• Archives of Plastic Surgery
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• 제49권3호
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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.

• Pediatric Infection and Vaccine
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• 제29권3호
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• pp.173-178
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• 2022

Streptococcus intermedius는 입안, 상부 호흡기, 위장관 등에 정상 상재균 중 하나로 존재하는 그람 양성 산소내성 혐기성 알균이다. 면역저하나 심장질환자에서 외상 또는 침습적 치료 후에 발생하는 기회 감염의 원인이 될 수 있다. 저자들은 최근 침습적 치료나 외상 등 특이 과거력이 없이 건강했던 7세 소아에서 S. intermedius에 의해 발생한 엉덩관절 화농 관절염을 경험하였기에 보고하고자 한다. 환자는 내원 3주전부터 왼쪽 엉덩관절 통증이 있었으며, 본원 내원 당일부터 발열이 발생하였다. 엉덩관절 자기공명영상에서 왼쪽 엉덩관절의 급성 화농 관절염으로 진단한 후 수술적 배농을 시행하였고, 혈액과 흡인 관절액에서 S. intermedius가 배양되었다. 수술 후 2주간의 ceftriaxone 정맥주사 후 3주간의 amoxicillin 경구 항생제로 치료한 후 재발없이 안정된 상태를 보이고 있다.

• 한국미생물·생명공학회지
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• 제50권4호
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• pp.488-500
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• 2022

Most fungal infections by opportunistic yeast pathogens such as Candida spp. are the major causes of morbidity and mortality in patients with lowered immune. Previous studies have reported that some strains of Candida secret secondary metabolites play an important role in the decreasing of immunity in the infected patient. In this study, 110 Candida spp. were isolated from different clinical specimens from Baghdad hospitals. Candida isolates were identified by conventional methods, they were processed for Candida speciation on CHROMagar. The results of identification were confirmed by internal transcribed spacer (ITS) sequencing. Phylogenetic trees were analyzed with reference strains deposited in GenBank. Antifungal susceptibility testing was evaluated by the disc diffusion method and performed as recommended by the Clinical and Laboratory Standard Institute (CLSI) M44-A document. Candida isolates investigated produce secondary metabolites gliotoxin with HPLC technique and quantification. Out of 110 Candida isolates, C. albicans (66.36%) was the most frequent isolate, followed by the isolates of C. tropicalis (10.9%) and C. glabrata (6.36%) respectively. Concerning the antifungal susceptibility test, Candida isolates showed a high level of susceptibility to Miconazole (70.9%), Itraconazole (68.2%), and Nystatine (64.5%). The ability of obtained isolates of Candida spp. to produce gliotoxin on RPMI medium was investigated, only 28 isolates had the ability to secret this toxin in culture filtrates. The highest concentrations were detected in C. albicans (1.048 ㎍/ml). Gliotoxin productivity of other Candida species was significantly lower. The retention time for gliotoxin was approximately 5.08 min.

• Mycobiology
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• 제51권6호
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• pp.452-462
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• 2023

Opportunistic infections due to Cryptococcus neoformans and C. gattii species complexes continue to rise unabated among HIV/AIDS patients, despite improved antifungal therapies. Here, we collected a total of 20 environmental and 25 presumptive clinical cryptococcal isolates from cerebrospinal fluid (CSF) samples of 175 patients enrolled in an ongoing clinical trial Ambition 1 Project (Botswana-Harvard Partnership). Identity confirmation of the isolates was done using MALDI-TOF MS and PCR. We describe the diversity of the isolates by PCR fingerprinting and sequencing (Oxford Nanopore Technology) of the intergenic spacer region. Mating types of the isolates were determined by amplification of the MAT locus. We report an unusual prevalence of 42.1% of C. neoformans × C. deneoformans hybrids Serotype AD (n = 16), followed by 39.5% of C. neoformans Serotype A (n = 15), 5.3% of C. deneoformans, Serotype D (n = 2), 7.9% of C. gattii (n = 3), and 5.3% of C. tetragattii (n = 2) in 38 representative isolates that have been characterized. Mating type-specific PCR performed on 38 representative environmental and clinical isolates revealed that 16 (42.1%) were MATa/MAT𝛼 hybrids, 17 (44.7%) were MAT𝛼, and five (13.2%) possessed MATa mating type. We used conventional and NGS platforms to demonstrate a potential link between environmental and clinical isolates and lay a foundation to further describe mating patterns/history in Botswana.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제27권2호
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• pp.95-103
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• 2024

