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Lee CM, Choe PG, Kang CK, Jo HJ, Kim NJ, Yoon SS, Kim TM, Park WB, Oh MD. Impact of T-Cell Engagers on COVID-19-Related Mortality in B-Cell Lymphoma Patients Receiving B-Cell Depleting Therapy. Cancer Res Treat 2024; 56:324-333. [PMID: 37448122 PMCID: PMC10789957 DOI: 10.4143/crt.2023.738] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023] Open
Abstract
PURPOSE B-cell depleting therapies, including T-cell engager (TCE), are increasingly used for patients with hematologic malignancies, including during the coronavirus disease 2019 (COVID-19) pandemic. We aimed to evaluate the relationship between TCE therapy and COVID-19-related outcomes among patients with COVID-19 and B-cell lymphomas receiving B-cell depleting therapy. MATERIALS AND METHODS This retrospective cohort study included patients with B-cell lymphoma, who were admitted to Seoul Natio-nal University Hospital with COVID-19 between September 2021 and February 2023, and received B-cell depleting therapy before COVID-19 diagnosis. Multivariable logistic regression was used to identify factors associated with severe to critical COVID-19 and COVID-19-related mortality. RESULTS Of 54 patients with B-cell lymphomas and COVID-19 who received B-cell depleting therapy, 14 were treated with TCE (TCE group) and 40 with rituximab (RTX group). COVID-19-related mortality was higher in the TCE group than in the RTX group (57.1% vs. 12.5%, p=0.002). In multivariable analyses, TCE therapy (adjusted odds ratio [aOR], 7.08; 95% confidence interval [CI], 1.29 to 38.76; p=0.024) and older age (aOR, 1.06; 95% CI, 1.00 to 1.13; p=0.035) were associated with severe to critical COVID-19. TCE therapy (aOR, 8.98; 95% CI, 1.48 to 54.40; p=0.017), older age (aOR, 1.13; 95% CI, 1.02 to 1.26; p=0.022), and prior bendamustine therapy (aOR, 7.78; 95% CI, 1.17 to 51.65; p=0.034) were independent risk factors for COVID-19-related mortality. CONCLUSION B-cell lymphoma patients treated with TCE had significantly worse outcomes from COVID-19 than those treated with RTX. TCE therapy should be used with caution in B-cell lymphoma patients during the COVID-19 epidemic.
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Affiliation(s)
- Chan Mi Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Hyeon Jae Jo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Sung-Soo Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
- Seoul National University Cancer Research Institute, Seoul,
Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
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Sweeney DA, Tuyishimire B, Ahuja N, Beigel JH, Beresnev T, Cantos VD, Castro JG, Cohen SH, Cross K, Dodd LE, Erdmann N, Fung M, Ghazaryan V, George SL, Grimes KA, Hynes NA, Julian KG, Kandiah S, Kim HJ, Levine CB, Lindholm DA, Lye DC, Maves RC, Oh MD, Paules C, Rapaka RR, Short WR, Tomashek KM, Wolfe CR, Kalil AC. Baricitinib Treatment of Coronavirus Disease 2019 Is Associated With a Reduction in Secondary Infections. Open Forum Infect Dis 2023; 10:ofad205. [PMID: 37206623 PMCID: PMC10191442 DOI: 10.1093/ofid/ofad205] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/13/2023] [Indexed: 05/21/2023] Open
Abstract
We performed a secondary analysis of the National Institutes of Health-sponsored Adaptive COVID-19 Treatment Trial (ACTT-2) randomized controlled trial and found that baricitinib was associated with a 50% reduction in secondary infections after controlling for baseline and postrandomization patient characteristics. This finding provides a novel mechanism of benefit for baricitinib and supports the safety profile of this immunomodulator for the treatment of coronavirus disease 2019.
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Affiliation(s)
- Daniel A Sweeney
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | | | - Neera Ahuja
- Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - John H Beigel
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Tatiana Beresnev
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | | | - Jose G Castro
- Department of Medicine, University of Miami, Miami, FL, USA
| | - Stuart H Cohen
- Department of Internal Medicine, University of California Davis, Sacramento, CA, USA
| | | | - Lori E Dodd
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Nathan Erdmann
- Department of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Monica Fung
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Varduhi Ghazaryan
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Sarah L George
- Department of Medicine, Saint Louis University and St. Louis VA Medical Center, Saint Louis, MO, USA
| | - Kevin A Grimes
- Department of Medicine, Houston Methodist, Houston, TX, USA
| | - Noreen A Hynes
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kathleen G Julian
- Department of Medicine, Pennsylvania State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | | | - Hannah Jang Kim
- Community Health Systems Department, University of California San Francisco, San Francisco, CA, USA
- Department of Nursing, Kaiser Permanente National Patient Care Services, Oakland, CA, USA
| | - Corri B Levine
- Department of Internal Medicine Galveston, University of Texas Medical Branch, TX, USA
| | - David A Lindholm
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Department of Medicine, Brooke Army Medical Center, Joint Base San Antonio-Ft Sam Houston, TX, USA
| | - David C Lye
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Ryan C Maves
- Departments of Internal Medicine and Anesthesiology, Wake Forest University, Winston-Salem, NC, USA
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University Hospital College of Medicine, Seoul, Korea
| | - Catharine Paules
- Department of Medicine, Pennsylvania State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Rekha R Rapaka
- Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Willam R Short
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kay M Tomashek
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | | | - Andre C Kalil
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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3
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Lee CM, Choe PG, Kang CK, Lee E, Song KH, Bang JH, Kim E, Kim HB, Kim NJ, Kim HR, Kim Y, Lee CH, Shin H, Park SW, Park WB, Oh MD. Low humoral and cellular immune responses early after breakthrough infection may contribute to severe COVID-19. Front Immunol 2023; 14:1106664. [PMID: 37033936 PMCID: PMC10073433 DOI: 10.3389/fimmu.2023.1106664] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 03/13/2023] [Indexed: 04/11/2023] Open
Abstract
Background Little is known about the immune determinants for severe coronavirus disease 2019 (COVID-19) in individuals vaccinated against severe acute respiratory syndrome coronavirus 2. We therefore attempted to identify differences in humoral and cellular immune responses between patients with non-severe and severe breakthrough COVID-19. Methods We prospectively enrolled hospitalized patients with breakthrough COVID-19 (severe and non-severe groups) and uninfected individuals who were vaccinated at a similar time (control group). Severe cases were defined as those who required oxygen therapy while hospitalized. Enzyme-linked immunosorbent assays and flow cytometry were used to evaluate humoral and cellular immune responses, respectively. Results Anti-S1 IgG titers were significantly lower in the severe group than in the non-severe group within 1 week of symptom onset and higher in the non-severe group than in the control group. Compared with the control group, the cellular immune response tended to be diminished in breakthrough cases, particularly in the severe group. In multivariate analysis, advanced age and low anti-S1 IgG titer were associated with severe breakthrough COVID-19. Conclusions Severe breakthrough COVID-19 might be attributed by low humoral and cellular immune responses early after infection. In the vaccinated population, delayed humoral and cellular immune responses may contribute to severe breakthrough COVID-19.
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Affiliation(s)
- Chan Mi Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eunyoung Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ji Hwan Bang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hang-Rae Kim
- Department of Anatomy & Cell Biology and Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
- BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Youngju Kim
- BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chang-Han Lee
- BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Pharmacology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyun Mu Shin
- BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
- Wide River Institute of Immunology, Seoul National University, Hongcheon, Republic of Korea
- *Correspondence: Hyun Mu Shin, ; Sang-Won Park, ; Wan Beom Park,
| | - Sang-Won Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
- *Correspondence: Hyun Mu Shin, ; Sang-Won Park, ; Wan Beom Park,
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- *Correspondence: Hyun Mu Shin, ; Sang-Won Park, ; Wan Beom Park,
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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4
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Lee CM, Kim M, Kang CK, Choe PG, Kim NJ, Bang H, Cho T, Shin HM, Kim HR, Park WB, Oh MD. Different degree of cytokinemia and T-cell activation according to serum IL-6 levels in critical COVID-19. Front Immunol 2023; 14:1110874. [PMID: 37081872 PMCID: PMC10110916 DOI: 10.3389/fimmu.2023.1110874] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/27/2023] [Indexed: 04/22/2023] Open
Abstract
Introduction Tocilizumab, a humanized anti-interleukin-6 receptor (IL-6R) antibody, is recommended for the treatment of severe to critical coronavirus diseases 2019 (COVID-19). However, there were conflicting results on the efficacy of tocilizumab. Therefore, we hypothesized that the differences in tocilizumab efficacy may stem from the different immune responses of critical COVID-19 patients. In this study, we described two groups of immunologically distinct COVID-19 patients, based on their IL-6 response. Methods We prospectively enrolled critical COVID-19 patients, requiring oxygen support with a high flow nasal cannula or a mechanical ventilator, and analyzed their serial samples. An enzyme-linked immunosorbent assay and flow cytometry were used to evaluate the cytokine kinetics and cellular immune responses, respectively. Results A total of nine patients with critical COVID-19 were included. The high (n = 5) and low IL-6 (n = 4) groups were distinguished by their peak serum IL-6 levels, using 400 pg/mL as the cut-off value. Although the difference of flow cytometric data did not reach the level of statistical significance, the levels of pro-inflammatory cytokines and the frequencies of intermediate monocytes (CD14+CD16+), IFN-γ+ CD4+ or CD8+ T cells, and HLA-DR+PD-1+ CD4+ T cells were higher in the high IL-6 group than in the low IL-6 group. Conclusion There were distinctive two groups of critical COVID-19 according to serum IL-6 levels having different degrees of cytokinemia and T-cell responses. Our results indicate that the use of immune modulators should be more tailored in patients with critical COVID-19.
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Affiliation(s)
- Chan Mi Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Minji Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Anatomy & Cell Biology and Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
- BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyeeun Bang
- Research and development team 2, Molecular Diagnostics Division, Quantamatrix Inc., Seoul, Republic of Korea
| | - Taeeun Cho
- Research and development team 2, Molecular Diagnostics Division, Quantamatrix Inc., Seoul, Republic of Korea
| | - Hyun Mu Shin
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
- BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, Republic of Korea
- Wide River Institute of Immunology, Seoul National University, Hongcheon, Republic of Korea
- *Correspondence: Hyun Mu Shin, ; Hang-Rae Kim, ; Wan Beom Park,
| | - Hang-Rae Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Anatomy & Cell Biology and Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
- BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, Republic of Korea
- Wide River Institute of Immunology, Seoul National University, Hongcheon, Republic of Korea
- Medical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
- *Correspondence: Hyun Mu Shin, ; Hang-Rae Kim, ; Wan Beom Park,
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- *Correspondence: Hyun Mu Shin, ; Hang-Rae Kim, ; Wan Beom Park,
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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Oh SM, Lee CM, Choi SJ, Lee E, Kang CK, Moon SM, Choe PG, Song KH, Park WB, Bang JH, Kim ES, Park SW, Kim HB, Kim IH, Kim NJ, Oh MD. 208. Clinical outcomes of empirical versus pre-emptive broad spectrum antifungal therapy in patients with acute myelogenous leukemia receiving antimold prophylaxis. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.285] [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: 12/23/2022] Open
Abstract
Abstract
Background
Since antimold prophylaxis has been widely used in induction chemotherapy for acute myelogenous leukemia (AML), it should be re-evaluated whether broad spectrum antifungal therapy should be empirically used in prolonged febrile neutropenia. Therefore, we compared clinical outcomes of empirical versus pre-emptive antifungal therapy in patients with AML receiving antimold prophylaxis.
Methods
From September 2016 to December 2020, all adult AML patients (≥ 18 years) receiving antimold prophylaxis who had febrile neutropenia for ≥ 4 days during induction or re-induction chemotherapy at Seoul National University Hospital were retrospectively reviewed. They were classified into the empirical group (therapeutic broad spectrum antifungal agents had been used without evidence of invasive fungal infection [IFI]) or the pre-emptive group (antimold prophylaxis had been maintained until the emergence of IFI’s evidence). We compared clinical outcomes between the two groups after propensity score matching.
Results
A total of 229 chemotherapy episodes, 36 in the empirical group and 193 in the pre-emptive group, were analyzed. In the pre-emptive group, broad spectrum antifungal therapy was administered in 45 (23.3%) episodes. After 1:3 matching with age, gender, induction or re-induction chemotherapy, and worst qSOFA score at febrile neutropenia, incidence of proven or probable IFI (0/36 [0%] in the empirical group vs. 5/97 [5.2%] in the pre-emptive group, P=0.323) and all-cause mortality (3/36 [8.3%] in the empirical group vs. 4/97 [4.1%] in the pre-emptive group, P=0.388) were not different between the two groups.
Conclusion
Clinical outcomes of empirical versus pre-emptive broad spectrum antifungal therapy were comparable in patients with AML receiving antimold prophylaxis. Broad spectrum antifungal therapy could be delayed until the emergence of evidence of IFI, in the current era of antimold prophylaxis.
Disclosures
All Authors: No reported disclosures.
