Pichia ohmeri에 의한 악성외이도염 1예

손준성,신상엽,민태훈,장현하,정숙인,오원섭,김성민,백경란,송재훈 대한감염학회 2002 감염 Vol.34 No.5

오염된 완충용액으로 인한 Alcaligenes xylosoxidans의 가유행성 발생

김옥선,윤성원,백경란,박선영,이남용,송재훈 대한병원감염관리학회 2003 의료관련감염관리 Vol.8 No.1

고도정수처리 공정에서의 천연유기물질 특성변화 및 소독부산물 전구물질의 제거특성 평가

노재순,손희종,박은주,황영도,최동훈,배석문,신판세 慶星大學校 環境問題硏究所 2002 環境硏報 Vol.12 No.1

In this research the movement and apparent molecular weight distribution of hydrophilic/hydrophobic organic matters in advanced water treatment process were investigated using the raw water of Maeri area, located in downstream of Nakdong river, and the variation of the disinfection by-product formation potential was also investigated. In the raw water used in experiments, the content of BDOC (biodegradable dissolved organic carbon) in dissolved organic carbon (DOC) was about 39%, and this value is far above a normal, Pre-ozone treatment showed an increase of 40% in the BDOC content, and this means that biodegradability was remarkably increased by ozone treatment BDOC concentration in BAC treated water was 0.09 mg/L, which means 84% of BDOC removal rate compared with that in post-ozone treated water. The variation of chlorine disinfection by-product formation potential in each process unit of water treatment process was analyzed. TOXFP concentration in raw water was 449 ㎍/L, and the contents of THMFP and HAAFP among TOXFP were 24% and 23%, respectively. The removabilities of these materials BAC process had an order of TOXFP > HAAFP > THMFP. BAC process was less effective for THMFP than others. The distribution of hydrophilic organic matters were evaluated in each treatment process. Hydrophilic and hydrophobic matters in the raw water had a ratio of 50 : 50, and the ozone treatment decreased the content of hydrophobic matters. The BAC treatment made the ratio 85:15. These mean that the removal of hydrophilic matters is more difficult than that of hydrophobic materials in water treatment process. In addition the portions of humic and fulvic acid in hydrophobic matters were analyzed. Fulvic acid a large portion among hydrophobic matters in the raw water, and the portion was 78%. Ozone treatment was more effective on the removal of fulvic acid than humic acid. After BAC treatment, the concentration of residual fulvic acid was high than humic acid. Chlorine disinfection by-product formation for hydrophilic and hydrophobic mattrts was compared in each process unit. in the raw water TOXFP and THMFP formation for hydrophobic matter was higher, and HAAFP was highly formated for hydrophobic matter. After post-ozone or BAC treatment, chlorine disinfection by-product formation has high potential for hydrophobic matters. Comparing humic and fulvic acids, chlorine disinfection by-product formation potential was higher for humic acid than for fulvic acid in all processes. In the comparison of the reactivity with chlorine disinfection by-product per unit DOC, THMFP and DOXFP showed higher reactivity with hydrophobic matter than with hydrophilic matter in all processes, and HAAFP was highly reacitive with hydrophilic matter. Apparent molecular weight distributions of organic matters were investigated in each process step.The content of low molecular weight organic matters less than 1000 Da in DOC was high in all processes except raw water, but molecular weight organic matters more than 1000 da was higher than molecular weight organic matters less than 1000 Da in the formation potential of chlorine disinfection by-product.

