• Journal of Korean Neurosurgical Society
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• v.53 no.5
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• pp.312-315
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• 2013

Aspergillosis in the central nervous system (CNS) is a very rare disease in immune-competent patients. There was a case of a healthy man without a history of immune-compromised disease who had invasive aspergillosis with unusual radiologic findings. A 48-year-old healthy man with diabetes mellitus, presented with complaints of blurred vision that persisted for one month. Brain magnetic resonance imaging (MRI) showed multiple nodular enhancing lesions on the right cerebral hemisphere. The diffusion image appeared in a high-signal intensity in these areas. Cerebrospinal fluid examination did not show any infection signs. An open biopsy was done and intraoperative findings showed grayish inflammatory and necrotic tissue without a definitive mass lesion. The pathologic result was a brain abscess caused by fungal infection, morphologically aspergillus. Antifungal agents (Amphotericin B, Ambisome and Voriconazole) were used for treatment for 3 months. The visual symptoms improved. There was no recurrence or abscess pocket, but the remaining focal enhanced lesions were visible in the right temporal and occipital area at a one year follow-up MRI. This immune-competent patient showed multiple enhancing CNS aspergillosis in the cerebral hemisphere, which had a good outcome with antifungal agents.

• Tuberculosis and Respiratory Diseases
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• v.45 no.1
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• pp.213-221
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• 1998

Pulmonary mucormycosis is an uncommon, but important opportunistic fungal infection associated with diabetes mellitus, leukemia, lymphoma and other immunocompromised states. Mucor species grow best in acidic-high glucose medium. which explaining the particular susceptibility of diabetic patient who are ketoacidic. Early consideration of this diagnosis, along with aggressive diagnostic evaluation, is critical to effective therapy and patient survival. We have experienced a case of pulmonary murcomycosis mimicking bilateral pulmonary edema on chest Xray that associated with diabetic ketoacidosis. A brief review of the literature was given.

• Archives of Plastic Surgery
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• v.49 no.3
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• pp.397-404
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• 2022

Background Excessive use of corticosteroids therapy along with gross immunocompromised conditions in the novel coronavirus disease 2019 (COVID-19) pandemic has raised the risks of contracting opportunistic fungal infections. Here, we describe our experience with the implementation of a surgical protocol to treat and reconstruct rhino-orbital-cerebral mucormycosis. Methods A retrospective review of our prospectively maintained database was conducted on consecutive patients diagnosed with mucormycosis undergoing immediate reconstruction utilizing our "Mucormycosis Management Protocol." All patients included in this study underwent reconstruction after recovering from COVID-19. Wide local excision was performed in all cases removing all suspected and edematous tissue. Reconstruction was done primarily after clear margins were achieved on clinical assessment under a cover of injectable liposomal amphotericin B. Results Fourteen patients were included. The average age was 43.6 years and follow-up was 24.3 days. Thirteen patients had been admitted for inpatient care of COVID-19. Steroid therapy was implemented for 2 weeks in 11 patients and for 3 weeks in 3 patients. Eight patients (57.1%) had a maxillectomy and mucosal lining resection with/without skin excision, and six patients (42.8%) underwent maxillectomy and wide tissue excision (maxillectomy and partial zygomatic resection, orbital exenteration, orbital floor resection, nose debridement, or skull base debridement). Anterolateral thigh (ALT) flaps were used to cover defects in all patients. All flaps survived. No major or minor complications occurred. No recurrence of mucormycosis was noted. Conclusion The approach presented in this study indicates that immediate reconstruction is safe and reliable in cases when appropriate tissue resection is accomplished. Further studies are required to verify the external validity of these findings.

