• Tuberculosis and Respiratory Diseases
• /
• v.63 no.6
• /
• pp.511-514
• /
• 2007

Mycoplasma pneumoniae is a common pathogen of community-acquired pneumonia. Mycoplasma pneumonia causes upper and lower respiratory tract symptoms in all age groups, with the highest attack rates in subjects 5 to 20 years old. In patients with mycoplasma pneumonia, the most common radiographic findings may be reticulonodular or interstitial infiltration, which have a predilection for the lower lobes. Findings that show lung collapse on a chest X-ray are very rare. We report a case of mycoplasma pneumonia that showed right upper lobe collapse.

• Tuberculosis and Respiratory Diseases
• /
• v.63 no.3
• /
• pp.273-277
• /
• 2007

70세 남자가 내원 7일전 발생한 우측 흉부 통증, 고열 및 가래를 동반한 기침으로 입원하였다. 백혈구와 CRP(C reactive protein)의 상승, 흉부 방사선 소견상 우하엽에 폐렴을 시사하는 소견이 관찰되어 지역 사회 획득성 폐렴에 준한 경험적 항생제를 투여하였다. 처음 두 번의 연속적인 가래 배양 검사에서 항생제 감수성이 있는 Acinetobacter baumannii균이 동정 되었으며 항생제 치료 후 임상 증상 및 방사선 소견이 점차 호전되었다. Acinetobacter baumannii는 중환자실에서 주로 발생하는 병원 획득성 폐렴의 주요 균으로 알려져 있으며 지역 사회 획득성 폐렴의 흔한 원인균은 아니다.

• Journal of Life Science
• /
• v.24 no.3
• /
• pp.318-322
• /
• 2014

Chlamydophila pneumonia is a common cause of community-acquired pneumonia throughout the world. It causes mild pneumonia or bronchitis in adolescents and young adults. Older adults may experience more severe disease and repeated infections. To the best of our knowledge, no study has attempted to investigate the prevalence of C. pneumonia in a closed community in Korea. We compared the infection rate of C. pneumonia among university dormitory residents using the miro-immunofluorescence (MIF) method. Antibody titers of IgG (1:32 or more) indicate past infection of C. pneumonia. A recent infection was defined as serum with a high titer of IgG (1:512 or more) or a positive IgM (1:16 or more). The past infection rate of C. pneumonia among the university dormitory residents was 71.7%. The recent infection rate of C. pneumonia according to IgG and IgM titers was 28.3% and 23.3%, respectively. The past infection positive rate according to the number of residence months was 1 month (50%), 7 months (71.4%), 13 months (66.7%), and 35 months (89.5%). The recent infection positive rate according to IgG antibody titers was 1 month (50%), 7 months (28.6%), 13 months (33.3%), and 35 months (10.5%). The recent infection rate of C. pneumonia according to IgM antibody titers was 1 month (41.7%), 7 months (28.6%), 13 months (26.7%), and 35 months (5.3%). The results suggest that the past infection rate of C. pneumonia is increased by the number of residence months in a closed community and that the recent infection rate of C. pneumonia according to IgG and IgM serological tests is decreased by the number of residence months.

• Tuberculosis and Respiratory Diseases
• /
• v.71 no.5
• /
• pp.335-340
• /
• 2011

Background: Community-acquired pneumonia (CAP) is an important cause of morbidity and mortality throughout the world in all age groups. Viral causes of CAP are less well characterized than bacterial causes. We analyzed the characteristics of hospitalized patients with CAP who had a viral pathogen detected by multiplex polymerase chain reaction (PCR). Methods: Multiplex real-time PCR was performed for respiratory viruses in samples collected from 520 adults who developed CAP at Chungnam National University Hospital. Clinical, laboratory, and radiological features at presentation as well as other epidemiological data were analyzed. Results: Of 520 patients with CAP, a viral pathogen was detected in 60 (11.5%), and influenza A was the most common. The virus detection rate in patients with CAP was highest in November. Two or more pathogens were detected in 13 (21.7%) patients. Seven patients had severe disease and were administered in the intensive care unit. Most patients (49/60, 81.7%) had comorbidities. However, nine (15%) patients had no comorbidities, and their age was <60 years. The ground glass opacity pattern was the most common radiological feature. Seven (11.7%) patients died from CAP. Conclusion: Viral pathogens are commonly detected in patients with CAP, and a respiratory virus may be associated with the severity and outcome of pneumonia. Careful attention should be paid to the viral etiology in adult patients with CAP.

