제주지역 성인 지역사회획득 폐렴의 원인균 및 임상양상

전봉희 ( Bong Hee Jeon ),김미옥 ( Mi Ok Kim ),김정홍 ( Jeong Hong Kim ),신상엽 ( Sang Yop Shin ),이재천 ( Jae Chun Lee ) 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.66 No.5

연구배경: 폐렴의 치료는 해당 지역사회의 역학 자료, 항생제에 대한 감수성, 임상양상 등에 따라 적절한 항생제를 선택하는 것이 중요하다. 한반도 남단의 섬지역인 제주지역에서 이와 같은 연구가 시행된 바가 없다. 제주 지역에서 발생한 지역사회 획득 폐렴의 임상양상과 원인균을 전향적으로 조사하여, 향후 적절한 항생제를 선택할 수 있는 자료로 활용하고자 연구를 시행하였다. 방법: 임상양상으로 지역사회획득폐렴을 진단 받은 환자를 대상으로 전향적으로 원인균 동정을 위해 객담 도말 및 배양검사, Streptococcus pneumoniae, Legionella 등 항원검사, Mycoplasma, Chlamydia 등에 대한 항체검사를 시행하였다. 진단 당시의 임상 양상, 검사실 자료, 초기 경험적 항생제 치료의 실패 여부 등을 분석하였다. 결과: 203명(평균 64세)의 지역사회 획득 폐렴 환자로부터 10균주의 원인균(90명, 동정률 44.3%)이 동정되었다. 30명(33.3%)에서 두 개 이상의 세균이 동정된 다세균 감염이었다. S. pneumoniae, M. pneumoniae, C. pneumoniae, S. aureus, P. aeruginosa 등의 순으로 동정되었다. 초기 치료 실패로 항균제를 변경한 예가 약 1/4이었으며, 다세균 감염, 흉수, 높은 염증반응수치 등이 초기 치료실패의 위험요인이었다. 환자들로부터 분리된 30균주의 S. pneumoniae에서 penicillin (53.3%), macrolides (66.3%) 등에 대해 항생제 비감수성을 보였으며, levofloxacin과 ceftriaxone에 대해서는 항생제 감수성을 보였다. 결론: 제주지역 지역사회획득 폐렴의 원인균은 S. pneumoniae이 가장 흔하고, M. pneumoniae, C. pneumoniae, S. aureus, 그람음성간균 등의 순이다. 초기 항생제 치료시 항생제 내성을 고려하여 약제를 선택해야 하며, 초기 치료 실패가 높은 임상양상에 주의를 요한다. 제주지역 지역사회획득 폐렴의 치료로 2∼3세대 세팔로스포린 또는 호흡기계 퀴놀론 등을 초기 경험적 항생제로 추천한다. Background: The appropriate empirical antimicrobial choice in the treatment of community-acquired pneumonia (CAP) should be advocated by community-based information on the etiologic pathogens, their susceptibility to antimicrobials, clinical characteristics and outcomes. Jeju is a geographically isolated and identical region in Korea. However, there is no regional reference on adult CAP available. This study investigated the etiologic agents and clinical outcomes of adult patients diagnosed with CAP in Jeju, Korea, to help guide the empirical antimicrobial choice. Methods: A prospective observational study for one year in a referral hospital in Jeju, Korea. Patients diagnosed with CAP were enrolled with their clinical characteristics. Microbiological evaluations to identify the etiologic agents in the adult patients with CAP were performed with blood culture, expectorated sputum smear and culture, antibody tests for mycoplasma, chlamydophila, and antigen tests for legionella and pneumococcus. The clinical outcomes of the initial empirical treatment were analyzed. Results: Two hundred and three patients with mean age of 64 and 79 females were enrolled. Ten microbials from 90 cases (44.3%) were isolated and multiple isolates were confirmed in 30. Among the microbial isolates, S. pneumoniae (36.3%) was the most common, followed by M. pneumoniae (23.0%), C. pneumoniae (17.0%), S. aureus (9.6%) and P. aeruginosa (5.9%). The initial treatment failure (23.8%) was related to the isolation of polymicrobial pathogens, elevated inflammatory markers, and the presence of pleural effusion. Among the 30 isolates of S. pneumoniae, 16 (53.3%) were not susceptible to penicillin, and 19 isolates (63.3%) to erythromycin and clarithromycin. However, 29 isolates (96.7%) were susceptible to levofloxacin and ceftriaxone. Conclusion: S. pneumoniae, M. pneumoniae, S. aureus, and P. aeruginosa are frequent etiologic agents of adult CAP in Jeju, Korea. The clinical characteristics and antibiotic resistance should be considered when determining the initial empirical antimicrobial choice. Respiratory quinolone or ceftriaxone is recommended as an empirical antimicrobiotic in the treatment of adult CAP in Jeju, Korea.