• Tuberculosis and Respiratory Diseases
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• v.44 no.5
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• pp.1083-1093
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• 1997

Background : So far, there have been numerous reports on organ damage due to cryptococcosis, however, cases of lung localization have been infrequently reported. Recently pulmonary cryptococcosis has been reported more frequently than before due to enhanced diagnostic techniques and increased underlying diseases. Method : The author, therefore, analyzed the clinical manifestations of 5 cryptococcosis cases that we experienced at Hanyang University Hospital from 1985 to 1996 and 9 cases reported in Korea from 1984 and 1996 retrospectively. The following results were obtained. Results : Cryptococcosis occurred frequently over sixth decade and the male to female ratio was 3.6 : 1. Underlying diseases included acute rejection after kidney transplantation, rheumatoid arthritis, autoimmune hepatitis, diabetes mellitus and state of bilateral adrenalectomy. Remaining 8 cases had no evidence of an underlying disease. Because the symptoms were subacute & nonspecific, and not improved by conventional antibiotics, 6 patients of 14 pulmonary cryptococcosis patients were treated as pulmonary tuberculosis before correct diagnosis was made. There were three asymptomatic cases. According to the results of CXR, solitary alveolar consolidation was the most common finding(8 cases) followed by diffuse infiltration(5 cases). It also showed pleural effusion, hilar lymphadenopathy and cavity formation that was rarely reported in world literature. The diagnasis was made through fine needle aspiration biopsy in 10 cases, open thoracotomy in 2 cases, transbronchial lung biopsy in 1 case. and thoracentesis with pleural biopsy in 1 case. Only one case showed positive result in sputum stain and culture, serum latex agglutination test for cryptococcus neoformans. Treatment modalities were various such as fluconazole, amphotericin B, flucytosine, ketoconazole, surgery and it's combination. After 1990 year, there was a trend that fluconazole or ketoconazole are more used than other therapeutic modalities. Conclusion : Because the symptoms are subacute & nonspecific and not improved by conventional antibiotics, pulmonary cryptococcosis is likely to misdiagnosis as pulmonary tuberculosis in Korea. Because the diagnosic yield of sputum stain, culture and serologic test for pulmonary cryptococcosis is low, histologic diagnosis is need in most pulmonary cryptococcosis.

• Journal of Microbiology and Biotechnology
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• v.30 no.5
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• pp.689-699
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• 2020

Brevibacillus brevis GZDF3 is a gram-positive, plant growth-promoting rhizosphere bacterium (PGPR) isolated from the rhizosphere soil of Pinellia ternata (an important herb in traditional Chinese medicine). The GZDF3 strain produces certain active compounds, such as siderophores, which are the final metabolite products of non-ribosomal peptide synthetase (NRPS) and independent non-ribosomal peptide synthetase (NIS) activity. With the present study, we attempted to investigate the siderophore production characteristics and conditions of Bacillus sp. GZDF3. The antibacterial activity of the siderophores on pathogenic fungi was also investigated. Optimal conditions for the synthesis of siderophores were determined by single factor method, using sucrose 15 g/l, asparagine 2 g/l, 32℃, and 48 h. The optimized sucrose asparagine medium significantly increased the production of siderophores, from 27.09% to 54.99%. Moreover, the effects of different kinds of metal ions on siderophore production were explored here. We found that Fe³⁺ and Cu²⁺ significantly inhibited the synthesis of siderophores. The preliminary separation and purification of siderophores by immobilized-metal affinity chromatography (IMAC) provides strong antibacterial activity against Candida albicans. The synergistic effect of siderophores and amphotericin B was also demonstrated. Our results have shown that the GZDF3 strain could produce a large amount of siderophores with strong antagonistic activity, which is helpful in the development of new biological control agents.

