrative strategy decided after her severe search fur herself and a literary style reflecting her critical mind toward society. So far, as looking at Park, Wahn-Seo and her literary world, this study has a significance as a quest for an answer f3r this question, "Through what kind of narrative strategy, as a practice of alternative plan, can novels possibly become the way of encounter the life?" At the same time, it may be a meaningful attempt in the sense that is a romantic exploration about problems in modern Korean society.