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Affiliation(s)
- Sang-Min Oh
- Jeonbuk National University Medical School , Jeonju, Cholla-bukto , Republic of Korea
| | - Chan Mi Lee
- Seoul National University College of Medicine , Seoul, Seoul-t'ukpyolsi , Republic of Korea
| | - Seong Jin Choi
- Seoul National University College of Medicine , Seoul, Seoul-t'ukpyolsi , Republic of Korea
| | - Eunyoung Lee
- Seoul National University College of Medicine , Seoul, Seoul-t'ukpyolsi , Republic of Korea
| | - Chang Kyung Kang
- Seoul National University College of Medicine , Seoul, Seoul-t'ukpyolsi , Republic of Korea
| | - Song Mi Moon
- Seoul National University College of Medicine , Seoul, Seoul-t'ukpyolsi , Republic of Korea
| | - Pyoeng Gyun Choe
- Seoul National University College of Medicine , Seoul, Seoul-t'ukpyolsi , Republic of Korea
| | - Kyoung-Ho Song
- Seoul National University College of Medicine , Seoul, Seoul-t'ukpyolsi , Republic of Korea
| | - Wan Beom Park
- Seoul National University College of Medicine , Seoul, Seoul-t'ukpyolsi , Republic of Korea
| | - Ji Hwan Bang
- Seoul National University College of Medicine , Seoul, Seoul-t'ukpyolsi , Republic of Korea
| | - Eu Suk Kim
- Seoul National University College of Medicine , Seoul, Seoul-t'ukpyolsi , Republic of Korea
| | - Sang Won Park
- Seoul National University College of Medicine , Seoul, Seoul-t'ukpyolsi , Republic of Korea
| | - Hong Bin Kim
- Seoul National University College of Medicine , Seoul, Seoul-t'ukpyolsi , Republic of Korea
| | - In Ho Kim
- Seoul National University College of Medicine , Seoul, Seoul-t'ukpyolsi , Republic of Korea
| | - Nam Joong Kim
- Seoul National University College of Medicine , Seoul, Seoul-t'ukpyolsi , Republic of Korea
| | - Myoung-don Oh
- Seoul National University College of Medicine , Seoul, Seoul-t'ukpyolsi , Republic of Korea
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6
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Kim J, Jeong J, Lee CM, Lee DW, Kang CK, Choe PG, Kim NJ, Oh MD, Lee CH, Park WB, Lee KH, Im SA. Prospective longitudinal analysis of antibody response after standard and booster doses of SARS-COV2 vaccination in patients with early breast cancer. Front Immunol 2022; 13:1028102. [DOI: 10.3389/fimmu.2022.1028102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/26/2022] [Indexed: 11/18/2022] Open
Abstract
IntroductionSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its variants brought waves of pandemics with breakthrough infections in vaccinated individuals. We analyzed the antibody responses after primary and booster vaccination in healthy controls (HC) and patients with early breast cancer (BC).MethodsIn this prospective longitudinal cohort study, the binding activity of serum antibody level against spike proteins and antigens of SARS-CoV-2 variants was measured within 21 days after each vaccination in the BC group and HC group.ResultsAll participants, 40 in the BC and 20 in the HC group, had increased antibody response after vaccination. BC group, however, had weaker humoral responses than the HC group (IgG: 1.5, 2.3, 2.5-folds in BC vs. 1.9, 3.6, 4.0-folds in HC after each dose; IgA: 2.1, 3.0, 3.6-folds in BC vs. 4.2, 10.4, 5.2-folds in HC after each dose, respectively). Those under concurrent cytotoxic chemotherapy had weaker antibody response than the non-cytotoxic treatment group and HC. Adjunct use of steroids and age were not significant risk factors. The levels of binding antibody against the Delta and the Omicron (BA1) variants were lower than the wild-type, especially in BC.ConclusionIn the waves of new sub-variants, our study suggests that an additional dose of vaccinations should be recommended according to the anti-cancer treatment modality in patients with BC who had received booster vaccination.
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Kim J, Chang E, Park SY, Lee DW, Kang CK, Choe PG, Kim NJ, Oh MD, Park WB, Lee KH, Im SA. Evaluation of Seropositivity After Standard Doses of Vaccination Against SARS-CoV-2 in Patients With Early Breast Cancer Receiving Adjuvant Treatment. Oncologist 2022; 27:e931-e937. [PMID: 36218350 PMCID: PMC9732225 DOI: 10.1093/oncolo/oyac196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/09/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) pandemic affected millions of individuals, and patients with cancer are known to be more susceptible. Vaccines against SARS-CoV-2 have been developed and used for patients with cancer, but scarce data are available on their efficacy in patients under active anti-cancer therapies. MATERIALS AND METHODS In this study, we semi-quantitatively measured the titers of the immunoglobulin G against the anti-spike protein subunit 1 of SARS-CoV-2 after vaccination of patients with early breast cancer undergoing concurrent chemotherapy, endocrinal or targeted non-cytotoxic treatments, and no treatments. RESULTS Standard doses of COVID-19 vaccines provided sufficient immune responses in patients with early breast cancer, regardless of the type of anticancer therapies. However, the post-vaccination serum anti-spike antibody titers were significantly lower in the patients under cytotoxic chemotherapy. CONCLUSION Our study emphasizes the importance of the personalized risk stratification and consideration for booster doses in more vulnerable populations.
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Affiliation(s)
| | | | - Song Yi Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Dae-Won Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Wan Beom Park
- Wan Beom Park, MD, PhD, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongro-gu, Seoul 03080, Republic of Korea. Tel: +82 2 2072 3596; Email
| | - Kyung-Hun Lee
- Corresponding author: Kyung-Hun Lee, MD, PhD, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongro-gu, Seoul 03080, Republic of Korea. Tel: 82 2 2072 7207; Email
| | - Seock-Ah Im
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea,Cancer Research Institute, Seoul National University, Seoul, Korea
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8
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Kang CK, Choi B, Kim S, Sun CH, Yoon SH, Kim K, Chang E, Jung J, Choe PG, Park WB, Kim ES, Kim HB, Kim NJ, Oh MD, Im H, Kim J, Lee YH, Lee J, Chun H, Koh Y, Lee JY, Moon JH, Song KH, Jung I. Clinical impact of clonal hematopoiesis on severe COVID- 19 patients without canonical risk factors. Haematologica 2022; 108:257-260. [PMID: 36106393 PMCID: PMC9827170 DOI: 10.3324/haematol.2022.280621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Indexed: 02/05/2023] Open
Affiliation(s)
- Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,*CKK and BC contributed equally as co-first authors
| | - Baekgyu Choi
- Department of Biological Sciences, Korea Advanced Institute of Science and Technology (KAIST), Daejeon,*CKK and BC contributed equally as co-first authors
| | | | | | - Soon Ho Yoon
- Department of Radiology, Seoul National University College of Medicine, Seoul
| | - Kyukwang Kim
- Department of Biological Sciences, Korea Advanced Institute of Science and Technology (KAIST), Daejeon
| | - Euijin Chang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul
| | - Jongtak Jung
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul
| | | | - Joohae Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul
| | - Yong Hoon Lee
- Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu
| | - Jaehee Lee
- Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu
| | - Hyonho Chun
- Department of Mathematical Sciences, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Youngil Koh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,Genome Opinion Inc., Seoul
| | - Ji Yeon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul,JYL, JHM, K-HS and IJ contributed equally as co-senior authors
| | - Joon Ho Moon
- Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu,JYL, JHM, K-HS and IJ contributed equally as co-senior authors
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,JYL, JHM, K-HS and IJ contributed equally as co-senior authors
| | - Inkyung Jung
- Department of Biological Sciences, Korea Advanced Institute of Science and Technology (KAIST), Daejeon,JYL, JHM, K-HS and IJ contributed equally as co-senior authors
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Kang CK, Kim M, Hong J, Kim G, Lee S, Chang E, Choe PG, Kim NJ, Kim IS, Seo JY, Song D, Lee DS, Shin HM, Kim YW, Lee CH, Park WB, Kim HR, Oh MD. Distinct Immune Response at 1 Year Post-COVID-19 According to Disease Severity. Front Immunol 2022; 13:830433. [PMID: 35392102 PMCID: PMC8980227 DOI: 10.3389/fimmu.2022.830433] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/23/2022] [Indexed: 01/10/2023] Open
Abstract
Background Despite the fact of ongoing worldwide vaccination programs for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), understanding longevity, breadth, and type of immune response to coronavirus disease-19 (COVID-19) is still important to optimize the vaccination strategy and estimate the risk of reinfection. Therefore, we performed thorough immunological assessments 1 year post-COVID-19 with different severity. Methods We analyzed peripheral blood mononuclear cells and plasma samples at 1 year post-COVID-19 in patients who experienced asymptomatic, mild, and severe illness to assess titers of various isotypes of antibodies (Abs) against SARS-CoV-2 antigens, phagocytic capability, and memory B- and T-cell responses. Findings A total of 24 patients (7, 9, and 8 asymptomatic, mild, and severe patients, respectively) and eight healthy volunteers were included in this study. We firstly showed that disease severity is correlated with parameters of immune responses at 1 year post-COVID-19 that play an important role in protecting against reinfection with SARS-CoV-2, namely, the phagocytic capacity of Abs and memory B-cell responses. Interpretation Various immune responses at 1 year post-COVID-19, particularly the phagocytic capacity and memory B-cell responses, were dependent on the severity of the prior COVID-19. Our data could provide a clue for a tailored vaccination strategy after natural infection according to the severity of COVID-19.
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Affiliation(s)
- Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Minji Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
- Department of Anatomy & Cell Biology, Seoul National University College of Medicine, Seoul, South Korea
- BrainKorea21 (BK21) FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, South Korea
| | - Jisu Hong
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
- BrainKorea21 (BK21) FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, South Korea
- Department of Pharmacology, Seoul National University College of Medicine, Seoul, South Korea
| | - Gwanghun Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
- Department of Anatomy & Cell Biology, Seoul National University College of Medicine, Seoul, South Korea
- BrainKorea21 (BK21) FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, South Korea
| | - Soojin Lee
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
- Department of Anatomy & Cell Biology, Seoul National University College of Medicine, Seoul, South Korea
- BrainKorea21 (BK21) FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, South Korea
| | - Euijin Chang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Ik Soo Kim
- Department of Microbiology, School of Medicine, Gachon University, Incheon, South Korea
| | - Jun-Young Seo
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
- BrainKorea21 (BK21) Project for Medical Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Daesub Song
- College of Pharmacy, Korea University, Sejong, South Korea
| | - Dong-Sup Lee
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
- Department of Anatomy & Cell Biology, Seoul National University College of Medicine, Seoul, South Korea
- BrainKorea21 (BK21) FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, South Korea
- Medical Research Institute, Seoul National University College of Medicine, Seoul, South Korea
- Wide River Institute of Immunology, Seoul National University, Hongcheon, South Korea
| | - Hyun Mu Shin
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
- BrainKorea21 (BK21) FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, South Korea
- Wide River Institute of Immunology, Seoul National University, Hongcheon, South Korea
| | - Yong-Woo Kim
- Wide River Institute of Immunology, Seoul National University, Hongcheon, South Korea
| | - Chang-Han Lee
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
- BrainKorea21 (BK21) FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, South Korea
- Department of Pharmacology, Seoul National University College of Medicine, Seoul, South Korea
- Wide River Institute of Immunology, Seoul National University, Hongcheon, South Korea
- *Correspondence: Hang-Rae Kim, ; Wan Beom Park, ; Chang-Han Lee,
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- *Correspondence: Hang-Rae Kim, ; Wan Beom Park, ; Chang-Han Lee,
| | - Hang-Rae Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
- Department of Anatomy & Cell Biology, Seoul National University College of Medicine, Seoul, South Korea
- BrainKorea21 (BK21) FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, South Korea
- Medical Research Institute, Seoul National University College of Medicine, Seoul, South Korea
- Wide River Institute of Immunology, Seoul National University, Hongcheon, South Korea
- *Correspondence: Hang-Rae Kim, ; Wan Beom Park, ; Chang-Han Lee,
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
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Lee H, Sung HK, Lee D, Choi Y, Lee JY, Lee JY, Oh MD. Comparison of Complications after Coronavirus Disease and Seasonal Influenza, South Korea. Emerg Infect Dis 2022; 28:347-353. [PMID: 35076368 PMCID: PMC8798693 DOI: 10.3201/eid2802.211848] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We conducted a retrospective cohort study using claims data to determine the number and types of complications from coronavirus disease (COVID-19) that patients experience and which patients are more vulnerable to those complications compared with complications in patients with influenza. Among the cohort, 19.6% of COVID-19 patients and 28.5% of influenza patients had >1 new complication. In most complications, COVID-19 patients had lower or similar relative risk compared with influenza patients; exceptions were hair loss, heart failure, mood disorder, and dementia. Young to middle-aged adult COVID-19 patients and patients in COVID-19 hotspots had a higher risk for complications. Overall, COVID-19 patients had fewer complications than influenza patients, but caution is necessary in high-risk groups. If the fatality rate for COVID-19 is reduced through vaccination, management strategies for this disease could be adapted, similar to those for influenza management, such as easing restrictions on economic activity or requirements for close-contact isolation.
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11
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van Doremalen N, Letko M, Fischer RJ, Bushmaker T, Schulz J, Yinda CK, Seifert SN, Kim NJ, Hemida MG, Kayali G, Park WB, Perera RA, Tamin A, Thornburg NJ, Tong S, Queen K, van Kerkhove MD, Choi YK, Oh MD, Assiri AM, Peiris M, Gerber SI, Munster VJ. Surface‒Aerosol Stability and Pathogenicity of Diverse Middle East Respiratory Syndrome Coronavirus Strains, 2012‒2018. Emerg Infect Dis 2021; 27:3052-3062. [PMID: 34808078 PMCID: PMC8632154 DOI: 10.3201/eid2712.210344] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Middle East respiratory syndrome coronavirus (MERS-CoV) infects humans and dromedary camels and is responsible for an ongoing outbreak of severe respiratory illness in humans in the Middle East. Although some mutations found in camel-derived MERS-CoV strains have been characterized, most natural variation found across MERS-CoV isolates remains unstudied. We report on the environmental stability, replication kinetics, and pathogenicity of several diverse isolates of MERS-CoV, as well as isolates of severe acute respiratory syndrome coronavirus 2, to serve as a basis of comparison with other stability studies. Although most MERS-CoV isolates had similar stability and pathogenicity in our experiments, the camel-derived isolate C/KSA/13 had reduced surface stability, and another camel isolate, C/BF/15, had reduced pathogenicity in a small animal model. These results suggest that although betacoronaviruses might have similar environmental stability profiles, individual variation can influence this phenotype, underscoring the need for continual global viral surveillance.
