황색포도알균이 가장 흔한 원인인 우리나라 4개 대학병원의 감염성심내막염의 특징

서성우,김태형,현민수,추은주,전민혁,문철,송단,김종화,이용관,최종효,전웅,조영신,최문한 대한감염학회 2008 Infection and Chemotherapy Vol.40 No.6

Background : To evaluate whether Staphylococcus aureus is actually the leading cause of infective endocarditis in Korea, investigation on updated clinical pictures, treatments, and prognosis was performed. This study also aims to describe differences in clinical characteristics of infective endocarditis in patients undergoing maintenance hemodialysis. Materials and Methods : Fifty five patients who were diagnosed with infective endocarditis, using modified Duke criteria, at 4 Soon Chun Hyang University Hospitals (located in Seoul, Bucheon, Cheonan, and Gumi) from January of 2000 to June of 2007 were enrolled. Patients were separated into two groups; those on hemodialysis and those who were not on hemodialysis (control group). Medical records and laboratory results of each patient were reviewed retrospectively. Results : The positive rate of blood culture was 72.7%. Staphylococcus aureus was isolated in 38.2% of the patients, making it the most common causative organism of infective endocarditis. It was also the most common organism in both hemodialysis group and non-hemodialysis group. Six patients (10.9%) died while admitted to the hospital and the in-hospital death rate for hemodialysis group was significantly higher. Conclusion : In most parts of the world, S. aureus is increasingly becoming the principal causative organism of infective endocarditis. To our knowledge, this is the first study that shows S. aureus to be the most common causative organism of infective endocarditis in Korea, and that Korea is not except from this global epidemiology. Background : To evaluate whether Staphylococcus aureus is actually the leading cause of infective endocarditis in Korea, investigation on updated clinical pictures, treatments, and prognosis was performed. This study also aims to describe differences in clinical characteristics of infective endocarditis in patients undergoing maintenance hemodialysis. Materials and Methods : Fifty five patients who were diagnosed with infective endocarditis, using modified Duke criteria, at 4 Soon Chun Hyang University Hospitals (located in Seoul, Bucheon, Cheonan, and Gumi) from January of 2000 to June of 2007 were enrolled. Patients were separated into two groups; those on hemodialysis and those who were not on hemodialysis (control group). Medical records and laboratory results of each patient were reviewed retrospectively. Results : The positive rate of blood culture was 72.7%. Staphylococcus aureus was isolated in 38.2% of the patients, making it the most common causative organism of infective endocarditis. It was also the most common organism in both hemodialysis group and non-hemodialysis group. Six patients (10.9%) died while admitted to the hospital and the in-hospital death rate for hemodialysis group was significantly higher. Conclusion : In most parts of the world, S. aureus is increasingly becoming the principal causative organism of infective endocarditis. To our knowledge, this is the first study that shows S. aureus to be the most common causative organism of infective endocarditis in Korea, and that Korea is not except from this global epidemiology.

활동성 인공판막 심내막염: 임상 양상, 검사 소견 및 중기 수술 성적

김환욱,김준범,김희중,주석중,송현,이재원,정철현 대한흉부외과학회 2009 Journal of Chest Surgery (J Chest Surg) Vol.42 No.4

