Annals of Clinical Microbiology, The official Journal of the Korean Society of Clinical Microbiology


Weeks in Review


Weeks to Publication
Indexed in KCI, KoreaMed, Synapse, DOAJ
Open Access, Peer Reviewed
pISSN 2288-0585 eISSN 2288-6850

September, 2004. Vol. 7 No. 2.

Review article

Pandemic Threat Posed by Avian Influenza A Viruses

Won-Kil Lee

Ann Clin Microbiol 2004 September, 7(2): 95-104. Published on 20 September 2004.

Phylogenetic studies of influenza A viruses have revealed species-specific lineages of viral genes, and that aquatic birds are the source of all influenza viruses in other animal species including humans, pigs, horses, sea mammals and birds. Influenza pandemics, defined as global outbreaks of the disease due to new antigenic subtypes, have exacted a high death toll from human populations. The most devastating pandemic, the so-called Spanish influenza of 1918 to 1919, resulted from an H1N1 virus and caused the deaths of at least 20 million people worldwide. Other much less catastrophic pandemics occurred in 1957 (Asian influenza [H2N2 virus]), 1968 (Hong Kong influenza [H3N2 virus]), and 1977 (Russian influenza [H1N1 virus]). It is noteworthy that both the Asian and Hong Kong outbreaks were caused by hybrid viruses, or reassortants, that harbored a combination of avian and human viral genes. Avian influenza viruses are therefore key contributors to the emergence of human influenza pandemics. 

Fowl plague caused by highly pathogenic avian influenza A viruses is a constant threat to the poultry industry, but until the Hong Kong influenza outbreak, there was no zoonotic evidence that avian viruses could be transmitted directly to humans. In May 1997, an H5N1 influenza virus was isolated from a 3-year-old boy in Hong Kong, who died of extensive influenza pneumonia. By the end of 1997, a total of 18 cases of human influenza as an emerging infection had been identified, all caused by the same H5N1 virus. With this outbreak, it became clear that the virulence potential of these viruses extended to humans. The H5N1 isolates were not reassortants like the 1957 and 1968 pandemic strains; instead, all of the viral genes had originated from an avian virus. It will be critical to identify the molecular determinants that allow efficient transmission and replication of avian influenza viruses in humans, so that probable pandemics can be anticipated well before the death toll begins to mount. And health officials should begin to consider the production of emergency vaccines against all 15 existing HA subtypes of influenza virus. Also, given the existence of a vast number of influenza viruses in the aquatic wild-bird reservoir, we must accept the fact that they always pose pandemic threats. Thus, it is recommended that poultry (chickens, turkeys, etc.), domesticated ducks, and pigs be kept in ecologically controlled, secure houses with limited access to wild birds.

[in Korean]

Original article

Analysis of Clinical Features and Hepatitis B Virus DNA Level in the Concomitant Cases of Hepatitis B Surface Antigen and Antibody

Byung Ryul Jeon, Rojin Park, Jeong Won Shin, Tae Youn Choi, Hee Bong Shin, You Kyung Lee, Young Jin Choi, Hwi Jun Kim, and Jee Young Ahn

Ann Clin Microbiol 2004 September, 7(2): 105-110. Published on 20 September 2004.

Background : After an infection with HBV, HBsAg is the first virologic marker detectable in the serum. If anti-HBs against ‘a’ determinant of HBsAg appears, HBsAg will disappear and the patients will recover from the HBV infection in most cases. However, we encounter not infrequently concomitant cases of HBsAg and anti-HBs. In this study we evaluated HBV DNA levels in concomitant cases to aid in the interpretation of these serologic results.

Methods : This study included 36 cases with positivity for both HBsAg and anti-HBs in an electrochemiluminescent immunoassay as well as a radioimmunoassay. They were tested for HBeAg, anti-HBe, and HBV DNA levels.

Results : Chronic viral hepatitis was the most frequent diagnosis (15/36 : 41.7%) and AST and ALT levels were normal in 17 (47.2%) and 20 (55.6%) cases, respectively, among total 36 concomitant cases. HBeAg was positive in 24 and anti-HBe in 17 cases. HBV DNA was positive in 33 cases (91.7%). including all 24 HBeAg positive cases and 9 (75%) of 12 HBeAg negative cases; 6 (50%) of 12 HBeAg negative cases had HBV DNA levels higher than 105copy/mL.