소아 대엽성 폐렴에서 마이코플라즈마 폐렴의 임상적 특성

양은애,강미현,유선영,김진환,이재호 대한 소아알레르기 호흡기학회 2012 Allergy Asthma & Respiratory Disease Vol.22 No.3

Purpose:This study was conducted to evaluate the prevalence, clinical characteristics and laboratory findings of lobar pneumonia in children caused by Mycoplasma pneumonia and to find a diagnostic tool for identifying M. pneumoniae infection in children. Methods:We analyzed medical records of 78 children between March 2010 and December 2011, who were admitted to our hospital and diagnosed with lobar pneumonia on the basis of chest X-rays. White blood cells (WBC), C-reactive protein (CRP), procalcitonin (PCT), specific antibodies to M. pneuomoniae, and cold agglutinin (CA) were measured at the time of admission. Children were divided into 2 groups: those with M. pneumoniae infection (group A) and those without infection (group B). Group A children were also subdivided into 2 categories: those with increased CA (group 1) and those without (group 2). Results:The prevalence of lobar pneumonia was higher in the year 2011 than in 2010. M. pneumoniae infection usually occurs in summer and autumn. Group A children accounted for 75.6% (59/78) of all the cases. The onset ages was higher in group A than in group B (P=0.016). WBC counts and PCT values were higher in group B than in group A.(P=0.015 and P=0.011, respectively) Radiologic findings showed that the lower lobe was most commonly involved without predilection for either side and pleural effusion was present in 13.6% of all the cases. The duration of fever before admission was longer in group 1 than in group 2.(P=0.019)Conclusion:It is concluded that lobar pneumonia caused by M. pneumoniae can be more accurately diagnosed using serum PCT values than using CRP values. 목 적:저자들은 흉부 방사선 검사로 진단된 소아의 대엽성 Mycoplasma pneumoniae 감염에 의한 특징적인 임상 증상 및 검사 결과들을 비교 분석하여 M. pneumoniae에 의해 발생하는 대엽성 폐렴을 유용하게 진단할 수 있는 방법을 연구하고자 하였다. 방 법:2010년 3월부터 2011년 12월까지 충남대학교병원 소아청소년과에 입원하여 흉부 방사선 검사에서 대엽성 폐렴(lobar pneumonia)으로 진단 받은 환아 78명을 대상으로 입원 당시 말초 혈액 백혈구 수, 혈청 C-reactive protein (CRP), 혈청 procalcitonin (PCT)을 검사하였고, 혈청학적 진단 방법으로 M. pneumoniae 특이 항체 및 한랭 응집소를 측정하였다. 대상 환아들을 마이코플라즈마 폐렴 군(A군)과 마이코플라즈마 폐렴이 아닌 군(B군)으로 구분한 다음 A 군을 한랭 응집소 양성 군(1군)과 음성 군(2군)으로 분류하였다. 본 연구는 의무기록을 후향적으로 조사하여 실시하였다. 결 과:대엽성 폐렴의 발생 빈도는 2010년보다 2011년에 높았으며, M. pneumoniae에 의한 폐렴이 75.6% (59/ 78)로 여름과 가을에 호발하였다. 발생 연령은 A군에서 B군보다 높았으며,(P=0.016) 말초혈액 백혈구 수 및 혈청 PCT은 B군에서 유의하게 높았다.(P=0.015, P=0.011) 흉부 방사선 검사 결과 좌우에 관계없이 두 군 모두에서 하엽 경화가 많았으며(50%) A군의 13.6%에서 늑막삼출이 동반되었다. A군 중에서 1군은 32명, 2군은 19명이었고, 입원 전 평균 발열 기간은 1군에서 2군보다 길었으나(P= 0.019) 말초혈액 백혈구의 수, 중성구 분율, 혈청 CRP와 PCT은 두 군 사이에 유의한 차이를 보이지 않았다. 결 론:본 연구 결과 M. pneumoniae에 의한 소아의 대엽성 페렴 군에서 M. pneumoniae에 의하지 않은 군보다 혈청 PCT 값이 낮았다. 그러므로 혈청 PCT 검사가 마이코플라즈마 폐렴을 전형적 세균성 폐렴과 감별하는데 CRP보다 유용한 지표로 활용될 수 있을 것이다.