배경: 인공판막 심내막염은 자연판막 심내막염보다 초기 임상양상이 불량하고, 심내막의 감염 뿐 아니라 주변 조직으로 염증 파급이 용이하다. 특히, 합병증을 동반하여 악화된 임상양상으로 술 전 충분한 항생제 치료를 기대할 수 없는 상태(활동성 심내막염)에서 판막 재치환술을 시행하는 경우는 만족스럽지 못한 술 후 예후를 가진다. 본 연구는 활동성 인공판막 심내막염의 임상 양상, 검사 소견 및 중기 수술 성적 알아보기 위해 수행되었다. 대상 및 방법: 1998년 1월부터 2008년 7월까지 감염성 심내막염으로 진단 및 수술이 이루어진 276명의 환자 중 인공판막 심내막염으로 수술이 이루어진 경우는 31명이었다. 이 중 24명의 활동성 인공판막 심내막염 환자를 연구 대상으로 하였다. 결과: 열감이 가장 흔한 임상증상이었으나, 전신성 색전증을 동반한 경우도 8예(33.3%)였으며, 이 중 5예(20.8%)는 중추신경계가 이환되었다. 경식도 초음파 검사상 우종(vegetation)이 가장 많이 관찰된 소견이며, 포도상 구균(Staphylococcus species)이 배양된 주된 원인 균주였다. 42.1±36.9달의 평균 추적 관찰 기간 동안 조기사망 4예, 만기사망 4예 있었으며, 누적 생존율은 1년 후에는 79%, 3년 후에는 73%, 5년 후에는 66%, 7년 후에는 49.5%였다. 결론: 악화된 임상양상 등의 이유로 술 전 충분한 항생제 치료를 기대할 수 없는 활동성 인공판막 심내막염은 술 후 불량한 예후를 가진다. 그럼에도 불구하고, 조기 수술은 물론, 정상 조직이 노출이 될 때까지 광범위한 염증 조직 제거하는 것이 환자의 생존율을 높일 수 있는 방법이라 생각된다. Background: Prosthetic valve endocarditis usually presents with clinical symptoms that are more severe than native valve endocarditis, and prosthetic valve endocarditis shows the spread of infection into the surrounding tissue as well as into the superficial endocardial layers. The postoperative prognosis is especially poor for valve re-replacement for the cases of active endocarditis that are unable to receive a full-course of pre-antibiotic therapy due to complications and the ensuing clinical aggravation. The aim of this study was to evaluate the clinical profiles, laboratory findings and mid-term surgical results of active prosthetic valve endocarditis. Material and Method: Among the 276 surgically treated infective endocarditis patients who were treated during the period from January 1998 to July 2008, 31 patients were treated for prosthetic valve endocarditis. Among these patients, 24 received surgical treatment for an 'active' state, and they were selected for evaluation. Result: The most frequently encountered symptom was a febrile sensation. Eight cases (33.3%) were accompanied by systemic thromboembolism, among which 5 cases (20.8%) had an affected central nervous system. 'Vegetations' were most commonly found on transesophageal echocardiography, and the 'Staphylococcus species' were the most frequent pathogens. There were 4 deaths in the immediate postoperative period, and an additional 4 patients died during the follow-up period (Mean± SD, 42.1±36.9 months). The cumulative survival rate was 79% at 1 year, 73% at 3 years, 66% at 5 year, and 49.5% at 7 years. Conclusion: The cases of active prosthetic valve endocarditis that were unable to receive a full course of preoperative antibiotics therapy generally have a poor prognosis. Nevertheless, early surgery and extensive resection of all the infected tissue is pivotal in improving the survival rate of patients with surgically treated active prosthetic valve endocarditis.

Two Cases of Infective Endocarditis in Patients with Atopic Dermatitis

( Bok Won Park ),( Yo Sup Shin ),( Eun Byul Cho ),( Eun Joo Park ),( Kwang Ho Kim ),( Kwang Joong Kim ) 대한피부과학회 2019 Annals of Dermatology Vol.31 No.1

