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Tsai CH, Ni BY, Ho YT, Jao LY, Peng MY, Wu PS, Sim JY. Clinical progression of asynchronous cutaneous lesions in a patient with locally acquired mpox infection. J Microbiol Immunol Infect 2023; 56:1118-1120. [PMID: 37344329 PMCID: PMC10279525 DOI: 10.1016/j.jmii.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/06/2023] [Accepted: 05/27/2023] [Indexed: 06/23/2023]
Abstract
We present one of the earliest domestic mpox cases in Taiwan, highlighting the asynchronous and atypical progression of cutaneous lesions which could pose significant diagnostic challenges for clinicians.
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Affiliation(s)
- Chi-Hsuan Tsai
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 289 Jianguo Road, Xindian District, New Taipei City, 23142, Taiwan
| | - Bo-Yang Ni
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 289 Jianguo Road, Xindian District, New Taipei City, 23142, Taiwan
| | - Yi-Ta Ho
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 289 Jianguo Road, Xindian District, New Taipei City, 23142, Taiwan
| | - Lun-Yu Jao
- Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 289 Jianguo Road, Xindian District, New Taipei City, 23142, Taiwan
| | - Ming-Yieh Peng
- Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 289 Jianguo Road, Xindian District, New Taipei City, 23142, Taiwan
| | - Ping-Sheng Wu
- Department of Pediatrics, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 289 Jianguo Road, Xindian District, New Taipei City, 23142, Taiwan
| | - Jun Yi Sim
- Department of Pediatrics, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 289 Jianguo Road, Xindian District, New Taipei City, 23142, Taiwan; Department of Pediatrics, Buddhist Tzu Chi University College of Medicine, Hualien, Taiwan.
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Yang MC, Wu YK, Lan CC, Yang MC, Chiu SK, Peng MY, Su WL. Antibiotic Stewardship Related to Delayed Diagnosis and Poor Prognosis of Critically Ill Patients with Vancomycin-Resistant Enterococcal Bacteremia: A Retrospective Cohort Study. Infect Drug Resist 2022; 15:723-734. [PMID: 35256846 PMCID: PMC8898016 DOI: 10.2147/idr.s354701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 02/18/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose Patients with septicemia caused by vancomycin-resistant Enterococcus (VRE) bacteremia have higher mortality rates than patients infected by VSE. Vancomycin or teicoplanin is selected as the antibiotic stewardship intervention to cover methicillin-resistant Staphylococcus aureus infections before blood culture reveals VRE bacteremia in critically ill patients with Gram-positive cocci (GPC) bacteremia; this may require linezolid or daptomycin treatment instead. We thus evaluated antibiotic stewardship practices, such as appropriate timing of antibiotic use in GPC bacteremia, and clinical outcomes of critically ill patients with VRE infection. Patients and Methods This retrospective study enrolled 191 critically ill patients with enterococcal bacteremia at the Taipei Tzu Chi Hospital during January 1, 2019–December 31, 2020. Demographic and clinical characteristics, as well as disease outcomes and appropriate antibiotic use after GPC bacteremia diagnosis, were compared between the VRE and VSE groups. Results Of 191 patients, 55 had VRE bacteremia (case group) and 136 had VSE bacteremia (control group). The rate of antibiotic change after initial antibiotic use for GPC bacteremia was higher in the VRE bacteremia group (100% vs 10.3%; p<0.001). The time to appropriate antibiotic administration after GPC bacteremia diagnosis was longer in the VRE bacteremia group (3.3±2.1 vs 1.5±1.8 days; p<0.001). Patients with VRE bacteremia had higher 28-day mortality rates (relative risk, 1.997; 95% confidence interval [CI], 1.041–3.83). Multivariate Cox regression analysis showed that delayed appropriate antibiotic administration of >3 days after GPC bacteremia diagnosis increased the risks of 28-day all-cause mortality (adjusted hazard ratio, 2.045; 95% CI, 1.089–3.84; p=0.026) in patients with VRE infection. Conclusion Patients with VRE bacteremia with delayed appropriate antibiotic administration of >3 days after GPC bacteremia diagnosis had increased 28-day mortality risks. New strategies for early VRE detection in GPC bacteremia may shorten the time to administer appropriate antibiotics and lower mortality rates.
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Affiliation(s)
- Mu-Chun Yang
- Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan, Republic of China
- School of Medicine, Tzu Chi University, Hualien, Taiwan, Republic of China
| | - Yao-Kuang Wu
- School of Medicine, Tzu Chi University, Hualien, Taiwan, Republic of China
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan, Republic of China
| | - Chou-Chin Lan
- School of Medicine, Tzu Chi University, Hualien, Taiwan, Republic of China
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan, Republic of China
| | - Mei-Chen Yang
- School of Medicine, Tzu Chi University, Hualien, Taiwan, Republic of China
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan, Republic of China
| | - Sheg-Kang Chiu
- School of Medicine, Tzu Chi University, Hualien, Taiwan, Republic of China
- Division of Infectious Disease, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan, Republic of China
| | - Ming-Yieh Peng
- Division of Infectious Disease, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan, Republic of China
| | - Wen-Lin Su
- School of Medicine, Tzu Chi University, Hualien, Taiwan, Republic of China
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan, Republic of China
- Correspondence: Wen-Lin Su, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 289 Jianguo Road, Xindian District, New Taipei City, 23142, Taiwan, Republic of China, Tel +886-2-66289779, Fax +886-2-66289009, Email
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Su WL, Lin CP, Huang HC, Wu YK, Yang MC, Chiu SK, Peng MY, Chan MC, Chao YC. Clinical application of 222 nm wavelength ultraviolet C irradiation on SARS CoV-2 contaminated environments. J Microbiol Immunol Infect 2022; 55:166-169. [PMID: 35094944 PMCID: PMC8755561 DOI: 10.1016/j.jmii.2021.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/11/2021] [Accepted: 12/25/2021] [Indexed: 11/25/2022]
Abstract
This was a preliminary study on ultraviolet C (UVC) irradiation for SARS-CoV-2-contaminated hospital environments. Forty-eight locations were tested for SARS-CoV-2 using RT-PCR (33.3% contamination rate). After series dosages of 222-nm UVC irradiation, samples from the surfaces were negative at 15 s irradiation at 2 cm length (fluence: 81 mJ/cm2).
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Affiliation(s)
- Wen-Lin Su
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chih-Pei Lin
- Department of Pathology and Laboratory Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Hui-Ching Huang
- Department of Pathology and Laboratory Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Yao-Kuang Wu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Mei-Chen Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Sheg-Kang Chiu
- Division of Infectious Disease, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan; Infection Control Center, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Ming-Yieh Peng
- Division of Infectious Disease, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan; Infection Control Center, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Ming-Chin Chan
- Infection Control Center, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - You-Chen Chao
- School of Medicine, Tzu Chi University, Hualien, Taiwan; Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
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Su WL, Lin CP, Huang HC, Wu YK, Yang MC, Chiu SK, Peng MY, Chan MC, Chao YC. Clinical Application of Ultraviolet C Inactivation of Severe Acute Respiratory Syndrome Coronavirus 2 in Contaminated Hospital Environments. Viruses 2021; 13:v13122367. [PMID: 34960637 PMCID: PMC8706350 DOI: 10.3390/v13122367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 01/25/2023] Open
Abstract
To overcome the ongoing coronavirus disease 2019 (COVID-19) pandemic, transmission routes, such as healthcare worker infection, must be effectively prevented. Ultraviolet C (UVC) (254 nm) has recently been demonstrated to prevent environmental contamination by infected patients; however, studies on its application in contaminated hospital settings are limited. Herein, we explored the clinical application of UVC and determined its optimal dose. Environmental samples (n = 267) collected in 2021 were analyzed by a reverse transcription-polymerase chain reaction and subjected to UVC irradiation for different durations (minutes). We found that washbasins had a high contamination rate (45.5%). SARS-CoV-2 was inactivated after 15 min (estimated dose: 126 mJ/cm2) of UVC irradiation, and the contamination decreased from 41.7% before irradiation to 16.7%, 8.3%, and 0% after 5, 10, and 15 min of irradiation, respectively (p = 0.005). However, SARS-CoV-2 was still detected in washbasins after irradiation for 20 min but not after 30 min (252 mJ/cm2). Thus, 15 min of 254-nm UVC irradiation was effective in cleaning plastic, steel, and wood surfaces in the isolation ward. For silicon items, such as washbasins, 30 min was suggested; however, further studies using hospital environmental samples are needed to confirm the effective UVC inactivation of SARS-CoV-2.
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Affiliation(s)
- Wen-Lin Su
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 23142, Taiwan; (Y.-K.W.); (M.-C.Y.)
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan; (C.-P.L.); (S.-K.C.); (Y.-C.C.)