3세 이하 소아에서 마이코플라즈마 폐렴의 연령별 임상양상

박재륜,이현희 대한 소아알레르기 호흡기학회 2011 Allergy Asthma & Respiratory Disease Vol.21 No.2

Purpose:Mycoplasma pneumoniae pneumonia is rarely found in children under 3 years old. Nevertheless, infants have been recently and frequently diagnosed with M. pneumoniae pneumonia. Therefore, the clinical characteristics of such children were investigated in this study. Methods:Subjects were 232 infants (group A: 0 to 11 months, group B: 12 to 23 months, group C: 24 to 35 months) who were diagnosed between January 2004 and December 2009 with M. pneumoniae pneumonia infection at Myongji Hospital. We reviewed their medical records, the early and monthly incidence of infection, clinical manifestations, and laboratory findings. Results:Group A consisted of 28 patients (12.1%), group B 78 (33.6%), and group C 126 (54.3 %). The younger patient group in the peak season, 2006, demonstrated a high incidence rate. Wheezing was more often auscultated in group A than in the other groups. Negative findings on chest X-rays were more often observed in group A. Serologically, high titers of mycoplasma-specific antibody (>1:1,280) were observed in lobar pneumonia and correlated with the severity of clinical manifestations. Conclusion:The age at which M. pneumoniae infection has been diagnosed has recently decreased and has been found with a particularly high frequency in infants. Despite shorter fever duration before hospitalization and uncertain radiological findings, including M. pneumoniae in the differential diagnosis of pneumonia is recommended for children under 1 year. 목적:3세 이하에서 마이코플라즈마 폐렴은 드문 것으로 알려져 있으나, 최근 영유아에서도 마이코플라즈마 폐렴이 많이 발생하고 있어, 3세 이하에서의 임상적 특성을 연령별로 알아보고자 한다. 방 법:2004년 1월부터 2009년 12월까지 6년간 관동대학교 의과대학 명지병원 소아청소년과에 입원하여 마이코플라즈마 폐렴으로 진단된 3세 이하 환아 232명을 대상으로 하였다. 진단된 3세 이하 환아 232명의 의무기록을 후향적으로 조사하였고, 이들을 0-11개월(A군), 12-23개월(B군), 24-35개월(C군)으로 나누었으며 세 군에서 연도별, 월별 발생빈도, 임상증상, 신체검사 소견, 검사실 소견, 흉부방사선 소견 등을 비교분석 하였다. 결 과:대상환자에서 연령이 낮을수록 유행시기에 상대적으로 발병률이 높았다. 천명은 14례(6.0%)에서 동반 되었는데 A군에서 청진 상 천명음이 더 많이 청진되었다. 방사선 검사에서 특이소견이 없었던 경우는 49례(21.1%)였고 이 중 A군에서 12례(42.9%)로 높았다. 폐엽성 폐렴의 경우는 1:1,280 이상이 B군 24명 중 18명, C군은 20명 중 12명으로 통계학적으로 유의하게 높았다. 결 론:마이코플라즈마 폐렴이 발생하는 평균 연령이 낮아지는 추세를 보이고 있고 영유아에서의 빈도가 증가하는 소견을 보이고 있다. 특히 영아에서 유행시기에 상대적으로 발병이 높고, 흉부방사선 소견이 뚜렷하지 않아도 천명을 동반하는 호흡기 증상 시 마이코플라즈마 감염에 대한 감별진단을 하는 것이 치료에 도움이 될 것이다.