Patients with atopic dermatitis have high rates of skin surface colonization of Staphylococcus aureus. At the same time, S. aureus is the major causative organism in infective endocarditis, approximately accounting for 30%∼50% cases of infective endocarditis. A 22-year-old male with severe atopic dermatitis presented with fever and myalgia. He was diagnosed with active infective endocarditis causing multiple cerebral infarction, splenic infarction, and septic shoulder requiring synovectomy. Blood culture proved methicillinsensitive Staphylococcus aureus bacteremia, and the culture from the skin revealed same bacteria. After treated with intravenous antibiotics for 6 weeks, patient was improved. Another 42-year-old female with severe atopic dermatitis who presented with fever and chilling was hospitalized due to acute infective endocarditis. She also had left flank pain and visual disturbance, due to splenic infarction and acute cerebral infarction, respectively. As blood culture revealed methicillin-sensitive Staphylococcus aureus bacteremia, she treated with intravenous antibiotics for 6 weeks. The route of entry of two patients was attributed to the patient eczematous scratching lesion of poorly controlled atopic dermatitis. Infective endocarditis can result in the context of acute deterioration of atopic dermatitis. Dermatologists need to pay attention to this risk and actively manage such conditions in order to decrease the risk of infective endocarditis arising from skin lesions in atopic patients. For these reasons, we herein report two cases of infective endocarditis in patients with atopic dermatitis. (Ann Dermatol 31(1) 70∼74, 2019)

뇌출혈이 합병된 감염성 심내막염 1례

박동건,이재욱,권삼,이동철,강승완 동국대학교 경주대학 1997 東國論集 Vol.16 No.2

감염성심내막염에 의한 신경계 합병증은 색전성 뇌경색, 색전성 뇌출혈, 두개내 패혈성 동맥류, 뇌농양, 뇌막염등 다양한데 항생제 요법의 발달과 판막치환술에도 불구하고 그 빈도는 감소되지 않고 있다. 이 중 두개내 패혈성 동맥류의 파열에 의한 뇌출혈은 사망률이 80%로 치명적일 수 있어 조기 발견 및 적절한 치료가 필요하다. 저자들은 두통, 열감, 근육통 등의 증상으로 내원하여 감염성 심내막염으로 진단받고, 항생제 치료로 임상증세의 호전중에 심한 두통과 전신적 발작이 있은 후 갑자기 발생한 두개내 뇌출혈을 심장초음파 및 뇌 컴퓨터 단층촬영을 통하여 진단, 경험하였기에 문헌고찰과 함께 보고하는 바이다. The complications of infective endocarditis may involve any organ system ie, cardia, neurologic, vascular, dermatologic, and kidney. Extracardiac complications are usually caused by either embolization of vegetations or deposition of immune complexes. Neurologic complications remain a significant problem in bacterial endocarditis and have been reported to occur in up to 20% to 40% of cases of infective endocarditis. The various types of central nervous system disease seen in patients with infective endocarditis are cerebral embolism (with infarction or with intracerebral hemorrhage), intracranial mycotic aneurysm, seizures, brain abscess, meningitis, mental change, psychiatric disorder. Mycotic aneurysms are uncommon but not rare and are an important cause of local or systemic sepsis and acute hemorrhage following aneurysmal rupture. Cerebral mycotic aneurysms have been noted in 2∼10% of cases of bacterial endocarditis and account for 2.5∼6.2% of all intracerebral aneurysms. We have experienced a case of neurologic complication due to infective endocarditis in a 23 year-old female patient, who admitted to our hospital because of fever, chill, headache, myalgia. This case was diagnosed by echocardiography, brain computed tomography. The patient died of sudden intracerebral hemorrhage in the 53th hospital day despite intensive medical treatment. We report one case of intracerebral hemorrhage complicated with infective endocarditis.

황색포도알균이 가장 흔한 원인인 우리나라 4개 대학병원의 감염성심내막염의 특징

서성우,김태형,현민수,추은주,전민혁,문철,송단,김종화,이용관,최종효,전웅,조영신,최문한 대한감염학회 2008 감염과 화학요법 Vol.40 No.6