Conclusions : This study showed that viral replication still exists in most cases of concomitant HBsAg and anti-HBs, and even in some HBeAg negative cases. So in the concomitant cases, HBV DNA quantitation may aid in the interpretation of clinical significance of these cases.

[in Korean]

Original article

Prevalence of CTX-M-type Extended-Spectrum β-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae Isolates in Korea, 2003

Jung Hyun Lee, Il Kwon Bae, Su Bong Kwon, Seok Hoon Jeong, Gun Jo Woo, Jongwook Lee, Wee Gyo Lee, Jung Oak Kang, Ji Young Ahn, Seong Geun Hong, Jong Hee Shin, Young Uh, Yeon Jun Park, Eui-Chong Kim, Kyungwon Lee, Dongeun Yong

Ann Clin Microbiol 2004 September, 7(2): 111-118. Published on 20 September 2004.

Background : The aims of this study were to survey nationwide susceptibilities of Escherichia coli and Klebsiella pneumoniae isolates against cefotaxime and to determine the prevalences of CTX-Mtype extended-spectrum β-lactamases(ESBLs).

Methods : During the period of February to July, 2003, E. coli and K. pneumoniae isolates were collected from 12 hospitals. Antimicrobial susceptibilities to cefotaxime were tested by the disk diffusion method. ESBL production was determined by the double disk synergy test. Cefotaxime-resistance of the ESBL-producers was transfered to E. coli DH5αand E. coli Top10-F by transformation. MICs of β-lactam antibiotics were determined by the agar dilution method. Searches for blaCTX-M genes was performed by PCR amplication; pIs of β-lactamases were determined by isoelectric focusing.

Results : Among 230 isolates of E. coli and 232 isolates of K. pneumoniae, 27 (11.7%) and 79 (34.1%) were intermediate or resistant to cefotaxime, respectively. Twenty-four (10.4%) isolates of E. coli and 58 (25.0%) K. pneumoniae isolates showed positive results in the double disk synergy test. Three isolates of E. coli and 13 K. pneumoniae isolates harbored blaCTX-M-3 gene, 4 E. coli isolates harbored blaCTX-M-15 gene, and 1 E. coli and 5 K. pneumoniae isolates harbored blaCTX-M-14 gene.

Conclusion : E. coli and K. pneumoniae isolates producing CTX-M-type ESBLs were not uncommon in Korean hospitals. It is thought that periodical surveys are necessary for inspecting the spread of CTX-M-type ESBL genes are necessary.

[in Korean]

Original article

Evaluation of a Rapid Antigen Test for Detection of Influenza Virus

Wee Gyo Lee, Hae Kyung Lee, Han Jin Kim, June Key Chung, Eun Hee Lee, Hae Ran Moon

Ann Clin Microbiol 2004 September, 7(2): 119-123. Published on 20 September 2004.

Background : Influenza virus is a cause of annual outbreaks of acute respiratory disease and is responsible for considerable mortality and morbidity in all age groups. To achieve maximum efficacy antiinfluenza drugs must be started within 48 h of the development of influenza symptoms. Improvements in rapid diagnosis methods are needed to identify influenza infections. The aim of this study was to compare a quick rapid antigen test with viral culture assays.

Methods : A total of 87 nasopharyngeal swab specimens were collected from symptomatic paediatric patients during March, 2004. The performance of the Quick S-Influ A/B rapid test for influenza virus detection was compared to that of the viral culture.

Results : The overall rate of detection for viral culture was 23.4% for influenza A virus and 13.4% for influenza B virus. The Quick S-Influ A/B assay identified 17 of 18 influenza A viruses (sensitivity, 94.4%; specificity, 96.8%; PPV, 89.5%; NPV, 98.4%), and identified 7 of 9 influenza B viruses (sensitivity, 77.8%; specificity, 98.4%; PPV, 87.5%; NPV, 96.8%).

Conclusions : The Quick S-Influ A/B assay was easy to perform and showed comparable sensitivities and specificities. This rapid test kit can be an alternative tool for interventions in disease management. 

