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증례 : 감염 ; 국내에서 발생한 중추신경계 합병증을 동반한 삼일열 말라리아 1예
권순하 ( Soon Ha Kwon ),궁현정 ( Hyeon Jeong Goong ),이은정 ( Eun Jung Lee ),전민혁 ( Min Hyok Jeon ),김태형 ( Tae Hyong Kim ),박선아 ( Sun A Park ),추은주 ( Eun Ju Choo ) 대한내과학회 2012 대한내과학회지 Vol.82 No.3
A 51-year-old man diagnosed with Plasmodium vivax malaria was transferred to our clinic with newly developed drowsy mentality and myoclonus after the initiation of hydroxychloroquine therapy. Following therapy to treat the vivax malaria and supportive care, the patient recovered completely with no sequelae. Cerebral complications caused by vivax malaria are very rare worldwide, and only two cases have been reported in Korea. Here, we report the third published case of P. vivax infection with cerebral complications in Korea. (Korean J Med 2012;82:382-385)
일차성 Streptococcus pneumoniae 균혈증에 동반된 흉부 하행 대동맥염 1예
전민혁,고옥배,정우진,최영준,이정훈,최상호,김미나,김양수,우준희,류지소 대한감염학회 2005 감염과 화학요법 Vol.37 No.5
페렴구균에 의한 대동맥염은 국내에서 1예만 보고될 정도로 매우 드문 감염증이다. 저자들은 원발성의 폐렴구균혈증에 합병된 페렴구균 대동맥염 환자 1례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Bacterial aortitis is rare and without surgical intervention, it usually leads to uncontrolled sepsis or catastrophic hemorrhage, ultimately, resulting in death. In the postantibiotic era, the dominant infecting organisms are Staphylococcus aureus and Salmonella spp.. In spite of frequent pneumococcal bacteremia, vascular seeding is rare and there is only one published report in Korea. We describe a 77-year-old female with primary pneumococcal bacteremia followed by aortitis of the descending aorta, which was successfully treated by aneurysmectomy, wide excision of periaortic tissue, aortobiiliac bypass via prosthetic graft, and antibiotic therapy.
일개 대학 병원에서 경험한 뎅기열-뎅기출혈열 4예와 국내 문헌 고찰
최문한,추은주,김태형,전민혁,박의주,신동원,이설희,최종효 대한감염학회 2008 감염과 화학요법 Vol.40 No.6
Dengue virus infection is an emerging imported disease in Korea. A total of 4 cases of dengue fever or dengue hemorrhagic fever diagnosed at Soonchunhyang University Hospital in Bucheon between January 2001 and December 2007 were retrospectively reviewed, In addition, relevant domestic literatures from Korean bibliographic databases, which matched 'dengue fever', 'dengue hemorrhagic fever' or 'dengue shock syndrome' as key words, have been reviewed. Ten articles (13 patients) met the inclusion criteria and were included in this review. All the patients except for one who was infected in Africa, were infected in Asian countries: Philippines (4), Indonesia (3), India (2), Cambodia (2), Sri Lanka (1), Thailand (1), Bangladesh (1), Myanmar (1), and Malaysia (1). Clinical manifestations after returning from abroad were as follows: fever (100%), chills (82%), headache (65%), myalgia (53%), nausea (41%), neutropenia (82%), thrombocytopenia (82%) and elevation of AST (82%) and ALT (53%). Most of the patients improved with conservative care except for one who died of dengue shock syndrome.
항문주위 괴사근막염 수술 후 발생한 두덩결합 골수염의 경험
김지연,김태형,추은주,전민혁,이은정,김종화,박의주,이재철,진소영 대한감염학회 2009 감염과 화학요법 Vol.41 No.3
Osteomyelitis of the pubic symphysis is not common and has often been reported to occur after urological or gynecological procedures, It can be spontaneous in origin but it also is associated with trauma, athletic exertion, pregnancy, and parturition. The early symptoms of osteomyelitis of the pubic symphysis mimic those of osteitis pubis and therefore, the differential diagnosis between these two entities is of clinical importance. A fifty nine-year-old man who had previously received debridement and wide excision of perianal necrotizing fasciitis visited our hospital with pain on both inguinal areas. The core biopsy of the pubic symphysis and aspiration culture were performed, from which Pseudomonas aeruginosa was recovered. He was treated with parenteral ceftazidime for 5 days followed by cefepime for 7 weeks and showed favorable clinical response. To our knowledge this is the first report on osteomyelitis of pubic symphysis resulting from debridement and wide excision of perianal necrotizing fasciitis in Korea.