• Journal of Periodontal and Implant Science
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• v.28 no.1
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• pp.17-35
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• 1998

Chitosan, with a chemical structure similar to hyaluronic acid, has been implicated as a wound healing agent. The purpose of this research was to evaluate the effects of chitosan on the characteristics of periodontal ligament cells, calvaria cells and gingival fibroblasts and to define the effects of chitosan on bone formation in vitro. In control group, the cells were cultured alone with Dulbecco's Modified Eagle's Medium contained with 10% Fetal bovine serum, 100unit/ml penicillin, $100{\mu}g/ml$ streptomycin, $0.5{\mu}g/ml$ amphotericin-B. In experimental group, chitosan($40{\mu}g/ml$) is added into the above culture condition. And then each group was characterized by examining the cell proliferation at 1,3,5,7,9,12,15 day, the amount of total protein synthesis, alkaline phosphatase activity at 3, 7 day and the ability to produce mineralized nodules of rat calvaria cell at 11 day. The results were as follows : 1. At early time both periodontal ligament cells and calvaria cells in chitosan-treated group proliferated more rapidly than in non-treated control group, but chitosan-treated group of periodontal ligament cells at 9 days and calvaria cells at 12days showed lower growth rate than control group. Gingival fibroblast in chitosan-treated group had lower growth rate than in control group but the difference was not statistically significant (P< 0.01).2. Both periodontal ligament cells and calvaria cells in chitosan-treated group showed much protein synthesis than in control group at 3 days, but showed fewer than in control group at 7 days. Amount of total protein synthesis of gingival fibroblast didn't have statistically significant difference among the two groups(P< 0.01). 3. At 3 and 7 days, alkaline phosphatase activity of periodontal ligament cells and calvaria cells was increased in chitosan-treated group, but at 7 days there was not statistically significant difference among the two groups of calvaria cells (P< 0.01). Alkaline phosphatase activity of gingival fibroblast didn't have statistically significant difference among the two groups(P<0.01). 4. Mineralized nodules in chitosan-treated group of rat calvaria cells were more than in control group. In summery, chitosan had an effect on the proliferation, protein systhesis, alkaline phosphatase activity of periodontal ligament cells and calvaria cells, and facilitated the formation of bone. It is thought that these effects can be used clinically in periodontal regeneration therapy.

• Journal of Periodontal and Implant Science
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• v.28 no.2
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• pp.291-310
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• 1998

This study was performed to evaluate the effects of extracts of Drynariae Rhizoma on the characteristics of rat calvaria cells(RCV) and bone marrow cells(RBM) which have the important role on the bone formation in vitro. Drynariae Rhizoma has been known as the useful herbal medicament for treatment of the wound healing including regeneration of bone fracture, and also has been used to treat the periodontal lesions, tooth mobility, gingival bleeding and pus discharge via sulcus in Oriental Medicine. In control group, the cells were cultured alone with Dulbeco's Modified Eagle's Medium contained with 10% fetal bovine serum, 100U/ml penicillin, $100{\mu}g/ml$ streptomycin, $0.5{\mu}g/ml$ amphotericin-B. In experimental group, extracts of Drynariae Rhizoma(0.1, 1, 5, 10, $50{\mu}g/ml$) were added into the above culture condition. And then each group was characterized by examing the cell proliferation at 1, 3, 7, 14, 21, 30th day, the amount of total protein synthesis and alkaline phosphatase activity of RCV at 2,4th day and those of RBM at 3, 6th day. And also, the calcified nodule of RCV was examed at 3, 5th day in three goup, control, experimental, culture with the PDGF group. The results were as follow ; 1. Both RCV and RBM cells in Drynariae Rhizoma-treated experimental group proliferated more rapidly than nontreated control group. The experimental group below $5{\mu}g/ml$ Drynariae Rhizoma-treated showed more prominent cell proliferation from the 7th day to the 21st day than the control group and above $10\;{\mu}g/ml$ treated group in RCV. 2. Amount of total protein synthesis was more increased in Drynariae Rhizomatreated group than in control group. In $5{\mu}g/ml$ Drynariae Rhizoma-treated group showed most prominent protein synthesis of the any other exrperimental group and control group. 3. Alkaline phosphatase activity also more increased in Drynariae Rhizomatreated group than control group. 4. Mineralized nodules in Drynariae Rhizoma-treated group were more than not in control group but also in PDGF-treated group. From the above results, Drynariae Rhizoma appeared to enhanced the proliferation, protein synthesis, alkaline phosphatase activity and cellular ability of mineralized nodule formation than PDGF. So that, we conclude that Drynariae Rhizoma enhances the activities of bone cells which have the important role on the periodontal regeneration and optimal application of Drynariae Rhizoma was thought to be useful as the means in bone regeneration.