- Correspondence: ; Tel.: +886-2-6628-9779
| | - Chih-Pei Lin
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan; (C.-P.L.); (S.-K.C.); (Y.-C.C.)
- Department of Pathology and Laboratory Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 23142, Taiwan;
| | - Hui-Ching Huang
- Department of Pathology and Laboratory Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 23142, Taiwan;
| | - Yao-Kuang Wu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 23142, Taiwan; (Y.-K.W.); (M.-C.Y.)
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan; (C.-P.L.); (S.-K.C.); (Y.-C.C.)
| | - Mei-Chen Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 23142, Taiwan; (Y.-K.W.); (M.-C.Y.)
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan; (C.-P.L.); (S.-K.C.); (Y.-C.C.)
| | - Sheg-Kang Chiu
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan; (C.-P.L.); (S.-K.C.); (Y.-C.C.)
- Division of Infectious Disease, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 23142, Taiwan;
- Infection Control Center, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 23142, Taiwan;
| | - Ming-Yieh Peng
- Division of Infectious Disease, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 23142, Taiwan;
- Infection Control Center, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 23142, Taiwan;
| | - Ming-Chin Chan
- Infection Control Center, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 23142, Taiwan;
| | - You-Chen Chao
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan; (C.-P.L.); (S.-K.C.); (Y.-C.C.)
- Division of Gastroenterology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 23142, Taiwan
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Yiang GT, Tzeng IS, Shui HA, Wu MY, Peng MY, Chan CY, Chan ED, Wu YK, Lan CC, Yang MC, Huang KL, Wu CW, Chang CH, Su WL. Early Screening of Risk for Multidrug-Resistant Organisms in the Emergency Department in Patients With Pneumonia and Early Septic Shock: Single-Center, Retrospective Cohort Study. Shock 2021; 55:198-209. [PMID: 32694392 DOI: 10.1097/shk.0000000000001599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Pneumonia is the fourth leading cause of death globally, with rapid progression during sepsis. Multidrug-resistant organisms (MDROs) are becoming more common with some healthcare-associated pneumonia events. Early detection of MDRO risk improves the outcomes; however, MDROs risk in pneumonia with sepsis is unknown. This study investigated the disease outcomes of pneumonia with septic shock in patients admitted in the emergency department (ED) intensive care unit (ICU), a population with a high prevalence of MDROs, after early screening of MDROs risk. METHODS In this retrospective cohort study, patients with pneumonia and early septic shock (n = 533) admitted to the ED at the Taipei Tzu Chi Hospital from 2013 to 2019 were selected. The study population was divided into four subgroups after the MDROs risk and screening procedure were completed within 1 or 6 h of admission. ICU mortality and multidrug antibiotic therapy were compared. RESULTS The high-risk MDROs groups had higher percentage of P aeruginosa than the low-risk group. Furthermore, the appropriate ED first antibiotics were higher in the 1-h subgroup than in the 6-h subgroup of the high-risk MDROs group. In multivariate analysis, the 6-h high-risk MDROs group had an adjusted odds ratio of 7.191 (95% CI: 2.911-17.767, P < 0.001) and 2.917 (95% CI: 1.456-5.847, P = 0.003) for ICU mortality and multidrug therapy in the ICU, respectively, after adjusting for other confounding factors. CONCLUSIONS MDRO screening within 1 h is recommended following admission of patients with pneumonia and early septic shock in the ED, especially in areas with a high prevalence of MDROs.
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Affiliation(s)
- Giou-Teng Yiang
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - I-Shiang Tzeng
- Department of Medical Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Hao-Ai Shui
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Meng-Yu Wu
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Ming-Yieh Peng
- Division of Infectious Disease, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Chih-Yu Chan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Edward D Chan
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Denver at Anschutz Medical Center, Denver, Colorado
- Denver Veterans Affairs Medical Center, Denver, Colorado
- Department of Medicine, Division of the Mycobacterial and Respiratory Infections, National Jewish Health, Denver, Colorado
| | - Yao-Kuang Wu
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Chou-Chin Lan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Mei-Chen Yang
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Kuo-Liang Huang
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Chih-Wei Wu
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Chia-Hui Chang
- Divisions of Endocrine and Metabolism, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Wen-Lin Su
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
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Wang YN, Peng MY, Xie WQ, Li XJ, Lan XL, Shen ZY, Liang ZY, Wu MY, Li GX, Deng HJ. [Short-term outcomes of single incision plus one port laparoscopic surgery for colorectal cancer]. Zhonghua Wei Chang Wai Ke Za Zhi 2021; 24:48-53. [PMID: 33461252 DOI: 10.3760/cma.j.cn.441530-20200409-00193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: Although single port laparoscopic surgery has achieved good clinical results, many surgeons are discouraged by the difficulties of operation, conflict of instruments, lack of antagonistic traction, and straight-line perspective. Therefore, some surgeons have proposed a single incision plus one hole laparoscopic surgery (SILS+1) surgical method. This study explored the safety and feasibility of SILS+1 for radical resection of colorectal cancer. Methods: A descriptive cohort study was carried out. The clinical data, including the operation, pathology and recovery situation, of 178 patients with colorectal cancer undergoing SILS+1 at Department of General Surgery, Nanfang Hospital, Southern Medical University from March 2018 to January 2019 were prospectively collected and retrospectively analyzed. Clavien-Dindo criteria was used for postoperative complication evaluation and visual analog scale was used for pain standard. Follow-up studies were conducted through outpatient service or telephone and the follow-up period was up to May 2019. Results: A total of 178 patients with colorectal cancer underwent SILS+1, including 111 male patients (62.4%) with an average age of 59 years. Eleven (6.2%) patients received added 1-3 operation ports during operation, and 1 patient was converted to open surgery due to ileocolic artery hemorrhage. The operative time was (135.2±42.3) minutes. The intraoperative blood loss was (34.6±35.5) ml. The number of harvested lymph nodes was 33.1±17.6. The distal margin was (4.7±17.8) cm. The proximal margin was (10.2±5.3) cm. Operation-related complications were observed in 16 patients (9.0%) within 30 days after the operation, of whom 6 had Clavien-Dindo III complications (3.4%). The postoperative pain scores were lower than 3. The average postoperative hospital stay was (5.6±2.6) days. Three patients (1.7%) returned to hospital within 30 days after operation due to intestinal obstruction and infection around stoma. The cosmetic evaluation of all the patients was basically satisfied. Conclusion: SILS+1 is safe and feasible in the treatment of colorectal cancer, and can reduce the postoperative pain.
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Affiliation(s)
- Y N Wang
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - M Y Peng
- First Department of Cinical Medicine, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - W Q Xie
- First Department of Cinical Medicine, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - X J Li
- First Department of Cinical Medicine, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - X L Lan
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Z Y Shen
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Z Y Liang
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - M Y Wu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - G X Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - H J Deng
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
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Wu JS, Peng MY, Kuo CY, Wu JD. A case of methicillin resistant Staphylococcus aureus necrotizing pneumonia with pulmonary cryptococcosis. J Microbiol Immunol Infect 2021; 54:760-762. [PMID: 33495066 DOI: 10.1016/j.jmii.2020.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 12/20/2020] [Accepted: 12/24/2020] [Indexed: 10/22/2022]
Abstract
A 37-year-old healthy man was transferred to the emergency department of this hospital because of fever and hemoptysis. A radiograph of the chest revealed a cavitary lesion in the right upper lobe. Computed tomography of the chest showed necrotizing cavitary pneumonia. Urgent throacoscopic lobectomy was performed. Sputum and intraoperative pleural pus grew methicillin resistant Staphylococcus aureus (MRSA). The pathological examination reportedly revealed cryptococcal infection. He had a full recovery after intravenous linezolid treatment.
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Affiliation(s)
- Jiunn-Sheng Wu
- Division of Infectious Diseases, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
| | - Ming-Yieh Peng
- Division of Infectious Diseases, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Chan-Yen Kuo
- Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Jiann-Der Wu
- Department of Pathology, Chia Yi Christian Hospital, Chia Yi City, Taiwan
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Li C, Peng MY, Chang CH, Hsu YY, Hsieh MS, Lin SK, Lee YH, Yang MC. Differential diagnosis of atypical encephalopathy in critical care: a case report. BMC Infect Dis 2020; 20:763. [PMID: 33066738 PMCID: PMC7566023 DOI: 10.1186/s12879-020-05492-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 10/08/2020] [Indexed: 11/16/2022] Open
Abstract
Background A lower level of consciousness is a common presentation in critical care, with many different causes and contributory factors, of which more than one may be present concurrently. Case presentation We described a woman with poorly controlled diabetes and steroid-dependent asthma who presented in a deep coma. She was found to have Streptococcus intermedius bacteremia and pyogenic ventriculitis that originated from right middle lobe pneumonia. Also, multiple small parenchymal lesions were observed on brain magnetic resonance imaging and increased protein concentration was noted in cerebral spinal fluid. Initially, her coma was thought to be due to diabetic ketoacidosis and septic encephalopathy. However, her lowered level of consciousness was disproportionate to either diabetic ketoacidosis or septic encephalopathy, and her clinical course was not as expected for these two conditions. Treatment with antibiotic, corticosteroid and antihelminthic drugs was administered resulting in improving consciousness. The Streptococcus intermedius pneumonia progressed to form a large cavity that needed an early surgical lobectomy and resulted in the unexpected diagnosis of chronic cavitary pulmonary aspergillosus. Conclusions In critical care, a lowered level of consciousness may have many etiologies, and critical care clinicians should be familiar with the signs and symptoms of all possible causes to enable prompt diagnosis and appropriate treatment.
