http://chineseinput.net/에서 pinyin(병음)방식으로 중국어를 변환할 수 있습니다.
변환된 중국어를 복사하여 사용하시면 됩니다.
증례 : 신장 ; 혈액 투석 환자에서 크립토코쿠스혈증을 동반한 크립토코쿠스 연조직염
정일우 ( Il Woo Jeong ),김지은 ( Ji Eun Kim ),김상훈 ( Sang Hun Kim ),김지형 ( Ji Hyoung Kim ),홍유아 ( Yu Ah Hong ),고강지 ( Gang Jee Ko ),권영주 ( Young Joo Kwon ) 대한내과학회 2015 대한내과학회지 Vol.88 No.4
일반적으로 피부에 연조직염의 증상을 보일 때 많은 경우에 세균성 연조직염을 생각하고 치료하는 경향이 있으나 스테로이드 등의 면역 억제제를 사용하거나 면역이 저하되어있는 환자의 경우, 그리고 면역 저하 요인이 없지만 항생제에 치료 반응이 낮을 경우에는 진균에 의한 감염의 가능성을 고려해야 한다. 이때 정확한 진단을 위해 피부 조직 생검등의 추가적인 검사가 필요하고 또한 혈액 배양과 latex agglutination test 역시 도움될 수 있으며, 검사 결과에 따라서 항진균제 사용을 고려하는 것이 중요하다. Cryptococcus neoformans is a fungus that causes opportunistic infections in immunocompromised hosts. Skin lesions are found in 10-20% of systemic cryptococcal infections, usually secondary to cryptococcemia, while primary cutaneous cryptococcosis with cryptococcemia is very rare. We report a case of rapidly spreading cryptococcal cellulitis in a 64-year-old male on maintenance hemodialysis taking steroids for encapsulated peritoneal sclerosis. Bluish bullous cellulitis developed on the left forearm and spread rapidly to the other forearm. We identified C. neoformans in the blood and skin lesions. We treated him successfully with liposomal amphotericin B and fluconazole for 15 months. We also review the literature.
홍화정(Hwa Jeong Hong),이정환(Chung Hwan Lee),박종오(Chong Oh Park),정일우(Il Woo Jung),이승호(Seung Ho Lee),고경식(Kyung Sik Ko),김구엽(Koo Yeop Kim),서환조(Hwan Jo Suh) 대한내과학회 1997 대한내과학회지 Vol.53 No.3
N/A Objective: Staphylococcus aureus has persisted and is now resurging as an important hospital and community pathogen. Nosocomial infection caused by methicillin-resistant S.aureus(MRSA) is a major problem which may be connected with heavy or prolonged use of antibiotics S.aureus bacteremia caused acute complications, which occasionally resulted in death, and infectious/suppurative complications, which necessitated prolonged antibiotic therapy, sometimes in conjunction with surgery. Therefore, S.aureus bacteremia is a serious medical problem in association with high morbidity and mortality. Methods: 130 patients with S.aureus bacteremia who were admitted in the Kyung Hee University Hospital from January, 1991 to December, 1994 were analyzed retrospectively. We compared the clinical and laboratory characteristics, and antibiotics resistances between MRSA and MSSA bacteremia and also we evaluated risk factors that contribute to fatal outcome in patients with S.aureus bacteremia. Results : 1) of 130cases, 80 were male and 50 were female. The mean age was 44.5±25.1 years. 2) 84(65%) of S.aureus bacteremia were nosocomial and 46(35%) were community-acpuired. The percentage of MRSA stains studied was 55%(71/130) and The percentage of MRSA bacteremia in hospital-acpuired and community-accquired S. aureus bacteremia were 64% (54/84) and 36%(17/46), respectively. Sources of bacteremia were uncertain in 85(65%) with intravascular catheter(20%) and skin wound sites (8%) being the most common sources in remainder(35%) 3) 110(85%) of 130 patients had one or more underlying diseases. Common underlying dieases were cerebrovascular disease(33%), malignancy(17%), Diabetes mellitus(15%), chronic renal failure(8%) and liver cirrhosis(6%). 4) Acute complications occurred in 35 patients and were fatal in 21 5) The risk factors associated with MRSA bacteremia were various severe underlying diseases, vairous invasive procedures, IV catheter-associated infection, hypoalbuminemia, previous use of antibiotics, male sex and old age. 6) The Case fatality rate for patients with S. aureus bacteremia was 18% and those for patients with MRSA and MSSA bactermia were 20% and 12%, respectively. The risk factors that contribute to the increment of mortality rate in patients with S. aureus bacteremia were acute complication, low serum level of total protein, hypoalbuminemia, various invasive procedures and IV catheter-associated infection, 7) In the antibiotic sensitivity test S. aureus was resistant to penicillin in 98.5%, ofloxacin in 73%, cefotaxime in 67%, erythromycin in 58%, aztreonam in 56%, clindamycin in 52%, vancomycin in 0%. 8) In the multiple antibiotic resistance of S. aureus, 43(68%) of MRSA was resistant to more than 10 antibotics, revealing multiply resistant nature of strains, While all but one MSSA was resistant to 1 to 4 antibiotics, one revealing resistance to 8 antibiotics. Conclusion: S. aureus bacteremia is a cause of considerable morbidity and mortality in hospitalized patients who especially, exposed to various risk factors. MRSA revealed higher resistance rate to most antibiotics tested and more marked multiply resistant nature than MSSA. But there was no significant difference in case fatality rate between patients with MRSA and MSSA bacteremia.