Sang Oh Lee

Middle East Respiratory Syndrome Infection Control and Prevention Guideline for Healthcare Facilities

Middle East Respiratory Syndrome (MERS) is an acute viral respiratory illness with high mortality caused by a new strain of betacoronavirus (MERS-CoV). Since the report of the first patient in Saudi Arabia in 2012, large-scale outbreaks through hospital-acquired infection and inter-hospital transmission have been reported. Most of the patients reported in South Korea were also infected in hospital settings. Therefore, to eliminate the spread of MERS-CoV, infection prevention and control measures should be implemented with rigor. The present guideline has been drafted on the basis of the experiences of infection control in the South Korean hospitals involved in the recent MERS outbreak and on domestic and international infection prevention and control guidelines. To ensure efficient MERS-CoV infection prevention and control, care should be taken to provide comprehensive infection control measures including contact control, hand hygiene, personal protective equipment, disinfection, and environmental cleaning.

Tuberculous peritonitis in cirrhotic patients: comparison of spontaneous bacterial peritonitis caused by Escherichia coli with tuberculous peritonitis.

The aim of this study was to compare the characteristics of tuberculous peritonitis (TP) and spontaneous bacterial peritonitis (SBP) in cirrhotic patients. In a retrospective review of the medical records of a single tertiary hospital between 1988 and 2006, 15 patients met the diagnostic criteria TP and liver cirrhosis. For comparison, we randomly selected 3 cirrhotic patients with SBP caused by Escherichia coli for each cirrhotic patient with TP. Compared to SBP, TP in cirrhotic patients was more frequently associated with extra-peritoneal tuberculosis (TP vs SBP: 53.3% vs 0%), an insidious onset (≥2 weeks; 60% vs 2.2%), and Child–Pugh classification class B at onset (80% vs 8.9%) (p<0.05). Compared to SBP, TP was associated with lower white blood cell count in ascites (TP vs SBP: 2.0±2.2×103/mm3 vs 7.2±7.5×103/mm3), a higher proportion of mononuclear leukocytes (lymphocytes and monocytes) in ascites (88.9±9.5% vs 16.6±15.3%), higher protein concentration in ascites (3.1±1.7 g/dl vs 1.2±0.3 g/dl), and higher adenosine deaminase activity in ascites (62.3±31.8 U/l vs 6.9±3.1 U/l) (p<0.05). TP should be suspected in cirrhotic patients with relevant clinical manifestations and characteristics of ascites.

Risk factors for mortality in patients with invasive mucormycosis.

Background Mucormycosis is an uncommon and life-threatening fungal infection. The clinical predictors of outcome were evaluated in patients with invasive mucormycosis. Materials and Methods We retrospectively reviewed histologically proven cases of invasive mucormycosis in our institution from 1996 to 2012. Results A total of 64 patients were analyzed. The median age was 59 years (interquartile range [IQR], 50-67), and 32 patients (50%) were male. The most common underlying diseases were diabetes mellitus (67%), hematologic malignancy (22%), and solid cancer (19%). The most common infection sites were the rhino-orbito-cerebral area (56%) and the lungs (31%). The 180-day all-cause mortality was 33%. Disseminated infection was associated with increased mortality (hazard ratio [HR]: 169.74, 95% confidence interval [CI]: 6.41 to 4492.64; P = 0.002). Pulmonary infection (HR: 0.08, 95% CI: 0.01 to 0.66; P = 0.02) and complete surgical removal of infected tissue (HR: 0.12, 95% CI: 0.02 to 0.64; P = 0.01) were associated with decreased mortality. Conclusions These results suggest that patients with mucormycosis had a lower risk of mortality if they developed a pulmonary infection, rather than a disseminated infection and with complete debridement of infected tissue.