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Affiliation(s)
- Chung Li
- Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Ming-Yieh Peng
- Division of Infection Diseases and Tropical Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chia-Hui Chang
- School of Medicine, Tzu Chi University, Hualien, Taiwan.,Division of Endocrine and Metabolism, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Yuan-Yu Hsu
- School of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Medical Imaging, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Min-Shiau Hsieh
- Division of Thoracic Surgery, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Shinn-Kuang Lin
- School of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Yi-Hsin Lee
- School of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Anatomy Pathology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Mei-Chen Yang
- School of Medicine, Tzu Chi University, Hualien, Taiwan. .,Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 289, Jianguo Rd, Xindian District, New Taipei, 23143, Taiwan.
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Su WL, Hung PP, Lin CP, Chen LK, Lan CC, Yang MC, Peng MY, Chao YC. Masks and closed-loop ventilators prevent environmental contamination by COVID-19 patients in negative-pressure environments. J Microbiol Immunol Infect 2020; 54:81-84. [PMID: 32425995 PMCID: PMC7227532 DOI: 10.1016/j.jmii.2020.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/01/2020] [Accepted: 05/02/2020] [Indexed: 01/22/2023]
Abstract
Herein, we report that nosocomial infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may be mitigated by using surgical masks and closed looped ventilation for both non-critical and critical patients. These preventive measures resulted in no viral contamination of surfaces in negative pressure environments.
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Affiliation(s)
- Wen-Lin Su
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Po-Pin Hung
- Division of Infectious Disease, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chih-Pei Lin
- Department of Pathology and Laboratory Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Li-Kuang Chen
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chou-Chin Lan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Mei-Chen Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Ming-Yieh Peng
- Division of Infectious Disease, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - You-Chen Chao
- School of Medicine, Tzu Chi University, Hualien, Taiwan; Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
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Chen YC, Peng MY, Wu CJ, Lin YK, Chang SH. A Rare Case of Douche Injury Sustained during Water Recreation Activities: More Protection will Mean less Injury. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791602300507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Douche injury is a rare consequence of water recreation activities; it can manifest as vaginal laceration or even haemoperitoneum. Such severe trauma can cause massive bleeding and hypovolaemic shock; therefore, it is potentially life threatening. Herein, we present the case of a patient who had vaginal laceration and haemoperitoneum due to water recreation activities; surgery was performed to stop the bleeding. We suggest wearing a rubber or neoprene wetsuit during water recreation activities to prevent such potentially lethal injury.
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Affiliation(s)
- YC Chen
- Kaohsiung Medical University Chung-Ho Memorial Hospital, Department of Surgery, No.100 Tzyou 1st Road, Kaohsiung 807, Taiwan
| | - MY Peng
- Kaohsiung Medical University Chung-Ho Memorial Hospital, Department of Obstetrics & Gynecology, No.100 Tzyou 1st Road, Kaohsiung 807, Taiwan
| | - CJ Wu
- Kaohsiung Medical University Chung-Ho Memorial Hospital, Department of Medical Imaging, No.100 Tzyou 1st Road, Kaohsiung 807, Taiwan
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11
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Şafak K, Xin M, Callahan PT, Peng MY, Kärtner FX. All fiber-coupled, long-term stable timing distribution for free-electron lasers with few-femtosecond jitter. Struct Dyn 2015; 2:041715. [PMID: 26798814 PMCID: PMC4711637 DOI: 10.1063/1.4922747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 06/08/2015] [Indexed: 06/01/2023]
Abstract
We report recent progress made in a complete fiber-optic, high-precision, long-term stable timing distribution system for synchronization of next generation X-ray free-electron lasers. Timing jitter characterization of the master laser shows less than 170-as RMS integrated jitter for frequencies above 10 kHz, limited by the detection noise floor. Timing stabilization of a 3.5-km polarization-maintaining fiber link is successfully achieved with an RMS drift of 3.3 fs over 200 h of operation using all fiber-coupled elements. This all fiber-optic implementation will greatly reduce the complexity of optical alignment in timing distribution systems and improve the overall mechanical and timing stability of the system.
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Affiliation(s)
| | - M Xin
- Center for Free-Electron Laser Science , Deutsches Elektronen-Synchrotron, Notkestrasse 85, Hamburg 22607, Germany
| | - P T Callahan
- Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology , Cambridge, Massachusetts 02139, USA
| | - M Y Peng
- Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology , Cambridge, Massachusetts 02139, USA
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12
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Hsueh PR, Lau YJ, Ko WC, Liu CY, Huang CT, Yen MY, Liu YC, Lee WS, Liao CH, Peng MY, Chen CM, Chen YS. Consensus statement on the role of fluoroquinolones in the management of urinary tract infections. J Microbiol Immunol Infect 2011; 44:79-82. [PMID: 21439507 DOI: 10.1016/j.jmii.2011.01.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Revised: 01/07/2011] [Accepted: 01/10/2011] [Indexed: 11/30/2022]
Affiliation(s)
- Po-Ren Hsueh
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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13
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Lin TY, Yeh KM, Lin JC, Wang NC, Peng MY, Chang FY. Cryptococcal disease in patients with or without human immunodeficiency virus: clinical presentation and monitoring of serum cryptococcal antigen titers. J Microbiol Immunol Infect 2009; 42:220-226. [PMID: 19812855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND AND PURPOSE Cryptococcus neoformans is an encapsulated pathogenic yeast that causes a wide range of clinical manifestations. The serum cryptococcal latex agglutination test is a simple, rapid, and reliable diagnostic test for cryptococcosis. This study was performed to assess the clinical relevance of serum cryptococcal antigen (CRAG) titer in patients with cryptococcosis with or without human immunodeficiency virus (HIV). METHODS From January 1999 to December 2007, 45 patients with a diagnosis of cryptococcosis made by culture and/or histopathology were enrolled in this retrospective study. Ten patients had HIV and 35 were not infected. RESULTS Patients with HIV were more likely to have central nervous system (CNS) involvement than patients without HIV (100% vs 37.1%; p = 0.0005), higher serum CRAG titers (median, 1:1024 vs 1:64; p < 0.05), higher positive cerebrospinal fluid (CSF) CRAG (100% vs 37.1%; p = 0.0005), and higher CRAG titers in the CSF (median, 1:1024 vs 1:32; p < 0.001). Patients without HIV were more likely to have pulmonary involvement (62.9% vs 0%; p = 0.0005) and no underlying disease at diagnosis (42.9% vs 0%; p = 0.011). Serum CRAG titers among patients without HIV with CNS or pulmonary cryptococcosis declined during treatment and no relapse was noted when serum CRAG titers were <or=1:8 at the end of treatment. CONCLUSIONS Serum CRAG titer can be used to monitor disease activity during treatment for CNS and pulmonary cryptococcosis in patients without HIV.
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Affiliation(s)
- Te-Yu Lin
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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14
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Chiu SK, Lin JC, Wang NC, Peng MY, Chang FY. Impact of underlying diseases on the clinical characteristics and outcome of primary pyomyositis. J Microbiol Immunol Infect 2008; 41:286-293. [PMID: 18787734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND AND PURPOSE Primary pyomyositis is increasingly recognized in non-tropical areas, its incidence seeming to mirror the increase in immunocompromised populations. In this study, we sought to analyze the differences in clinical characteristics, causative organisms, treatment and outcome between pyomyositis patients with and without underlying diseases. METHODS Thirty five patients with a diagnosis of primary pyomyositis seen in our hospital between July 1989 and July 2006 were enrolled. Descriptive information concerning age, gender, clinical features, underlying comorbid diseases, results of blood tests, blood culture, muscle or pus culture, disease severity and clinical stages at the time of diagnosis, therapy, and outcome were collected by review of medical charts. RESULTS Of the 23 cases with underlying diseases, the mean age was 47.8 years (range, 24 to 79 years). Of the 12 patients without underlying diseases, the mean age was 26.2 years (range, 2 to 72 years). The lower extremities was the most common site of involvement. Staphylococcus aureus was the most frequent causative organism. Gram-negative organisms were isolated in 30.4% of patients with underlying diseases and in none of the patients without underlying diseases (p=0.07). Positive blood culture was significantly more common in patients with underlying diseases than in patients without underlying diseases (52.2% vs 8.3%, p=0.013). The mortality rate was higher in patients with underlying diseases than in patients without underlying diseases (39.1% vs 0.0%, p=0.015). White blood cell count (p=0.017), Acute Physiology and Chronic Health Evaluation (APACHE) II score (p<0.001), recurrence (p=0.004), and presence of underlying diseases (p=0.015) were significant prognostic factors for mortality by univariate analysis. APACHE II score (odds ratio, 1.57; 95% confidence interval, 1.13 to 2.20; p=0.008) was found to be a significant independent risk factor for mortality in multivariate logistic regression analysis. For prediction of mortality, the best cut-off point in APACHE II score was 16 (sensitivity, 77.8%; specificity, 92.3%; accuracy, 88.6%). CONCLUSIONS Patients with primary pyomyositis should be treated with appropriate broad-spectrum antibiotics and be monitored closely for complications. This study found that patients who suffered from primary pyomyositis with underlying diseases had a higher rate of Gram-negative bacterial infections, bacteremia and mortality. The APACHE II score at diagnosis was found to be an independent prognostic factor for mortality.