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12
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Hwang YH, Song KH, Choi Y, Go S, Choi SJ, Jung J, Kang CK, Choe PG, Kim NJ, Park WB, Oh MD. Can reactogenicity predict immunogenicity after COVID-19 vaccination? Korean J Intern Med 2021; 36:1486-1491. [PMID: 34038996 PMCID: PMC8588964 DOI: 10.3904/kjim.2021.210] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/11/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND/AIMS This study aimed to assess the association between local and systemic reactogenicity and humoral immunogenicity after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. METHODS Adverse events were prospectively evaluated using an electronic diary in 135 healthy adults who received a SARS-CoV-2 vaccine (AZD1222, AstraZeneca/Oxford, n = 42; or BNT162b2, Pfizer/BioNTech, n = 93). We semi-quantitatively measured anti-S1 immunoglobulin G (IgG) using an enzyme-linked immunosorbent assay at baseline, 3 weeks after the first dose of AZD1222 or BNT162b2, and 2 weeks after the second dose of BNT162b2. We evaluated the association between the maximum grade of local or systemic adverse events and the anti-S1 IgG optical density using multivariate linear regression with adjustment for age, sex, and use of antipyretics. RESULTS The median age of the 135 vaccinees was 30 years (36 years in the AZD1222 group and 29 years in the BNT162b2 group) and 25.9% were male (9.5% in the AZD1222 group and 33.3% in the BNT162b2 group). Local and systemic adverse events were generally comparable after the first dose of AZD1222 and the second dose of BNT162b2. The grades of local and systemic adverse events were not significantly associated with anti-S1 IgG levels in the AZD1222 or BNT162b2 group. CONCLUSION Local and systemic reactogenicity may not be associated with humoral immunogenicity after SARS-CoV-2 vaccination.
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Affiliation(s)
- Young Hoon Hwang
- Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Yunsang Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Suryeong Go
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Su-Jin Choi
- Laboratory of Infection & Immunity, Seoul National University Hospital Biomedical Research Institute, Seoul,
Korea
| | - Jongtak Jung
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
| | - Nam-Joong Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
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13
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Lee HY, Ahn J, Park J, Kang CK, Won SH, Kim DW, Park JH, Chung KH, Joh JS, Bang JIH, Kang CH, Oh MD, Pyun WB. Different therapeutic associations of renin-angiotensin system inhibitors with coronavirus disease 2019 compared with usual pneumonia. Korean J Intern Med 2021; 36:617-628. [PMID: 33858123 PMCID: PMC8137390 DOI: 10.3904/kjim.2020.656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/03/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND/AIMS Although it is near concluded that renin-angiotensin system inhibitors do not have a harmful effect on coronavirus disease 2019 (COVID-19), there is no report about whether angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) offer any protective role. This study aimed to compare the association of ARBs and ACEIs with COVID-19-related mortality. METHODS All patients with COVID-19 in Korea between January 19 and April 16, 2020 were enrolled. The association of ARBs and ACEIs with mortality within 60 days were evaluated. A comparison of hazard ratio (HR) was performed between COVID-19 patients and a retrospective cohort of pneumonia patients hospitalized in 2019 in Korea. RESULTS Among 10,448 COVID-19 patients, ARBs and ACEIs were prescribed in 1,231 (11.7%) and 57 (0.6%) patients, respectively. After adjusting for age, sex, and history of comorbidities, the ARB group showed neutral association (HR, 1.034; 95% CI, 0.765 to 1.399; p = 0.8270) and the ACEI groups showed no significant associations likely owing to the small population size (HR, 0.736; 95% CI, 0.314 to 1.726; p = 0.4810). When comparing HR between COVID-19 patients and a retrospective cohort of patients hospitalized with pneumonia in 2019, the trend of ACEIs showed similar benefits, whereas the protective effect of ARBs observed in the retrospective cohort was absent in COVID-19 patients. Meta-analyses showed significant positive correlation with survival of ACEIs, whereas a neutral association between ARBs and mortality. CONCLUSION Although ARBs or ACEIs were not associated with fatal outcomes, potential beneficial effects of ARBs observed in pneumonia were attenuated in COVID-19.
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Affiliation(s)
- Hae-Young Lee
- Korean Society of Hypertension, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Juhee Ahn
- Department of Public Health Sciences, Seoul National University, Seoul, Korea
| | - Juhong Park
- Department of Public Health Sciences, Seoul National University, Seoul, Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sung-Ho Won
- Department of Public Health Sciences, Seoul National University, Seoul, Korea
- Institute of Health and Environment, Seoul National University, Seoul, Korea
| | | | - Jong-Heon Park
- National Health Insurance Service, Wonju, Korea
- Department of Benefits Strategy, National Health Insurance Service, Wonju, Korea
| | - Ki-Hyun Chung
- National Medical Center, Seoul, Korea
- National Committee for Clinical Management of Emerging Infectious Diseases, Seoul, Korea
| | | | - JI Hwan Bang
- National Committee for Clinical Management of Emerging Infectious Diseases, Seoul, Korea
- The Central Infectious Disease Hospital, Seoul, Korea
| | | | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- National Committee for Clinical Management of Emerging Infectious Diseases, Seoul, Korea
| | - Wook Bum Pyun
- Korean Society of Hypertension, Seoul, Korea
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
- Correspondence to Wook Bum Pyun, M.D. Korean Society of Hypertension and Division of Cardiology, Department of Internal Medicine, Ewha Womans University School of Medicine, 1071 Anyangcheonro, Yangcheon-gu, Seoul 07985, Korea TEL: +82-2-6986-1627 FAX: +82-2-2650-6166 E-mail:
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14
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van Doremalen N, Letko M, Fischer RJ, Bushmaker T, Yinda CK, Schulz J, Seifert SN, Kim NJ, Hemida MG, Kayali G, Park WB, Perera RAPM, Tamin A, Thornburg NJ, Tong S, Queen K, van Kerkhove MD, Choi YK, Oh MD, Assiri AM, Peiris M, Gerber SI, Munster VJ. Surface-aerosol stability and pathogenicity of diverse MERS-CoV strains from 2012 - 2018. bioRxiv 2021:2021.02.11.429193. [PMID: 33594367 PMCID: PMC7885919 DOI: 10.1101/2021.02.11.429193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Middle East Respiratory Syndrome coronavirus (MERS-CoV) is a coronavirus that infects both humans and dromedary camels and is responsible for an ongoing outbreak of severe respiratory illness in humans in the Middle East. While some mutations found in camel-derived MERS-CoV strains have been characterized, the majority of natural variation found across MERS-CoV isolates remains unstudied. Here we report on the environmental stability, replication kinetics and pathogenicity of several diverse isolates of MERS-CoV as well as SARS-CoV-2 to serve as a basis of comparison with other stability studies. While most of the MERS-CoV isolates exhibited similar stability and pathogenicity in our experiments, the camel derived isolate, C/KSA/13, exhibited reduced surface stability while another camel isolate, C/BF/15, had reduced pathogenicity in a small animal model. These results suggest that while betacoronaviruses may have similar environmental stability profiles, individual variation can influence this phenotype, underscoring the importance of continual, global viral surveillance.
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Affiliation(s)
- Neeltje van Doremalen
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, 59840, USA
| | - Michael Letko
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, 59840, USA
- Paul G. Allen School of Global Animal Health, Washington State University, Pullman, WA, 99111, USA
- Corresponding author: Dr. Michael Letko, Paul G. Allen School of Global Animal Health, Washington State University, Pullman, WA, 99164, Tel: (509) 335-4058,
| | - Robert J. Fischer
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, 59840, USA
| | - Trenton Bushmaker
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, 59840, USA
| | - Claude Kwe Yinda
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, 59840, USA
| | - Jonathan Schulz
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, 59840, USA
| | - Stephanie N. Seifert
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, 59840, USA
- Paul G. Allen School of Global Animal Health, Washington State University, Pullman, WA, 99111, USA
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Maged G Hemida
- Department of Microbiology, College of Veterinary Medicine, King Faisal University, Al-Hasa, Saudi Arabia
- Department of Virology, Faculty of Veterinary Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Ghazi Kayali
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Sciences Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, Houston, Texas
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | | | - Azaibi Tamin
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Natalie J. Thornburg
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Suxiang Tong
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Krista Queen
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Maria D. van Kerkhove
- Department of Infectious Hazards Management, Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Young Ki Choi
- College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju City, Republic of Korea
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Abdullah M. Assiri
- Infection Prevention and Control, Assistant Deputy Minister, Preventive Health, Ministry of Health, Riyadh, Saudi Arabia
| | - Malik Peiris
- School of Public Health, University of Hong-Kong, Hong Kong SAR, China
| | - Susan I. Gerber
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Vincent J. Munster
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, 59840, USA
- Corresponding author: Dr. Michael Letko, Paul G. Allen School of Global Animal Health, Washington State University, Pullman, WA, 99164, Tel: (509) 335-4058,
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Park DH, Chang E, Kang CK, Choe PG, Kim NJ, Kim TS, Park WB, Oh MD. A Direct Rapid Phenotypic Antimicrobial Susceptibility Test Enables Early Selection of Optimal Antibiotics to Treat Bacteremia in COVID-19 Patients. Infect Chemother 2021; 53:776-785. [PMID: 34979608 PMCID: PMC8731248 DOI: 10.3947/ic.2021.0139] [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: 12/14/2021] [Accepted: 12/20/2021] [Indexed: 11/24/2022] Open
Abstract
Background Co-infection with bacteria and severe acute respiratory syndrome coronavirus 2 may result in greater use of healthcare resources and a poor prognosis. Therefore, early selection and use of optimal antibiotics are essential. The direct rapid antibiotic susceptibility test (dRAST) can detect antibiotic resistance within 6 h of a Gram smear result. This study aimed to assess the effectiveness of dRAST for improving early selection of appropriate antibiotics for coronavirus disease 2019 (COVID-19) patients with bacteremia. Materials and Methods This retrospective study included 96 blood culture-positive COVID-19 patients. Bacterial isolates and antimicrobial resistance profiles of each case were evaluated. Cases were divided into two groups based on whether they underwent conventional antibiotic susceptibility test (AST) or dRAST. The time to optimal targeted treatment for the two groups was investigated and compared. In addition, we examined the proportion of cases for which appropriate antibiotics were selected and broad spectrum antibiotics were administered at 72 h from blood sample collection. Results The mean time to optimal targeted antibiotic treatment was shorter for the dRAST group [55.7; standard deviation (SD), 28.7 vs. 92.3; SD, 51.1 h; P = 0.041]. The proportion of cases receiving optimal targeted antibiotics 72 h after blood collection for culture was higher [6/10 (60.0%) vs. 10/25 (40.0%)] and the percentage receiving broad spectrum antibiotics at 72 h was lower [6/10 (60.0%) vs. 19/25 (76.0%)] in the dRAST group than in the conventional AST group. In terms of microbiology profile, the contamination rate was high (35.5%) and multidrug-resistant strains were common (63.2%) in COVID-19 patients with bacteremia. Conclusion Application of dRAST for selection of antibiotics to treat bacteremia in COVID-19 patients may enable earlier and optimal treatment. The high incidence of contamination and resistant organisms in blood cultures from COVID-19 patients suggest that dRAST may speed up appropriate targeted treatment.
