You La Jeon

Mean platelet volume in Korean patients with acute ischemic stroke: a gender difference.

Mean platelet volume (MPV) is the most commonly used measure of platelet size [1]. MPV is determined directly from the platelet distribution curve analysis in automated hematology analyzers and used as a surrogate marker of platelet production and function [2, 3]. We previously studied that MPV showed significant differences in Korean patients with hepatic diseases [4]. Recently, Ha et al. reported a very interesting article about stroke prediction with MPV. Some other recent studies have presented that elevated MPV is linked with hypertension, peripheral artery disease and stroke, all of which are related to atherosclerosis [1, 2, 5, 6]. It has been also reported that larger platelets are enzymatically and metabolically more active and thrombophilic than smaller ones, although it is still on a debate [5, 7]. Therefore, in this study, we planned to investigate this platelet index in Korean patients with acute ischemic stroke (AIS). The study included 166 patients with newly diagnosed with AIS and 8 individuals of transient ischemic attack (TIA) for patients group at Kyung Hee University Hospital, a tertiary teaching hospital in Seoul, Korea, between November 2010 and August 2011. For the control group, 311 subjects for medical check-ups were enrolled in our hospital, which were used as controls in the previous study [4]. Patients were diagnosed to AIS or TIA by physical examinations and radiologic findings. These clinical data were collected through a medical chart review. ANOVA followed by post hoc analysis were used to compare means in our study. Blood sampling was performed through venepuncture and MPV was measured using EDTA-containing tubes in Advia 2120 (Bayer Diagnostics, Tarrytown, NY, USA) within 2 h. The statistical analyses were performed with MedCalc v11.6 (MedCalc Software, Mariakerke, Belgium) and Excel 2007 (Microsoft Corporation, Redmond, WA). Statistical significance was set at p1⁄4 0.05. Mean age of patient group was 54.33 (14–84 year), and male to female ratio was 108:58. Mean of MPV levels was 7.92 fl (6.5–12.1 fl) in patient group and did not significantly increased in patient group than control group. However, there was a gender difference, which showed increased MPV levels in female AIS patients than male (Figure 1). Cemin et al. [7] also pointed out gender specificity that MPV is higher in female than in male with AMI. Therefore, the further study with more patients should be followed to assess the usefulness of MPV in AIS and investigate the meaning of gender difference of MPV in various atherosclerotic diseases. We previously reported that there was a gender difference in protein S activity of ischemic stroke patients [8]. Investigation of gender differences in various coagulationassociated laboratory tests must be followed in the near future.

Mean platelet volume and mean platelet volume/platelet count ratio in infective endocarditis

Abstract Infective endocarditis (IE), an infection of the endocardial surface, frequently leads to life-threatening complications, such as thromboembolism due to platelet activation. We investigated the mean platelet volume (MPV) in Korean patients with IE and the serial changes thereof, in comparison with other laboratory parameters. We analyzed 248 MPV results from 22 patients diagnosed with IE in our hospital between January 2011 and April 2012. MPV was measured with an Advia 2120 (Siemens Healthcare Diagnostics, Tarrytown, NY) using EDTA-containing tubes. The mean MPV differed significantly between the patient and control groups, 8.74 vs. 7.96 fl, respectively. In addition, the platelet count and MPV/platelet count ratio were significantly decreased in the patient group. The total platelet mass and platelet size in IE might be increased. Further studies should examine more patients to verify the changes in the MPV and MPV/platelet count ratio in IE and assess in greater detail the relationship between MPV and thrombotic complications caused by platelet activation.

Combined Bacillus licheniformis and Bacillus subtilis infection in a patient with oesophageal perforation

Species of the genus Bacillus are a common laboratory contaminant, therefore, isolation of these organisms from blood cultures does not always indicate infection. In fact, except for Bacillus anthracis and Bacillus cereus, most species of the genus Bacillus are not considered human pathogens, especially in immunocompetent individuals. Here, we report an unusual presentation of bacteraemia and mediastinitis due to co-infection with Bacillus subtilis and Bacillus licheniformis, which were identified by 16S RNA gene sequencing, in a patient with an oesophageal perforation.

Factors influencing discordant results of the QuantiFERON-TB Gold In-tube test in patients with active TB

OBJECTIVES Indeterminate or negative results from the QuantiFERON-TB Gold In-tube test (QFT-GIT) for TB-confirmed patients indicate the lower sensitivity of this method. The aim of this study was to determine the factors associated with indeterminate and negative QFT-GIT results in active TB patients. METHODS We analyzed retrospectively the laboratory and clinical data of patients diagnosed with TB between December 2009 and April 2012 at a tertiary university hospital in Seoul, Korea. RESULTS Among 1301 patients who underwent QFT-GIT, TB-PCR and TB-culture, 168 (12.9%), those with positive TB-PCR or TB-culture were diagnosed with TB. Thirty-nine (23.2%) had indeterminate or negative results by QFT-GIT assay, which did not correlate with positive results of TB-PCR or TB-culture. These patients were older, had lower lymphocyte, total protein and albumin levels, and showed significantly higher CRP levels than the positive group. Multivariate logistic regression analysis showed that the probability of indeterminate and negative QFT-GIT results increased as CRP (odd ratio, 1.069; 95% CI, 1.013-1.127; P = 0.014) or age (1.030, 1.005-1.056, 0.02) increases. CONCLUSIONS When levels of markers of inflammation, such as CRP, are high or the patient is older, QFT-GIT results should be interpreted carefully and correlated with additional tests for TB.

A case series of autoimmune diseases accompanied by incidentally diagnosed monoclonal gammopathy: Is there a link between the two diseases?