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Affiliation(s)
- Sheng-Kang Chiu
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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15
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Chou YY, Lin TY, Lin JC, Wang NC, Peng MY, Chang FY. Vancomycin-resistant enterococcal bacteremia: comparison of clinical features and outcome between Enterococcus faecium and Enterococcus faecalis. J Microbiol Immunol Infect 2008; 41:124-129. [PMID: 18473099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND AND PURPOSE Vancomycin-resistant enterococci (VRE) have emerged as important nosocomial pathogens. This study was conducted to clarify the clinical features and outcome of patients with vancomycin-resistant enterococcal bacteremia. METHODS Patients with vancomycin-resistant enterococcal bacteremia treated at a medical center in northern Taiwan between November 1998 and July 2006 were reviewed. Clinical and bacteriological characteristics of Enterococcus faecium and Enterococcus faecalis were compared. RESULTS Twelve patients (6 males and 6 females) were included for analyses. The mean age was 69.3 years (range, 40 to 86 years), and 8 cases (66.7%) were older than 65 years. All patients had underlying disease. Two patients received total hip replacement before development of VRE bacteremia. Twelve patients had prior exposure to broad-spectrum antimicrobial therapy. Ten patients had prior intensive care unit stay and prior mechanical ventilation before VRE bacteremia. All of the patients (n = 12) had an intravascular catheter in place. Bacteremia was caused by E. faecalis in 4 patients and by E. faecium in eight. The portals of entry included urinary tract (8.3%), skin, soft tissue and bone (41.7%) and unknown sources (50.0%). E. faecium showed a higher rate of resistance to ampicillin and teicoplanin than E. faecalis (87.5% vs 0.0%, p=0.01). The 60-day mortality rate was higher in patients with E. faecium bacteremia than E. faecalis bacteremia (62.5% vs 0.0%), although statistical significance was not obtained (p=0.08). CONCLUSIONS VRE bacteremia may have an impact on the mortality and morbidity of hospitalized patients. Patients with bacteremia caused by vancomycin-resistant E. faecium had a grave prognosis, especially immunosuppressed patients. The prudent use of antibiotics and strict enforcement of infection control may prevent further emergence and spread of VRE.
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Affiliation(s)
- Yen-Yi Chou
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325 Section 2 Cheng-Kung Road, Neihu 114, Taipei, Taiwan
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16
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Kuo CB, Lin JC, Peng MY, Wang NC, Chang FY. Endocarditis: impact of methicillin-resistant Staphylococcus aureus in hemodialysis patients and community-acquired infection. J Microbiol Immunol Infect 2007; 40:317-24. [PMID: 17712466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND AND PURPOSE Staphylococcus aureus endocarditis showed an increase in the 1990s compared to the 1980s. In order to characterize the clinical and laboratory features of S. aureus endocarditis, we retrospectively reviewed the medical charts of patients diagnosed with endocarditis in the 5-year-period between 2000 and 2005. METHODS From August 2000 to August 2005, 22 patients with a definite diagnosis of infective endocarditis (IE) caused by S. aureus were reviewed. RESULTS Of the 22 patients reviewed, 16 cases were caused by methicillin-resistant S. aureus (MRSA) while the causative agent in the other 6 cases was methicillin-susceptible S. aureus (MSSA). Patients with MRSA infections were more likely to show hospital-acquired infections, hemodialysis and ventilator dependence, septic shock, impaired initial renal function, persistent bacteremia, and a higher 3-month mortality rate. MSSA infections in patients were more likely to be community-acquired, and show intravenous drug use and longer days of fever prior to admission. Three patients with MRSA endocarditis, however, presented community-acquired infections. The mortality rate of MRSA endocarditis in hemodialysis patients was 90% (9/10). CONCLUSIONS MRSA IE is more common than MSSA IE and is associated with a significantly poorer prognosis, especially in patients undergoing hemodialysis. Although most cases of MRSA IE are hospital acquired, we noticed 3 cases of community-acquired MRSA IE. As MRSA IE has been noticed in the community and hemodialysis patients in recent years, and is associated with higher mortalities, strategies for its prevention and management are warranted.
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Affiliation(s)
- Cheng-Bang Kuo
- Department of Internal Medicine, Taichung Armed Forces General Hospital, Taichung, Taiwan
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17
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Lee YT, Lin JC, Wang NC, Peng MY, Chang FY. Necrotizing fasciitis in a medical center in northern Taiwan: emergence of methicillin-resistant Staphylococcus aureus in the community. J Microbiol Immunol Infect 2007; 40:335-41. [PMID: 17712468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND AND PURPOSE Necrotizing fasciitis (NF) is a rapidly progressive life-threatening infection. It is located in the deep fascia, with secondary necrosis of the subcutaneous tissues requiring urgent surgical and medical therapy. Staphylococcus aureus is, historically, a very uncommon cause of NF, but we have recently noted an increasing number of these infections being caused by community-acquired methicillin-resistant S. aureus (CA-MRSA). METHODS The medical records of 53 patients diagnosed with NF between January 2001 and December 2005 were reviewed. A standardized instrument was used to abstract information from the medical records of each patient. RESULTS S. aureus monomicrobial infection accounted for 37.7% (20/53) of the causal organisms noted. Of the 20 strains of S. aureus, 8 were methicillin-sensitive S. aureus and 12 were MRSA. In the 12 patients with MRSA infection, 7 had CA-MRSA. All patients with NF caused by CA-MRSA had no serious coexisting conditions or risk factors. All CA-MRSA isolates were susceptible to ciprofloxacin, trimethoprim-sulfamethoxazole, and vancomycin in vitro. All were cured after surgical intervention and medical treatment. CONCLUSIONS For patients with severe invasive NF caused by CA-MRSA, glycopeptides may be prescribed as an empirical treatment until susceptibility results. The prognosis of NF caused by CA-MRSA was good after adequate surgical and antimicrobial treatment.
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Affiliation(s)
- Yu-Tsung Lee
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Neihu, Taipei, Taiwan
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Peng MY, Fan CK, Chang FY. Lemierre's syndrome. J Formos Med Assoc 2005; 104:764-7. [PMID: 16385382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
Lemierre's syndrome is a rare, potentially severe disease consisting of septic emboli from an internal jugular vein thrombus after oropharyngeal infection. We report a 20-year-old man who had a tonsillitis with fever for 3 days. After a 2-day defervescence, fever relapsed as well as painful swelling over the left side of the neck. Computed tomography scan and sonography of the neck revealed thrombosis of left internal jugular vein and swelling of surrounding soft tissue. Chest radiograph demonstrated cavitary infiltrates over the left upper lobe. Septic thrombophlebitis of the internal jugular vein and metastatic pulmonary emboli was highly suspected. Intravenous ceftriaxone and metronidazole were given empirically. Fusobacterium necrophorum was isolated from the blood culture with susceptibility to metronidazole. Complete defervescence and resolution of the neck swelling and pulmonary infiltrates occurred after antibiotic administration for 21 days. Lemierre's syndrome should be considered when encountering a febrile patient with painful neck swelling.