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Affiliation(s)
- Do Hyeon Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Euijin Chang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Taek Soo Kim
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Jung J, Choe PG, Kang CK, Song KH, Park WB, Bang JH, Kim ES, Park SW, Kim HB, Kim NJ, Oh MD. 813. The Reduction of the acquisition rate of carbapenem resistant Acinetobacter baumannii after room privatization in the intensive care unit. Open Forum Infect Dis 2020. [PMCID: PMC7776396 DOI: 10.1093/ofid/ofaa439.1002] [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] [Indexed: 11/17/2022] Open
Abstract
Background Acinetobacter baumannii is one of the major pathogens of hospital-acquired infection recently and hospital outbreaks have been reported worldwide. On September 2017, New intensive care unit(ICU) with only single rooms, remodeling from old ICU with multibed bay rooms, was opened in an acute-care tertiary hospital in Seoul, Korea. We investigated the effect of room privatization in the ICU on the acquisition of carbapenem-resistant Acinetobacter baumannii(CRAB). Methods We retrospectively reviewed medical records of patients who admitted to the medical ICU in a tertiary care university-affiliated 1,800-bed hospital from 1 January 2015 to 1 January 2019. Patients admitted to the medical ICU before the remodeling of the ICU were designated as the control group, and those who admitted to the medical ICU after the remodeling were designated as the intervention group. Then we compared the acquisition rate of CRAB between the control and intervention groups. Patients colonized with CRAB or patients with CRAB identified in screening tests were excluded from the study population. The multivariable Cox regression model was performed using variables with p-values of less than 0.1 in the univariate analysis. Results A total of 1,105 cases admitted to the ICU during the study period were analyzed. CRAB was isolated from 110 cases in the control group(n=687), and 16 cases in the intervention group(n=418). In univariate analysis, room privatization, prior exposure to antibiotics (carbapenem, vancomycin, fluoroquinolone), mechanical ventilation, central venous catheter, tracheostomy, the presence of feeding tube(Levin tube or percutaneous gastrostomy) and the length of ICU stay were significant risk factors for the acquisition of CRAB (p< 0.05). In the multivariable Cox regression model, the presence of feeding tube(Hazard ratio(HR) 4.815, 95% Confidence interval(CI) 1.94-11.96, p=0.001) and room privatization(HR 0.024, 95% CI 0.127-0.396, p=0.000) were independent risk factors. Table 1. Univariate analysis of Carbapenem-resistant Acinetobacter baumannii ![]()
Table 2. Multivariable Cox regression model of the acquisition of Carbapenem-resistant Acinetobacter baumannii ![]()
Conclusion In the present study, room privatization of the ICU was correlated with the reduction of CRAB acquisition independently. Remodeling of the ICU to the single room would be an efficient strategy for preventing the spreading of multidrug-resistant organisms and hospital-acquired infection. Disclosures All Authors: No reported disclosures
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Affiliation(s)
- Jongtak Jung
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongbuk-gu, Seoul-t’ukpyolsi, Republic of Korea
| | - Pyoeng Gyun Choe
- Seoul National University Hospital, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Kyung Ho Song
- Seoul National University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Ji-Hwan Bang
- Seoul Metropolitan Boramae Hospital, Dongjak-gu, Seoul-t’ukpyolsi, Republic of Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Sang Won Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Nam-Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea, Seoul, Seoul-t’ukpyolsi, Republic of Korea
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Ham SY, Jung H, Song KH, Moon SM, Kang CK, Kim NH, Park WB, Bang JH, Park SW, Kim NJ, Oh MD, Jeong SH, Kim HB, Kim ES. 1605. Differences in Clinical Characteristics of Third Generation Cephalosporin Resistance and Treatment Outcomes in Escherichia coli and Klebsiella pneumoniae Bacteremia in Patients with Liver Cirrhosis. Open Forum Infect Dis 2020. [PMCID: PMC7777603 DOI: 10.1093/ofid/ofaa439.1785] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background This study aimed to identify characteristics of third-generation cephalosporin (3GC) resistance in Escherichia coli bateremia (ECB) and Klebsiella pneumoniae bacteremia (KPB) in patients with liver cirrhosis (LC), and to investigate the effects of appropriateness of empirical antibiotic treatment on outcomes. Methods We retrospectively collected demographic, clinical and microbiological information on all ECB and KPB episodes in LC patients ≥ 18 years of age hospitalized to a tertiary-care teaching hospital in South Korea from 2007 to 2018. Clinical characteristics associated with 3GC resistance and treatment failure were analyzed using a multivariate logistic regression model. Treatment failure was defined as persistent bacteremia for ≥ 7 days, or relapsed bacteremia ≤ 30 days, or all-cause mortality ≤ 30 days. Results 3GC resistance rates of E. coli were 30.3% overall and increased significantly during the study period (P=0.001), while the rates of K. pneumoniae were not changed (24.3% overall) (P=0.994). Of total 356 ECB and KPB episodes, 112 were caused by 3GC resistant strains. The factor associated with 3GC resistance was isolation of 3GC resistant strain ≤ 1 year in both ECB (OR, 7.754; 95% CI, 2.094~28.716) and KPB (OR, 2.774; 1.318~5.838). In ECB, beta-lactam or fluoroquinolone treatment ≤ 30 days was another factor associated with 3GC resistance (OR, 2.774; 95% CI, 1.318~5.838), but not in KPB. The factor associated with treatment failure was high MELD score in both ECB (OR, 1.193 at 1 increase; 95% CI, 1.118~1.272) and KPB (OR, 1.163; 95% CI 1.083~1.250). Additionally, in ECB, non-alcoholic LC (OR 3.262; 95% CI 1.058~10.063), high Charlson Comorbidity Index (OR, 1.285; 95% CI 1.066~1.548), and inappropriate empirical antibiotic treatment (OR, 3.194; 95% CI 1.207~8.447) were associated with treatment failure. Conclusion During the study period, 3GC resistance increased in ECB, but not in KPB. In ECB, the severity of the underlying disease and the appropriateness of empirical antibiotics were associated with treatment failure, but there was no correlation in KPB. In ECB of LC patients, the appropriateness of empirical antibiotics was a factor associated with treatment outcome, and is the only correctable factor in the clinical setting. Disclosures All Authors: No reported disclosures
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Affiliation(s)
- Sin Young Ham
- Seoul National University Bundang Hospital, Seongnam, Kyonggi-do, Republic of Korea
| | - Hyungul Jung
- Korea CDC, Cheongju, Ch’ungch’ong-bukto, Republic of Korea
| | - Kyung Ho Song
- Seoul National University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Song Mi Moon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Nak-Hyun Kim
- Seoul National University Bundang Hospital, Seongnam, Kyonggi-do, Republic of Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Ji-Hwan Bang
- Seoul Metropolitan Boramae Hospital, Dongjak-gu, Seoul-t’ukpyolsi, Republic of Korea
| | - Sang Won Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Nam-Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Sook-Hyang Jeong
- Seoul National University Bundang Hospital, Seongnam, Kyonggi-do, Republic of Korea
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Eu Suk Kim
- Seoul National University Bundang Hospital, Seongnam, Kyonggi-do, Republic of Korea
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18
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Shin DH, Yoo SJ, Jung J, Jun KI, Kim H, Kang CK, Song KH, Choe PG, Park WB, Bang JH, Kim ES, Park SW, Kim HB, Kim NJ, Oh MD. 1147. Short Course of Voriconazole Therapy as a Risk Factor for Relapse of Invasive Pulmonary Aspergillosis. Open Forum Infect Dis 2020. [PMCID: PMC7777351 DOI: 10.1093/ofid/ofaa439.1333] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Invasive pulmonary aspergillosis (IPA) is a life-threatening opportunistic infection which usually occurs in immunocompromised patients. Recommended duration of voriconazole therapy is a minimum of 6-12 weeks for IPA, despite the lack of any firm evidence. In addition, risk factors for relapse of IPA are still unclear. Here, we explored risk factors for IPA relapse after initial treatment. Methods All patients with proven or probable IPA who had finished voriconazole treatment between 2005 and 2019 in a tertiary-care hospital were reviewed. IPA relapse was defined as re-diagnosis of proven or probable IPA at the same site within 1 year after treatment termination. Short course of voriconazole treatment was defined as a treatment less than 9 weeks, which is a median of the recommended minimum duration of therapy from the Infectious Disease Society of America. The radiological response was defined as a reduction in IPA burden by more than 50% on chest computed tomography (CT). Results Of 87 patients who had completed voriconazole treatment, 14 (16.1%) experienced IPA relapse. Multivariable Cox regression identified that short voriconazole treatment duration (adjusted hazard ratio [aHR], 3.7; 95% confidence interval [CI], 1.1–12.3; P=0.033) and radiological non-response (aHR, 4.6; 95% CI, 1.2–17.5; P=0.026) were independently associated with relapse of IPA after adjusting for several clinical risk factors. Conclusion Less improvement in CT, and short duration of voriconazole therapy were the independent risk factors for relapse after treatment of IPA. Longer duration of therapy should be considered for those at higher risk of relapse. Disclosures All Authors: No reported disclosures
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Affiliation(s)
- Dong Hoon Shin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Seung-Jin Yoo
- Seoul National University Hospital, Jongno-gu, Seoul-t’ukpyolsi, Republic of Korea
| | - Jongtak Jung
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongbuk-gu, Seoul-t’ukpyolsi, Republic of Korea
| | - Kang Il Jun
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Hyungjin Kim
- Seoul National University Hospital, Jongno-gu, Seoul-t’ukpyolsi, Republic of Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Kyung Ho Song
- Seoul National University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Pyoeng Gyun Choe
- Seoul National University Hospital, Jongno-gu, Seoul-t’ukpyolsi, Republic of Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Ji-Hwan Bang
- Seoul Metropolitan Boramae Hospital, Dongjak-gu, Seoul-t’ukpyolsi, Republic of Korea
| | - Eu Suk Kim
- Seoul National University Bundang Hospital, Bundang-gu, Kyonggi-do, Republic of Korea
| | - Sang Won Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Nam-Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea, Seoul, Seoul-t’ukpyolsi, Republic of Korea
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Choe PG, Kang CK, Suh HJ, Jung J, Kang E, Lee SY, Song KH, Kim HB, Kim NJ, Park WB, Kim ES, Oh MD. Antibody Responses to SARS-CoV-2 at 8 Weeks Postinfection in Asymptomatic Patients. Emerg Infect Dis 2020. [DOI: 10.3201/eid2610.20211] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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20
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Kim NJ, Choe PG, Park SJ, Lim J, Lee WJ, Kang CK, Park WB, Seong MW, Oh MD. A cluster of tertiary transmissions of 2019 novel coronavirus (SARS-CoV-2) in the community from infectors with common cold symptoms. Korean J Intern Med 2020; 35:758-764. [PMID: 32506866 PMCID: PMC7373952 DOI: 10.3904/kjim.2020.122] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/07/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND/AIMS As the global impact of the novel coronavirus disease 2019 (COVID-19) has been severe, many countries have intensified containment activities to eliminate virus transmission, through early detection and isolation strategies. To establish a proper quarantine strategy, it is essential to understand how easily the virus can spread in the communities. METHODS In this study, we collected detailed information on the circumstances in which human-to-human transmission occurred in the tertiary transmission cases of COVID-19 in the community. RESULTS On January 26, 2020, an imported case of COVID-19 was confirmed, and by February 10, 2020, one secondary transmission and three tertiary transmissions were identified. Secondary transmission occurred on the first day of illness of the infector, and his symptoms were suggestive of a common cold. The transmission occurred during a 90-minute long meal together in a restaurant. The people were sitting within one meter of each other, and had no direct contact. The tertiary transmission also occurred on the first-day illness of the other infector, and his only symptom was slight chills. The transmission occurred at a church during 2-hour-long worship, and two rows separated them. CONCLUSION Our findings suggest that mildly symptomatic patients with COVID-19 could transmit the virus from the first day of illness through daily activities in the community. Early detection and isolation of patients with COVID-19 may be challenging.
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Affiliation(s)
- Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Correspondence to Myoung-don Oh, M.D. Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea Tel: +82-2-2072-2945 Fax: +82-2-762-9662 E-mail:
| | - Sang-Joon Park
- Department of Internal Medicine, Myongji Hospital, Goyang, Korea
| | - Jaegyun Lim
- Department of Laboratory Medicine, Myongji Hospital, Goyang, Korea
| | - Wang Jun Lee
- Department of Surgery, Myongji Hospital, Goyang, Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Moon-Woo Seong
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Choe PG, Kang EK, Lee SY, Oh B, Im D, Lee HY, Jung H, Kang CK, Kim MS, Park WB, Choi EH, Cho B, Oh MD, Kim NJ. Selecting coronavirus disease 2019 patients with negligible risk of progression: early experience from non-hospital isolation facility in Korea. Korean J Intern Med 2020; 35:765-770. [PMID: 32460457 PMCID: PMC7373958 DOI: 10.3904/kjim.2020.159] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/26/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND/AIMS As the novel coronavirus (coronavirus disease 2019 [COVID-19]) outbreak progresses rapidly, staying home is recommended for suspected patients; however, the safety of this recommendation is uncertain. In Korea, non-hospital facilities called "living and treatment centers (LTCs)" have been established since 5 March 2020. The LTCs provided a unique opportunity to evaluate the safety of selection criteria for low-risk groups. METHODS Between 5 March and 9 April 2020, patients with COVID-19 who met the following criteria were admitted to the LTC; alert, age below 65 years old, no underlying disease or well-controlled underlying disease, body temperature below 38.0°C, whether taking antipyretics or not, and no dyspnea. Patients were closely observed by doctors or nurses' interviews twice a day and transferred to hospitals when symptoms worsened. RESULTS A total of 113 patients were admitted to the LTC; 52.2% were female, with a median age of 25 years (interquartile range, 21.5 to 39.5). Of 113 patients, 54 (47.8%) were asymptomatic at diagnosis, and 15 (13.3%) had no symptoms until they were released from isolation. During the follow-up period, two (1.8%) patients were transferred to a hospital but did not progress to severe status during hospitalization. CONCLUSION The risk of progression was negligible in COVID-19 patients who met the admission criteria for LTC at the time of diagnosis. LTCs could be a safe alternative considering shortage of hospital beds.
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Affiliation(s)
- Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Infection Control Office, Seoul National University Hospital, Seoul, Korea
| | - Eun Kyo Kang
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
| | - Sun Young Lee
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
| | - Boram Oh
- Infection Control Office, Seoul National University Hospital, Seoul, Korea
| | - Dahae Im
- Infection Control Office, Seoul National University Hospital, Seoul, Korea
| | - Hyo Yeon Lee
- Infection Control Office, Seoul National University Hospital, Seoul, Korea
| | - Hyemin Jung
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Min Sun Kim
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Infection Control Office, Seoul National University Hospital, Seoul, Korea
| | - Eun Hwa Choi
- Infection Control Office, Seoul National University Hospital, Seoul, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - BeLong Cho
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Infection Control Office, Seoul National University Hospital, Seoul, Korea
- Correspondence to Nam Joong Kim, M.D. Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: +82-2-2072-0835 Fax: +82-2-762-9662 E-mail:
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22
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Kang CK, Seong MW, Choi SJ, Kim TS, Choe PG, Song SH, Kim NJ, Park WB, Oh MD. In vitro activity of lopinavir/ritonavir and hydroxychloroquine against severe acute respiratory syndrome coronavirus 2 at concentrations achievable by usual doses. Korean J Intern Med 2020; 35:782-787. [PMID: 32460458 PMCID: PMC7373950 DOI: 10.3904/kjim.2020.157] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/04/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND/AIMS As the coronavirus disease-2019 global pandemic progresses, screening of antiviral agents effective against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is urgently needed. In addition, considering the viral load kinetics of SARS-CoV-2, which peaks early in the illness, and the massive burden of the disease, which may increase in the near future, identifying well-tolerated oral antivirals becomes increasingly important. We examined the in vitro activity of lopinavir/ritonavir and hydroxychloroquine on SARS-CoV-2, at concentrations which can be used to treat coronavirus-19 patients with little concern of toxicity. METHODS Lopinavir/ritonavir (7/1.75 μg/mL), hydroxychloroquine base (1 or 2 μg/mL), or a combination thereof were administered 1 hour after the inoculation of SARS-CoV-2 to Vero cells at a multiplicity of infection of 0.05. We examined cytopathic effects of virus 48 hours after administration of the respective treatments and measured viral loads at three time points (0, 24, and 48 hours post-treatment) by quantitative real-time reverse-transcription polymerase chain reaction, and compared the results obtained from the different antiviral regimens tested. RESULTS The severity of cytopathic effects was lower in lopinavir/ritonavir-treated cells, and viral load was significantly reduced in this group compared with the control group (p < 0.001). However, hydroxychloroquine did not show significant inhibitory effects on anti-SARS-CoV-2-mediated cytotoxicity or on viral load at either concentration. CONCLUSION Lopinavir/ritonavir showed significant inhibitory effects on SARS-CoV-2 in vitro at its usual plasma concentration. However, the in vitro antiviral activity of hydroxychloroquine at concentrations commonly used in humans was minimal, whether used alone or in combination with lopinavir/ritonavir.