• Tuberculosis and Respiratory Diseases
• /
• v.55 no.1
• /
• pp.59-68
• /
• 2003

Background : In intubated patients, cultures of endotracheal aspirates (EA) are apt to contamination throughout the endotracheal tube. Therefore, the identification of etiologic agents via conventional EA cultures is not always reliable. In order to differentiate a pulmonary infection from a non-infectious disease, and to identify the true etiologic agent of acute pulmonary infection, blinded protected specimen brushing (PSB) was used, and its efficacy evaluated. Methods : In 51 intubated patients, with suspected pneumonia, blind PSB were performed, and the results compared with blood and EA cultures. A protected specimen brush was introduced through the endotracheal tube, and settled at the affected large bronchus. A specimen brush was introduced to the expected region using the blind method. The tip of the brush was introduced with an aseptic technique after vigorously mixed for 1 minute in $1cm^3$ of Ringer's lactate solution. The specimens were submitted for quantitative culture within 15 minutes, with a culture being regarded as positive if the colony forming units were above $10^3/ml$. Results : Of the 51 patients, 15 (29.4%) had community-acquired pneumonia (CAP), 27 (52.9%) hospital-acquired pneumonia (HAP) and 9 (17.6%) non-infectious diseases. The sensitivity and specificity of the quantitative PSB culture for the diagnosis of pneumonia were 52.4 and 88.9%, respectively. The sensitivity and specificity of EA were 78.6 and 77.8%, respectively. The blind PSB was superior to the EA for the identification of true etiologic agents. Of 53 episodes of 27 HAP patients, MRSA (Methicillin-resistant staphylococcus aureus) (41.5%) was the most common causative agent followed by Pseudomonas aeruginosa (15.1%), Klebsiella sp. (7.5%) and Acinetobacter sp. (7.5%). Conclusions : As a simple, non-invasive diagnostic modality, the blind PSB is a useful method for the differentiation of a pulmonary infection from non-infectious diseases and to identify the etiologic agents in intubated patients. A blind PSB can be performed without bronchoscopy, so is safer, more convenient and cost-effectiveness for patients where bronchoscopy can not be performed.

• Tuberculosis and Respiratory Diseases
• /
• v.44 no.1
• /
• pp.114-123
• /
• 1997

Background : To assess the diagnostic role of bronchoscopic lavage for the evaluation of pneumonia in intensive care unit(ICU), the results were compared to blind endobronchial specimen. Method : From September 1993 to August 1996, twenty-eight ICU patients suspected pneumonia on the basis of clinical evidence and performed bronchoscopy under the diagnostic or therapeutic purpose were studied retrospectively for the clinical findings including culture of bronchoscopic and blind endobronchial specimen. Bronchoscopic specimen was got through small amount of bronchoalveolar lavage with 20-40ml saline, one or two times on the suspected site. Results : l. Main reasons of ICU admission were respiratory and impending respiratory failure Nosocomial pneumonia was most common with 16 cases; each for community acquired and immunocompromised type with 6 cases. Diagnostic purpose of bronchoscopy was performed in 20 cases as 71 percent in total, whereas therapeutic removal of secretion in 8 cases. The complication during bronchoscopic evaluation was trivial. 2. The agreement between blind endobronchial and bronchoscopic specimen on microbial culture was only 39.3 percent. However, 2 cases each for aspergillosis and tuberculosis were diagnosed under bronchoscopic evaluation. 3 The application of mechanical ventilation occured significantly frequently in multidrug resistant pneumonia compared with other pneumonia in terms of bronchoscopic specimen. 4. The application of mechanical ventilation was significantly common in nosocomial pneurmonia compared with other types of pneumonia. Conclusion : The selective bronchoalveolar lavage and therapeutic removal of bronchial secretion with bronchoscopy in ICU patient accompanying pneumonia is a very useful tool with safety. The multidrug resistant pneumonia or nosocomial pneumonia could be closely associated with the use of mechanical ventilation.

• Pediatric Infection and Vaccine
• /
• v.14 no.1
• /
• pp.69-74
• /
• 2007

Purpose : Human coronanviruses (hCovs) including hCoV-229E and hCoV-OC43 have been known as etiologic agents of the common colds and were regarded as clinically insignificant agents. However, recent identification of hCoV-NL63 and hCoV-HKU1 in children with lower respiratory tract infections has evoked the clinical concerns about their prevalence and the clinical significance of these hCoVs in children. This study was performed to investigate the prevalence of hCoVs in children with community-acquired pneumonia. Methods : From March 2006 to January 2007, nasopharyngeal specimens collected from children hospitalized with pneumonia, were tested for the presence of common respiratory viruses (respiratory syncytial virus, influenza A, influenza B, parainfluenza viruses, and adenovirus) using multiplex reverse transcriptase polymerase chain reaction (RT-PCR). Human metapneumovirus (hMPV) infection was excluded by nested RT-PCR using primers for the F-gene. To detect the different strains of hCoVs, nested RT-PCR assays specific for hCoVNL63, hCoV-OC43, hCoV-229E, and hCoV-HKU1 were performed. Results : Out of the 217 nasopharyngeal aspirate from children aged under 15 years, respiratory syncytial virus (RSV) was detected in 32 patients, hMPV in 18, human parainfluenza virus in 10, influenza virus A in 2, and adenovirus in 6. HCoVs were detected by RT-PCR in 8 (3.7%) of the 217 patients, hCoV-229E in 1, hCoV-NL63 in 3, and hCoVOC43 in 4 patients. HCoV-HKU1 was not detected in this study population. Conclusion : Recently identified hCoV-NL63 and hCoV-HKU1 seemed to have a little clinical significance in Korean children with severe or hospitalized community-acquired pneumonia.