인공 판막 환자에서 발생한 Listeria monocytogenes 심내막염 1예

신상엽,손준성,김형훈,민태훈,윤종욱,장현하,정숙인,오원섭,김성민,백경란,송재훈 대한감염학회 2002 감염 Vol.34 No.5

공여자의 종류에 따른 간이식 후 감염성 합병증의 비교 : Comparison between Orthotopic and Living Donor Transplantation

기현균,손준성,오원섭,백경란,이남용,김성주,조재원,이석구,송재훈 대한감염학회 2004 감염과 화학요법 Vol.36 No.3

목적 : 최근 간이식 수요가 증가함에 따라 이에 대한 하나의 대안으로 생체 부분 간이식(LDLT) 시행례가 증가하고 있다. 이에 뇌사자 사체 간이식(OLT)과의 감염 양상을 비교하기 위하여 본 연구를 시행하였다. 방법 : 1996년 5월부터 2003년 8월까지 삼성서울병원에서 간이식을 시행 받은 284명의 환자들을 대상으로 후향적으로 분석하였다. 결과 : 188명은 LDLT를, 96명은 OLT를 시행 받았다. 간이식 후 감염증은 총 191명에서 발생하였고(67.0%) OLT 환자군과 LDLT 환자군 사이에 감염증의 발생 빈도와 원인 병원체의 빈도는 유의한 차이를 보이지 않았다. 병원체 별로는 Enterococcus 균정(16.2%) S. aureus(15.1%), coagulase negative staphylococci (13.4%)의 순서였다. 감염증의 종류는 복강 내 감염이 총 83례로 가장 많았는데, LDLT에서 OLT에 비하여 유의하게 높게 발생하였다(34.0% vs 19.8%, P=0.012). 요로 감염증(11.5% vs 4.3%, P=0.022)과 침습성 아스페르길루스증(7.3% vs 1.6%, P=0.034)은 OLT을 시행한 경우에 많았다. 기타 감염증은 통계적으로 유의한 차이가 없었다. 결론 : 간이식 환자에서 공여자의 종류에 따른 감염의 발생빈도는 차이가 없었으나 감염증 중 복강 내 감염은 LDLT에서 더 많이 발생하였다. 장구균 감염, 특히 반코마이신 내성 장구균이 간이식 후 발생하는 감염증의 중요한 원인 병원체임을 확인하였다. Background : Living donor liver transplantation (LDLT) has been performed more frequently to circumvent the shortage of donor organs. However, infectious complications after LDLT compared with orthotopic liver transplantation (OLT) have not been well investigated to date. Methods : We have retrospectively reviewed the medical records of all consecutive cases of liver transplantation, which had been performed at the Samsung Medical Center, Seoul, Korea, from May 1996 to August 2003. Results : Of the 284 patients enrolled, 188 (66.2%) underwent LDLT. Overall incidence of infectious complications after liver transplantation was 67.0% (191/284). Incidence of infections was not different between OLT group (67.7%) and LDLT group (67.0%) (P=0.9). Bacterial infections were the most common infectious complications (146 cases) followed by viral infections (32 cases), fungal infections (26 cases), and tuberculosis (4 cases). Enterococcus spp. (16.2%) were the leading pathogens followed by Staphylococcus aureus (15.1 %) and coagulase-negative staphylococci (13.4%). However, the distribution of etiologic agents was not different between OLT and LDLT group. Intra-abdominal infections (83 cases) were the most common type of infectious complications, which were more frequent in LDLT group (34.0%) than in OLT group (19.8%) (P=O.Ol). Conclusion : LDLT resulted in intra-abdominal infections more frequently than OLT. Enterococcus spp., especially vancomycin-resistant enterococci, are emerging pathogens in patients with liver transplantation.

