• Tuberculosis and Respiratory Diseases
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• 제65권6호
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• pp.527-531
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• 2008

저자들은 복부와 왼쪽 상박 및 손등에 발생한 궤양성피부결절을 주소로 내원하여 폐결핵과 파종성 피부 크립토콕쿠스증이 동시에 진단된 1예를 경험하였기에 이를 보고하는 바이다.

• Tuberculosis and Respiratory Diseases
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• 제78권4호
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• pp.450-454
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• 2015

Although tuberculosis is highly prevalent worldwide, congenital tuberculosis is one of the least common manifestations of the disease. The diagnosis is usually difficult because of the non-specific clinical presentation and the lack of awareness of maternal disease prior to pregnancy and delivery. We present the case of a preterm neonate with congenital tuberculosis, born to a previously healthy mother who had developed severe disseminated tuberculosis during her pregnancy. Once the diagnosis was confirmed in the mother, the congenital infection was confirmed by isolation of Mycobacterium tuberculosis in gastric aspirates, and positive polymerase chain reaction in a cerebrospinal fluid examination. Treatment for tuberculosis with a four-drug regimen resulted in an adequate clinical response in both the mother and infant.

• Tuberculosis and Respiratory Diseases
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• 제60권1호
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• pp.97-101
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• 2006

Coccidioidomycosis is a rare systemic fungal infection in Korea. However, the incidence of coccidioidomycosis has recently begun to increase due to the increasing incidence of people traveling overseas to endemic areas. In previously reported cases of coccidioidomycosis in Korea, the radiographic findings usually showed a solitary pulmonary nodule, pleural effusion, cavitation, and hilar lymphadenopathy, but no miliary nodules. We report a case of disseminated coccidioidomycosis with miliary nodules in an immunocompetent patient. A 32 year old male, who had traveled in Corona, New Mexico, USA, was admitted for an evaluation of persistent cough with fever. Chest radiography revealed initially diffuse multiple small nodules that appeared to be miliary tuberculosis. However, a subsequent evaluation revealed that he had disseminated coccidioidomycosis.

• Clinical and Experimental Pediatrics
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• 제61권11호
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• pp.366-370
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• 2018

Purpose: Tuberculosis (TB) is one of the most important diseases that cause significant mortality and morbidity in young children. Data on TB transmission from an infected child are limited. Herein, we report a case of disseminated TB in a child and conducted a contact investigation among exposed individuals. Methods: A 4-year-old child without Bacille Calmette-$Gu{\acute{e}}rin$ vaccination was diagnosed as having culture-proven disseminated TB. The child initially presented with symptoms of inflammatory bowel disease, and nosocomial and kindergarten exposures were reported. The exposed individuals to the index case were divided into 3 groups, namely household, nosocomial, or kindergarten contacts. Evaluation was performed following the Korean guidelines for TB. Kindergarten contacts were further divided into close or casual contacts. Chest radiography and tuberculin skin test or interferon-gamma-releasing assay were performed for the contacts. Results: We examined 327 individuals (3 household, 10 nosocomial, and 314 kindergarten contacts), of whom 18 (5.5%), the brother of the index patient, and 17 kindergarten children were diagnosed as having latent TB infection (LTBI). LTBI diagnosis was more frequent in the children who had close kindergarten contact with the index case (17.1% vs. 4.4%, P=0.007). None of the cases had active TB. Conclusion: This is the first reported case of TB transmission among young children from a pediatric patient with disseminated TB in Korea. TB should be emphasized as a possible cause of chronic diarrhea and failure to thrive in children. A national TB control policy has been actively applied to identify Korean children with LTBI.

• Journal of Korean Neurosurgical Society
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• 제51권5호
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• pp.316-319
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• 2012

A 24-year-old man presented with mental change, fever, abdominal pain, tenderness and palpable mass on the lower abdomen. He was a non-Korean engineer and did not accompany a legal guardian, so medical history taking was difficult due to his mental status. Brain magnetic resonance imaging showed multiple rim-enhanced lesions of the brain, and abdominal computed tomography showed huge paraspinal abscess. Chest X-ray and computed tomography showed poorly defined nodular opacities. We initially thought that this patient was infected with toxoplasmosis with typical cerebral image finding and immunoglobulin laboratory finding of cerebrospinal fluid and serum study. The abdominal abscess was confirmed as tuberculosis through the pathologic finding of caseous necrosis. We used anti-tuberculosis medication and anti-toxoplasmosis medication for almost 4 months, and then his clinical state and radiological findings were considerably improved.

• Tuberculosis and Respiratory Diseases
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• 제69권4호
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• pp.298-302
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• 2010

Scedosporium apiospermum, the anamorph of Pseudallescheria boydii, is a ubiquitous saprophytic fungus. S. apiospermum can cause life-threatening infections usually in immunocompromised patients or after near-drowning incidents. Here, we report the first case of disseminated infection caused by S. apiospermum after near-drowning in Korea. A 44-year-old healthy man developed aspiration pneumonia, followed by multiple brain abscesses, and endopthalmitis, after a near-drowning incident in a septic tank. S. apiospermum infection was diagnosed on the 33rd day after the incident had occurred. The patient died from the progressive renal failure 255 days after incident, although he had been treated with voriconazole.