Purpose: Diarrhea is one of the leading causes of mortality in children living in developing countries. The etiology of acute diarrhea in each healthcare center varies depending on place, time, and population. This study aimed to identify pathogen patterns in human immunodeficiency virus (HIV)-infected and non-HIV children suffering from acute diarrhea, using multiplex real time reverse transcriptase polymerase chain reaction (RT-PCR), in an Indonesian tertiary hospital. Methods: This cross-sectional study was conducted at Dr. Cipto Mangunkusumo National Hospital from March 2019 to April 2020. Results: The study showed that multiplex RT-PCR results were positive in 58.9% of the specimens, with more positive results in HIV-infected children than in non-HIV-infected children (70% vs. 54.7%). Altogether 72 enteropathogens were detected from all specimens. Enteropathogens in non-HIV children with acute diarrhea consisted of bacteria (70.6%) and viruses (29.4%) with a predominance of enteroaggregative Escherichia coli (25.4%), followed by Campylobacter spp. (11.8%), enteropathogenic E. coli (9.8%), Norovirus GII (7.8%), and Clostridium difficile (7.8%). Enteropathogens in HIV-infected children consisted of viruses (57.1%), bacteria (28.6%), and parasites (14.3%) comprising Norovirus GII (24%), Cryptosporidium spp. (14.3%), Campylobacter spp. (14.3%), Norovirus GI (14.3%), and Astrovirus (14.3%). Cryptosporidium spp. was the only parasite found in this study and was found only in HIV-infected children. In non-HIV children with acute diarrhea, most pathogens were invasive bacteria, while in HIV-infected children, more viral and parasite infections occurred, primarily caused by opportunistic pathogens. Conclusion: The pattern of enteropathogens can help clinicians determine further examinations and appropriate empirical antimicrobial therapy for the patient.

• Tuberculosis and Respiratory Diseases
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• 제61권6호
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• pp.554-561
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• 2006

배 경: AIDS환자에게서 기회감염은 가장 치명적인 합병증으로 대부분은 폐 감염의 형태로 발현된다. 본 연구는 타 국가에 비해 아직까지는 유병률이 낮아서 상대적으로 자료가 부족한 국내의 현황에서, HIV 감염자 및 AIDS 환자의 임상양상을 살펴보고 특히 AIDS 환자들이 주로 어떤 호흡기 질환으로 발현하며, 호흡기 질환이 발현된 AIDS 환자와 기타 폐외 질환으로 발현하거나, HIV 단순감염자와의 임상상에 어떤 차이가 있는지를 중점적으로 살펴보고자 하였다. 방 법: 2001년부터 2006년 2월까지 중앙대학교 병원에 내원한 HIV 감염자 총28명을 대상으로, 이들 환자의 의무기록을 후향적으로 조사하여 분석하였다. 결 과: 총 28명의 HIV 감염자 중 27명이 남자이었고 평균연령은 40.6세로 30대가 40%로 가장 많은 분포를 보였다. 이 중에서 폐질환을 동반한 경우가 11명이었고, 폐외질환 환자가 16명이었다. 폐질환을 동반환 환자군과 폐외질환자에서 내원시 CD4+림프구수와 HIV RNA 수는 평균 79.5/mm3, 48,903 IU/ml, $400/mm^3$, 60,256 IU/ml을 보여(P value: 0.001, 0.695) 폐감염이 동반된 경우에 더 심한 면역억제 상태가 심하였다. 폐감염의 종류로는 폐결핵, 주폐포자충 폐렴이 가장 많은 빈도를 차지하였으며, 이들의 평균 CD4+림프구 수를 보면, 폐결핵이 $56/mm^3$, 주폐포자충폐렴이 $42/mm^3$이었다. 결 론: HIV에 관련된 폐질환이 동반된 경우 그렇지 않은 경우에 비해 월등히 면역억제가 심하였다. 이 중에서 폐결핵과 주폐포포자충 폐렴이 가장 흔한 형태의 폐감염이었다. 본 연구는 일개 대학병원에서 경험한 HIV 감염자와 특히 폐질환이 발현된 AIDS 환자의 임상상의 특징을 확인할 수 있었고 빠른 조기진단과 치료의 필요성을 다시 한번 확인하였다.

