• Title/Summary/Keyword: Occult infection

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Urinalysis: The Usefulness and Limitations of Urine Dipstick Testing (요검사: 요시험지봉 검사의 유용성과 한계)

  • Han, Tae Hee
    • Childhood Kidney Diseases
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    • v.17 no.2
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    • pp.42-48
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    • 2013
  • The urinalysis is an essential part of the diagnostic work-up for kidney disease and other renal system disorders. The dipstick test allows rapid and simultaneous chemical analyses of urine, including factors such as pH, specific gravity, protein, glucose, ketones, occult blood, bilirubin, urobilinogen, nitrite, and leukocyte-esterase. The chemical reactions on dipstick are complicated and can be affected by oxidizing, reducing, and discoloring substances in the urine. Therefore, false positive and false negative results are common in dipstick testing. To obtain reliable results with the dipstick, it is necessary to collect urine cleanly and examine the urine carefully. It is mandatory to clearly understand the principles of dipstick testing to evaluate abnormal findings. If the urine dipstick results suggest hematuria, proteinuria, or urinary tract infection, microscopy of the urine should be performed to confirm the findings.

A Case of Canine Babesia spp. Infection (Caine Babesia spp. 감염증예)

  • Chae Joon-Seak;Ihn Dong-Chul;Han Jae-Chul;Kim Nam-Soo;Lee Joo-Muk;Choi In-Hyuk
    • Journal of Veterinary Clinics
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    • v.6 no.1
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    • pp.185-191
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    • 1989
  • A dog which was hospitalized to Veterinary Teaching Hospital, College of Veterinary Medicine, Jeonbug National University on December 28, 1988 was revealed severe anemia: hemoglobinuria and weakness. In the inspections, abdominal pain and spleno megaly at the ventral abdomen were detected by palpations. In the examinations of blood, the obtained results were summarized as follows: Babesla spp. was identified on the blood smear stained with Giemsa. The Babesia spp. was assumed to the Babesia gibsoni for the their small size and pleomorphism such as comma form, ring form and dot form. In the blood examinations of the patient, Ht: 22.5%, RBC:354${\times}$10$^4$/${\mu}\ell$, Hb: 8.8g/dl, serum protein: 8g/dl, and WBC count was 21, 425/${\mu}\ell$. In the chemical examinations of serum, the value of AST(GOT) was 30iu and ALT(GPT) was 20iu, respectively. The blood sugar was 60mg/d1. In the urine test, urine protein was 30mg/d1 and the hemoglobin In the urine was the +++ and occult blood reaction(Benzidine test) in the feces was +++. Splenomegaly was confirmed by X-ray examination. To confirm for the Babesia spp. infection, 5ml of the whole blood of the patient(3% of Parasitized erythrocytes) were inoculated into the cephalic vein of the two normal dogs. In the blood of experimental dogs which were inoculated parasitized blood, Babesia spp. was detected in the two doss and pleomorphic parasites were observed, too. In the blood examinations of No. 1 the Ht and RBC were decreased to 6.8% and 52${\times}$10$^4$/${\mu}\ell$, respectively. WBC count was 10.600/${\mu}\ell$ and serum protein was 6.8g/dl. The rates of parasitized erythrocytes were 15% in the experimental dog. Also +++ of the hemoglobin was detected in the urine. In the X-ray examination, splenomegaly was comfirmed and it was confirmed by autopsy of the experimental dog(No. 1).

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Clinical Characteristics of Rhabdomyolysis in Children : Single Center Experience

  • Park, Yesul;Song, Ji Yeon;Kim, Su Young;Kim, Seong Heon
    • Childhood Kidney Diseases
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    • v.22 no.2
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    • pp.52-57
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    • 2018
  • Purpose: Rhabdomyolysis is a metabolic disorder in which the content of damaged muscle cells is released into plasma. Its manifestations include asymptomatic, myalgia, gross hematuria, and complications of acute kidney injury. Because of limited data on rhabdomyolysis in children, we performed this study to determine clinical characteristics of rhabdomyolysis in children. Methods: We retrospectively reviewed the records of patients with rhabdomyolysis who were treated at the Pusan National University Children's hospital from January 2011 to July 2016. The diagnostic criteria were serum myoglobin level of ${\geq}80ng/mL$, exclusive of acute myocardial injury, cardiac arrest, and brain damage. Results: Forty-five patients were enrolled; mean age, $116{\pm}68$ months. Of these, 35 were boys and 10 were girls. Twenty-six patients experienced myalgia and 12 patients showed gross hematuria. Among these, seven patients initially had both myalgia and gross hematuria. The most common causes of rhabdomyolysis were infection, physical exertion, prolonged seizures, metabolic abnormalities, and drug addiction. Acute kidney injury (AKI) was the most common complication, followed by disseminated intravascular coagulation. Thirty-seven patients improved with sufficient fluid supply but two patients underwent hemodialysis due to deterioration of kidney function. Gross hematuria, positive occult blood test, and positive urine protein were more common in patients with AKI than in those without AKI. Conclusions: In children, infection was the most common cause of rhabdomyolysis. Most patients recovered by sufficient fluid therapy. However, in severe cases, especially in patients with underlying kidney disease, hemodialysis may be necessary in the present study.