[in Korean]

Original article

Isolation of Klebsiella Oxytoca Clinical Isolate Producing AmpC β-lactamase, DHA-1

Wonkeun Song, Jae-Seok Kim, Han-Sung Kim, Tae Jae Lee, Min-Jeong Park, In-Heon Park, and Kyu Man Lee

Ann Clin Microbiol 2004 September, 7(2): 124-129. Published on 20 September 2004.

Background : Klebsiella oxytoca strain exhibiting an unusual inducible β-lactam resistance phenotype was isolated from a wound specimen of a patient at a university hospital in August 2002. The isolate was resistant to ampicillin, ampicillin-sulbactam, cephalothin, cefoxitin, and demonstrated reduced inhibition zone diameters for ceftazidime in combination with clavulanate versus those for ceftazidime when tested alone.

Methods : Antimicrobial susceptibilities were tested using the Etest and disk diffusion method. AmpC β-lactamase production was determined by modified Hodge test. The disk antagonism method was used to detect inducibility of β-lactamase. Conjugation experiments were performed by the filter mating method using the recipient Escherichia coli J53 Azir strain. PCR and DNA sequencing of DHA-specific PCR products were tested.

Results : The double disk synergy test was negative and the modified Hodge test was positive for the K. oxytoca isolate. Antagonism was observed between cefoxitin and oxyimino-cephalosporins. Sequence analysis of the DHA-specific PCR products revealed that they were identical to the amino acid sequence of the DHA-1 β-lactamase. Transfer of the resistance by conjugation experiments was successful.

Conclusions : We found a plasmid-mediated DHA-1 β-lactamase-producing K. oxytoca possessing an unusual inducible β-lactam resistance phenotype was found in a university hospital in Korea. The resistance phenotype was conferred by DHA-1 encoded by a self-transferable plasmid.

[in Korean]

Original article

Clinical Significance of Escherichia coli O26 Isolated from Clinical Specimens

Ue Suk Joung, Seon Ho Lee, Joseph Jeong, Sung-Ryul Kim

Ann Clin Microbiol 2004 September, 7(2): 130-134. Published on 20 September 2004.

Background : Non-O157 human isolates among enterohemorrhagic Escherichia coli (EHEC) serogroup have been reported with increasing frequency in recent years; the serotype O26 is the most common among the non-O157 isolates. We performed serotyping of E. coli isolates with O157, O26, and O111 antisera at Ulsan University Hospital and identified 27 isolates of O26. The purpose of this study was to investigate the clinical significance of E. coli O26 isolates.

Methods : During the 24-month period from January 2002 to December 2003, E. coli isolates were serotyped when requested by the physician because of bloody diarrhea or when blood was noted in the stool specimen at the laboratory. The isolates were identified biochemically by Vitek 1 (BioMerieux Vitek Inc., Mo., USA) and serotyped using diagnostic antisera of O157, O26, and O111 (NIH, Korea). When a positive agglutination reaction was shown, the patient’s was reviewed retrospectively.

Results : Of 4,921 isolates of E. coli during the 2-year period, 200 isolates were serotyped and 27 (13.5%) were identified as serotype O26. These were isolated from stool (13 isolates), urine (9), pus (1), blood (1), and bile (1). Among the 13 patients whose stool specimens grew E. coli O26, 12 had watery diarrhea and 7 bloody diarrhea; two patients had thrombocytopenia and purpura simultaneously. Two patients with watey diarrhea, two with bloody diarrhea, and one with TTP were among the 7 patients with E. coli O26 in the urine. Finally, one patient each with blood isolate and bile isolate of E. coli O26 both had acute gastroenteritis.

Conclusions : Most of the patients infected with E. coli  O26 had clinical manifestations consistent with EHEC infections. E. coli  isolates from patients with boody diarrhea should be serotyped with O157 and O26 antisera.

[in Korean]

Original article

Comparison of Mycobacterial Culture by Mycobacterium Growth Indicator Tube and Ogawa Media

Ue Suk Joung, Joseph Jeong, Seon Ho Lee, Sung-Ryul Kim

Ann Clin Microbiol 2004 September, 7(2): 135-138. Published on 20 September 2004.