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Affiliation(s)
- Ming-Yieh Peng
- Division of Infectious Diseases and Tropical Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Lee YT, Chou TD, Peng MY, Chang FY. Rapidly progressive necrotizing fasciitis caused by Staphylococcus aureus. J Microbiol Immunol Infect 2005; 38:361-4. [PMID: 16211146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Necrotizing fasciitis (NF) is a rapidly progressive life-threatening infection located in the deep fascia, with secondary necrosis of the subcutaneous tissues. Staphylococcus aureus as a single etiologic agent is rare. The pathogenicity of S. aureus infections is related to various bacterial surface components and extracellular proteins. A 56-year-old man developed fever, hypotension, impaired renal and hepatic functions, disseminated intravascular coagulation, and rapidly progressive NF affecting the 4 extremities due to methicillin-susceptible S. aureus (MSSA). The initial presenting symptoms were general weakness and muscular pain over bilateral thighs and left shoulder, and gradual onset of weakness of the limbs. On the third hospital day, multiple red-purplish discoloration spread across the right lower leg and left forearm. Fasciotomy and debridement was performed on the fifth hospital day, and the diagnosis of NF was confirmed. MSSA was the only pathogen isolated from 4 sets of blood cultures taken on admission and cultures of tissues collected during surgical debridement. The disease progressed rapidly over the 4 extremities despite appropriate antibiotic treatment. He recovered after multiple extensive surgical interventions and 8 weeks of intensive medical care. Early diagnosis, intensive surgical intervention, antibiotic treatment and intensive medical care are crucial for a successful outcome in patients with septic shock and extensive NF caused by S. aureus.
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Affiliation(s)
- Yu-Tsung Lee
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Yeh KM, Chiueh TS, Siu LK, Lin JC, Chan PKS, Peng MY, Wan HL, Chen JH, Hu BS, Perng CL, Lu JJ, Chang FY. Experience of using convalescent plasma for severe acute respiratory syndrome among healthcare workers in a Taiwan hospital. J Antimicrob Chemother 2005; 56:919-22. [PMID: 16183666 PMCID: PMC7110092 DOI: 10.1093/jac/dki346] [Citation(s) in RCA: 189] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES To describe the immunological responses and clinical outcome of coronavirus (SARS) infected healthcare workers (HCW) who had been administered with convalescent plasma as a treatment. METHODS Convalescent plasma (500 mL) was obtained from each of three SARS patients and transfused into the three infected HCW. Donors were blood type O and seronegative for hepatitis B and C, HIV, syphilis and human T-cell lymphotropic virus types I and II (HTLV-I and -II). Serum antibody (IgG) titre was >640. Apharesis was performed with a CS 3000 plus cell separator followed by the forming of the convalescent phase plasma. As part of the routine check with donated plasma, the convalescent plasma was confirmed free of residual SARS-CoV by RT-PCR. Serial serum samples obtained from the recipients of the convalescent plasma were collected to undertake real-time quantitative RT-PCR for SARS-CoV for direct measurement of viral concentration. Specific immunoglobulin IgM and IgG concentrations were titrated using an antigen microarray developed in-house. RESULTS Viral load dropped from 495 x 10(3), 76 x 10(3) or 650 x 10(3) copies/mL to zero or 1 copy/mL one day after transfusion. Anti-SARS-CoV IgM and IgG also increased in a time-dependent manner following transfusion. All three patients survived. One HCW became pregnant subsequently, delivering 13 months after discharge. Positive anti-SARS-CoV IgG was detected in the newborn. Passive transfer of anti-SARS-CoV antibody from the mother was considered as a possibility. CONCLUSIONS All infected HCW whose condition had progressed severely and who had failed to respond to the available treatment, survived after transfusion with convalescent plasma.
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Affiliation(s)
- Kuo-Ming Yeh
- Corresponding author. Tel: +866-2-8792-7257; Fax: +866-2-8792-7258; E-mail:
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Ni YH, Yeh KM, Peng MY, Chou YY, Chang FY. Community-acquired brain abscess in Taiwan: etiology and probable source of infection. J Microbiol Immunol Infect 2004; 37:231-5. [PMID: 15340651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Brain abscess is a life-threatening infection caused by spread from infected parameningeal or remote foci. Historically, streptococci have been the predominant organisms reported while brain abscess metastatic from liver abscess caused by Klebsiella pneumoniae has been a more recent emerging problem. This study retrospectively analyzed the characteristics of community-acquired brain abscess admitted during an 11-year period. There were 17 men and 7 women with age from 20 to 82 years (median, 41 years). The most common source of infection was liver abscess, followed by otitic infection and sinusitis. The classic triad of fever, headache and focal neurologic deficit was noted in only 25% of cases. Spread of the abscess to multiple lobes was common (n = 6). The most commonly identified organisms were Streptococcus spp. (n = 7) and K. pneumoniae (n = 5). All 5 cases of K. pneumoniae brain abscess also had concomitant pyogenic liver abscess and 4 of them had diabetes mellitus. In this study, brain abscess was common in young patients and in patients with diabetes mellitus. In Taiwan, Streptococcus spp. and K. pneumoniae are leading etiologies for community-acquired brain abscess. Liver abscess is the most likely source of K. pneumoniae brain abscess.
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Affiliation(s)
- Yuen-Hua Ni
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
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Lau SM, Peng MY, Chang FY. Resistance rates to commonly used antimicrobials among pathogens of both bacteremic and non-bacteremic community-acquired urinary tract infection. J Microbiol Immunol Infect 2004; 37:185-91. [PMID: 15221039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
This study examined the distribution of organisms and their antimicrobial resistance in patients admitted due to acute bacteremic and non-bacteremic community-acquired urinary tract infection (UTI). During a period of 1 year and 1 month, a total of 201 patients and 253 bacterial isolates were studied. Fever higher than 38.5 degrees C was significantly more common in the bacteremic group than the non-bacteremic group (68% vs 48%; p<0.05). Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Proteus mirabilis were the most common organisms isolated. E. coli was the leading pathogen and it was significantly more predominant in bacteremic UTI than non-bacteremic UTI (73% vs 49%; p<0.01). Bacteria other than E. coli (i.e., K. pneumoniae, P. aeruginosa, Proteus spp., Morganella morganii, Enterobacter cloacae, Citrobacter spp., Acinetobacter baumannii, Serratia marcescens, and Providencia spp.) were more common in non-bacteremic UTI than bacteremic UTI (44% vs 22%; p<0.01). E. coli isolated from both bacteremic and non-bacteremic patients had a high rate of resistance to ampicillin (80%), cephalothin (59%), gentamicin (29%), piperacillin (61%), trimethoprim-sulfamethoxazole (56%), amoxicillin-clavulanic acid (34%), and ticarcillin-clavulanic acid (36%). Isolates of P. aeruginosa, K. pneumoniae, and Proteus spp. from the non-bacteremic group showed a higher proportion of resistance to extended-spectrum cephalosporins, aminoglycosides (netilmicin and amikacin) and ciprofloxacin. The emergence of a high rate of resistance to commonly used antimicrobials (ampicillin, cephalothin, gentamicin, trimethoprim-sulfamethoxazole, piperacillin, amoxicillin-clavulanic acid and ticarcillin-clavulanic acid) may have an impact on the antibiotic treatment of patients admitted due to acute community-acquired bacteremic or non-bacteremic UTI in Taiwan. Further studies are needed to clarify the impact of antimicrobial resistance on the outcome in these conditions.
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Affiliation(s)
- Sheung-Mei Lau
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
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Lin JC, Yeh KM, Peng MY, Chang FY. Community-acquired methicillin-resistant Staphylococcus aureus bacteremia in Taiwan: risk factors for acquisition, clinical features and outcome. J Microbiol Immunol Infect 2004; 37:24-8. [PMID: 15060683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
The prevalence of community-acquired infection caused by methicillin-resistant Staphylococcus aureus (MRSA) in Taiwan has increased markedly in the past decade. This study investigated the risk factors for acquisition, the clinical features, and the outcome of community-acquired MRSA bacteremia. Data were collected from records of 86 patients with community-acquired S. aureus bacteremia admitted to a tertiary teaching hospital in Taipei from January 1994 to December 1999. MRSA accounted for 26% (22/86) of isolated pathogens. Over 90% of patients with S. aureus bacteremia had one or more underlying diseases. Significantly more patients with MRSA bacteremia [vs methicillin-susceptible S. aureus (MSSA) bacteremia] had congenital and valvular heart diseases (18% vs 0%, p=0.004), an initial presentation of acute respiratory failure (32% vs 11%, p=0.022), an implant as a portal of entry (9% vs 0%, p=0.014), and mortality (41% vs 20%, p=0.05). Acute Physiology and Chronic Health Evaluation (APACHE) III score was significantly higher in patients who died than in patients who survived in both the MRSA and MSSA bacteremia groups. Inappropriate treatment was more frequent in patients with MRSA bacteremia than in MSSA bacteremia. When a Gram-positive coccemia is initially noted in a patient with high APACHE III score and/or acute respiratory failure, early and aggressive treatment including glycopeptide should be considered.