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Affiliation(s)
- Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Moon-Woo Seong
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Su-Jin Choi
- Laboratory of Infection & Immunity, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Taek Soo Kim
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Hoon Song
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Nam-Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Correspondence to Wan Beom Park, M.D. Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: +82-2-2072-3596 Fax: +82-2-762-9662 E-mail:
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Seong JS, Kim H, Park WB, Kim NJ, Oh MD, Park SS, Park JS, Choi YM. Successful Pregnancy and Delivery with Intracytoplasmic Sperm Injection in HIV-Serodiscordant Couple: the First Case in Korea. J Korean Med Sci 2020; 35:e197. [PMID: 32597043 PMCID: PMC7324268 DOI: 10.3346/jkms.2020.35.e197] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 05/07/2020] [Indexed: 11/20/2022] Open
Abstract
With highly active antiretroviral therapy, human immunodeficiency virus (HIV) infection is considered to be a manageable chronic disease. The improved prognosis increases the desire of individuals with HIV to have biological offspring. With the establishment of washing protocol, no HIV transmission has been reported among more than 11,000 assisted reproduction technology (ART) cycles. Although the Acquired Immunodeficiency Syndrome Prevention Act in Korea prevents the use of HIV-infected blood, organs, tissues and semen, we recently obtained the authentic approval from the Korea Centers for Disease Control and Prevention for the practice of ART in HIV-serodiscordant couples. We report a 32-year-old HIV-seronegative female with her husband who was HIV-1 seropositive. After semen washing was performed by means of a density gradient and the swim-up technique, HIV-1 ribonucleic acid was not detected in the semen. An aliquot of processed semen was cryopreserved before ART. None of 3 cycles of intrauterine insemination was successful. After the third frozen-thawed embryo transfer following two cycles of intracytoplasmic sperm injection, an intrauterine singleton pregnancy was identified. She gave birth to a normal healthy male baby at full term by Cesarean section. She and her baby were tested for HIV during pregnancy and after delivery and the results were negative. Semen washing may be a safe ART method for HIV-serodiscordant couples who desire to have a baby in Korea.
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Affiliation(s)
- Ji Su Seong
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Hoon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Sup Park
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Joong Shin Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Young Min Choi
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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Chang E, Kim JH, Bang JH, Park WB, Kim ES, Park SW, Oh MD. Application of the severe fever with thrombocytopenia syndrome prediction score: Differentiation of febrile diseases using basic laboratory parameters. PLoS One 2020; 15:e0229920. [PMID: 32134948 PMCID: PMC7059982 DOI: 10.1371/journal.pone.0229920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/18/2020] [Indexed: 02/04/2023] Open
Abstract
Background The prolonged manifestation of concurrent leukopenia, thrombocytopenia and normal C-reactive protein (CRP) (named as SFTS prediction score) in febrile diseases is not usual and may be used to make an initial differential diagnosis, which is a characteristic finding of severe fever with thrombocytopenia syndrome (SFTS). Methods The dynamics of SFTS prediction scores was investigated in SFTS patients. The study subjects for the comparison were febrile patients aged ≥ 16 years with SFTS scores of 2 (S2) or 3 (S3) who visited an emergency room for a 4-year study period. The dynamic distribution of S2 and S3 at presentation with regards to onset of illness, the characteristics of responsible diseases and the predictability of SFTS in both groups were described. Results In 104 patients with SFTS, the daily proportion of S2 or S3 ranged from 58.3 to 100% from day (D) 1 to D12 after the onset of illness. The S2 subtype of ‘leukopenia plus thrombocytopenia’ and S3 represented 72.7–100% of all scores. In contrast, for the 130 patients in the febrile cohort, 73.8% of evaluations were distributed between D1 and D4 after the onset of illness, and 68.8% of patients had the S2 subtype of ‘leukopenia plus normal CRP’. Upper respiratory infection was the most frequent (50.0%) cause of diseases. Pneumonia (13.8%) and urosepsis (6.2%) initially presented with either S2 with normal CRP or S3 but had poor prognosis. The presence of S2 or S3 predicted SFTS with sensitivity and specificity of 0.85 (0.42–0.99; 95% CI) and 0.98 (0.98–0.98; 95% CI), respectively. Conclusion The temporal distribution and composition of S2 or S3 were unique in several febrile diseases including SFTS, and the SFTS prediction score may be useful for differentiating febrile diseases in primary care settings of SFTS endemic areas.
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Affiliation(s)
- Euijin Chang
- Department of Internal Medicine, Boramae Medical Center, Seoul, Republic of Korea
| | - Jeong-Han Kim
- Department of Internal Medicine, Boramae Medical Center, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Hwan Bang
- Department of Internal Medicine, Boramae Medical Center, Seoul, Republic of Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sang Won Park
- Department of Internal Medicine, Boramae Medical Center, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- * E-mail:
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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Il Jun K, Moon J, Soo Kim T, Kyung Kang C, Mi Moon S, Song KH, Gyun Choe P, Hwan Bang J, Won Park S, Suk Kim E, Kim NJ, Oh MD, Chu K, Beom Park W. 238. Direct identification of Bacterial Species with MinION Nanopore Sequencer In Clinical Specimens Suspected of Polybacterial Infection. Open Forum Infect Dis 2019. [PMCID: PMC6809971 DOI: 10.1093/ofid/ofz360.313] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Conventional culture tests usually identify only a few bacterial species, which can grow well in the culture system, in the cases of polybacterial infection. 16S rRNA gene nanopore sequencing enables semi-quantitative identification of bacterial genetic materials. We aimed to evaluate usefulness of 16s rRNA gene nanopore sequencing in the cases suspected of polybacterial infection. Methods The research was conducted in a single university hospital for one year. Conventional bacterial culture identification and nanopore sequencing of 16s rRNA gene were carried out simultaneously for cases where polybacterial infection is strongly suspected. Blood agar plate was used for conventional culture, and Microscan (Beckman Coulter, United States) and Vitek 2 (Biomerieux, FR) automated systems were used for identification. For nanopore sequencing, 16S rRNA gene PCR was performed from the clinical specimens, and sequencing libraries were generated from the PCR products using the rapid barcoding sequencing kit (Oxford nanopore technologies, UK). MinION sequencing was performed for 1–3 hours and the generated reads were analyzed using the EPI2ME 16S BLAST workflow. Results Specimens were obtained from 15 patients; 6 liver abscess, 2 psoas abscess, 2 thigh abcess, 1 paraspinal abscess, 1 mycotic aneurysm, 1 necrotizing fasciitis, 1 fingertip gangrene and 1 abscess in coccyx area. 16s rRNA gene nanopore sequencing showed monobacterial organism in 8 (53.3%) specimens and polybacterial organisms in 7 (46.6%) specimens. In three (37.5%) cases of 8 cases with monobacterial infections identified by 16s rRNA gene sequencing, no organism was grown in conventional culture, possibly due to previous antibiotic administration. Notably, among 8 cases with polybacterial infection by 16s rRNA gene nanopore sequencing test, traditional culture test showed polybacterial infection in only two (25%) cases and single bacterial organism was identified in the other 6 (75%) cases. Conclusion Nanopore sequencing of 16s rRNA gene using the MinION sequencer may be useful for identification of causing microorganism and differentiation between monobacterial and polybacterial infection when polybacterial infection is suspected. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Kang Il Jun
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Jangsup Moon
- Seoul National University Hospital, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Taek Soo Kim
- Seoul National University Hospital, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Song Mi Moon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Pyoeng Gyun Choe
- Seoul National University Hospital, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Ji Hwan Bang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Sang Won Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Nam-Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Kon Chu
- Seoul National University Hospital, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea, Seoul, Seoul-t’ukpyolsi, Republic of Korea
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Hoon Shin D, Il Jun K, Mi Moon S, Beom Park W, Hwan Bang J, Suk Kim E, Won Park S, Bin Kim H, Kim NJ, Kyung Kang C, Oh MD. 116. Risk Factors and Clinical Outcomes of Carbapenem Non-Susceptible Gram-Negative Bacteremia in Patients with Acute Myelogenous Leukemia. Open Forum Infect Dis 2019. [PMCID: PMC6809704 DOI: 10.1093/ofid/ofz360.191] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Early administration of susceptible antibiotics is crucial in Gram-negative bacteremia (GNB), especially in immunocompromised patients. We aimed to explore risk factors and clinical outcomes of carbapenem non-susceptible (Carba-NS) GNB in patients with acute myelogenous leukemia (AML). Methods Cases of all GNB during induction or consolidation chemotherapy for AML in a 15-year period in a tertiary hospital were retrospectively reviewed. Independent risk factors for Carba-NS GNB were sought and its clinical outcomes were compared with those of carbapenem susceptible (Carba-S) GNB. Results Among 485 GNB cases from 930 patients, 440 (91%) were Carba-S and 45 (9%) were Carba-NS GNB. Frequent Carba-NS isolates were Stenotrophomonas maltophilia (n = 23), Pseudomonas aeruginosa (n = 11), and Acinetobacter baumannii (n = 10). Independent risk factors for Carba-NS GNB were carbapenem use at the onset of GNB (aOR [95% CI], 78.6 [24.4–252.8]; P < 0.001), the isolation of imipenem-resistant A. baumannii in the prior 1 year (aOR [95% CI], 14.6 [2.7–79.9]; P = 0.002), time interval from chemotherapy to GNB ≥20 days (aOR [95% CI], 4.7 [1.7–13.1]; P = 0.003), and length of hospital stay ≥30 days (aOR [95% CI], 3.4 [1.3–9.1]; P = 0.013). Except breakthrough GNBs which occurred during carbapenem treatment, the frequency of Carba-NS GNB was 48% (19/40) in cases having ≥2 risk factors other than carbapenem use. 30-day overall mortality (Carba-NS, 36% vs. Carba-S, 6%; P < 0.001) and in-hospital mortality (Carba-NS, 47% vs. Carba-S, 9%; P < 0.001) were significantly higher in Carba-NS GNB. Conclusion Carba-NS GNB in AML patients was independently associated with the use of carbapenem, the past isolation of resistant organism, and late onset of GNB, and its clinical outcomes were poorer than those of Carba-S GNB. Carba-NS organisms should be considered for antibiotic selection in AML patients having these risk factors. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Dong Hoon Shin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Kang Il Jun
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Song Mi Moon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Ji Hwan Bang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Sang Won Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Hong Bin Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Kyonggi-do, Kyonggi-do, Republic of Korea
| | - Nam-Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
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Jin Chang E, Il Jun K, Mi Moon S, Beom Park W, Hwan Bang J, Suk Kim E, Won Park S, Bin Kim H, Kim NJ, Kyung Kang C, Oh MD. 273. Low Positive Predictive Value of β-d-Glucan in Hematology Patients Receiving Antimold Prophylaxis. Open Forum Infect Dis 2019. [PMCID: PMC6809573 DOI: 10.1093/ofid/ofz360.348] [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] [Indexed: 11/17/2022] Open
Abstract
Background Detection of β-D-glucan (BDG) in serum is recognized as the mycological evidence in the diagnosis of invasive fungal infection (IFI). However, its diagnostic value in low prevalence of IFI has not been elucidated. We aimed to examine the performance of BDG in hematology patients receiving antimold prophylaxis. Methods We retrospectively reviewed all BDG results performed for the purpose of diagnosis or surveillance for IFI in hematology patients receiving posaconazole or micafungin prophylaxis from January 2017 to February 2019 in a tertiary hospital. At least two consecutive positive results of BDG were regarded as positive BDG. All the episodes were classified into true-positive (TP, positive BDG with probable/proven IFI), true-negative (TN, negative BDG without probable/proven IFI), false-positive (FP, positive BDG without probable/proven IFI), false-negative (FN, negative BDG with probable/proven IFI), and nonevaluable (could not be determined for the occurrence of breakthrough IFI). When BDG test was performed in the setting of persistent fever ≥72 hours in spite of broad-spectrum antibiotics or with a suspicion of IFI, it was defined as a diagnostic BDG episode, while others were defined as a surveillance BDG episode. Results Of a total of 140 episodes, 24 episodes were non-evaluable. Among 116 evaluable episodes, 75 received induction chemotherapy for acute leukemia or myelodysplastic syndrome, 35 underwent stem cell transplantation, and 10 had intensive treatment for graft-vs.-host disease. There were three episodes of probable/proven IFI (2.6%). Ninety-one (78.4%) were performed with diagnostic purpose, while 25 (21.6%) were performed for surveillance. TP, TN, FP, and FN were 2 (1.7%), 91, 22, and 1, respectively. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value were 66.7%, 80.5%, 8.3% and 98.9%, respectively. PPV was 13.3% and 0% in diagnostic and surveillance BDG episodes, respectively. Conclusion The PPV of BDG was low in hematology patients receiving antimold prophylaxis, even in the diagnostic-driven episodes. The routine screening of BDG is not helpful, and the BDG test may be used for exclusion of IFI rather than for diagnosis in these patients. ![]()
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Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Eui Jin Chang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Kang Il Jun
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Song Mi Moon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Ji Hwan Bang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Sang Won Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Hong Bin Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Kyonggi-do, Republic of Korea
| | - Nam-Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
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Kim KH, Kim J, Ko M, Chun JY, Kim H, Kim S, Min JY, Park WB, Oh MD, Chung J. An anti-Gn glycoprotein antibody from a convalescent patient potently inhibits the infection of severe fever with thrombocytopenia syndrome virus. PLoS Pathog 2019; 15:e1007375. [PMID: 30707748 PMCID: PMC6380599 DOI: 10.1371/journal.ppat.1007375] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 02/19/2019] [Accepted: 01/14/2019] [Indexed: 11/19/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease localized to China, Japan, and Korea that is characterized by severe hemorrhage and a high fatality rate. Currently, no specific vaccine or treatment has been approved for this disease. To develop a therapeutic agent for SFTS, we isolated antibodies from a phage-displayed antibody library that was constructed from a patient who recovered from SFTS virus (SFTSV) infection. One antibody, designated as Ab10, was reactive to the Gn envelope glycoprotein of SFTSV and protected host cells and A129 mice from infection in both in vitro and in vivo experiments. Notably, Ab10 protected 80% of mice, even when injected 5 days after inoculation with a lethal dose of SFTSV. Using cross-linker assisted mass spectrometry and alanine scanning, we located the non-linear epitope of Ab10 on the Gn glycoprotein domain II and an unstructured stem region, suggesting that Ab10 may inhibit a conformational alteration that is critical for cell membrane fusion between the virus and host cell. Ab10 reacted to recombinant Gn glycoprotein in Gangwon/Korea/2012, HB28, and SD4 strains. Additionally, based on its epitope, we predict that Ab10 binds the Gn glycoprotein in 247 of 272 SFTSV isolates previously reported. Together, these data suggest that Ab10 has potential to be developed into a therapeutic agent that could protect against more than 90% of reported SFTSV isolates. Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease localized to China, Japan, and Korea. The tick-borne virus that causes SFTS has infected more than 5,000 humans, with a 6.4% to 20.9% fatality rate. Currently, there are no prophylactic or therapeutic measures against this virus. Historically, antibodies from patients who recovered from viral infection have been used to treat new patients, and commercially available antiviral monoclonal antibodies have been developed. Palivizumab was approved for the prophylaxis of respiratory syncytial virus (RSV) infection, and ibalizumab-uiyk was recently approved for the treatment of human immunodeficiency virus (HIV)-infected patients. To develop an antiviral monoclonal antibody for SFTS patients, we selected 10 antibodies from a patient who recovered from SFTS and found that one antibody potently inhibited SFTS viral infection both in vitro and in animal studies. We mapped the binding site of this antibody on the SFTS virus, which allowed us to predict that this antibody could bind 247 out of the 272 SFTS virus isolates reported to date. We anticipate that this antibody could be developed into a therapeutic treatment against SFTS.