Revised Adult Immunization Guideline Recommended by the Korean Society of Infectious Diseases, 2014

The Korean Society of Infectious Diseases (KSID) published the 1st edition of Adult Immunization (Koonja Publishing, Inc., Seoul) in October, 2007. Five years later, in May of 2012, the 2nd edition of the book was published (M.I.P, Seoul). The KSID decided to make small-scale revisions every two years before the publication of the new edition of the adult immunization textbook, due to rapid changes in the environment related to adult immunization. In August, 2012, the KSID set up the Committee on Adult Immunization to develop and revise the guideline, and to conduct research on adult immunization. n nThis is the revised version of the existing adult immunization recommendations, reflecting the latest research results and trends on each vaccine after the publication of Adult Immunization 2nd Edition in 2012. This revision provides information about vaccines against Streptococcus pneumoniae; tetanus-diphtheria-pertussis; herpes zoster; human papillomavirus; influenza; meningococcus; Japanese encephalitis; and yellow fever. Partial revisions have been made to recommendations for vaccines against S. pneumoniae, tetanus-diphtheria-pertussis, herpes zoster, and human papillomavirus. For vaccines against influenza, meningococcus, Japanese encephalitis, and yellow fever, the Committee on Adult Immunization has summarized its opinions on recent issues regarding the vaccines. There are no changes from Adult Immunization 2nd Edition for vaccines not mentioned in this revised edition.

Factors associated with a strong response to the T-SPOT.TB in patients with extrapulmonary tuberculosis.

Limited data are available on which factors are associated with strong immunologic responses to T-SPOT.TB. We investigated the factors associated with strong positive responses in patients with extrapulmonary tuberculosis (E-TB). Of 173 patients with E-TB who gave positive results on T-SPOT.TB, 26 (15%) with a strong positive response (defined as ≥1,000 spot-forming units (SFU)/2.5×105 PBMC to ESAT-6 or CFP-10) and 71 (41%) with a low positive response (≤ 99 SFU (6-99 SFU)/2.5×105 PBMC) were further analyzed. Miliary TB was independently associated with a strong positive response to T-SPOT.TB, while advanced age and immunosuppression were independently associated with weak positive T-SPOT.TB responses.

Five-year decreased incidence of surgical site infections following gastrectomy and prosthetic joint replacement surgery through active surveillance by the Korean Nosocomial Infection Surveillance System

BACKGROUNDnSurveillance of healthcare-associated infection has been associated with a reduction in surgical site infection (SSI).nnnAIMnTo evaluate the Korean Nosocomial Infection Surveillance System (KONIS) in order to assess its effects on SSI since it was introduced.nnnMETHODSnSSI data after gastrectomy, total hip arthroplasty (THA), and total knee arthroplasty (TKA) between 2008 and 2012 were analysed. The pooled incidence of SSI was calculated for each year; the same analyses were also conducted from hospitals that had participated in KONIS for at least three consecutive years. Standardized SSI rates for each year were calculated by adjusting for SSI risk factors. SSI trends were analysed using the Cochran-Armitage test.nnnFINDINGSnThe SSI rate following gastrectomy was 3.12% (522/16,918). There was a significant trend of decreased crude SSI rates over five years. This trend was also evident in analysis of hospitals that had participated for more than three years. The SSI rate for THA was 2.05% (157/7656), which decreased significantly from 2008 to 2012. The risk factors for SSI after THA included the National Nosocomial Infections Surveillance risk index, trauma, reoperation, and age (60-69 years). The SSI rate for TKA was 1.90% (152/7648), which also decreased significantly during a period of five years. However, the risk-adjusted analysis of SSI did not show a significant decrease for all surgical procedures.nnnCONCLUSIONnThe SSI incidence of gastrectomy and prosthetic joint replacement declined over five years as a result of active surveillance by KONIS.

Nuclear Factor-Kappa B Inhibition Reduces Markedly Cell Proliferation in Epstein-Barr Virus-Infected Stomach Cancer, But Affects Variably in Epstein-Barr Virus-Negative Stomach Cancer

ABSTRACT Nuclear factor-kappa B (NF-κB) inhibition by NF-κB p65-specific siRNA induced a near-cessation of cell proliferation in EBV-positive stomach cancer cell, and notably diminished cell proliferation in EBV- positive Raji lymphoma cell. In EBV-negative stomach cancer cells, NF-κB inhibition affected variably cell proliferation. Regardless of cell type, NF-κB inhibition suppressed antiapoptotic function of NF-κB, and tended to promote the nuclear accumulation of beta-catenin. This inverse relationship between NF-κB and beta-catenin was evident in 120 resected gastric carcinomas. Conclusively, NF-κB inhibition may be beneficial in the therapy of EBV-positive stomach cancer, but influence variously EBV-negative stomach cancer.