폐렴 구균(Streptococcus pneumoniae)에 의한 척수 경막외 농양 1예

이지영,위유미,손경목,기현균,문치숙,오원섭,백경란,송재훈 대한감염학회 2004 감염과 화학요법 Vol.36 No.6

폐렴구균은 보통 폐렴이나 뇌막염을 일으키는 균으로 척수 경막외 농양을 일으키는 경우는 매우 드물다. 본 저자들은 폐렴 구균에 의한 척수 경막 외 농양을 경험하여 보고하는 바이다. 과거 건강했던 36세 남자 환자로 사다리에서 낙상한 후 요통 및 고열, 신경학적 이상으로 내원하여 자기 공명 촬영 결과 척수 경막 외 농양으로 진단받고 항균제 투여와 함께 응급 수술을 시행하였다. 농 배양 결과 페니실린 감수성인 폐렴 구균이 분리 되었고, 수술 요법과 항생제 투여 후 농양은 치유되었으나 신경학적 이상은 호전 없는 상태로 타원으로 전원되었다. Pneumonia and meningitis are the most frequent manifestations of pneumococcal infections. Pneumococcal spinal epidural abscesses have been rarely reported. Spinal epidural abscess by Streptococcus pneumoniae has been diagnosed among the patients with diabetes mellitus, alcoholism, corticosteroid therapy, intravenous drug use, chronic renal failure, AIDS, and history of spinal surgery. Recently, we experienced a case of pneumococcal spinal epidural abscess after spinal trauma. A 36-year-old male patient was admitted with back pain, fever, and paraplegia which occurred 5 days after the trauma. Spine MRI revealed spinal epidural abscess at the level from T2 to T9. He was treated with antimicrobial agents and surgical exploration for spinal epidural abscess. Pus culture grew S. pneumoniae which was susceptible to penicillin. Despite early surgical treatment, neurologic sequelae remained. Considering the high mortality and morbidity of pneumococcal spinal epidural abscess, early diagnosis and aggressive treatment including surgical intervention and antibiotics therapy should be implemented immediately.

과일과피로부터 폴리페놀 분리에 따른 생리기능연구

안봉전,이진태,곽재훈,박정미,이진영,박태순,손준호,최청 경산대학교 생명자원개발연구소 2003 생명자원과 산업 Vol.7 No.-

Biological activities and anticarcinogenicity of Korean Pear peel were investigated. Electron donating activity and superoxide dismutase(SOD)-like activity of fraction Ⅱ, Ⅲ were up to 90% and 50-60% at 50ppm, respectively. Inhibitory effects on xanthine oxidase were about 80% at 50ppm, breast adenocarcinoma was about 60% at 2,000 ppm, higher Ⅲ than Ⅱ. Inhibitory effect on prostate adenocarcinoma was about 23% at 500 ppm. In conclusion, Korean Pear peel was expected to use as a functional material.

불명열 환자에서 진단된 중증 만성 활동성 Epstein-Barr virus 감염증

전경만,김응호,손준성,장현하,정숙인,오원섭,백경란,송재훈,고광철,정철원,고영혜 대한감염학회 2003 감염과 화학요법 Vol.35 No.4

최근 장기적이고 심각한 임상 증상을 유발하는 만성 활동성 EBV 감염증의 개념이 정립되면서 그 증례들이 보고되고 있다. 만성 활동성 EBV 감염증은 소아나 젊은 성인들에게서 주로 발생되며, EBV-VCA IgG, EBV-EA IgG의 수치가 높게 관찰되고, 지속적인 발열, 전신쇠약감, 광범위한 임파선비대증, 간비장비대, 범혈구감소증, 다크론성감마병증을 나타낸다. 이 질환은 환자의 임상소견, 혈액학적 소견, EBV 항체 역가 및 침범 장기의 EBV genome 검출로 확진 되며 치료로 항 바이러스 체제, 항암 치료, 골수이식술 등이 시도되고 있으나 아직 검증되어 있지 않다. 저자들은 불명열을 주소로 내원하여 중증 만성 활동성 EBV 감염증으로 진단된 증례 4례를 경험하였다. 한 례에서는 항 바이러스 제제를 추여 후 임상적, 혈액학적 호전을 보였으나 치료 20일째 발생한 세균성 복막염과 패혈증으로 사망하였고, 두 례에서 총 6회의 CHOP 항암치료와 자가조혈모세포이식을 시행 받은 후 현재까지 증상 없이 추적관찰 중이다. 지속되는 발열을 주소로 내원한 불명열 환자들에게서 EBV에 대한 검사를 시행할 경우 불명열의 원인을 규명하는데 하나의 단서를 제공할 수 있을 것으로 사료된다. Epstein-Barr virus (EBV) is one of eight human herpesvirus. Primary infection with EBV in childhood is generally asymptomatic or mild, however, often causes overt diseases such as infectious mononucleosis (IM) and lymphoproliferative disorder (LPD), the latter occursing in immunologically compromised individuals. Historically, EBV has been considered to be etiologically linked to human malignancies such as EBV genome positive Burkitt's lymphoma and nasopharyngeal carcinoma. Recently, however, another category of EBV-related disease, "chronic active EBV infection", has been made to describe persons without a clearly defined underlying disease. We report 4 cases of patients, presented with episodic fever of unknown origin (FUO), who were diagnosed as severe chronic active EBV infection. A combined application of serology for EBV and in-situ hybridization established the diagnosis of the EBV infection.