Clinical and Histopathological Findings in Mice Heavily infected with Fibricola seoulensis (Fibricolu seoulensis 중감염 마우스의 임상적 및 조직병리학적 소견)

  • Sun Huh;Jong-Yil Chai;Sung-Tae HONG;Soon-Hyung Lee
    • Parasites, Hosts and Diseases
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    • v.26 no.1
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    • pp.45-54
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    • 1988
  • To observe the clinical course and intestinal histopathology in heavy infection of Fibricola seoulensis, an experimental study was performed in mice. Clinical, experimental infection with 1, 000 metacercariae. On the 11th day after infection, the mice began to die and all of the infected mice were dead by the 16th day. The infected mice showed gradual weight loss. Occult blood was detected after the 10th day. Diarrhea accurred after the 9th day and was recognized in all of the infected mice on the 12th day. Hemoglobin and mean corpuscular hemoglobin decreased significantily after the 12th day, and mean corpuscular hemoglobin concentration decreased in all infected mice. The histopathological changes were more marked in the duodenum than in the jejunum or ileum. Major changes were villous atrophy and crypt hyperplasia, with decreased villus/crypt ratio, inflammatory cell infiltration and stromal edema. The present results suggest that the cause of death of mice heavily infected with F. seoulensis should be malnutrition and severe fluid loss due to malabsorption, together with intestinal bleeding.

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Studies on Ancylostomiasis I. An Experimental Study on Hookworm Infection and Anemia (구충증(鉤蟲症)에 관(關)한 연구(硏究) 제1편(第1篇) 구충(鉤蟲)의 감염(感染) 및 구충성빈혈(鉤蟲性貧血)에 관(關)한 고찰(考奈))