• 한국식품위생안전성학회지
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• 제34권6호
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• pp.576-582
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• 2019

Staphylococcus pseudintermedius는 개에서 기회감염을 유발하는 병원체이며, 공중보건학적으로도 주요한 인수공통 병원체이다. 개에서 분리된 S. pseudintermedius 균주들은 주로 항생제 내성 및 개에서 피부 감염을 유발하는 주요 원인균으로 연구되어 왔지만, 가축에서 분리된 S. pseudintermedius 균주들의 항생제 내성 및 장내 독소 생성에 대한 정보는 매우 제한적이다. 본 연구에서는 개, 돼지, 육우에서 분리된 S. pseudintermedius 균주들에서 18가지의 장내 독소 (staphylococcal enterotoxin; SE) 유전자와 toxic shock syndrome toxin 유전자(tst-1)의 분포양상을 조사하였다. 또한, S. pseudintermedius 균주들의 항생제 내성 양상과 더불어 mecA 유전자 및 SCCmec type 또한 확인하였다. 육우에서 분리한 하나의 균주를 제외한 모든 개와 돼지 분리주 들이 4개 이상의 항생제에 내성을 보였으며, 개에서 분리된 6개의 균주 중 4개의 S. pseudintermedius 균주들이 메티실린 내성과 더불어 SCCmec V를 가진 것으로 확인 되었다. 총 11개의 SE 유전자들 (seb, sec, see, seg, sei, sej, sel, seo, sep, seq, seu) 및 tst-1가 개, 돼지 및 육우로부터 분리된 S. pseudintermedius 균주들에서 확인 되었으며, 대부분의 분리주들 (83%)에서 2개 이상의 SE 유전자들이 확인 되었고, 그 중 sel (42%) 및 sep (42%)가 가장 빈번하게 검출 되었다. 본 연구를 통하여 반려견에서 뿐만 아니라 주요 가축에서 존재하는 S. pseudintermedius 균주들에서 높은 항생제 내성 양상을 확인 하였으며, 항생제 내성과 더불어 여러 staphylococcal enterotoxin 및 tst-1 유전자들을 전파할 가능성을 확인 하였다.

• Parasites, Hosts and Diseases
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• 제56권5호
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• pp.409-418
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• 2018

Acanthamoeba spp. are free-living protozoa that are opportunistic pathogens for humans. Cysteine proteases of Acanthamoeba have been partially characterized, but their biochemical and functional properties are not clearly understood yet. In this study, we isolated a gene encoding cysteine protease of A. castellanii (AcCP) and its biochemical and functional properties were analyzed. Sequence analysis of AcCP suggests that this enzyme is a typical cathepsin L family cysteine protease, which shares similar structural characteristics with other cathepsin L-like enzymes. The recombinant AcCP showed enzymatic activity in acidic conditions with an optimum at pH 4.0. The recombinant enzyme effectively hydrolyzed human proteins including hemoglobin, albumin, immunoglobuins A and G, and fibronectin at acidic pH. AcCP mainly localized in lysosomal compartment and its expression was observed in both trophozoites and cysts. AcCP was also identified in cultured medium of A. castellanii. Considering to lysosomal localization, secretion or release by trophozoites and continuous expression in trophozoites and cysts, the enzyme could be a multifunctional enzyme that plays important biological functions for nutrition, development and pathogenicity of A. castellanii. These results also imply that AcCP can be a promising target for development of chemotherapeutic drug for Acanthamoeba infections.