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Affiliation(s)
- Ki Hyun Kim
- Department of Biochemistry and Molecular Biology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jinhee Kim
- Respiratory Virus Laboratory, Institut Pasteur Korea, Gyeonggi-do, Republic of Korea
| | - Meehyun Ko
- Respiratory Virus Laboratory, Institut Pasteur Korea, Gyeonggi-do, Republic of Korea
| | - June Young Chun
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyori Kim
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seungtaek Kim
- Zoonotic Virus Laboratory, Institut Pasteur Korea, Gyeonggi-do, Republic of Korea
| | - Ji-Young Min
- Respiratory Virus Laboratory, Institut Pasteur Korea, Gyeonggi-do, Republic of Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Junho Chung
- Department of Biochemistry and Molecular Biology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Republic of Korea
- * E-mail:
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Lee YH, Choe YJ, Cho SI, Bang JH, Oh MD, Lee JK. Increasing varicella incidence rates among children in the Republic of Korea: an age-period-cohort analysis. Epidemiol Infect 2019; 147:e245. [PMID: 31364576 PMCID: PMC6805734 DOI: 10.1017/s0950268819001389] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 08/20/2018] [Revised: 05/18/2019] [Accepted: 05/31/2019] [Indexed: 11/06/2022] Open
Abstract
In the Republic of Korea, despite the introduction of one-dose universal varicella vaccination in 2005 and achieving a high coverage rate of 98.9% in 2012, the incidence rate has been increased sevenfold. This study aimed to investigate time trends of varicella incidence rate, assessing the age, period and birth cohort effects. We used national data on the annual number of reported cases from 2006 to 2017. A log-linear Poisson regression model was used to estimate age-period-cohort effects on varicella incidence rate. From 2006 to 2017, the incidence of varicella increased from 22.5 cases to more than 154.8 cases per 100 000. Peak incidence has shifted from 4 to 6 years old. The estimated period and cohort effects showed significant upward patterns, with a linear increasing trend by net drift. There has been an increase in the incidence among the Korean population regarding period and cohort despite the universal vaccination of varicella vaccine. Our data suggest the need for additional studies to address the current gap in herd immunity.
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Affiliation(s)
- Young Hwa Lee
- Department of Epidemiology, Seoul National University School of Public Health, Seoul, Republic of Korea
| | - Young June Choe
- Division of Pediatric Infectious Diseases, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Sung-Il Cho
- Department of Epidemiology, Seoul National University School of Public Health, Seoul, Republic of Korea
| | - Ji Hwan Bang
- Division of Infectious Diseases, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jong-Koo Lee
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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Bak SL, Jun KI, Jung J, Kim JH, Kang CK, Park WB, Kim NJ, Oh MD. An Atypical Case of Middle East Respiratory Syndrome in a Returning Traveler to Korea from Kuwait, 2018. J Korean Med Sci 2018; 33:e348. [PMID: 30595687 PMCID: PMC6306328 DOI: 10.3346/jkms.2018.33.e348] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 11/29/2018] [Indexed: 01/13/2023] Open
Abstract
We report a case of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in a 61-year-old businessman returning from Kuwait. The patient arrived there on August 16, 2018, developed watery diarrhea on August 28 (day 0), and came back to Korea on September 7 (day 10) as his condition worsened. Upon arrival, he complained of diarrhea and weakness, but denied any respiratory symptoms, and he directly went to visit an emergency room. Chest radiography revealed interstitial infiltrates in the lungs, and he was immediately transferred to an isolation unit. Quantitative real-time PCR analysis of sputum samples taken on day 11 returned positive for MERS-CoV. No secondary MERS-CoV infection was identified among people who had close contact with him. This case underscores the importance of a high index of suspicion of MERS-CoV infection in any febrile patients who present after a trip to the Middle East.
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Affiliation(s)
- Song Lee Bak
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kang Il Jun
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jongtak Jung
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong-Han Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Nam-Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Lee YH, Bang JH, Park SM, Kang CR, Cho SI, Oh MD, Lee JK. Cost-Effectiveness of Voluntary HIV Testing Strategies in a Very Low-Prevalence Country, the Republic of Korea. J Korean Med Sci 2018; 33:e304. [PMID: 30416412 PMCID: PMC6221859 DOI: 10.3346/jkms.2018.33.e304] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/16/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The Republic of Korea has a very low prevalence of human immunodeficiency virus (HIV) infection, but the number of new HIV diagnoses has steadily risen, strongly indicating a large number of undetected HIV infections. Thus, it is important for Korean public health authorities to adopt and encourage cost-effective HIV detection tools, such as rapid HIV screening tests. In this study, we aimed to evaluate the cost-effectiveness of enzyme-linked immunosorbent assays (ELISA) and rapid tests in a public health center (PHC) setting. METHODS We developed a decision analytic model to assess the per-examinee cost and the cost-effectiveness of identifying HIV patients in a PHC setting using two HIV testing strategies: conventional HIV screening by ELISA versus rapid HIV testing. Analysis was performed in two scenarios: HIV testing in an average-risk population and in a high-risk population. RESULTS Compared to the ELISA, the rapid test was cost-saving and cost-effective. The per-examinee cost was USD 1.61 with rapid testing versus USD 3.38 with ELISA in an average-risk population, and USD 4.77 with rapid testing versus USD 7.62 with ELISA in a high-risk population. The cost of identifying a previously undiagnosed HIV case was USD 26,974 with rapid testing versus USD 42,237 with ELISA in an average-risk population, and USD 153 with rapid testing versus USD 183 with ELISA in a high-risk population. CONCLUSION Rapid testing would be more cost-effective than using conventional ELISA testing for identifying previously undiagnosed HIV-infected cases in Korea, a country with extremely low HIV prevalence.
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Affiliation(s)
- Young Hwa Lee
- Department of Epidemiology, Seoul National University Graduate School of Public Health, Seoul, Korea
| | - Ji Hwan Bang
- Division of Infectious Diseases, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sang Min Park
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Cho Ryok Kang
- Environmental Health Division, Seoul Metropolitan Government, Seoul, Korea
| | - Sung-Il Cho
- Department of Epidemiology, Seoul National University Graduate School of Public Health, Seoul, Korea
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jong-Koo Lee
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea
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Jung J, Lee E, Song KH, Choe PG, Park WB, Bang JH, Kim ES, Kim HB, Park SW, Kim NJ, Oh MD. Efficacy and Tolerability of Linezolid for Treatment of Infectious Spondylitis. ACTA ACUST UNITED AC 2018. [DOI: 10.3904/kjm.2018.93.5.464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Park WB, Jun KI, Kim G, Choi JP, Rhee JY, Cheon S, Lee CH, Park JS, Kim Y, Joh JS, Chin BS, Choe PG, Bang JH, Park SW, Kim NJ, Lim DG, Kim YS, Oh MD, Shin HS. Correlation between Pneumonia Severity and Pulmonary Complications in Middle East Respiratory Syndrome. J Korean Med Sci 2018; 33:e169. [PMID: 29892209 PMCID: PMC5990444 DOI: 10.3346/jkms.2018.33.e169] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 04/17/2018] [Indexed: 01/13/2023] Open
Abstract
This nationwide, prospective cohort study evaluated pulmonary function and radiological sequelae according to infection severity in 73 survivors from the 2015 Middle East respiratory syndrome (MERS) outbreak in Korea. Patients with severe pneumonia in MERS-coronavirus infection had more impaired pulmonary function than those with no or mild pneumonia at the 1-year follow-up, which was compatible with the radiological sequelae. Severe pneumonia significantly impairs pulmonary function and makes long radiological sequelae in MERS.
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Affiliation(s)
- Wan Beom Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kang Il Jun
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Gayeon Kim
- Center for Infectious Diseases, National Medical Center, Seoul, Korea
| | - Jae-Phil Choi
- Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
| | - Ji-Young Rhee
- Division of Infectious Disease, Department of Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Shinhyea Cheon
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Chang Hyun Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Jun-Sun Park
- Infectious Diseases Research Center, Research Institute, National Medical Center, Seoul, Korea
| | - Yeonjae Kim
- Center for Infectious Diseases, National Medical Center, Seoul, Korea
| | - Joon-Sung Joh
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Bum Sik Chin
- Center for Infectious Diseases, National Medical Center, Seoul, Korea
| | - Pyeong Gyun Choe
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Hwan Bang
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Won Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Gyun Lim
- Center for Infectious Diseases, National Medical Center, Seoul, Korea
| | - Yeon-Sook Kim
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyoung-Shik Shin
- Center for Infectious Diseases, National Medical Center, Seoul, Korea
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Oh MD, Park WB, Park SW, Choe PG, Bang JH, Song KH, Kim ES, Kim HB, Kim NJ. Middle East respiratory syndrome: what we learned from the 2015 outbreak in the Republic of Korea. Korean J Intern Med 2018; 33:233-246. [PMID: 29506344 PMCID: PMC5840604 DOI: 10.3904/kjim.2018.031] [Citation(s) in RCA: 148] [Impact Index Per Article: 24.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 02/13/2018] [Indexed: 02/07/2023] Open
Abstract
Middle East Respiratory Syndrome coronavirus (MERS-CoV) was first isolated from a patient with severe pneumonia in 2012. The 2015 Korea outbreak of MERSCoV involved 186 cases, including 38 fatalities. A total of 83% of transmission events were due to five superspreaders, and 44% of the 186 MERS cases were the patients who had been exposed in nosocomial transmission at 16 hospitals. The epidemic lasted for 2 months and the government quarantined 16,993 individuals for 14 days to control the outbreak. This outbreak provides a unique opportunity to fill the gap in our knowledge of MERS-CoV infection. Therefore, in this paper, we review the literature on epidemiology, virology, clinical features, and prevention of MERS-CoV, which were acquired from the 2015 Korea outbreak of MERSCoV.
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Affiliation(s)
- Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Won Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Hwan Bang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Kim JH, Kim TS, Song SH, Choi J, Han S, Kim DY, Kwon S, Lee E, Song KH, Choe PG, Bang JH, Kim ES, Park SW, Kim HB, Kim NJ, Park WB, Oh MD. Direct rapid antibiotic susceptibility test (dRAST) for blood culture and its potential usefulness in clinical practice. J Med Microbiol 2018; 67:325-331. [DOI: 10.1099/jmm.0.000678] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Jeong-Han Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Taek Soo Kim
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang Hoon Song
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | | | | | | | - Eunyoung Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Pyeong Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Hwan Bang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang Won Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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Lee MJ, Kim KH, Yi J, Choi SJ, Choe PG, Park WB, Kim NJ, Oh MD. In vitro antiviral activity of ribavirin against severe fever with thrombocytopenia syndrome virus. Korean J Intern Med 2017; 32:731-737. [PMID: 27899013 PMCID: PMC5511939 DOI: 10.3904/kjim.2016.109] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/20/2016] [Accepted: 07/08/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND/AIMS Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease caused by severe fever with thrombocytopenia syndrome virus (SFTSV), a novel bunyavirus. As yet, there is no effective antiviral therapy for SFTS. Ribavirin is a broad-spectrum antiviral agent, which has been tried for treatment of SFTS. In this study, antiviral activity of ribavirin against SFTSV has been investigated. METHODS Vero cell-grown SFTSV strain Gangwon/Korea/2012 was treated with ribavirin at various concentrations. Antiviral activity of ribavirin was evaluated by inhibition of the SFTSV cytopathic effect in Vero cells and quantification of viral RNA load in culture supernatant using one-step real-time reverse transcription polymerase chain reaction. Cytotoxicity of ribavirin was determined by a tetrazolium-based colorimetric method. RESULTS Ribavirin reduced SFTSV titers in a dose-dependent manner, with a half-maximal inhibitory concentration ranged from 3.69 to 8.72 μg/mL. Cytopathic effects were reduced as ribavirin concentration increased. No significant cytotoxicity was detected at ribavirin concentrations of ≤ 31.3 μg/mL. CONCLUSIONS Ribavirin exhibited inhibitory activity against SFTSV replication in vitro, which suggests that ribavirin can be used as a potential antiviral agent for SFTS.