  • Lee, Mun-Ho;Kim, Dong-Jip;Lee, Jang-Kyu;Seo, Byong-Sul;Lee, Soon-Hyung
    • The Korean Journal of Nuclear Medicine
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    • v.1 no.1
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    • pp.55-66
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    • 1967
  • In view of its prevalence in the Far East area, a more detailed knowledge on the hookworm infection is one of the very important medical problems. The present study was aimed to; determine the infectivity of the artificially hatched ancylostoma duodenale larvae in man after its oral administration, evaluate the clinical symptomatology of such infection, determine the date of first appearance of the ova in the stool, calculate the blood loss per worm per day, assess the relation-ships between the ova count, infectivity(worm load), blood loss and severity of anemia. An erythrokinetic study was also done to analyse the characteristics of hookworm anemia by means of $^{59}Fe\;and\;^{51}Cr$. Materials and Methods Ten healthy male volunteers(doctors, medical students and laboratory technicians) with the ages ranging from 21 to 40 years were selected as the experimental materials. They had no history of hookworm infection for preceding several years, and care was taken not to be exposed to reinfection. A baseline study including a through physical examinations and laboratory investigations such as complete blood counts, stool examination and estimation of the serum iron levels was done, and a vermifuge, bephenium hydroxynaphoate, was given 10 days prior to the main experiment. The ancylostoma duodenale filariform larvae were obtained in the following manner; The pure ancylostoma duodenale ova were obtained from the hookworm anemia patients and a modified filter paper method was adopted to harvest larger number of infective larvae, which were washed several times with saline. The actively moving mature larvae were put into the gelatine capsules, 150 in each, and were given to the volunteers in the fasting state with 300ml. of water. The volunteers were previously treated with intramuscular injection of 15mg. of chlorpromazine in order to prevent the eventual nausea and vomiting after the larvae intake. The clinical symptoms and signs mainly of the respiratory and gastrointestinal tracts, appearance of the ova and occult blood in the stool etc. were checked every day for the first 20 days and then twice weekly until the end of the experiment, which usually lasted for about 3 months. Roentgenological survey of the lungs was also done. The hematological changes such as the red blood cell, white blood cell and eosinophil cell counts, hemoglobin content and serum iron levels were studied. The appearance of the ova in the stool was examined by the formalin ether method and the ova were counted in triplicate on two successive days using the Stoll's dilution method. The ferrokinetic data were calculated by the modified Huff's method and the apparent half survival time of the red blood cells by the modified Gray's method. The isotopes were simultaneously tagged and injected intravenously, and then the stool and blood samples were collected as was described by Roche et al., namely, three separate 4-day stool samples with the blood sample drawing before each 4-day stool collection. The radio-activities of the stools ashfied and the blood were separately measured by the pulse-height analyser. The daily blood loss was calculated with the following formula; daily blood loss in $ml.=\frac{cpm/g\;stool{\times}weight\;in\;g\;of\;4-day\;stool}{cpm/ml\;blood{\times}4}$ The average of these three 4-day periods was given as the daily blood loss in each patient. The blood loss per day per worm was calculated by simply dividing the daily blood loss by the number of the hookworm recovered after the vermifuge given twice a week at the termination of the experiment. The iron loss in mg. through the gastrointestinal tract was estimated with the daily iron loss in $mg=\frac{g\;Hgb/100ml{\times}ml\;daily\;blood\;loss{\times}3.40}{100}$ 3.40=mg of iron per g Hgb following formula; Results 1. The respiratory symptoms such as cough and sputum were noted in almost all cases within a week after the infection, which lasted about 2 weeks. The roentgenological findings of the chest were essentially normal. A moderate degree of febril reaction appeared within 2 weeks with a duration of 3 or 4 days. 2. The gastrointestinal symptoms such as nausea, epigastric fullness, abdominal pain and loose bowel appeared in all cases immediately after the larvae intake. 3. The reduction of the red blood cell count was not remarkable, however, the hemoglobin content and especially the serum iron level showed the steady decreases until the end of the experiment. 4. The white blood cells and eosinophil cells, on the contrary, showed increases in parallel and reached peaks in 20 to 30 days after the infection. A small secondary rise was noted in 2 months. 5. The ova first appeared in the stool in 40. 1 days after the infection, ranging from 29 to 51 days, during which the occult blood reaction of the stool became also positive in almost cases. 6. The number of ova recovered per day was 164, 320 on the average, ranging from 89,500 to 253,800. The number of the worm evacuated by vermifuge was in rough correlation with the number of ova recovered. 7. The infectivity of ancylostoma duodenale was 14% on the average, ranging from 7.3 to 20.0%, which is relatively lower than those reported by other workers. 8. The mean fecal blood loss was 5.78ml. per day, with a range of from 2.6 to 11.7ml., and the mean blood loss per worm per day was 0.30ml., with a range of from 0.13 to 0.73ml., which is in rough coincidence with those reported by other authors. There appeared to exist, however, no correlation between the blood loss and the number of ova recovered. 9. The mean fecal iron loss was 2.02mg. per day, with a range of from 1.20 to 3.89mg., which is less than those appeared in the literature. 10. The mean plasma iron disappearance rate was 0.80hr., with a range of from 0.62 to 0.95hr., namely, a slight accerelation. 11. The hookworm anemia appeared to be iron deficiency in origin caused by continuous intestinal blood loss.

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A Study of Clinical Manifestations of Gastrointestinal Symptoms in Children with Henoch-Schönlein Purpura (소아 Henoch-Schönlein Purpura 환아에서 위장관 증상 유무에 따른 임상 소견에 대한 연구)

  • Oh, Se-Whung;Choe, Jae-Hyung;Kim, Yong-Joo
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.9 no.2
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    • pp.183-192
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    • 2006
  • Purpose: This study was undertaken to evaluate the factors correlated with the clinical course and outcome in patients of Henoch-Sch${\ddot{o}}$nlein Purpura. Methods: The medical records of 104 children diagnosed with Henoch-Sch${\ddot{o}}$nlein Purpura (HSP) from January 1996 to April 2006 were reviewed retrospectively. The patients were divided into two groups: patients with Gastrointestinal (GI) symptoms and those without GI symptoms. When there were joint, scrotum, and renal symptoms except for skin lesion in whole HSP, those patients were excluded. The history of acute infection, duration of admission, treatment requirement, recurrence of HSP, CBC, stool occult blood test, abdominal ultrasonographic findings and GI endoscopic findings were reviewed. Results: Among 104 patients, patients with GI symptoms included 66 cases (63.5%), those without GI symptoms accounted for 38 cases (36.5%). GI symptoms included: abdominal pain in 57 cases (54.8%), vomiting 21 cases (20.2%), GI bleeding 5 cases (4.8%), nausea 3 cases (2.9%) and diarrhea 3 case (2.9%). Positive GI symptoms and GI mucosal lesions on GI endoscopy had a statistically significant correlation with increased admission duration, treatment requirement, recurrence of HSP, and positive stool occult blood. Six cases with small intestinal wall thickening were noted on abdominal ultrasonography. Six cases of hemorrhagic gastritis and hemorrhagic duodenitis, 3 cases of duodenal ulcer, 3 cases of hemorrhagic gastritis and duodenal ulcer, 2 cases of hemorrhagic duodenitis and colitis, and 1 case of colitis were noted on GI endoscopy. Conclusion: These results suggest that GI endoscopic examination may be helpful for the diagnosis and treatment of children with HSP.