• Tuberculosis and Respiratory Diseases
• /
• v.78 no.3
• /
• pp.232-238
• /
• 2015

Background: A relationship between low vitamin D levels and the development or outcomes of respiratory diseases has been identified. However, there is no data on the vitamin D status in patients with acute eosinophilic pneumonia (AEP). We evaluated the vitamin D status in patients with AEP among South Korean military personnel. Methods: We prospectively compared the serum levels of total 25-hydroxyvitamin D [25(OH)D], 25(OH)D3, and 25(OH)D2 among patients with AEP, pulmonary tuberculosis (PTB), and community-acquired pneumonia (CAP). Results: In total, 65 patients with respiratory diseases, including AEP (n=24), PTB (n=19), and CAP (n=22), were identified. Of the 24 patients with AEP, 2 (8%) had deficient total 25(OH)D levels (<10 ng/mL), 17 (71%) had insufficient total 25(OH)D levels (${\geq}10$ to <30 ng/mL), and only 5 (21%) had sufficient total 25(OH)D levels (${\geq}30$ to <100 ng/mL). The difference in the total 25(OH)D levels among patients with AEP, PTB, and CAP was not statistically significant (p=0.230). The median levels of total 25(OH)D, 25(OH)D3, and 25(OH)D2 were 22.84, 22.84, and 0.00 ng/mL, respectively, and no differences in the 25(OH)D level were present among patients with AEP, PTB, and CAP with the exception of the total 25(OH)D level between patients with AEP and PTB (p=0.042). Conclusion: We have shown that low vitamin D levels are frequently found in patients with AEP and are comparable with those in patients with PTB and CAP.

• Pediatric Infection and Vaccine
• /
• v.26 no.1
• /
• pp.71-79
• /
• 2019

Mycoplasma pneumoniae (MP) is the most common causative agent of community-acquired pneumonia in school-aged children. An 8-year-old boy who had been diagnosed with autism looked severely ill when he presented to our hospital due to dyspnea and lethargy. He had fever and cough 7 days prior to hospitalization. He had signs and symptoms of severe respiratory distress. The percutaneous oxygen saturation was 88% at high oxygen supply. Chest radiography showed diffusely increased opacity with moderate pleural effusion. He was intubated immediately and admitted to the intensive care unit. Under the clinical impression of mycoplasmal pneumonia, intravenous clarithromycin was started. Laboratory findings showed leukocytosis, hepatitis, decreased renal function, and presence of serum MP immunoglobulin (Ig) M (+) IgG (+) and sputum MP polymerase chain reaction (+). On hospital day 2, the patient developed multiple organ failure with acute respiratory distress syndrome (ARDS). Veno-venous extracorporeal membrane oxygenation (ECMO) was performed with continuous renal replacement therapy (CRRT) and was weaned successfully. This is the first reported case of an ARDS due to MP infection complicated by multiple organ failure that was successfully treated with ECMO and CRRT in South Korea.

• Tuberculosis and Respiratory Diseases
• /
• v.54 no.3
• /
• pp.295-303
• /
• 2003

Backgroung : The incidence of penicillin-resistant streptococcus pneumoniae(PRSP) accounts for almost 70% of all pneumococcal pneumonia cases in Korea. It is still unclear as to whether the efficacy of penicillin or equally active beta-lactam agents is compromised in PRSP pneumonia. This study investigated the prevalence of PRSP in community-acquired pneumonia and its clinical course. Methods : A total of 42 patients with community-acquired pneumococcal pneumonia were evaluated from July 1999 to May 2001. The cultured strains of Streptococcus pneumoniae were divided into susceptible, intermediately resistant, and resistant strains by an E-test, and the effect of the clinical course was investigated. Results : From a total of 42 patients, 22 (52.4%) patients had an intermediate resistance (MIC $0.1-1{\mu}g/m{\ell}$) and six (14.3%) showed a high resistance ($MIC{\geq}2.0{\mu}g/m{\ell}$) with current penicillin susceptibility categories. However, according to the classification of the DRSPTWG (Drug Resistant Streptococcus pneumoniae Therapeutic Working Group), there were 11 cases (26.2%) of intermediate resistance and no case of high resistance. Under empirical antimicrobial treatment, there was no difference in the clinical outcome between the penicillin susceptible and resistant group. Conclusion : The clinical outcome of PRSP pneumonia with empirical therapy was acceptable. These results suggest that the current MIC breakpoint for penicillin resistance in Streptococcus pneumoniae has been set at a very low level and penicillin resistance according to the NCCLS classification does not significantly influence the outcome of the empirical treatment for pneumococcal pneumonia.