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Affiliation(s)
- Jung-Chung Lin
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
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Huang WJ, Peng HS, Peng MY, Chen LY. Removal of bromate and assimilable organic carbon from drinking water using granular activated carbon. Water Sci Technol 2004; 50:73-80. [PMID: 15566189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This study investigated the feasibility of using granular activated carbon (GAC) to remove bromate ion (BrO3-) and assimilable organic carbon (AOC) from drinking water through a rapid small-scale column test (RSSCT) method and a pilot-scale study. Results from RSSCT indicated that the GAC capacity for BrO3- removal was dependent on the GAC type, empty bed contact time (EBCT), and source water quality. The GAC with a high number of basic groups and higher pHpzc values showed an increased BrO3- removal capacity. BrO3- removal was improved by increasing EBCT. The high EBCT provides a greater opportunity for BrO3- to be adsorbed and reduced to Br- on the GAC surface. On the other hand, the presence of dissolved organic carbon (DOC) and anions, such as chloride, bromide, and sulfate, resulted in poor BrO3- reduction. In the GAC pilot plant, a GAC column preloaded for 12 months achieved a BrO3- and AOC removal range from 79-96% and 41-75%, respectively. The BrO3- amount removed was found to be proportional to the influent BrO3- concentration. However, the BrO3- removal rate apparently decreased with increasing operation time. In contrast, the AOC apparently increased during the long-term operation period. This may be a result of the contribution due to new GAC being gradually transformed into biological activated carbon (BAC), and the bacterial biomass adsorbed on GAC surface hindering BrO3- reduction by GAC either by blocking pores or adsorbing at the activated sites for BrO3- reduction.
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Affiliation(s)
- W J Huang
- Department of Environmental Engineering, HungKuang University, Sha-Lu, Taichung, Chinese Taiwan.
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Wang NC, Ni YH, Peng MY, Chang FY. Acute acalculous cholecystitis and pancreatitis in a patient with concomitant leptospirosis and scrub typhus. J Microbiol Immunol Infect 2003; 36:285-7. [PMID: 14723261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Concomitant leptospirosis and scrub typhus is rare. The spectrum of clinical severity for both scrub typhus and leptospirosis ranges from mild to fatal. Acute pancreatitis and cholecystitis are infrequent complications in adult patients with either leptospirosis or scrub typhus. We report a case of leptospirosis and scrub typhus coinfection in a 41-year-old man presenting with acute acalculous cholecystitis, pancreatitis and acute renal failure. Abdominal computed tomography revealed edematous change of the gallbladder without intrahepatic or pancreatic lesions. The patient was successfully treated with doxycycline and ceftriaxone, and supportive management.
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Affiliation(s)
- Ning-Chi Wang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
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Dai MS, Chang H, Peng MY, Ho CL, Chao TY. Suppurative salmonella thyroiditis in a patient with chronic lymphocytic leukemia. Ann Hematol 2003; 82:646-8. [PMID: 12879283 DOI: 10.1007/s00277-003-0702-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2002] [Accepted: 06/24/2003] [Indexed: 10/26/2022]
Abstract
We describe an 82-year-old man with undiagnosed chronic lymphocytic leukemia (CLL) who presented with acute swelling of the thyroid goiter. Subsequent thyroid aspirate and blood culture yielded group B Salmonella thyroid abscess with septicemia. Infectious complications are the major cause of morbidity and mortality in patients with CLL since most of them can be timely detected and few can arise from innocent-looking lesions.
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Affiliation(s)
- M S Dai
- Division of Hematology/Oncology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan.
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Ni YH, Wang NC, Peng MY, Chou YY, Chang FY. Bacteroides fragilis bacteremia associated with portal vein and superior mesentery vein thrombosis secondary to antithrombin III and protein C deficiency: a case report. J Microbiol Immunol Infect 2002; 35:255-8. [PMID: 12542252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Hypercoagulability is one of the causes of portal vein and superior mesentery vein thrombosis. We report a case of Bacteroides fragilis bacteremia associated with portal vein and superior mesentery vein thrombosis secondary to antithrombin III and protein C deficiency. The patient presented with high fever for more than 3 weeks. Abdominal sonography revealed a liver cyst of 1.7 cm in diameter over segment 4 and a renal stone of 0.7 cm in size over the lower portion of the right kidney but no evidence of hydronephrosis. Elevation of liver enzymes was also noted. Intermittent fever was noted despite treatment with ceftriaxone and doxycycline. On Day 15 of hospitalization, blood culture revealed B. fragilis, which prompted further investigation of the source of intraabdominal and pelvic infection. Abdominal computed tomography revealed portal vein and superior mesentery vein thrombosis. Endoscopic studies of the gastrointestinal tract showed no tumor or diverticulum. Study of coagulation factors disclosed deficiency of antithrombin III and protein C. Clinicians should remain aware of the need to promptly search for a portal or mesentery vein thrombosis in cases of Bacteroides bacteremia of unknown origin.
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Affiliation(s)
- Yuen-Hua Ni
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
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Yeh KM, Lu JJ, Siu LK, Peng MY, Chang FY. Phenotypes and genotypes of vancomycin-resistant enterococci isolated during long-term follow-up in a patient with recurrent bacteremia and colonization. J Microbiol Immunol Infect 2002; 35:243-8. [PMID: 12542250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Twenty-seven isolates of vancomycin-resistant enterococci were obtained at monthly intervals from a bed-ridden man with hypoxic encephalopathy. During the 28-month period of the patient's hospitalization, 3 episodes of bacteremia and one episode of catheter-related infection caused by vancomycin-resistant enterococci occurred. Rectal swabs showed colonization of vancomycin-resistant enterococci for more than 2 years. Three months after termination of antimicrobial therapy, the rectal colonization for vancomycin-resistant enterococci was eradicated. Four species (Enterococcus faecium, Enterococcus gallinarum, Enterococcus faecalis, and Enterococcus casseliflavus) were identified among the 27 vancomycin-resistant enterococcus isolates. Three non-clonal related patterns were found among 17 strains of E. faecium by pulsed-field gel electrophoresis. All of the 3 E. faecalis isolates were of the VanB phenotype, but of the vanA genotype. Linezolid had the most potent in vitro activity against these vancomycin-resistant enterococcus isolates, with minimum inhibitory concentrations >2 microg/mL. Eighty-five percent of these vancomycin-resistant enterococcus isolates were susceptible to tetracycline and 66% were susceptible to quinupristin-dalfopristin. Although a high genetic correlation of E. faecium was identified in the patient with prolonged hospitalization, the isolation of 3 genetically unrelated colonized isolates suggested a lack of correlation between infection and colonization. Precautions against resistant organisms, adapted antibiotic policies, and elimination of patient carriage are useful for controlling the spread of vancomycin-resistant enterococci.
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Affiliation(s)
- Kuo-Ming Yeh
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
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Lin JC, Yeh KM, Peng MY, Chang FY. Efficacy of cefepime versus ceftazidime in the treatment of adult pneumonia. J Microbiol Immunol Infect 2001; 34:131-7. [PMID: 11456359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Effective empiric treatment of pneumonia requires antibiotic coverage against gram-negative and gram-positive pathogens, including drug-resistant isolates. This study evaluated the efficacy of cefepime treatment in 20 patients with community-acquired pneumonia (CAP) and 21 patients with hospital-acquired pneumonia (HAP), and ceftazidime treatment in 20 patients with HAP. The mean age of patients was over 70 years. More than half of the patients had multiple lobe involvement. There was no significant difference in the severity of illness according to the acute physiology, age, chronic health evaluation (APACHE) III score between the HAP-cefepime and HAP-ceftazidime group. The most common bacteria isolated from sputum of patients with CAP were Streptococcus pneumoniae (n = 7), Klebsiella pneumoniae (n = 4), and Pseudomonas aeruginosa (n = 2). In patients with HAP, P. aeruginosa (n = 13), Acinetobacter baumannii (n = 11), Serratia marcescens (n = 6), K. pneumoniae (n = 5), Stenotrophomonas maltophilia (n = 5), Enterobacter cloacae (n = 3), Citrobacter spp. (n = 2), and Escherichia coli (n = 2) were isolated. The cure rates were 95%, 76%, and 60% in the CAP-cefepime group, the HAP-cefepime group, and the HAP-ceftazidime group, respectively. The increased rates of antimicrobial resistance commonly found among isolates causing CAP and HAP indicate that extended-spectrum antimicrobial agents, such as cefepime, would be more appropriate therapeutic agents.