아시아 지역 폐렴 구균의 항균제 내성 현황 및 변화 양상 : Asian Network for Surveillance of Resistant Pathogens (ANSORP) Study

정숙인,김나영,손준성,기현균,고관수,서지연,장현하,김연숙,오원섭,백경란,이남용,송재훈,항생제 내성 감시를 위한 아시아 연합 (ANSORP) 대한감염학회 2004 감염과 화학요법 Vol.36 No.1

목적 : 1980년대부터 페니실린을 비롯한 β-lactam 계열과 비 β-lactam 계열 항균제에 대한 폐렴구균의 항생제 내성이 급격하게 증가하여 국내 뿐 아니라 세계적인 문제로 대두되고 있다. ANSORP 에서는 아시아 지역에서 폐렴구균의 항균제 내성과 그 변화 추이, 내성의 기전 및 위험인자를 분석하고자 본 국제 공동 연구를 시행하였다. 재료 및 방법 : 1999년 11월부터 2001년 8월까지 아시아 지역 12개국의 14개 기관에서 폐렴구균 감염증 환자의 임상 검체로 분리된 침습성 폐렴구균을 대상으로 액체배지 미량희석법을 이용하여 16개 항생제의 MIC를 구하였다. 위험인자의 분석을 위하여 폐렴구균 감염증 환자를 대상으로 의무기록지를 조사하였다. Quellung 반응을 통해 혈청형을 결정하였다. 결과 : 총 685균주 중 52.4%가 페니실린에 대하여 비감수성(중등도 내성 22.9%, 내성 29.5%)을 보였고, 그 빈도는 베트남(92.1%), 스리랑카(85.7%), 홍콩(67.9%), 한국(64.5%)의 순이었다. Erythromycin에 대한 비감수성 비율은 베트남(92.1%), 대만(87.7%), 한국(80.6%), 홍콩(76.8%) 등에서 높게 나타났고, 베트남, 대만, 한국, 홍콩 등의 erythromycin의 MIC_(90)이 32㎍/mL를 넘는 고도내성을 보였다. 홍콩, 싱가포르, 대만, 인도에서는 fluoroquinolone에 대한 내성 균주가 출현하였다. 전체 균주 중 다제내성 균주의 비율은 47.7%였다. 혈청형은 19형과 23형이 가장 많았고, 그 외 6형, 14형 등이 있었다. 페니실린 비감수성 감염증의 위험인자로는 5세 미만(OR=1.7; 95%, CI, 1.2-2.4; P=0.002), 기관지폐질환(OR=2.0; 95%, CI, 1.3-3.1; P=0.003), 악성종양(OR=2.3; 95%, CI, 1.2-4.6; P=0.015), 스테로이드의 사용(OR=2.8; 95%, CI, 1.1-7.4; P=0.032)이 확인되었다. 결론 : 침습성 폐렴구균 균주를 대상으로 한 본 연구의 결과 아시아 국가들에서 페니실린, β-lactam 및 macrolide에 대한 폐렴구균의 내성률 및 내성 정도가 급증하고 있음을 확인하였다. Background : Emergence of pneumococcal resistance became a global issue since 1990s. According to the ANSORP studies with clinical isolates and carriage isolates between 1996 and 1999, some Asian countries showed alarmingly high prevalence of resistance to penicillin and other antimicrobial agents. To investigate the changing trends of pneumococcal resistance, ANSORP study group has performed a multinational surveillance study with invasive pneumococcal isolates from Asian countries. Methods : All isolates from various invasive pneumococcal diseases were prospectively collected from 14 centers in 12 countries between November 1999 to August 2001. Broth microdilution tests with 16 antimicrobial agents were performed according to the NCCLS procedures. Serotyping was performed by means of Quelling reaction with use of group-specific antisera. Results : A total of 685 isolates were collected. Overall, 52.4% of invasive isolates from Asian countries were not susceptible to penicillin (intermediate (1), 22.9%, Resistant (R), 29.5%). Vietnam showed the highest prevalence of penicillin non-susceptibility (1 20.6%, R 71.4%) followed by Sri Lanka (1 71.4%, R 14.3%), Hong Kong (1 24.1%, R 76%) and Korea (1 9.7%, R 54.8%). China (I 19.8%, R 23.4%) and Malaysia (1 9.1%, R 29.5%) also showed remarkable increase in penicillin resistance compared with previous ANSORP data, which were less than 10%. Vietnam (92.1%), Taiwan (87.7%), Korea (80.6%), and Hong Kong (76.8%) showed high prevalence of erythromycin resistance. MIG_(90)S for ciprofloxacin were 4 ㎍/mL (Hong Kong) and 2 ㎍/mL (11 Asian countries except Hong Kong), respectively. Conclusion : Compared with previous data from ANSORP studies, antimicrobial resistance among invasive pneumococcal isolates has markedly increased in Vietnam, Sri Lanka, Taiwan, China, and Malaysia. Continuous surveillance of pneumococcal resistance in Asia is strongly warranted.