Although the etiology of plasma cell dyscrasia is poorly understood, there is evidence for immune dysregulation or sustained immune stimulation playing a pivotal role in the pathogenesis of these diseases, including chronic infection and autoimmune disorders. In this study, we report four autoimmune disease cases where monoclonal gammopathy (MG) was incidentally found during follow‐up.

Prevalence and Antibiotic Susceptibility of Mycoplasma hominis and Ureaplasma urealyticum in Pregnant Women

Mycoplasma hominis (M. hominis) and Ureaplasma urealyticum (U. urealyticum) are important opportunistic pathogens that cause urogenital infections and complicate pregnancy. The aim of this study was to investigate the prevalence, effects on pregnancy outcomes, and antimicrobial susceptibilities of M. hominis and U. urealyticum. We tested vaginal swabs obtained from 1035 pregnant women for the presence of genital mycoplasmas between June 2009 and May 2014. The laboratory and clinical aspects of genital mycoplasmas infection were reviewed retrospectively, and the identification and antimicrobial susceptibility of genital mycoplasmas were determined using the Mycoplasma IST-2 kit. A total of 571 instances of M. hominis and/or U. urealyticum were detected. Of them, M. hominis was detected in two specimens, whereas U. urealyticum was detected in 472 specimens. The remaining 97 specimens were positive for both M. hominis and U. urealyticum. Preterm deliveries were frequently observed in cases of mixed infection of M. hominis and U. urealyticum, and instances of preterm premature rupture of membrane were often found in cases of U. urealyticum. The rates of non-susceptible isolates to erythromycin, empirical agents for pregnant women, showed increasing trends. In conclusion, the prevalence of M. hominis and/or U. urealyticum infections in pregnant women is high, and the resistance rate of antimicrobial agents tends to increase. Therefore, to maintain a safe pregnancy, it is important to identify the isolates and use appropriate empirical antibiotics immediately.

Crystalloid podocytopathy with focal segmental glomerulosclerosis in PCM: a case report

BackgroundCrystalloid podocytopathy with focal segmental glomerulosclerosis in plasma cell myeloma (PCM) is rare.Case PresentationWe present a case of crystalline deposition in the bone marrow (BM) and various renal cells with only proteinuria as a symptom. As workup for proteinuria, a renal biopsy sample was obtained. EM showed multiple crystalline depositions in renal tubular cells and podocytes. Focal segmental glomerulosclerosis with crystalloid podocytopathy was diagnosed. Because monoclonal gammopathy was detected in the serum and urine, a BM study was also performed. Plasma cells with needle-shaped inclusion bodies were observed. The crystalline deposits in the plasma cells and podocytes were positive for Masson’s trichrome and kappa light-chain staining. These findings indicated that the crystalline deposits originated from paraprotein. The case showed a rare process of focal segmental glomerulosclerosis via crystalline deposition in podocytes in plasma cell myeloma.ConclusionsCrystalloid podocytopathy is a likely cause of renal damage such as FSGS in PCM, although it is an uncommon mechanism for myeloma kidney.

A Case of Sepsis in a 92-Year-Old Korean Woman Caused by Aerococcus urinae and Identified by Sequencing the 16S Ribosomal RNA Gene

Aerococcus urinae is an uncommon pathogen that was first identified in 1992. Herein, we report a case of bloodstream infection caused by A. urinae, which occurred in a 92-year-old Korean female patient with an underlying urologic infection who had altered consciousness. The blood culture yielded positive results for A. urinae; however, identifying A. urinae was challenging. Ultimately, we used 16S ribosomal RNA (rRNA) gene sequencing to identify the organism. The patient recovered after being treated with ertapenem and meropenem. To our knowledge, this is the first report of a case of A. urinae sepsis in South Korea.

Misidentification of Acinetobacter baumannii as Alcaligenes faecalis by VITEK 2 System; Case Report

Acinetobacter baumannii (A. baumannii) is widely known as an opportunistic bacterial pathogen that causes infection more frequently among immunocompromised individuals. Our case demonstrated the limitation of the current VITEK 2 system for the idendification of A. baumannii. Four clinical isolates of A. baumannii were identified as Alcaligenes faecalis by the VITEK 2 system. Misidentification might lead to unnecessary tests and inappropriate treatments. Additional methods appear to be helpful for the accurate identification of A. baumannii for clinical microbiology laboratories.

Diagnostic Utility of New Equation for Active Tuberculosis Based on Parameters of Interferon-γ Release Assay

Background We derived a new equation to include interferon-γ (IFN-γ) levels in the QuantiFERON-Gold In-Tube (QFT-GIT) assay to discriminate active tuberculosis (ATB) infection from latent TB, and compared the diagnostic performance of the QFT-GIT assay and the new equation. Methods From January 2013 through May 2015, we retrospectively enrolled 159 and 408 patients with and without ATB, respectively, in this study. Discriminant analysis was performed to derive an equation to distinguish the ATB group from the non-ATB group. Results The sensitivity and specificity of the QFT-GIT assay for diagnosing ATB were 90.6% and 63.0%, respectively. The positive and negative predictive values of the QFT-GIT assay were 48.8% and 94.5%, respectively. When the optimal cutoff for the new equation [Z = (0.031 × Nil) + (0.007 × TBAg) - 0.978] was set to -0.435, the sensitivity and specificity were 84.3% and 69.1% (positive predictive value, 51.5%; negative predictive value, 91.9%), respectively. Conclusions The QFT-GIT assay and the equation derived from each IFN-γ could not discriminate ATB from latent TB without considering other cytokines involved in immunity against TB.