Background : Mycobacterial disease is still greatly concerned in the developing and industrialized countries. Ogawa media has been used to diagnose mycobacterial disease in Korea in spite of a low sensitivity and long incubation time. Mycobacterium Growth Indicator Tube (MGIT) 960 system has been developed to overcome the pitfalls of Ogawa media. So, we investigated improvement in dectection rate and the detection time of mycobacteria using the MGIT 960 system along with 3% Ogawa media.

Methods : A total of 8,045 clinical specimens referred to the department of laboratory medicine in Ulsan University Hospital from January in 2001 to June in 2002 were cultured for mycobacteria. Specimens were processed with the NALC-NAOH (final concentration of NaOH: 1%) and inoculated into both MGIT and Ogawa media. Mycolic acid in the cultured products were analyzed by High performance liquid chromatography to discriminate between Mycobacterium tuberculosis and nontuberculous mycobacteria.

Results : Of 8,045 clinical specimens cultured, mycobacteria grew in 957 (11.9%) specimens, 840 (87.8%) M. tuberculosis and 117 (12.2%) nontuberculous mycobacteria. Mycobacteria were detected in 939 specimens (98.1%) by MGIT and 771 (80.6%) specimens by Ogawa media; 753 (78.7%) were detected by both media, 186 (19.4%) by MGIT only, and 18 (1.9%) by Ogawa media only. Mycobacteria were detected in 11.7 days by MGIT 960 and 28.4 days by Ogawa media.

Conclusions : The detection rate and detection time of mycobacteri are improved considerably by the MGIT system; however a combined use of MGIT system and Ogawa media is the most ideally recommended for increasing the detection rate and shortening the detection time.

[in Korean]

Original article

Prevalence of OXA-23 Extended-Spectrum β-Lactamase-Producing Clinical Isolates of Acinetobacter baumannii in a University Hospital, Busan, Korea

Byung-Chan Jeon, Ki-Young Kwon, Seok Hoon Jeong, Il Kwon Bae, Su Bong Kwon, Byung Kyu Cho, Dongeun Yong, Kyungwon Lee

Ann Clin Microbiol 2004 September, 7(2): 139-147. Published on 20 September 2004.

Background : Acinetobacter baumannii is a glucose-nonfermenting gram-negative rod and is a well-recognized nosocomial pathogen. In recent years, A. baumannii strains showing resistance to carbapenems by producing metallo-β-lactamases or OXA-type β-lactamases have increased, and it is considered to be a serious clinical problem. But genotypes of carbapenemases produced by A. baumannii isolates in Korea have been rarely reported. The purpose of this study was to investigate the prevalence of imipenem-resistant A. baumannii and to determine the mechanism of resistance.

Methods : During the period of January through September, 2003, susceptibilities to imipenem of A. baumannii isolates from patients admitted in Kosin University Gospel Hospital in Busan, Korea were investigated. The modified Hodge and EDTA-disk synergy tests were performed for screening of carbapenemase and metallo-β-lactamase-production. Minimal inhibitory concentrations (MICs) were determined by the agar dilution method. For detection of IMP, VIM and OXA-type β-lactamases genes, polymerase chain reactions (PCR) were performed, and the DNA sequences of OXA-type β-lactamases genes were determined by using the dideoxy-chain termination method. The isoelectric points of β-lactamases were determined by isoelectric focusing. Pulsed-field gel electrophresis (PFGE) of the SmaI-digested genomic DNA was performed.

Results : A total of 193 strains of A. baumannii were collected from patients during the surveillance period. Twenty-seven percents (52/193) of A. baumannii isolates were resistant to imipenem. Among the 52 imipenem-resistant isolates, 41 isolates (78.8%) showed positive results in the modified Hodge test, but none of the isolates showed positive results in the EDTA-disk synergy test. Thirty-eight modified Hodge test-positive isolates harbored blaOXA-23 gene, but none of the isolates harbored IMP- or VIM-type metallo-β-lactamases genes. Analytical isoelectric focusing revealed that all the 38 isolates had a nitrocefin-positive band at pI of 6.65. Thirty-five OXA-23-producing isolates showed a similar PFGE pattern when digested by SmaI endonuclease.

Conclusion : Thirty-eight clinical isolates of A. baumannii acquired resistance to imipenem by producing OXA-23 β-lactamase. Among them were 35 isolates thought to be originated from the same source, because they contained a similar chromosomal type. To the best of our knowledge, this is the first time that OXA-23 β-lactamase has been detected in Korea.