• Tuberculosis and Respiratory Diseases
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• v.45 no.1
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• pp.197-203
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• 1998

Invasive pulmonary aspergillosis is a disease occuring predominantly in patients with defects in immunity such as neutropenia, hematologic malignancies or with defects in cell-mediated immunity. The isolation of Aspergillus from respiratory tract of normal host usually signifies tracheobronchial colonization, making this diagnosis difficult. There are isolated case reports occuring in normal hosts but most of them were diagnosed postmortem at autopsies indicating that early diagnosis of invasive aspergillosis in normal host is difficult. We describe here a case of invasive aspergillosis in a immunocompetent host diagnosed by lung biopsy which was successfully treated with Amphotericin-B. Invasive pulmonary aspergillosis should be included as one of the differential diagnosis if a patient with pneumonic consolidation does not respond to usual therapy, even if the patient does not have any defect in immunity.

• Journal of Yeungnam Medical Science
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• v.27 no.2
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• pp.113-121
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• 2010

Background and purpose : Patients with acute leukemia experience prolonged periods of neutropenia due to their disease or its treatment. For this reason, they often develop serious infectious complications. Although antibiotic therapy has improved in recent years, the fatality rate from infection remains high. For the control of infection, protected environment was developed. But because of economic issue, most of chemotherapy with acute myeloid leukemia have conducted in non-protected environment. So this study compared the rate of complete remission, days with neutropenia, rate of fever, rate of positive culture, rate of overt infection and use of antibacterial and antifungal agents with patients within non-protected environment and protected environment, retrospectively, Patients with acute myeloid leukemia during first remission induction chemotherapy were eligible for this study, Methods : Retrospective analysis was conducted between patients in non-protected (25 patients) and protected environment (14 patients) with acute myeloid leukemia during remission induction chemotherapy Results : Rate of overt infection, rate of fever, rate of positive culture and rate of use of antibiotics were significantly high in patients within non-protected environment compared with patients within protected environment. There were no differences in rate of complete remission and days of neutropenia Conclusions : This study suggests protected environment for patients with acute myeloid leukemia during remission induction chemotherapy could reduce rate of overt infection, and rate of use of antibiotics.

• Clinical and Experimental Pediatrics
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• v.45 no.7
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• pp.847-854
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• 2002

Purpose : Long term hospitalized infants in neonatal intensive care units(NICUs) are prone to systemic infection. It is important to differentiate systemic candidiasis from systemic bacterial infection early in the course. Thus, in this study, we have compared clinical characteristics of systemic candidiasis and systemic bacterial infection, in premature low birth weight infants. Methods : Retrospective chart review of the medical records of 20 patients with systemic candidiasis and 23 patients with systemic bacterial infection was performed. Results : Among the risk factors of systemic candidiasis, total parenteral nutrition(TPN), the use of broad spectrum antibiotics, central catheter insertion, endotracheal intubation and the use of H2 blockers were more frequent in neonates with systemic candidiasis than neonates with systemic bacterial infection. Apnea with bradycardia developed more frequently in neonates with systemic candidiasis compared with systemic bacterial infection(75% vs 39%). In laboratory findings at symptom onset, seven cases(35%) of systemic candidal infections and two cases(9%) of systemic bacterial infections showed leukopenia and thrombocytopenia(P=0.03). Blood was the most frequent isolation site of candida and bacteria. Conclusion : In neonates with systemic candidiasis, apnea with bradycardia, pneumonia and thrombocytopenia were prone to develop more frequently. The use of TPN, antibiotics and central catheters was strongly associated with systemic candidiasis. Empirical treatment with antifungal agent should be considered in critically ill neonates with above findings.