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Affiliation(s)
- Myung Jin Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kye-Hyung Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jongyoun Yi
- Department of Laboratory Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Su Jin Choi
- Laboratory of Infection & Immunity, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Correspondence to Myoung-don Oh, M.D. Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: +82-2-2072-2945 Fax: +82-2-762-9662 E-mail:
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Keam B, Kim MK, Choi Y, Choi SJ, Choe PG, Lee KH, Kim TM, Kim TY, Oh DY, Kim DW, Im SA, Kim NJ, Heo DS, Park WB, Oh MD. Optimal timing of influenza vaccination during 3-week cytotoxic chemotherapy cycles. Cancer 2016; 123:841-848. [DOI: 10.1002/cncr.30468] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 08/11/2016] [Accepted: 08/15/2016] [Indexed: 01/04/2023]
Affiliation(s)
- Bhumsuk Keam
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Republic of Korea
- Cancer Research Institute; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Min-Kyung Kim
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Yunhee Choi
- Medical Research Collaborating Center; Seoul National University Hospital; Seoul Republic of Korea
| | - Su-Jin Choi
- Laboratory of Infection and Immunity, Biomedical Research Institute; Seoul National University Hospital; Seoul Republic of Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Kyung-Hun Lee
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Republic of Korea
- Cancer Research Institute; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Tae Min Kim
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Republic of Korea
- Cancer Research Institute; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Tae-Yong Kim
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Republic of Korea
- Cancer Research Institute; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Do-Youn Oh
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Republic of Korea
- Cancer Research Institute; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Dong-Wan Kim
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Republic of Korea
- Cancer Research Institute; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Seock-Ah Im
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Republic of Korea
- Cancer Research Institute; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Nam-Joong Kim
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Republic of Korea
- Laboratory of Infection and Immunity, Biomedical Research Institute; Seoul National University Hospital; Seoul Republic of Korea
| | - Dae Seog Heo
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Republic of Korea
- Cancer Research Institute; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Wan Beom Park
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Republic of Korea
- Laboratory of Infection and Immunity, Biomedical Research Institute; Seoul National University Hospital; Seoul Republic of Korea
| | - Myoung-don Oh
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Republic of Korea
- Laboratory of Infection and Immunity, Biomedical Research Institute; Seoul National University Hospital; Seoul Republic of Korea
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Seong MW, Kim SY, Corman VM, Kim TS, Cho SI, Kim MJ, Lee SJ, Lee JS, Seo SH, Ahn JS, Yu BS, Park N, Oh MD, Park WB, Lee JY, Kim G, Joh JS, Jeong I, Kim EC, Drosten C, Park SS. Microevolution of Outbreak-Associated Middle East Respiratory Syndrome Coronavirus, South Korea, 2015. Emerg Infect Dis 2016; 22:327-30. [PMID: 26814649 PMCID: PMC4734539 DOI: 10.3201/eid2202.151700] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
During the 2015 Middle East respiratory syndrome coronavirus outbreak in South Korea, we sequenced full viral genomes of strains isolated from 4 patients early and late during infection. Patients represented at least 4 generations of transmission. We found no evidence of changes in the evolutionary rate and no reason to suspect adaptive changes in viral proteins.
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Kim M, Song KH, Kim CJ, Song M, Choe PG, Park WB, Bang JH, Hwang H, Kim ES, Park SW, Kim NJ, Oh MD, Kim HB. Electronic Alerts with Automated Consultations Promote Appropriate Antimicrobial Prescriptions. PLoS One 2016; 11:e0160551. [PMID: 27532125 PMCID: PMC4988717 DOI: 10.1371/journal.pone.0160551] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 07/21/2016] [Indexed: 12/02/2022] Open
Abstract
Background To promote appropriate antimicrobial use in bloodstream infections (BSIs), we initiated an intervention program consisting of electronic alerts and automated infectious diseases consultations in which the identification and antimicrobial susceptibility test (ID/AST) results were reported. Methods We compared the appropriateness of antimicrobial prescriptions and clinical outcomes in BSIs before and after initiation of the program. Appropriateness was assessed in terms of effective therapy, optimal therapy, de-escalation therapy, and intravenous to oral switch therapy. Results There were 648 BSI episodes in the pre-program period and 678 in the program period. The proportion of effective, optimal, and de-escalation therapies assessed 24 hours after the reporting of the ID/AST results increased from 87.8% (95% confidence interval [CI] 85.5–90.5), 64.4% (95% CI 60.8–68.1), and 10.0% (95% CI 7.5–12.6) in the pre-program period, respectively, to 94.4% (95% CI 92.7–96.1), 81.4% (95% CI 78.4–84.3), and 18.6% (95% CI 15.3–21.9) in the program period, respectively. Kaplan-Meier analyses and log-rank tests revealed that the time to effective (p<0.001), optimal (p<0.001), and de-escalation (p = 0.017) therapies were significantly different in the two periods. Segmented linear regression analysis showed the increase in the proportion of effective (p = 0.015), optimal (p<0.001), and de-escalation (p = 0.010) therapies at 24 hours after reporting, immediately after program initiation. No significant baseline trends or changes in trends were identified. There were no significant differences in time to intravenous to oral switch therapy, length of stay, and 30-day mortality rate. Conclusion This novel form of stewardship program based on intervention by infectious disease specialists and information technology improved antimicrobial prescriptions in BSIs.
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Affiliation(s)
- Moonsuk Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- * E-mail:
| | - Chung-Jong Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Minkyo Song
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Hwan Bang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hee Hwang
- Center of Medical Informatics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang-Won Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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Jang HC, Park WB, Kim UJ, Chun JY, Choi SJ, Choe PG, Jung SI, Jee Y, Kim NJ, Choi EH, Oh MD. First Imported Case of Zika Virus Infection into Korea. J Korean Med Sci 2016; 31:1173-7. [PMID: 27366020 PMCID: PMC4901014 DOI: 10.3346/jkms.2016.31.7.1173] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 05/25/2016] [Indexed: 11/20/2022] Open
Abstract
Since Zika virus has been spreading rapidly in the Americas from 2015, the outbreak of Zika virus infection becomes a global health emergency because it can cause neurological complications and adverse fetal outcome including microcephaly. Here, we report clinical manifestations and virus isolation findings from a case of Zika virus infection imported from Brazil. The patient, 43-year-old Korean man, developed fever, myalgia, eyeball pain, and maculopapular rash, but not neurological manifestations. Zika virus was isolated from his semen, and reverse-transcriptase PCR was positive for the virus in the blood, urine, and saliva on the 7th day of the illness but was negative on the 21st day. He recovered spontaneously without any neurological complications. He is the first case of Zika virus infection in Korea imported from Brazil.
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Affiliation(s)
- Hee-Chang Jang
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Uh Jin Kim
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Korea
| | - June Young Chun
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Su-Jin Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sook-In Jung
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Korea
| | - Youngmee Jee
- Center for Pathology and Immunology, National Institute of Health, Korea Centers for Disease Control and Prevention, Osong, Korea
| | - Nam-Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Hwa Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Kang CI, Kim SH, Park WB, Lee KD, Kim HB, Kim EC, Oh MD, Choe KW. Clinical Epidemiology of Ciprofloxacin Resistance and Its Relationship to Broad-Spectrum Cephalosporin Resistance in Bloodstream Infections Caused by Enterobacter Species. Infect Control Hosp Epidemiol 2016; 26:88-92. [PMID: 15693414 DOI: 10.1086/502492] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 11/04/2022]
Abstract
AbstractObjectives:To evaluate the clinical features of ciprofloxacin-resistant Enterobacter bacteremia and to examine the risk factors for ciprofloxacin resistance in Enterobacter species isolates causing bacteremia.Design:A case-control study.Setting:A 1,500-bed, tertiary-care university hospital and referral center.Patients:All patients older than 16 years with Enterobacter species isolated from blood were enrolled. The medical records of 183 patients with clinically significant Enterobacter bacteremia from January 1998 to December 2002 were identified. We compared patients with bacteremia caused by ciprofloxacin-susceptible isolates with patients with bacteremia caused by ciprofloxacin-resistant isolates.Results:Twenty-three (12.6%) of the patients had bacteremia caused by isolates resistant to ciprofloxacin. There were no significant differences in age, gender, underlying diseases, primary site of infection, or Acute Physiology and Chronic Health Evaluation II score between the ciprofloxacin-resistant and the ciprofloxacin-susceptible groups. Broad-spectrum cephalosporin resistance, defined as resistance to cefotaxime or ceftazidime in vitro, was detected in 21 (91.3%) of 23 ciprofloxacin-resistant isolates compared with 65 (40.6%) of 160 ciprofloxacin-susceptible isolates (P < .001). Multivariate analysis revealed that independent risk factors for ciprofloxacin resistance were the prior receipt of fluoroquinolones (P < .001) and broad-spectrum cephalosporin resistance (P < .001).Conclusions:In Enterobacter species isolates causing bacteremia, ciprofloxacin resistance was closely associated with the prior receipt of fluoroquinolones and broad-spectrum cephalosporin resistance. The close relationship between ciprofloxacin resistance and broad-spectrum cephalosporin resistance is particularly troublesome because it severely restricts the therapeutic options for Enterobacter species infection.
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Affiliation(s)
- Cheol-In Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Kim CJ, Song JS, Choi SJ, Song KH, Choe PG, Park WB, Bang JH, Kim ES, Park SW, Kim HB, Kim NJ, Kim EC, Oh MD. Serotype Distribution and Antimicrobial Susceptibilities of Invasive Streptococcus pneumoniae Isolates from Adults in Korea from 1997 to 2012. J Korean Med Sci 2016; 31:715-23. [PMID: 27134492 PMCID: PMC4835596 DOI: 10.3346/jkms.2016.31.5.715] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 02/17/2016] [Indexed: 11/20/2022] Open
Abstract
In Republic of Korea, a 7-valent pneumococcal conjugated vaccine (PCV7) was licensed for use in infants in 2003, and 13-valent PCV (PCV13) replaced it since 2010. We investigated trends in serotype distribution and antibiotic susceptibility of pneumococcal isolates from adult patients with invasive pneumococcal diseases (IPD). Invasive pneumococcal isolates from adult patients of ≥ 16 years of age were collected from 1997 to 2012. Serotypes of the isolates were determined by the Quellung reaction. Distribution of serotypes was analyzed according to the vaccine types. Antibiotic susceptibility was tested by using E-test strips. A total of 272 invasive pneumococcal isolates were included. The most common serotypes were serotype 19F (8.5%, 23/272), and serotype 3 (8.1%, 22/272), and 24.6% (67/272) of the isolates were of non-vaccine serotypes. Of the 272 isolates, 2.6% (7/272) were penicillin MICs of ≥ 4 µg/mL. The proportion of the PCV13 serotypes decreased from 63.3% (50/79) in 1997-2003 to 48.6% (17/35) in 2011-2012, whereas that of non-vaccine serotypes was 26.6% (21/79) and 25.7% (9/35), respectively, for the same periods. The proportion of the PCV13 serotypes showed a decreasing trend among adult patients with IPD over the study period.
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Affiliation(s)
- Chung Jong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jin-Su Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Su-Jin Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kyoung Ho Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Pyeong Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Hwan Bang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Won Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Nam-Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Eui-Chong Kim
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Yoon D, Koo HL, Choe PG, Song KH, Park WB, Bang JH, Kim ES, Park SW, Kim HB, Oh MD, Kim NJ. The purpose and appropriateness of carbapenem use in a single university hospital, 2009–2013. Expert Rev Clin Pharmacol 2016; 9:863-5. [DOI: 10.1586/17512433.2016.1159129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Doran Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hei Lim Koo
- Infection Control Service, Seoul National University Hospital, Seoul, Republic of Korea
| | - Pyeong Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Infection Control Service, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Hwan Bang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang Won Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Infection Control Service, Seoul National University Hospital, Seoul, Republic of Korea
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Kang CR, Bang JH, Cho SI, Kim KN, Lee HJ, Ryu BY, Cho SK, Lee YH, Oh MD, Lee JK. Patients Presenting with Advanced Human Immunodeficiency Virus Disease: Epidemiological Features by Age Group. J Korean Med Sci 2016; 31:178-82. [PMID: 26839469 PMCID: PMC4729495 DOI: 10.3346/jkms.2016.31.2.178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 10/02/2015] [Indexed: 11/20/2022] Open
Abstract
We explored factors influencing presentation with advanced human immunodeficiency virus (HIV) disease by age group. Data were derived from a city-wide cross-sectional survey of 759 HIV-infected adults living in Seoul, Korea. The significance of each observed factor was assessed via multivariate logistic regression. Of subjects aged 20-34 years, lower educational level had a positive influence on presentation with advanced HIV disease (adjusted odds ratio [aOR], 2.43; 95% confidence interval [CI], 1.36-4.34); those recently diagnosed with HIV were more likely to be presented with advanced HIV disease (aOR, 3.17; 95% CI, 0.99-10.2). Of the subjects aged 35-49 years, those w ith advanced HIV disease were more likely to have been diagnosed during health check-ups (aOR, 2.91; 95% CI, 1.15-7.32) or via clinical manifestations (aOR, 3.61; 95% CI, 1.39-9.36). Of the subjects aged ≥ 50 years, presentation with advanced HIV disease was significantly more common in older subjects (aOR per increment of 5 years, 2.06; 95% CI, 1.32-3.23) and less common among individuals diagnosed with HIV in 2000-2006 (aOR, 0.18; 95% CI, 0.04-0.83). In conclusion, a lower educational level in younger subjects and more advanced age in older subjects positively influence the presentation of advanced HIV disease.