[in Korean]

Original article

Identification of Mycobacteria using High Performance Liquid Chromatography in Clinical Specimens

Joseph Jeong, Seon Ho Lee, Ue-Suk Jeong, Chulhun L. Chang, Sung-Ryul Kim

Ann Clin Microbiol 2004 September, 7(2): 148-155. Published on 20 September 2004.

Background : As tuberculous and nontuberculous mycobacterial infections are increasing, it is very important to differentiate the myobacterial species. High performance liquid chromatography (HPLC) method has been proven to be a useful technique for the identification of mycobacteria. The purpose of this study was to investigate the identification rate using HPLC and to know nontuberculous mycobacterial distribution in Ulsan University Hospital.

Method : Mycobacteria grew in 959 clinical specimens, which were analyzed by HPLC, and their distribution was reviewed by retrospective studies.

Results : The patterns of HPLC were divided into single, double, and triple cluster groups which consist of 9, 20, and 4 species of mycobacteria respectively. The identification rate of mycobacteria by HPLC was 98.9%, And the rate of nontuberculous mycobacteria in mycobacterial culture positive specimens was 12.2%.

Conclusion : HPLC is an excellent tool for mycobacterial identification. And the culture rate of nontuberculous mycobacteria in clinical specimens is increasing in Korea.

[in Korean]

Original article

The Evaluation of Clinical Utility of ATB FUNGUS 2 for Antifungal Susceptibility Testing in Candida Species

Hye Gyung Bae, Yong-Hak Sohn, Jong Hee Shin, Mi-Na Kim

Ann Clin Microbiol 2004 September, 7(2): 156-163. Published on 20 September 2004.

Background : Although the National Committee for Clinical Laboratory Standards (NCCLS) defined a standard reference broth microdilution method for testing the susceptibility of Candida species to antifungal drugs, many clinical laboratories require easier but reliable alternatives for routine antifungal susceptibility testing. We evaluated ATB FUNGUS 2 (bioMerieux, France.; ATB) compared to the method recommended by the NCCLS (NCCLS).

Methods : A total of 28 strains of Candidaspecies consecutively isolated from blood and CSF cultures at Asan Medical Center from April to June 2004 were tested. In addition, 12 strains comprising C. krusei (3), C. glabrata (7) and C. guilliermondii (2) from the collection of Chonnam National University Hospital were included in the study. These strains were tested for minimum inhibitory concentrations (MICs) against flucytosine (FC), fluconazole (FZ), itraconazole (IZ) and amphotericin B (AB) by both of ATB and NCCLS. In NCCLS, MICs were read using a spectrophotometer after 24 and 48 hour-incubation.

Results : The concordance rates of MICs between ATB and NCCLS after 24 hour-incubation were 100%, 75%, 89% and 96% within two-fold dilution and 100%, 97%, 97%, 100% within four-fold dilution for FC, FZ, IZ and AB, respectively. For C. krusei, all three FC and FZ-resistant strains were either intermediate or SDD and one IZ-resistant strain was SDD in ATB, respectively. One C. tropicalis strain resulted in AB MICs of 0.5 μg/mL in NCCLS, but 2 μg/mL in ATB.

Conclusions : ATB showed good concordance rates with NCCLS after 24 hour-incubation. ATB appears to be a useful alternatives to NCCLS for routine antifungal susceptibility tests. However, ATB needs further evaluation with more clinical strains, especially those resistant to antifungal agents.

[in Korean]

Original article

Distribution and Antifungal Susceptibility of Candida species Isolated from Clinical Specimens during the Past Six Years

Jeong Hwan Shin, Hye Ran Kim, Jeong Nyeo Lee

Ann Clin Microbiol 2004 September, 7(2): 164-170. Published on 20 September 2004.

Background : The epidemiology of Candida species isolated from nonsterile as well as normally sterile sites is important because colonization of the former may precede invasive Candida infections.

Methods : We investigated the epidemiology and antifungal susceptibility of Candida species recovered in Busan Paik Hospital during the past 6 years and compared these results according to the type of specimens.