급성 림프구성 백혈병 환자에서 발생한 침습성 국균 심내막염 2예

신성철,백경란,정재홍,송봉근,김동희,전경만,채제욱,손준성,정숙인,오원섭,송재훈 대한감염학회 2003 감염과 화학요법 Vol.35 No.5

국균은 호흡기를 통해 유입되며 심한 면역기능저하 환자에서 기회감염을 일으키는 진균이며 주로 혈관을 따라 폐를 침범하고 심장과 골침범은 매우 드문 것으로 알려져 있다. 저자들은 급성 림프구성 백혈병 환자에서 발생한 침습성 국균 심내막염을 2예을 경험하였다. 19세 남자환자로 동종 조혈모세포이식 후 발생한 고열과 요통의 원인으로 감염성 심내막염 진단하에 수술결과 국균에 의한 감염으로 확증되어 수술적 절제술과 liposomal amphotericin B로 치료하였으나 국균 심내막염의 재발과 국균 척추염의 악화, 뇌 출혈로 사망하였다. 23세 남자환자로 관해요법 후 발생한 고열과 요통의 원인으로 국균 심내막염과 국균 척추염 진단하에 수술적 절제술과 amphotericin B로 치료하여 1년 2개월 동안 국균 심내막염의 재발은 없었으나 지속적인 백혈병의 재발과 국균 척추염의 악화, 침습성 폐 국균증으로 사망하였다. Although Aspergillus endocarditis has rarely been reported, it can cause fatal complications in hematologic malignancy patients and allogeneic stem cell transplant recipients. We experienced two cases of aspergillus endocarditis developed in acute lymphoblastic leukemia patients. Case; A 19-year-old patient developed Aspergillus endocarditis after allogenic hemopoietic stem cell transplantation. He was treated with surgical intervention and liposomal amphotericin B. He died of recurred Aspergillus endocarditis and cerebral hemorrhage probably related with aspergillosis of central nervous system. Case 2; A 23-year-old patient developed invasive Aspergillus endocarditis after induction chemotherapy. Aspergillus endocarditis was successfully treated by surgical intervention and amphotericin B. He died of refractory neutropenic fever and sepsis after the third relapse of leukemia and repetitive chemotherapy. He probably had invasive pulmonary aspergillosis without evidence of endocarditis recurrence. Because the mortality of Aspergillus endocarditis is very high, early diagnosis and surgical intervention are very important for better outcome.