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Affiliation(s)
- Cho Ryok Kang
- Seoul Center for Infectious Disease Control, Seoul, Korea
- Institute of Endemic Diseases, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Hwan Bang
- Seoul Center for Infectious Disease Control, Seoul, Korea
- Division of Infectious Diseases, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sung-Il Cho
- Seoul Center for Infectious Disease Control, Seoul, Korea
- Department of Epidemiology, Seoul National University Graduate School of Public Health, Seoul, Korea
| | - Kui Nam Kim
- Division of Life & Health, Seoul Metropolitan Government, Seoul, Korea
| | - Hee-jin Lee
- Division of Life & Health, Seoul Metropolitan Government, Seoul, Korea
| | - Bo Yeong Ryu
- Seoul Center for Infectious Disease Control, Seoul, Korea
- Institute of Endemic Diseases, Seoul National University College of Medicine, Seoul, Korea
| | - Soo Kyung Cho
- Seoul Center for Infectious Disease Control, Seoul, Korea
- Institute of Endemic Diseases, Seoul National University College of Medicine, Seoul, Korea
| | - Young Hwa Lee
- Seoul Center for Infectious Disease Control, Seoul, Korea
- Department of Epidemiology, Seoul National University Graduate School of Public Health, Seoul, Korea
| | - Myoung-don Oh
- Seoul Center for Infectious Disease Control, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jong-Koo Lee
- Seoul Center for Infectious Disease Control, Seoul, Korea
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea
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45
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Park WB, Kwon NJ, Choe PG, Choi SJ, Oh HS, Lee SM, Chong H, Kim JI, Song KH, Bang JH, Kim ES, Kim HB, Park SW, Kim NJ, Oh MD. Isolation of Middle East Respiratory Syndrome Coronavirus from a Patient of the 2015 Korean Outbreak. J Korean Med Sci 2016; 31:315-20. [PMID: 26839489 PMCID: PMC4729515 DOI: 10.3346/jkms.2016.31.2.315] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 01/11/2016] [Indexed: 01/26/2023] Open
Abstract
During the 2015 outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) in Korea, 186 persons were infected, resulting in 38 fatalities. We isolated MERS-CoV from the oropharyngeal sample obtained from a patient of the outbreak. Cytopathic effects showing detachment and rounding of cells were observed in Vero cell cultures 3 days after inoculation of the sample. Spherical virus particles were observed by transmission electron microscopy. Full-length genome sequence of the virus isolate was obtained and phylogenetic analyses showed that it clustered with clade B of MERS-CoV.
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Affiliation(s)
- Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Laboratory of Infection & Immunity, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | | | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Su-Jin Choi
- Laboratory of Infection & Immunity, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Hong Sang Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Min Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | | | - Jong-Il Kim
- Department of Biochemistry and Molecular Biology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Hwan Bang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hong-Bin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Won Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Laboratory of Infection & Immunity, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Laboratory of Infection & Immunity, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
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Oh MD, Choe PG, Oh HS, Park WB, Lee SM, Park J, Lee SK, Song JS, Kim NJ. Middle East Respiratory Syndrome Coronavirus Superspreading Event Involving 81 Persons, Korea 2015. J Korean Med Sci 2015; 30:1701-5. [PMID: 26539018 PMCID: PMC4630490 DOI: 10.3346/jkms.2015.30.11.1701] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 10/05/2015] [Indexed: 11/29/2022] Open
Abstract
Since the first imported case of Middle East respiratory syndrome coronavirus (MERS-CoV) infection was reported on May 20, 2015 in Korea, there have been 186 laboratory-confirmed cases of MERS-CoV infection with 36 fatalities. Ninety-seven percent (181/186) of the cases had exposure to the health care facilities. We are reporting a superspreading event that transmitted MERS-CoV to 81 persons at a hospital emergency room (ER) during the Korean outbreak in 2015. The index case was a 35-yr-old man who had vigorous coughing while staying at the ER for 58 hr. As in severe acute respiratory syndrome outbreaks, superspreading events can cause a large outbreak of MERS in healthcare facilities with severe consequences. All healthcare facilities should establish and implement infection prevention and control measure as well as triage policies and procedures for early detection and isolation of suspected MERS-CoV cases.
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Affiliation(s)
- Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hong Sang Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Min Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jinkyeong Park
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Kook Lee
- Department of Internal Medicine, Good Morning Hospital, Pyeongtaek, Korea
| | - Jeong-Sup Song
- Department of Internal Medicine, Pyeongtaek St. Mary's Hospital, Pyeongtaek, Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Choe YJ, Jee Y, Oh MD, Lee JK. Measles Elimination Activities in the Western Pacific Region: Experience from the Republic of Korea. J Korean Med Sci 2015; 30 Suppl 2:S115-21. [PMID: 26617443 PMCID: PMC4659862 DOI: 10.3346/jkms.2015.30.s2.s115] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 10/12/2015] [Indexed: 12/05/2022] Open
Abstract
We describe the global status of measles control and elimination, including surveillance and vaccination coverage data provided by the World Health Organization (WHO). Since 2000, two doses of measles vaccine (MCV2) became recommended globally and the achievement of high vaccination coverage has led to dramatic decrease in the measles incidence. Our finding indicates that, in the Western Pacific Region (WPR), substantial progress has been made to control measles transmission in some countries; however, the measles virus continues to circulate, causing outbreaks. The Republic of Korea (ROK) experienced a series of resurgence of measles due to the importation and healthcare-associated transmission in infants, however overall incidence and surveillance indicators met the WHO criteria for measles elimination. The ROK was verified to be measles-free along with Australia, Mongolia, and Macau, China in 2014. One of the effective elimination activities was the establishment of solid keep-up vaccination system in school settings. The lessons learnt from the measles elimination activities in Korea may contribute to enhancing the surveillance schemes and strengthening of vaccination programs in member countries and areas of WPR.
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Affiliation(s)
- Young June Choe
- Department of Epidemiology, Seoul National University School of Public Health, Seoul, Korea
| | - Youngmee Jee
- Center for Immunology and Pathology, Korea National Institute of Health, Seoul, Korea
| | - Myoung-don Oh
- Department of Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jong-Koo Lee
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea
- JW Lee Center for Global Medicine, Seoul National University College of Medicine, Seoul, Korea
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Kim KH, Yi J, Oh WS, Kim NH, Choi SJ, Choe PG, Kim NJ, Lee JK, Oh MD. Human granulocytic anaplasmosis, South Korea, 2013. Emerg Infect Dis 2015; 20:1708-11. [PMID: 25271737 PMCID: PMC4193166 DOI: 10.3201/eid2010.131680] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report a patient with human granulocytic anaplasmosis in South Korea. The patient had fever and thrombocytopenia. Human granulocytic anaplasmosis was confirmed by seroconversion, PCR, and sequence analysis for Anaplasma phagocytophilum. Morulae were observed in the cultured HL-60 cells inoculated with blood from the patient.
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Park SW, Ha NY, Ryu B, Bang JH, Song H, Kim Y, Kim G, Oh MD, Cho NH, Lee JK. Urbanization of scrub typhus disease in South Korea. PLoS Negl Trop Dis 2015; 9:e0003814. [PMID: 26000454 PMCID: PMC4441427 DOI: 10.1371/journal.pntd.0003814] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 05/05/2015] [Indexed: 01/19/2023] Open
Abstract
Background Scrub typhus is an endemic disease in Asia. It has been a rural disease, but indigenous urban cases have been observed in Seoul, South Korea. Urban scrub typhus may have a significant impact because of the large population. Methods Indigenous urban scrub typhus was epidemiologically identified in Seoul, the largest metropolitan city in South Korea, using national notifiable disease data from 2010 to 2013. For detailed analysis of clinical features, patients from one hospital that reported the majority of cases were selected and compared to a historic control group. Chigger mites were prospectively collected in the city using a direct chigger mite-collecting trap, and identified using both phenotypic and 18S rDNA sequencing analyses. Their infection with Orientia tsutsugamushi was confirmed by sequencing the 56-kDa antigen gene. Results Eighty-eight cases of urban scrub typhus were determined in Seoul. The possible sites of infection were mountainous areas (56.8%), city parks (20.5%), the vicinity of one’s own residence (17.0%), and riversides (5.7%). Eighty-seven chigger mites were collected in Gwanak mountain, one of the suspected infection sites in southern Seoul, and seventy-six (87.4%) of them were identified as Helenicula miyagawai and eight (9.2%) as Leptotrombidium scutellare. Pooled DNA extracted from H. miyagawai mites yielded O. tsutsugamushi Boryong strain. Twenty-six patients from one hospital showed low APACHE II score (3.4 ± 2.7), low complication rate (3.8%), and no hypokalemia. Conclusions We identified the presence of indigenous urban scrub typhus in Seoul, and a subgroup of them had mild clinical features. The chigger mite H. miyagawai infected with O. tsutsugamushi within the city was found. In endemic area, urban scrub typhus needs to be considered as one of the differential febrile diseases and a target for prevention. Scrub typhus is one of the high burdened infectious diseases in endemic rural areas. Our study showed that the disease could be endemic in urban areas. Indigenous urban scrub typhus may also have significant impact in terms of a disease burden and differential diagnosis. A low rate of characteristic eschar and skin rash may make the clinical suspicion more troublesome. Scrub typhus is the 3rd most frequent notifiable infectious disease in South Korea. Seoul is a densely populated capital city located in northwestern South Korea. We epidemiologically identified indigenous urban cases. A subgroup of them showed mild clinical characteristics. Direct mite collection from a suspected infection site, Mt. Gwanak in Seoul, showed that Helenicula miyagawai (87.4%) and Leptotrombidium scutellare (9.2%) were the dominant species. In addition, O. tsutsugamushi-specific gene, tsa56, was identified in a fraction of the collected H. miyagawai. The 18S rDNA sequencing of the chigger mites was complementarily helpful for the differentiation of species. Our data are from one region, but urban scrub typhus is likely a scenario in endemic areas. Urban areas should be included as possible locations for scrub typhus.
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Affiliation(s)
- Sang-Won Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Boramae Medical Center, Seoul, Republic of Korea
| | - Na-Young Ha
- Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Biomedical Science, Seoul National University College of Medicine and Bundang Hospital, Seoul, Republic of Korea
| | - Boyeong Ryu
- Medical Research Center, Seoul National University College of Medicine, Seoul, Republic of Korea
- Seoul Center for Infectious Disease Control, Seoul, Republic of Korea
| | - Ji Hwan Bang
- Department of Internal Medicine, Boramae Medical Center, Seoul, Republic of Korea
- Seoul Center for Infectious Disease Control, Seoul, Republic of Korea
| | - Hoyeon Song
- Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Biomedical Science, Seoul National University College of Medicine and Bundang Hospital, Seoul, Republic of Korea
| | - Yuri Kim
- Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Biomedical Science, Seoul National University College of Medicine and Bundang Hospital, Seoul, Republic of Korea
| | - Gwanghun Kim
- Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Biomedical Science, Seoul National University College of Medicine and Bundang Hospital, Seoul, Republic of Korea
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Seoul Center for Infectious Disease Control, Seoul, Republic of Korea
| | - Nam-Hyuk Cho
- Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Biomedical Science, Seoul National University College of Medicine and Bundang Hospital, Seoul, Republic of Korea
- * E-mail: (NHC); (JkL)
| | - Jong-koo Lee
- Seoul Center for Infectious Disease Control, Seoul, Republic of Korea
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- * E-mail: (NHC); (JkL)
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Kim SH, Kang CI, Kim HB, Youn SS, Oh MD, Kim EC, Park SY, Kim BK, Choe KW. Outcomes of Hickman Catheter Salvage in Febrile Neutropenic Cancer Patients WithStaphylococcus aureusBacteremia. Infect Control Hosp Epidemiol 2015; 24:897-904. [PMID: 14700404 DOI: 10.1086/502157] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [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: 11/03/2022]
Abstract
AbstractObjective:To evaluate the outcome of attempted Hickman catheter salvage in neutropenic cancer patients withStaphylococcus aureusbacteremia who were not using antibiotic lock therapy.Design:Retrospective cohort study.Setting:A university-affiliated, tertiary-care hospital with 1,500 beds for adult patients.Patients:All neutropenic cancer patients who had a Hickman catheter andS. aureusbacteremia (32 episodes in 29 patients) between January 1998 and March 2002.Methods:Salvage attempts were defined as cases where the Hickman catheter was not removed until we obtained the results of follow-up blood cultures performed 48 to 72 hours after starting treatment with antistaphylococcal antibiotics. Salvage was considered to be successful if the Hickman catheter was still in place 3 months later without recurrent bacteremia or death.Results:Catheter salvage was attempted in 24 (75%) of the 32 episodes. Of the salvage attempts, the success rate was 50% (12 of 24). Salvage attempts were successful in 14% (1 of 7) of the episodes with positive follow-up blood cultures, and in 65% (11 of 17) of those with negative follow-up blood cultures (P= .07). If the analysis is confined to cases with no external signs of catheter infection, salvage attempts were successful in 14% (1 of 7) of the episodes with positive follow-up blood cultures and in 80% (8 of 10) of those with negative follow-up blood cultures (P= .02).Conclusion:In neutropenic cancer patients withS. aureusbacteremia, attempted catheter salvage without antibiotic lock therapy was successful in 50% of the cases.
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Affiliation(s)
- Sung-Han Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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