Results : Among the 2364 strains, C. albicans(53.8%) was the most frequently isolated, followed by C. tropicalis (17.5%), and C. guilliermondii (10.0%). Non-albicans Candida species were more prevalent in normally sterile sites (P<0.001); the prevalence of C. tropicalis and C. parapsilosis was significantly higher in normally sterile than in nonsterile sites (P<0.001). The prevalence of C. parapsilosis was higher in blood, intravenous catheter tips, and ear discharge, whereas C. tropicalis was more frequently isolated from urine. C. guilliermondii was the most frequently isolated from bronchial washings. The susceptibilities of Candida species to 5-flucytosine, amphotericin B, nystatin, miconazole, econazole, and ketoconazole were 98.3, 99.3, 99.7, 94.9, 86.3, and 94.5%, respectively. The susceptibilities of the organisms from normally sterile sites were lower than those from nonsterile sites.

Conclusion : The distribution of Candida species differed among various types of specimens, especially those from normally sterile versus nonsterile sites. We assume that the frequency of infections of exogenous origin is high. We presume that the candidemia of C. parapsilosis is associated with the use of central venous catheter and that C. parapsilosis is acquired from exogenous sources.

[in Korean]

Original article

Antimicrobial Resistance of Clinically Important Bacteria Isolated from 12 Hospitals in Korea

Seong Geun Hong, Jongwook Lee, Dongeun Yong, Eui-Chong Kim, Seok Hoon Jeong, Yeon Jun Park, Tae Yeal Choi, Young Uh, Jong Hee Shin, Wee Kyo Lee, Ji Young Ahn, Sung-Hee Lee, Gun-Jo Woo, and Kyungwon Lee

Ann Clin Microbiol 2004 September, 7(2): 171-177. Published on 20 September 2004.

Background : A rapid increase in antimicrobial-resistant bacteria has become a serious problem in Korea. Moreover, the antibiotic resistance problem has worsened noticeably during the past several years. The aim of this study was to determine the prevalence of resistance among frequently isolated gram-positive and -negative bacteria in Korea.

Methods : Routine susceptibility data for medically important bacteria isolated during 6 months of 2003 were collected from 12 university and general hospital laboratories in Korea. 

Results : The proportion of methicillin-resistant Staphylococcus aureus (MRSA) was 66%; however, vancomycin-resistant strains were not detected. The rates of vancomycin-resistant Enterococcus faecium and penicillin-nonsusceptible Streptococcus pneumoniae (PNSP) were 22% and 73%, respectively. The resistance rates to 3rd generation cephalosporins and monobactam were: Escherichia coli 8-12%, Klebsiella pneumoniae 18-22%, Citrobacter freundii 22-32%, Enterobacter cloacae 34-37%, and Serratia marcescens 12-21%, respectively. Imipenem resistance rates of Acinetobacter baumannii and Pseudomonas aeruginosa were 23% and 25%, respectively.

Conclusions : Antimicrobial resistant strains were already prevalent among the clinically important isolates, especially, MRSA, PNSP, and extended-spectrum cephalosporin resistant gram-negative bacilli in Korea. The imipenem-resistant rates of A. baumannii and P. aeruginosa increased, respectively, from 13% and 20% in 2002 to 23% and 25% in 2003. The results of this study will provide a basis for proper treatment of bacterial infections and prevention of spread of resistant bacteria. A continuous nationwide surveillance of antimicrobial resistance is very important and should be performed.

[in Korean]

Original article

Evaluation of Urinary Antigen Test for Rapid Diagnosis of Community-Acquired Pneumococcal Pneumonia

Nam Hee Ryoo, Jung Sook Ha, Dong Suk Jeon, Jae Ryong Kim

Ann Clin Microbiol 2004 September, 7(2): 178-181. Published on 20 September 2004.

Background : Streptococcus pneumoniae is one of the most common pathogens of communityacquired pneumonia (CAP) which needs rapid diagnosis and appropriate therapeutic approaches. We evaluated a new rapid urinary antigen test kit, NOW S. pneumoniae antigen test (Binax Inc., Maine, USA), for the detection of the S. pneumoniae antigen in the urine of patients who were suspected of CAP.