• Tuberculosis and Respiratory Diseases
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• 제72권5호
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• pp.452-456
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• 2012

Disseminated Mycobacterium avium complex (MAC) infection can occur in immunocompromised patients, and rarely in immunocompetent subjects. Due to the extensive distribution of the disease, clinical presentation of disseminated MAC may mimic malignancies, and thorough examinations are required in order to make accurate diagnosis. We report a case of disseminated Mycobacterium intracellulare disease in an immunocompetent patient, which involved the lung, lymph nodes, spleen, and multiple bones. F-18 fluorodeoxyglucose positron-emission tomography imaging showed multiple hypermetabolic lesions, which are suggestive of typical hematogenous metastasis. However, there was no evidence of malignancy in serial biopsies, and M. intracellulare was repeatedly cultured from respiratory specimens and bones. Herein, we should know that disseminated infection can occur in the immunocompetent subjects, and it can mimic malignancies.

• Tuberculosis and Respiratory Diseases
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• 제58권1호
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• pp.11-17
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• 2005

연구배경 : 결핵의 발병에 유전적인 소인이 존재하며 숙주 면역 반응에 $IFN-{\gamma}$가 중요한 역할을 한다고 알려져 있다. 파종성 NTM 또는 BCG 감염증 환자에서 $IFN-{\gamma}$ 수용체 유전자 돌연변이가 밝혀져 있는데, 결핵 환자에서 $IFN-{\gamma}$ 수용체의 부분결핍 유무는 잘 알려져 있지 않았다. 방 법 : 2개 이상의 장기를 침범한 파종성 결핵 환자 6명을 대상으로 염기순서분석을 통해 $IFN-{\gamma}$ 수용체 1과 $IFN-{\gamma}$ 수용체 2의 부분결핍을 초래하는 유전자 이상이 있는지를 살펴보았다. 결 과 : $IFN-{\gamma}R1$의 부분결핍을 초래하는 I87T와 818delT 818del4, 818insA 그리고 $IFN-{\gamma}R2$의 부분결핍을 초래하는 R114C 돌연변이 등 기존에 보고된 유전자 이상은 발견되지 않았다. 결 론 : 본 연구의 대상인 6명의 파종성 결핵 환자에서 $IFN-{\gamma}$ 수용체의 부분결핍을 초래하는 유전자 이상은 발견되지 않았다.

• 대한의생명과학회지
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• 제23권2호
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• pp.89-95
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• 2017

Tuberculosis (TB), mainly disseminated by infection of the respiratory tract, remains an unsolved community health problem by Mycobacterium tuberculosis (MTB). However, because of the different susceptibility to MTB, people infected with MTB do not all develop TB. These differences of disease arise from individual genetic susceptibility as well as the property of the microorganisms itself. CD226, one of the genetic factors that influences TB, interact with its ligand PVR and ITGB2. It is induced various cellular responses that contribute multiple innate and adaptive responses. In a previous study, CD226 enhanced immune efficacy induced by Ag85A DNA vaccination that is secreted protein by MTB. The aim of this study was to investigate the association between six genetic polymorphisms of CD226 gene and TB status with Korean population. Our results show that two SNPs of CD226 were identified to associate with tuberculosis. The highest significant SNP was rs17081766 (OR=0.70, CI: 0.54~0.90, $P=5.4{\times}10^{-3}$). According to this study, polymorphisms of CD226 gene affect the outbreak of TB in MTB-infected patients. It is suggested that polymorphism of other genes also associated with immune responses results in susceptibility to TB. The results from this study suggest that not only the characteristics of the microorganism itself but also the genetic background of the individual may affect progression of TB in MTB-infected patients.

• Tuberculosis and Respiratory Diseases
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• 제52권5호
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• pp.497-505
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• 2002

연구배경 : 결핵의 방어면역에서 IFN-${\gamma}$는 매우 중요한 역할을 한다. IFN-${\gamma}$ 수용체의 완전결손이 있는 환자는 Mycobacterium 감염에 감수성이 높아서 매우 치명 적이다. 매우 드문 일부 Mycobacterium 감염에서 IFN-${\gamma}$ 수용체의 완전결손 외에 여러 종류의 부분결손들과 STAT1의 돌연변이들이 알려져 있다. 특히, IFN-${\gamma}$ 수용체의 부분결손이 있는 환자들의 경우 병리학적 소견파 임상적 경과가 일반적 결핵과 유사한 소견을 보이는 것으로 알려져 있다. 방 법 : 임상적 결핵환자에서 IFN-${\gamma}$ 수용체의 기능을 평가하여 대조군과 비교하였다. IFN-${\gamma}$ 수용체의 이상이 있을 가능성이 가장 높은 파종성 결핵환자의 DNA에서 앞서 발표된 증례들에서 확인된 IFN-${\gamma}$ 수용제와 STAT1의 유전적 이상을 확인하였다. 결 과 : 말초혈액 단핵구를 recombinant IFN-${\gamma}$ (100, 1000IU/ml)로 자극하였을 때 대조군과 환자군에 모두 HLA-DR과 CD64의 발현이 증가하였으나, 두 군간의 차이는 없었다. 대조군과 환자군에서 모두 LPS자극하였을 때 TNF-${\alpha}$의 생산이 증가하였으며 IFN-${\gamma}$로 전처치 후에 다시 LPS로 자극하였을 때 TNF-${\alpha}$의 생산은 더욱 더 증가하였다. 그러나, 두 군간의 통계적으로 유의한 차이는 없었다. 파종성 결핵 환자에서 기존에 알려진 IFNgR1과 STAT1의 돌연 변이를 확인하였을 때 특이한 이상소견을 발견할 수 없었다. 결 론 : 임상적 결핵에서 IFN-${\gamma}$ 수용체의 기능적 및 유전적 이상을 확인할 수 없었다. 기존의 연구에서 BCG와 NTM 감염과 관련 있는 것으로 알려진 IFN-${\gamma}$수용체의 이상 만으로는 임상적 결핵의 개체감수성을 설명할 수 없었다.