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Affiliation(s)
- J C Lin
- Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan, ROC
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Lau SM, Peng MY, Chang FY. Outcomes of Aeromonas bacteremia in patients with different types of underlying disease. J Microbiol Immunol Infect 2000; 33:241-7. [PMID: 11269369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Over a 6-year period, 42 patients with different underlying diseases developed Aeromonas bacteremia in our hospital. The male to female ratio was 2:1. The vast majority of these patients had underlying diseases, including various types of neoplasm (n = 14), liver cirrhosis (n = 11), biliary tract disorder (n = 10) and other illnesses (n = 7). Community-acquired bacteremia was predominant (33 cases, 79%). Aeromonas hydrophila was the most common species isolated (88%). Monomicrobial bacteremia was more common than polymicrobial bacteremia (64% vs 36%). Monomicrobial bacteremia was associated with neoplasm or liver cirrhosis in 80% of patients. Polymicrobial bacteremia was more common in patients with biliary tract disorder than in patients from other groups (60% vs 40%). Escherichia coli (60%) was the predominant concomitant organism isolated. The major clinical manifestations were fever (74%), jaundice (57%), and abdominal pain (45%). Recognized infection sites included biliary tract, soft tissue involvement, peritoneal involvement, while 50% of patients had no recognized infection site. Eight patients (80%) received cholecystectomy due to gall stone with acute cholecystitis. However, none of the cirrhotic patients with necrotizing fasciitis received surgical treatment. The mortality attributed to Aeromonas bacteremia was 70%. Patients with liver cirrhosis or malignancy had a higher acute mortality (death within 7 days after admission) than the other patients (89% vs 11%). We conclude that Aeromonas bacteremia can cause a rapidly fatal outcome and should be considered an important pathogen for septicemia in patients with liver cirrhosis or neoplasm.
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Affiliation(s)
- S M Lau
- Department of Internal Medicine, Tri-Service General Hospital, and National Defense Medical Center, Taipei, Taiwan, ROC
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Abstract
OBJECTIVE The objective of this study was to evaluate prospectively the use of CT cystography, using retrograde filling of the bladder with diluted iodinated contrast material, versus conventional cystography to identify bladder injury in patients with hematuria after blunt abdominal trauma. SUBJECTS AND METHODS Inclusion criteria consisted of the adult hemodynamically stable abdominal trauma patient with hematuria referred for abdominopelvic CT and also being considered for cystography. An initial abdominopelvic CT scan using IV iodinated contrast material was obtained, as would have been done routinely in the trauma victim. A second CT scan through the pelvis was obtained after retrograde distention of the bladder with dilute iodinated contrast material. CT cystography revealing bladder injury was followed with appropriate therapy. CT cystograms not revealing injury were followed by conventional cystography. Results of patient outcome were evaluated. RESULTS Over a 21-month period from January 1995 through September 1996, CT cystography was performed on 55 patients who presented with hematuria after blunt abdominal trauma. Five of the 55 patients had bladder injury on CT cystography. The injury in each of these five patients was confirmed intraoperatively. In the remaining 50 patients, both CT and conventional cystography did not reveal bladder injury. CONCLUSION CT cystography is an accurate method for evaluating bladder injury in the blunt abdominal trauma victim with hematuria. CT cystography, performed in conjunction with routine CT of the abdomen and pelvis for evaluating traumatic hematuria, would therefore preclude conventional cystograms in these patients.
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Affiliation(s)
- M Y Peng
- Department of Radiology, Los Angeles County-University of Southern California Medical Center, Los Angeles, CA 90033, USA
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Peng MY. Randomized, double-blind, comparative study of levofloxacin and ofloxacin in the treatment of complicated urinary tract infections. J Microbiol Immunol Infect 1999; 32:33-9. [PMID: 11561568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Levofloxacin, the optical S-(-) isomer of ofloxacin, was compared with ofloxacin in the treatment of complicated urinary tract infections (UTIs). Patients eligible for the trial were randomly assigned to either a daily 300 mg of levofloxacin or 600 mg of ofloxacin for 10 consecutive days. The double blind design was achieved by a double-dummy technique utilizing placebo of both test drugs. Efficacy variables measured were: urine white blood cell counts for the effects on pyuria, urine cultures for effects on bacteriuria, subjective symptoms, and overall clinical efficacy which combined results from effects on bacteriuria, pyuria and subjective symptoms. Safety endpoints were the incidence of adverse events and laboratory test monitoring after a 10-day treatment. A total of 104 patients were enrolled into this trial and 46 patients were evaluable for efficacy endpoints. Most patients with culture-negative (48 cases), mixed flora (5 cases), and less than 10,000 colony forming units/mL of bacteria (3 cases) were excluded from analyses. None of the demographic and baseline characteristics were significantly different between treatments (p > 0.05). Therapeutic effects upon bacteriuria for both treatment groups were similar with a response rate of 90.0% for levofloacin and 88.5% for ofloxacin. Efficacy on the subjective symptoms revealed response rates of 90.0% in the levofloxacin group and 80.7% in the ofloxacin group, with the overall clinical efficacy of 90% in the levofloxacin and 84.6% in the ofloxacin groups. All the efficacy variables measured between treatments were not statistically different which indicated an equivalent efficacy in the treatment of complicated UTIs (p > 0.05). Of the 104 patients exposed to the test medications, only three having adverse effects. One developed epigastralgia in the levofloxacin group, and 2 developed a headache in the ofloxacin treatment. All events were moderate in severity and were resolved quickly after medication. Four laboratory data abnormalities were observed (defined by 25% as exceeding the normal range), and were considered to not be related to the test medications. Both antibiotics were efficacious in the treatment of complicated UTIs (response rates ranging from 80 to 90%) and were well tolerated. Levofloxacin demonstrated comparable antibacterial effects and safety profiles with double potency dosage, compared to the ofloxacin.
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Affiliation(s)
- M Y Peng
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
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Yang CH, Young T, Peng MY, Weng MC. Clinical spectrum of Pseudomonas putida infection. J Formos Med Assoc 1996; 95:754-61. [PMID: 8961672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The clinical and microbiologic characteristics of 55 cases of Pseudomonas putida infection in 53 patients in a medical center in Taiwan from April 1988 to March 1993 are reported. P. putida was cultured in the decreasing order of frequency from urine (24 isolates), sputum (12), blood (10), wound discharge (3), peritoneal fluid (3), cerebrospinal fluid (2) and umbilical swab (1). Of the adult patients, 23% (12/53) were considered to be contaminated or colonized with P. putida. Of the 41 patients with manifest disease. 17 (41%) had urinary tract infections, 10 (24%) had pneumonia, 8 (19%) had septicemia, 3 (7%) had wound infections, 2 (5%) had meningitis and 1 (2%) had peritonitis. Of these, 55% were nosocomial infections. The case fatality rate was 29% (12/41). There was no significant correlation between patient mortality and the type of disease caused by the bacterium. Results of in vitro susceptibility tests suggested that imipenem and ceftazidime were more effective than other antimicrobials. This study indicates that the clinical spectrum of diseases caused by P. putida is broader and the incidence of true infection is higher than previously expected, especially among hospitalized patients who undergo invasive procedures such as placement of intravascular devices, urinary catheterization and intubation.
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Affiliation(s)
- C H Yang
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
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Yang CH, Young TG, Peng MY, Lee HS. Cutaneous manifestation of Kikuchi's disease: a case report. Zhonghua Yi Xue Za Zhi (Taipei) 1995; 55:472-5. [PMID: 7634186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A 22-year-old male was admitted with a 1-month history of chills, fever, multiple skin eruption and painless lymphadenopathy. He has later been confirmed by typical histopathological findings to be a case of Kikuchi's histiocytic necrotizing lymphadenitis. Extranodal involvement with skin manifestation in Kikuchi's disease has rarely been reported; herein this unusual case is described.
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Affiliation(s)
- C H Yang
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
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Yang CH, Young TG, Peng MY, Hsu GJ. Unusual presentation of acute abdomen in scrub typhus: a report of two cases. Zhonghua Yi Xue Za Zhi (Taipei) 1995; 55:401-404. [PMID: 7641127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Two young soldiers presented with acute abdomens, then received surgical procedures under initial impression of acute cholecystitis and acute appendicitis respectively. Operative findings did not confirm the initial diagnosis, and the clinical condition did not improve after operation. Scrub typhus was suggested later by clinical manifestations of fever, chills, headache, lymphadenopathy, skin rash and presence of eschar formation; this diagnosis was finally confirmed by positive serologic results of high Weil-Felix OXK agglutination and/or Rickettsia tsutsugammushi immunoflorescence titers in paired sera. Both patients rapidly became afebrile after administration of tetracycline. This unusual presentation with acute abdomen in scrub typhus is emphasized, with caution that the possibility of scrub typhus should be taken considered, especially in patients coming from hyperendemic areas.
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Affiliation(s)
- C H Yang
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
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Yang CH, Hsu GJ, Peng MY, Young TG. Hepatic dysfunction in scrub typhus. J Formos Med Assoc 1995; 94:101-5. [PMID: 7613239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Scrub typhus is an acute febrile illness that generally causes non-specific symptoms and signs of which fever is the most common. It is one of the causes of "fevers of unknown origin" in the Asia-Pacific region. The relationship between hepatic dysfunction and scrub typhus has been given little attention in the literature. From 1982 to 1993, 47 patients diagnosed with scrub typhus at Tri-Service General Hospital, Taipei, were studied, with attention being given to hepatic dysfunction. The medical records of these patients were reviewed thoroughly. Hepatic dysfunction occurred in 77% (36/47) of patients. Among the liver function parameters, the percentage of abnormality was 74.5% for aspartate aminotransferase, 74.5% for alanine aminotransferase, 57.4% for alkaline phosphatase, 44.7% for lactate dehydrogenase and 44.7% for serum bilirubin. Six patients presented with a picture of true hepatitis similar to acute viral hepatitis. The results indicate that hepatocellular damage does occur in scrub typhus, and is perhaps, more common than previously realized. We recommend that the differential diagnosis of patients from high-risk groups and endemic areas who present with hepatitis-like symptoms should include examination for scrub typhus.