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Clinical Experience of Pyoderma Gangrenosum with Extensive Soft Tissue Necrosis (광범위 연조직 괴사를 동반한 괴저농피증의 치험례)

  • Lim, Sung Yoon;Park, Dong Ha;Pae, Nam Suk;Park, Myong Chul
    • Archives of Plastic Surgery
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    • v.35 no.5
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    • pp.615-618
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    • 2008
  • Purpose: Pyoderma gangrenosum is a rare cutaneous ulcerative disease. First described in 1930, the condition is characterized by progressive ulceration with deeply undermined purple-red edge. The lower extremities are most commonly affected but other parts of the skin and mucous membranes may also be involved. Although medical treatments with topical wound therapy are commonly used, surgical intervention is still controversial. In this paper, we report an atypical case of pyoderma gangrenosum which was characterized by extensive soft tissue breakdown. Methods: A 27-year-old male patient was referred to our institution with a $7{\times}8cm$ sized deeply undermined ulceration with pus-like discharge and fever. Incision and drainage was performed at another clinic 3 days prior to admission to our institution. After a thorough physical examination and the MRI review, a diagnosis of necrotizing faciitis was made. Accordingly, fasciotomy and debridement was performed. However, the wound enlarged progressively and the patient remained highly febrile for 9 days after the treatment. Septic screening did not reveal any occult infection. After a secondary review of the case, the initial diagnosis of necrotizing fasciitis was rejected and changed to pyoderma gangrenosum. With the use of dexamethasone intravenously, the wound improved dramatically and the fever was eliminated. Steroid mediation was tapered with duration of 1 month. The wound was stabilized and subsequently covered with split-thickness skin graft. Results: Split-thickness skin grafting with 1 : 1.5 mesh was successfully taken. Conclusion: Initial clinical features of pyoderma gangrenosum are very similar to that of necrotizing fasciitis. High fever and progressive ulceration with severe pain could invite earlier surgical approach. The advancing wound margins (the well defined violaceous, undermined border and necrotic ulcer base) and lack of isolation of pathogenic organism was used to make the correct diagnosis of pyoderma gangrenosum. We achieved a good result with proper medication and split-thickness skin graft.

Late-Onset Group B Streptococcal Meningitis Complicated with Extensive Cerebral Infarction (광범위한 뇌경색증이 합병된 지발형 B군 사슬알균에 의한 수막염 증례)

  • Cho, Min Su;Kim, Yongmin;Cho, Hye-Kyung;Choi, Soo-Han
    • Pediatric Infection and Vaccine
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    • v.25 no.1
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    • pp.45-49
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    • 2018
  • Group B streptococcus (GBS) is the leading cause of neonatal morbidity and mortality. Late-onset GBS disease commonly manifests as occult bacteremia or meningitis. Approximately 50% of survivors of late-onset meningitis have long-term neurologic sequelae. Cerebrovascular complications are often associated with unfavorable clinical outcomes of GBS meningitis. There have been a few reports of cerebral infarction accompanied by GBS meningitis. We report a 29-day-old girl with severe, widespread cerebral infarction due to late-onset GBS meningitis. Isolated GBS strain from this patient was serotype III, ST-19. Currently, she has cortical blindness and significant developmental delay.