Methods : A total of 115 urine samples were tested during April to July, 2004. Patients were divided into 2 groups: the first was the patients who were suspected of CAP and the second was the patients with other disorders. Urinary antigen test was performed done by immunochromatographic methods and results were read within 15 minutes. All the urine samples were random and unconcentrated. The patients were reviewed clinically, together with the results of sputum and blood cul-tures, urinalysis and other laboratory tests.

Results : Overall mean age was 62-years old and male proportion was 59%: Group 1 had mean age of 63-years old and male 54% whereas group 2 had 60-years old and 76%. S. pneumoniae antigen was detected in the urine from 14 (12.2%) of 115 patients. Of the 14 patients with positive urinary antigen tests, 12 were from 90 patients with CAP with fever, leukocytosis and appropriate radiological findings, giving the sensitivity of 13.3%; the remaining 2 patients were from 25 patients with other disorders. Only 2 of the 12 patients showed S. pneumoniae in sputum or bloodcultures, respectively. Urinary antigen was not detected in 23 of the 25 patients with other disorders, giving the specificity of 92%.

Conclusions : Since this simple and rapid urinary antigen test showed low sensitivity in this study, the clinical symptoms and signs and radiological findings of patients should be reviewed together with the results of the urine test for early and accurate diagnosis and treatment, consistent clinical symptoms and signs with radiological studies are inevitable. Thus further studies would be necessary. The urinary antigen test showed high specificity and therefore should be a useful adjunct to cultures to be in aid of the diagnosis of CAP.

[in Korean]

Original article

An Analysis of Antituberculosis Drug Susceptibility Test Results in Kyung Hee Medical Center During Recent Four years

Jeong-Hun Kim, Jin-Tae Suh, Myung-Hee Kim, Gee-Young Kim, Sun-Ryung Her, Hee-Joo Lee, Woo-In Lee, So-Young Kang

Ann Clin Microbiol 2004 September, 7(2): 182-185. Published on 20 September 2004.

Background : Tuberculosis is still one of the most seriously threatening infections in Korea, because of multidrug resistant tuberculosis. Results of antituberculosis drug susceptibility test can provide clinicians very important informations for selection of proper regimens for treatment. 

Methods : In this study the results of antituberculosis drug susceptibility test of 298 cases at Kyunghee Medical Center from 2000 to 2003 were retrospectively analysed to evaluate the trend of antituberculosis drug susceptibility. The procedure of drug susceptibility test was based on the absolute concentration method using Lowenstein-Jensen solid media. 

Results : The resistance rate of Mycobacterium tuberculosis to one or more drugs was increased from 29.3% in 2000 to 48.2% in 2003, and the rates of multiple resistance to two or more drugs increased from 13.3% in 2000 to 20.5% in 2003. The increase in resistance rate to individual drug during study period were 20.0% to 24.1% in isoniazid, 9.3% to 19.3% in rifampicin, 5.3% to 15.7% in ethambutol, 4.0% to 10.8% in para-aminosalicylic acid, 2.7% to 6.0% in kanamycin, 1.3% to 7.2% in ethionamide, 1.3% to 6.0% in capreomycin, 1.3% to 7.2% in prothionamide, 0.0% to 12.1% in ofloxacin, 6.7% to 3.6% in streptomycin, 6.7% to 7.2% in cycloserine, 10.7% to 8.4%in pyrazinamide, respectively. 

Conclusions : The resistance rate of M. tuberculosis has been increased with years and multidrug resistant M. tuberculosis was commonly encountered in the specimens from the patients visited Kyunghee Medical center.

[in Korean]

Case report

A Case of Escherichia coli O157 and Campylobacter species Gastroenteritis

Young Uh , Soon Deok Park, Gyu Yul Hwang, Kap Jun Yoon, Hwang Min Kim, and Hyo Youl Kim

Ann Clin Microbiol 2004 September, 7(2): 186-189. Published on 20 September 2004.

Verotoxin-producing Escherichia coli O157 is a primary cause of severe and bloody diarrhea. Campylobacter spp. are one of the commonly reported bacterial cause of gastrointestinal infections throughout the world. Only a few cases involving both E. coli O157 and Campylobacter species have been reported. The authors simultaneously isolated verotoxin-producing E. coli O157 and Campylobacter species from the stool of a 3 year-old male with bloody diarrhea, fever and abdominal pain. 

[in Korean]