Background : To evaluate whether Staphylococcus aureus is actually the leading cause of infective endocarditis in Korea, investigation on updated clinical pictures, treatments, and prognosis was performed. This study also aims to describe differences in clinical characteristics of infective endocarditis in patients undergoing maintenance hemodialysis. Materials and Methods : Fifty five patients who were diagnosed with infective endocarditis, using modified Duke criteria, at 4 Soon Chun Hyang University hospitals (located in Seoul, Bucheon, Cheonan and Gumi) from January of 2000 to June of 2007 were enrolled, Patients were separated into two groups; those on hemodialysis and those who were not on hemodialysis (control group). Medical records and laboratory results of each patient were reviewed retrospectively. Results : The positive rate of blood culture was 72.7%. Staphylococcus aureus was isolated in 38.2% of the patients making it the most common causative organism of infective endocarditis. It was also the most common organism in both hemodialysis group and non-hemodialysis group. Six patients (10.9%) died while admitted to the hospital and the in-hospital death rate for hemodialysis group was significantly higher. Conclusion : In most parts of the world, S. aureus is increasingly becoming the principal causative organism of infective endocarditis. To our knowledge, this is the first study that shows S. aureus to be the most common causative organism of infective endocarditis in Korea, and that Korea is not except from this global epidemiology.

[P147] Two cases of infectious endocarditis in patients with atopic dermatitis

( Bok Won Park ),( Jun Yeong Park ),( Eun Byul Cho ),( Eun Joo Park ),( Kwang Ho Kim ),( Kwang Joong Kim ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

A 22-year-old male with severe atopic dermatitis presented with fever and myalgia. He was diagnosed with active infective endocarditis causing multiple cerebral infarction, splenic infarction, and septic shoulder requiring synovectomy. Blood culture proved methicillin-resistant Staphylococcal aureus bacteremia. After treated with intravenous nafcillin and vancomycin, patient was improved. Another 42-year-old female with severe atopic dermatitis who presented with fever and chilling was hospitalized due to acute infective endocarditis. She also had left flank pain and visual disturbance, due to splenic infarction and acute cerebral infarction, respectively. As blood culture revealed methicillin-resistant Staphylococcal aureus bacteremia, she treated with intravenous vancomycin. Infective endocarditis can arise in the context of acute exacerbations of atopic dermatitis. Dermatologists need to pay attention to this risk and actively manage such acute flares in order to decrease the risk of infective endocarditis arising from skin lesions in atopic patients. For these reasons, we herein report two cases of infective endocarditis in patients with atopic dermatitis.

Q 열에 의한 감염성 심내막염 2예

문수연,최영실,박미연,이정아,정혜숙,정두련,송재훈,백경란,정미경 대한감염학회 2009 Infection and Chemotherapy Vol.41 No.3

Q fever is a zoonosis caused by Coxiella burnetii, presenting as acute and chronic illness and it has been reported worldwide. Acute Q fever is usually asymptomatic or mild and self-limiting, but infective endocarditis is one of the most serious complications of chronic Q fever and can be fatal. Known risk factors for Q fever endocarditis are valvular heart disease, immunocompromised hosts, and pregnancy. There have been some reports on Q fever in Korea but there exists no report on Q fever endocarditis. We have experienced 2 cases of Q fever with underlying valvular heart disease; both patients came to the hospital for evaluation of prolonged fever. Although Q fever and Q fever endocarditis are rare in Korea, Q fever endocarditis should be considered in the differential diagnosis of patient with infective endocarditis when causative microorganism cannot be identified.

출혈성 심낭염과 진균성 상장간막 동맥류 파열에 의한 급성 혈복증이 병발한 감염성 심내막염 환자 1례

하희근,김민기,류종철,김두일,김동수,홍관희 대한순환기학회 1998 Korean Circulation Journal Vol.28 No.9

Use of a Valved-Conduit for Exclusion of the Infected Portion in the Prosthetic Pulmonary Valve Endocarditis

정준호,홍유선,이철주,임상현,최호,박수진 대한흉부외과학회 2013 Journal of Chest Surgery (J Chest Surg) Vol.46 No.3

A 51-year-old male was admitted to the hospital with complaints of fever and hemoptysis. After evaluation of the fever focus, he was diagnosed with pulmonary valve infective endocarditis. Thus pulmonary valve replacement and antibiotics therapy were performed and discharged. He was brought to the emergency unit presenting with a high fever (>39oC) and general weakness 6 months after the initial operation. The echocardiography revealed prosthetic pulmonary valve endocarditis. Therefore, redo-pulmonary valve replacement using valved conduit was performed in the Rastelli fashion because of the risk of pulmonary arterial wall injury and recurrent endocarditis from the remnant inflammatory tissue. We report here on the successful surgical treatment of prosthetic pulmonary valve endocarditis with an alternative surgical method.