정상면역을 가진 환자에서 발생한 복부대동맥의 진균 감염성동맥류 1예
이호영,김태형,추은주,전민혁,이은정,정은정,전성란,박의주,염욱,장원호,황정화,김동훈,김동원 대한감염학회 2008 감염과 화학요법 Vol.40 No.3
감염성동맥류는 드물지만, 치명적인 질환이다. 진성 진균성 감염성동맥류는 더 드물게 발생한다. 진균감염은 사망률과 이환율이 매우 높다. 그러나 증상이 비특이적이고 일반적인 진단방법으로는 민감하게 진단이 되지 않기 때문에 종종 진단이 어렵다. 저자들은 면역이 정상이고 다른 위험인자가 없는 환자에서 복부대동맥에 발생한 진균성 감염성동맥류를 경험하여 이를 보고한다. 컴퓨터 단층촬영과 혈관 수술에 기초하여 진단하였으며, 수술 후 조직배양에서 균이 동정되지는 않았으나 절제한 혈관조직에서 칸디다 감염을 시사하는 발아가 있는 효모균이 관찰되었다. 한국에서 1988년에서 2007년까지 복부에 발생한 감염성동맥류 17증례를 고찰하였을 때 진성 진균성 감염성동맥류는 없었으며, 저자들이 경험한 것이 복부에서 발생한 진균감염성 동맥류로는 첫 증례이다. Infected aneurysms are uncommon, frequently fatal lesions. "True" fungus-infected aneurysms are even rarer. Fungal infections have high morbidity and mortality. However, diagnosis is frequently difficult, since the symptoms are non-specific and standard diagnostic procedures are often insensitive. We experienced a patient with persistent fever and negative blood cultures. The patient was immunocompetent and had no risk factors, and was diagnosed with a fungus-infected aneurysm based on computed tomography and vascular surgery. The vascular tissue revealed some narrow-based budding yeast within the thrombus, suggesting Candida infection. Seventeen cases of infected aneurysm of the abdomen were reported in Korea from 1988 to 2007, although none were "true" fungus-infected aneurysms, making this the first fungus-infected aneurysm of the abdomen in Korea. Prompt diagnostic procedures and aggressive treatment modalities are necessary for patients with occult infection and negative blood cultures, regardless of their immunocompetence, because of the high morbidity and mortality of this condition.
황색포도알균이 가장 흔한 원인인 우리나라 4개 대학병원의 감염성심내막염의 특징
서성우,김태형,현민수,추은주,전민혁,문철,송단,김종화,이용관,최종효,전웅,조영신,최문한 대한감염학회 2008 감염과 화학요법 Vol.40 No.6
Background : To evaluate whether Staphylococcus aureus is actually the leading cause of infective endocarditis in Korea, investigation on updated clinical pictures, treatments, and prognosis was performed. This study also aims to describe differences in clinical characteristics of infective endocarditis in patients undergoing maintenance hemodialysis. Materials and Methods : Fifty five patients who were diagnosed with infective endocarditis, using modified Duke criteria, at 4 Soon Chun Hyang University hospitals (located in Seoul, Bucheon, Cheonan and Gumi) from January of 2000 to June of 2007 were enrolled, Patients were separated into two groups; those on hemodialysis and those who were not on hemodialysis (control group). Medical records and laboratory results of each patient were reviewed retrospectively. Results : The positive rate of blood culture was 72.7%. Staphylococcus aureus was isolated in 38.2% of the patients making it the most common causative organism of infective endocarditis. It was also the most common organism in both hemodialysis group and non-hemodialysis group. Six patients (10.9%) died while admitted to the hospital and the in-hospital death rate for hemodialysis group was significantly higher. Conclusion : In most parts of the world, S. aureus is increasingly becoming the principal causative organism of infective endocarditis. To our knowledge, this is the first study that shows S. aureus to be the most common causative organism of infective endocarditis in Korea, and that Korea is not except from this global epidemiology.
비장파열 또는 비장경색을 동반한 삼일열 말라리아 2예의 경험
정은정,추은주,김태형,전민혁,이은정,조영신,이호영,김지연 대한감염학회 2008 감염과 화학요법 Vol.40 No.3
말라리아 감염에 의한 비장의 구조적 변화로 무증상의 비장종대부터 자발성 비장파열, 비장혈종, 비장낭종, 비장염전, 비장경색 등의 다양한 합병증이 발생할 수 있는데, 저자들은 국내에서는 아직 드물게 나타나는 비장파열과 비장경색을 경험하였기에 문헌고찰과 함께 보고한다. Malaria is a protozoan disease transmitted by Anopheles mosquitoes. Since Plasmodium vivax malaria reemerged in the north west areas of South Korea in 1993, many cases with various manifestations have been reported, Clinicians should be aware of the rare and severe complications as well as the common complications. Splenic complications such as hematoma formation rupture, torsion, cyst formation, and infarction are unusual manifestations of tertian malaria: therefore we present two cases of P. vivax malaria with severe splenic complications with review of literature. One had a splenic infarction and the other had a splenic rupture, which was diagnosed by computed tomography. Both patients were successfully treated with a conservative approach.
에이즈 환자에서 발생한 파종성 조류형 결핵균 감염 1예
이설희,최재혁,최문한,신동원,최종효,김태형,전민혁,고은석,추은주 대한감염학회 2008 감염과 화학요법 Vol.40 No.5
Nontuberculous Mycobacteria, especially Mycobacterium avium complex (MAC) infection is a common opportunistic infection in patients with acquired immunodeficiency syndrome (AIDS). In patients with AIDS, MAC infection more frequently presents as disseminated form rather than localized infection. Disseminated MAC infection is associated with a high mortality rate in patient with AIDS. We report a case of disseminated MAC infection in an AIDS patient involving bone marrow, mediastinal lymph node and lung.