Sensitivity of the Cytomegalovirus Antigenemia Assay to Diagnose Cytomegalovirus Retinitis

Background Cytomegalovirus (CMV) retinitis is one of the most important tissue-invasive CMV diseases in immunocompromised patients. Since 1980, non-invasive diagnostic methods, notably the CMV antigenemia assay, have been widely used as adjunct tests to diagnose tissue-invasive CMV diseases. However, there are limited data on the diagnostic value of the CMV antigenemia assay for diagnosing CMV retinitis. Materials and Methods We performed a retrospective review of all cases of CMV retinitis at Asan Medical Center, Seoul, South Korea over a 9-year period. The diagnosis of CMV retinitis was made by experienced ophthalmologists according to medical history and an ophthalmoscopic appearance of typical retinopathy, together with absence of an alternative diagnosis. Results We analyzed 44 patients with CMV retinitis (affecting 57 eyes) for whom the CMV antigenemia assay was performed. Of the 44 patients, 31 (70%) were HIV-uninfected and 13 (30%) were HIV-infected. The overall sensitivity of the CMV antigenemia assay was 66% (95% confidence interval [CI] 50–80%). The test’s sensitivity showed a non-significant trend towards being higher in HIV-infected patients than in HIV-uninfected patients (sensitivity 85% vs 58%, respectively, P = 0.16). In a subgroup analysis of the 35 patients without other concurrent tissue-invasive CMV disease, the sensitivity of the CMV antigenemia assay was 57% (95% CI 40–74%). Conclusions The CMV antigenemia assay has limited value as a non-invasive diagnostic adjunct test for CMV retinitis. Therefore, the results of the assay need to be interpreted in the context of underlying disease, clinical presentation, and ophthalmoscopic findings.

Combined IFN-γ and TNF-α release assay for differentiating active tuberculosis from latent tuberculosis infection

OBJECTIVESnThe IFN-γ-release assay (IGRA) cannot differentiate active tuberculosis (TB) from latent TB infection (LTBI). We hypothesized that the TNF-α-release assay (TARA) combined with IGRA might discriminate active TB from not active TB without LTBI.nnnMETHODSnAdult patients with suspected TB, and with unrelated diseases such as herpes zoster as controls, were enrolled in an intermediate TB-burden country. Patients with confirmed or probable TB were regarded as active TB, and patients with not active TB were further classified as those having not active TB with and without LTBI based on IGRA results. The IGRA and TARA by using ELISPOT assays were performed on peripheral mononuclear cells.nnnRESULTSnThirty six patients with active TB and 53 patients including 18 not active TB with LTBI and 35 not active TB without LTBI were finally included. The sensitivity and specificity of the IGRA for those patients found to have active TB were 94% (CI, 80-99) and 66% (CI 52-78), respectively. Combining the IGRA and the TARA substantially increased the specificity for active TB (93%, CI, 82-98; Pu202f=u202f0.001) compared with the IGRA only, without compromising sensitivity (89%, CI, 73-96; Pu202f=u202f0.67).nnnCONCLUSIONSnCombining the IGRA and TARA appears to be useful for diagnosing active TB.

Severe Fever with Thrombocytopenia Syndrome Presenting with Rhabdomyolysis

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging febrile illness. While many kinds of severe complications including acute renal failure have been reported, rhabdomyolysis is rarely reported in association with SFTS. A 54-year-old female farmer was admitted with fever and diffuse myalgia. Laboratory finding showed thrombocytopenia, leukopenia, azotemia, extremely elevated muscle enzyme levels and myoglobinuria. We describe a fatal case of rhabdomyolysis with acute renal failure complicated by SFTS.