증식편에서 16S rRNA 직접 염기서열분석으로 진단한 Haemophilus parainfluenzae 심내막염

오성희,조민철,김재욱,안동희,정문희,김미나,최상호 대한진단검사의학회 2012 Laboratory Medicine Online Vol.2 No.2

The HACEK group of microorganisms is responsible for approximately 3-6% of endocarditis cases and is a major cause of culture-negative endocarditis. Here, we report a case of Haemophilus parainfluenzae infective endocarditis that was diagnosed by direct PCR sequencing of 16S rRNA from resected vegetation. A healthy 26-yr-old man was admitted to the emergency room (ER) on March 27, 2011 because of intermittent high fever. The patient was prescribed cefpodoxime for 5 days at the ER. Six and 11 sets of blood cultures were performed at the ER and in a general ward, respectively, using BACTEC Plus Aerobic/F (Becton-Dickinson, USA) and Lytic Anaerobic/F Plus (BD) together. Echocardiography revealed a large vegetation at the posterior mitral valve leaflet. After performing mitral valvoplasty on hospital day (HD) 11, the vegetation tissue was cultured in thioglycolate broth, blood agar, Brucella agar, and MacConkey agar for 7 days, but no organism was grown. Direct PCR sequencing of 16S rRNA of the tissue revealed the presence of H. parainfluenzae. In the 17 sets of blood cultures, bacterial growth was detected in only 2 aerobic bottles of 5 sets taken at HD 9 after 10-day and 14-day incubation. The organism was identified as H. parainfluenzae by using the VITEK NHI card (bioMerieux, France). Direct PCR sequencing of vegetation could be useful in diagnosing bacterial pathogens in infective endocarditis patients, especially in culture-negative cases. HACEK 군은 전체 심내막염 중 3-6%를 차지하며, 배양 음성 심내막염의 주요 원인이다. 혈액배양이 지연된 H. parainfluenzae 심내막염에서 증식편을 직접 염기서열 분석방법으로 진단한 증례를 보고한다. 건강했던 26세 남자가 2011년 3월 27일 간헐적 고열을 주소로 응급실에 내원하여 cefpodoxime을 5일간 처방받았다. 응급실과 입원 후 병실에서 각각 6쌍과 11쌍의 혈액배양 검사를 실시하였고 혈액은 BACTEC Plus Aerobic/F (Becton-Dickinson,USA)와 Lytic Anaerobic/F Plus (BD, USA)에 세트로 접종하였다. 심초음파 검사에서 승모판 후방에 큰 증식물이 관찰되어 심내막염으로 진단되었다. 입원 11일째 증식물 제거술 및 승모판 성형술을 시행한 후 증식편을 thioglycolate 액체배지, 혈액한천배지, 브루셀라 혈액한천배지, MacConkey 배지에 7일간 배양하였으나 균은자라지 않았다. 증식편에서 16S rRNA를 직접 염기서열 분석검사하여 H. parainfluenzae를 동정하였다. 입원 9일째 시행한 5쌍의 배양 중 2쌍의 호기성병에서 혈액 배양 10일, 14일 만에 균이 배양되었다. VITEK NHI card (bioMerieux, France)를 이용하여 H. parainfluenzae로동정하였다. 감염성 심내막염, 특히 배양 음성 심내막염 환자에서 증식편을 직접 염기서열 분석하여 원인균을 동정하는 것은 매우 유용한 진단법이 될 것이다.