Studies on the Pathogenicity of Cytoplasmic Polyhedrosis Virus and the Phenomena of Induction and Interference by Oral Inoculation of Foreign Virus to the Silkworm, Bombyx mori L. (가잠에 있어서 세포질다각체 바이러스의 병원성 및 이형 바이러스 접종에 의한 유발 간섭현상에 관한 연구)

  • 김근영;문재유;임종성;정태암
    • Journal of Sericultural and Entomological Science
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    • v.17 no.2
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    • pp.101-118
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    • 1975
  • The pathogenicity of hexagonal and tetragonal cytoplasmic polyhedron virus to one of present leading silkworm varieties, Jam 103${\times}$Jam 104, and its parents, Jam 103 and Jam 104, was investigated. The activation of occult virus by oral inoculation of foreign virus as well as the interference phenomena between the activated and inoculated cytoplasmic polyhedron viruses was observed and the results obtained are as follows. 1. The pathogenicity of cytoplasmic polyhedrosis viruses. 1) There was a high significant difference in the pathogenicity of hexagonal polyhedron virus between the hybrid and its parents showing the lowest infection rate in the hybrid (Jam 103${\times}$Jam 104), medium infection rate in the Japanese line (Jam 103) and the highest infection rate in the Chinese line (Jam 104). In the pathogenicityof tetragonal polyhedron virus, a significant difference was observed only between the hybrid (Jam 103${\times}$Jam 104) and the Chinese line (Jam 104) by showing a higher infection rate in the Chinese line than in the hybrid. 2) The pathogenicity of both hexagonal and tetragonal polyhedron viruses showed a high significant difference in different silkworm instars inoculated by showing a higher infection rate at the second instar than at the fourth instar. 3) The pathogenicity of both hexagonal and tetragonal polyhedron viruses was increased as the concentration of viruses inoculated increased. 2. The phenomena of induction and interference by oral inoculation of foreign virus. 1) The induction rate of cytoplasmic polyhedrosis virus was higher in the parents than in the hybrid. In the parents. a higher rate in the Chinese line than in the Japanese line was observed. 2) The effect of inoculation at different instars on the induction was studied and the induction rate was higher at the second instar inoculated than at the fourth instar inoculated. 3) The degree of activation of hexagonal polyhedron virus with inoculation of tetragonal polyhedron virus was very high when a lower concentration of virus was inoculated and it was very low when a higher concentration of virus was inoculated 4) The degree of activation of tetragonal polyhedron virus with inoculation of hexagonal polyhedron virus was very low when a lower concentration of virus was inoculated and it was not observed when a higher concentration of virus was inoculated. 5) The mixed infection rate with hexagonal and tetragonal polyhedron viruses was higher at the second instar inoculated than at the fourth instar inoculated. 6) It was observed that the secondary hexagonal pc]yhedron virus activated interfered with the primary tetragonal polyhedron virus inoculated when the inoculated concentration of the primary virus is low and the primary virus inoculated interfered with the secondary virus activated when the inoculated concentration of the primary virus is high.

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Case of Combined Acute Poststreptococcal Glomerulonephritis and Acute Invasive Meningococcal Disease (A군 연구균 감염 후 급성 사구체 신염과 동반된 침습성 수막구균감염증 1례)

  • Jeon, Hosang;Hahn, Wonho;Park, Dongkyun;Cha, Sungho
    • Pediatric Infection and Vaccine
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    • v.11 no.1
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    • pp.126-130
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    • 2004
  • Neisseria meningitidis is a leading cause of meningitis and septicemia in children and young adults. Meningococcemia, the most severe form of infection, represents a part of the various spectrum of the illness, and its clinical manifestations varied from mild fever and occult bacteriemia to fulminant catastrophic events(e.g., sepsis, shock, and death) within a few hours after onset of symptoms. Complement deficiencies, either congenital or acqired, increase the risk for invasive meningococcal disease. Since C3 plays a critical role in the complement cascade, congenital C3 deficiency or conditions that decrease C3(e.g., systemic lupus erythematosus, cirrhosis, nephritis, C3 nephritic factor) increase the risk for invasive disease due to pyogenic bacteria including N. meningitidis. We had experienced a case of meningococcemia and meningococcal meningitis presenting with mild fever, petechiae, and purpura. The patient was a 7-year old male. He had mild fever, vomiting, headache, nuchal rigidity, petechiae and purpura on both lower extremities, which spreaded to the whole body. His blood culture grew Neisseria meningitidis. The diagnosis of meningococcal meningitis was confirmed by examination of cerebrospinal fluid. The clinical symptoms of the illness were improved after treatment of antibiotics(cefotaxime) for 12 days. However the patient had developed generalized edema, microscopic hematuria & proteinuria on the third day after admission. High ASO titer and low serum C3 level were also noted. The microscopic hematuria returned to normal about 2 months after discharge. The C3 level returned to normal range about 3~4 months after discharge. we report a case of combined acute poststreptococcal glomerulonephritis and acute invasive meningococcal disease with reference review.

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