• Journal of Microbiology and Biotechnology
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• 제19권3호
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• pp.323-330
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• 2009

Nontuberculous mycobacteria (NTM) are a major cause of opportunistic infections in immunocompromised patients, making the reliable and rapid identification of NTM to the species level very important for the treatment of such patients. Therefore, this study evaluated the usefulness of the novel target genes tuf and tmRNA for the identification of NTM to the species level, using a PCRrestriction fragment length polymorphism analysis (PRA). A total of 44 reference strains and 17 clinical isolates of the genus Mycobacterium were used. The 741 bp or 744 bp tuf genes were amplified, restricted with two restriction enzymes (HaeIII/MboI), and sequenced. The tuf gene-PRA patterns were compared with those for the tmRNA (AvaII), hsp65 (HaeIII/HphI), rpoB (MspI/HaeIII), and 16S rRNA (HaeIII) genes. For the reference strains, the tuf gene-PRA yielded 43 HaeIII patterns, of which 35 (81.4%) showed unique patterns on the species level, whereas the tmRNA, hsp65, rpoB, and 16S rRNA-PRAs only showed 10 (23.3%), 32 (74.4%), 19 (44.2%), and 3 (7%) unique patterns after single digestion, respectively. The tuf gene-PRA produced a clear distinction between closely related NTM species, such as M. abscessus (557-84-58) and M. chelonae (477-84-80-58), and M. kansasii (141-136-80-63-58-54-51) and M. gastri (141-136-117-80-58-51). No difference was observed between the tuf-PRA patterns for the reference strains and clinical isolates. Thus, a diagnostic algorithm using a tuf gene-targeting PRA is a promising tool with more advantages than the previously used hsp65, rpoB, and 16S rRNA genes for the identification of NTM to the species level.

• Journal of Microbiology and Biotechnology
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• 제27권8호
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• pp.1529-1538
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• 2017

Klebsiella pneumoniae is an opportunistic and clinically significant emerging pathogen. We investigated the relative roles of Toll-like receptor (TLR) 2 and TLR4 in initiating host defenses against K. pneumoniae. TLR2 knockout (KO), TLR4 KO, TLR2/4 double KO (DKO), and wild-type (WT) mice were inoculated with K. pneumoniae. Mice in each group were sacrificed after either 12 or 24h, and the lungs, liver, and blood were harvested to enumerate bacterial colony-forming units (CFU). Cytokine and chemokine levels were analyzed using enzyme-linked immunosorbent assay and real-time PCR, and pneumonia severity was determined by histopathological analysis. Survival was significantly shortened in TLR4 KO and TLR2/4 DKO mice compared with that of WT mice after infection with $5{\times}10^3CFU$. TLR2 KO mice were more susceptible to infection than WT mice after exposure to a higher infectious dose. Bacterial burdens in the lungs and liver were significantly higher in TLR2/4 DKO mice than in WT mice. Serum $TNF-{\alpha}$, MCP-1, MIP-2, and nitric oxide levels were significantly decreased in TLR2/4 DKO mice relative to those in WT mice, and TLR2/4 DKO mice showed significantly decreased levels of $TNF-{\alpha}$, IL-6, MCP-1, and inducible nitric oxide synthase mRNA in the lung compared with those in WT mice. Collectively, these data indicate that TLR2/4 DKO mice were more susceptible to K. pneumoniae infection than single TLR2 KO and TLR4 KO mice. These results suggest that TLR2 and TLR4 play cooperative roles in lung innate immune responses and bacterial dissemination, resulting in systemic inflammation during K. pneumoniae infection.