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Affiliation(s)
- C H Yang
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan R.O.C
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Peng MY, Young TG, Yang CH, Chou MY. Enterococcal bacteremia in a medical center. Zhonghua Yi Xue Za Zhi (Taipei) 1994; 54:306-11. [PMID: 7834553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND The enterococci have become important nosocomial pathogens. They can cause multiple site infections and enterococcal bacteremia becomes more frequently associated with a high mortality rate. Previous studies of enterococcal bacteremia showed a variety of results. To establish the significance and importance of enterococci as nosocomial pathogens in this hospital, to characterize their clinical pictures and to search for the risk factors for mortality, this retrospective study was performed. METHODS There were 208 cases of enterococcal bacteremia which occurred from 1988 to 1992. Twenty-seven cases had no medical charts, dismissing possibility of evaluation. Finally, 181 cases of enterococcal bacteremia were analysed. RESULTS One hundred and eighteen episodes were nosocomial infections. Polymicrobial bacteremia occurred in 68.5% of the patients and the most common co-isolate was Pseudomonas aeruginosa. Those patients (78.5%) with underlying diseases and malignancies were the most common underlying problems. The portal of entry could be found in 69.6 percent of patients, with the gastrointestinal tract the most common sources. Antimicrobial susceptibility testing showed high gentamicin resistance rate (89.5%), and ampicillin still had about 80 percent sensitivity rate. The group who received specific antibiotic therapy for enterococcus showed lower mortality (36.4% versus 47.6%). Only one case had infective endocarditis. Forty-nine patients suffered from septic shock, the cause of 30 deaths. Totally 75 patients died during hospitalization. Besides sepsis, another major cause of death was their underlying diseases itself. CONCLUSIONS Enterococci have no doubt become important nosocomial pathogens and enterococcal bacteremia were associated with high mortality, especially in elderly patients with underlying diseases such as malignancy or diabetes. When clinically dealing with sepsis from the gastrointestinal or biliary tract, especially when previous cephalosporins therapy showed no response, the possibility of enterococcal bacteremia should always be considered.
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Affiliation(s)
- M Y Peng
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
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Yang CH, Yiang TG, Peng MY, Hsu GJ. Neurological complications of varicella: a report of two cases. Zhonghua Yi Xue Za Zhi (Taipei) 1994; 53:253-6. [PMID: 8004533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Varicella (chickenpox) is the primary infection of Varicella-Zoster virus, characterized by generalized vesicular eruption, fever and mild constitutional symptoms. Chiefly infecting children of 1 to 14 years of age, the disease has been almost neglected because of its inevitable and benign outcome. Adults are rarely infected with an incidence of less than 20%. These two cases are presented of normal adults with marked neurological complications 10 and 14 days, respectively, following typical skin eruption of varicella. The first case developed transverse myelitis and the second, an encephalomyelitis. Neurological complications are very rare post-varicella infection. Although prognosis is good and complete recovery is the rule, still some morbidity with neurological sequelae and mortality have been reported. The present cases had extensive neurological deficit, despite aggressive treatment, making a high index of suspicion for differential diagnosis in patients who present with encephalitis. Especially following the typical exanthema of varicella, this possibility is emphasized and the literature is reviewed.
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Affiliation(s)
- C H Yang
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
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Hsu GJ, Young T, Peng MY, Chang FY, Chou MY. Septicemia caused by Vibrio parahemolyticus: a case report. Zhonghua Yi Xue Za Zhi (Taipei) 1993; 52:351-4. [PMID: 8299034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Vibrio parahemolyticus is a halophilic marine vibrio commonly associated with outbreaks of acute gastroenteritis which also sometimes causes serious wound infection. It is an uncommon cause of septicemia. A few reports suggest that patients with chronic liver disease and leukemia are more susceptible. A case of liver cirrhosis with septicemia caused by this organism is discussed. The patient's condition rapidly deteriorated, and he died 12 hours after admission.
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Affiliation(s)
- G J Hsu
- Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan, R.O.C
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Chang FY, Young T, Hsu GJ, Peng MY, Yang CH, Chou MY. Serodiagnosis of tuberculosis using the A60 IgG ELISA. Zhonghua Min Guo Wei Sheng Wu Ji Mian Yi Xue Za Zhi 1993; 26:151-9. [PMID: 7988281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The serodiagnosis of tuberculosis (TB) by using an enzyme-linked immunosorbent assay (ELISA) to detect IgG against mycobacterial antigen 60 (A60) was evaluated. Forty-three controls (10 healthy adults, 19 patients with non-tuberculous pulmonary diseases and 14 patients with non-pulmonary infectious diseases) and 63 patients with TB in different disease activity (50 patients with active TB and 13 patients with old pulmonary TB) were studied. When a cut-off value of 200 units was selected, the results obtained with controls were: 100% negative in IgG titers in healthy adults and patients with non-pulmonary infectious diseases, 89% negative in IgG titers in patients with non-tuberculous pulmonary diseases. The overall "false positive" rate was 5% in the control groups. The percentage of serologically positive cases of active TB was: 82% in smear-positive, 67% in smear-negative/culture-positive and 38% in culture-negative. Of the 13 patients with calcified pulmonary TB, four had a positive serological response (31%). Four out of eight patients with active TB showed an elevation in IgG titer 1 to 3 months after diagnosis and anti-TB chemotherapy. The positive and negative predictive values of the test may provide valuable information according to the prevalence of TB in different populations. When the TB prevalence is high, a positive IgG ELISA test may support the diagnosis of active TB.
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Affiliation(s)
- F Y Chang
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
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Ben RJ, Peng MY, Hsu GJ, Chen SG, Lee FY, Chou MY, Lee HS. [Infected common iliac aneurysm due to Salmonella: a case report]. Zhonghua Yi Xue Za Zhi (Taipei) 1993; 52:62-5. [PMID: 8364784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A 62-year-old male, presenting with chills and fever and RLQ abdominal pain, was found to have an infected aneurysm of the right common iliac artery infected by Salmonella group C1. CT scan of abdomen and arteriography definitely identified the lesions. Antibiotic treatment and surgical intervention with aneurysmectomy and suprapubic crossover femoro-femoral artery graft resulted in a good recovery and outcome.
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Affiliation(s)
- R J Ben
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center
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42
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Hsu GJ, Young T, Peng MY, Chang FY, Chou MY, Sheu LF. Acute renal failure associated with scrub typhus: report of a case. J Formos Med Assoc 1993; 92:475-7. [PMID: 8104604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We report on a 25-year-old man who had scrub typhus with the unusual complication of acute renal failure. The clinical features of fever, headache, high Weil-Felix OX-K agglutination and Rickettsia tsutsugamushi immunofluorescence titers confirmed the diagnosis of scrub typhus. Acute renal failure was proven by oliguria, urinary diagnostic indices and renal biopsy. The patient had a complete recovery after adequate medical treatment.
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Affiliation(s)
- G J Hsu
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan R.O.C
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Hsu GJ, Young TG, Chou JW, Peng MY, Chang FY, Chou MY. Gram-negative bacillary meningitis in adults. J Formos Med Assoc 1993; 92:317-23. [PMID: 8104579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
To evaluate the clinical aspects of gram-negative bacillary meningitis (GNBM), we reviewed 41 adult patients with bacteriologically proven gram-negative bacillary meningitis, seen from 1985 to 1990. Thirty-two patients had post-neurosurgical GNBM and nine patients had spontaneous GNBM. Spontaneous GNBM appeared to have a sudden onset, a relatively fulminant course, and was caused most often by Escherichia coli. Post-neurosurgical GNBM, however, had a more insidious onset, a more protracted course, and was more often caused by nosocomial organisms which were resistant to multiple antibiotics. The overall mortality was 39%. Patients treated with combined aminoglycoside therapy had a lower mortality rate than those treated with intravenous aminoglycoside (17% vs 48%). The use of third-generation cephalosporins has made a significant therapeutic advance in the treatment of GNBM, with a lower mortality of 21%. We recommend treatment of GNBM with third-generation cephalosporins and aminoglycosides. If aminoglycosides are to be employed, it is suggested that they be administered both intravenously and directly into the central nervous system.
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Affiliation(s)
- G J Hsu
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
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