Current perspectives on atypical pneumonia in children

Shim, Jung Yeon The Korean Pediatric Society 2020 Clinical and Experimental Pediatrics (CEP) Vol.63 No.12

The major pathogens that cause atypical pneumonia are Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Legionella pneumophila. Community-acquired pneumonia (CAP) caused by M. pneumoniae or C. pneumoniae is common in children and presents as a relatively mild and self-limiting disease. CAP due to L. pneumophila is very rare in children and progresses rapidly, with fatal outcomes if not treated early. M. pneumoniae, C. pneumoniae, and L. pneumophila have no cell walls; therefore, they do not respond to β-lactam antibiotics. Accordingly, macrolides, tetracyclines, and fluoroquinolones are the treatments of choice for atypical pneumonia. Macrolides are the first-line antibiotics used in children because of their low minimum inhibitory concentrations and high safety. The incidence of pneumonia caused by macrolide-resistant M. pneumoniae that harbors point mutations has been increasing since 2000, particularly in Korea, Japan, and China. The marked increase in macrolide-resistant M. pneumoniae pneumonia (MRMP) is partly attributed to the excessive use of macrolides. MRMP does not always lead to clinical nonresponsiveness to macrolides. Furthermore, severe complicated MRMP responds to corticosteroids without requiring a change in antibiotic. This implies that the hyper-inflammatory status of the host can induce clinically refractory pneumonia regardless of mutation. Empirical macrolide therapy in children with mild to moderate CAP, particularly during periods without M. pneumoniae epidemics, may not provide additional benefits over β-lactam monotherapy and can increase the risk of MRMP.

연령에 따른 Mycoplasma pneumoniae 폐렴 발병의 최근 경향

이효상,최경민 대한소아감염학회 2008 Pediatric Infection and Vaccine Vol.15 No.2

Purpose : It has been previously reported that for patients with Mycoplasma pneumoniae pneumonia was previously recognized that overt illness is unusual under the age of three and the peak incidence of illness occurs in school-aged children. However, a higher incidence of this illness in younger children has been recently noted. Thus we investigated the incidence of M. pneumoniae pneumonia. Methods : The study subjects were 414 children who were diagnosed with M. pneumoniae pneumonia from January 2004 to December 2006 at Myong Ji Hospital were enrolled. The diagnostic criteria consisted of an anti-mycoplasma antibody (AMA) titer greater than 1: 320 or a four-fold rise in the titer at follow up. Results : The age distribution was as follows: before 2 years of age: 58 patients (14%), 2-4 years of age 157 patients (37.9%) and 5-15 years of age 199 patients (48.1%). The yearly incidence for the children before 5 years of age was 52 (44%), 49 (44.6%) and 114 (61.3%), respectively. The distribution according to the antibody titer was as follows; 1: 320 in 130 patients, 1:640 in 63 patients and greater than 1:1,280 in 221 patients. The hospital stay according to the antibody titer was not significant according to either age or the AMA titers. Conclusion : M. pneumoniae pneumonia showed a peak incidence in preschool children with a higher prevalence in children under the age of three than was previously recognized. The emergence of M. pneumoniae pneumonia as a cause of community acquired pneumonia in younger children calls for an epidemiologic study to investigate the changes of the pathogens in this age group and to recommend the proper treatment. (Korean J Pediatr Infect Dis 2008;15:162-166) Purpose : It has been previously reported that for patients with Mycoplasma pneumoniae pneumonia was previously recognized that overt illness is unusual under the age of three and the peak incidence of illness occurs in school-aged children. However, a higher incidence of this illness in younger children has been recently noted. Thus we investigated the incidence of M. pneumoniae pneumonia. Methods : The study subjects were 414 children who were diagnosed with M. pneumoniae pneumonia from January 2004 to December 2006 at Myong Ji Hospital were enrolled. The diagnostic criteria consisted of an anti-mycoplasma antibody (AMA) titer greater than 1: 320 or a four-fold rise in the titer at follow up. Results : The age distribution was as follows: before 2 years of age: 58 patients (14%), 2-4 years of age 157 patients (37.9%) and 5-15 years of age 199 patients (48.1%). The yearly incidence for the children before 5 years of age was 52 (44%), 49 (44.6%) and 114 (61.3%), respectively. The distribution according to the antibody titer was as follows; 1: 320 in 130 patients, 1:640 in 63 patients and greater than 1:1,280 in 221 patients. The hospital stay according to the antibody titer was not significant according to either age or the AMA titers. Conclusion : M. pneumoniae pneumonia showed a peak incidence in preschool children with a higher prevalence in children under the age of three than was previously recognized. The emergence of M. pneumoniae pneumonia as a cause of community acquired pneumonia in younger children calls for an epidemiologic study to investigate the changes of the pathogens in this age group and to recommend the proper treatment. (Korean J Pediatr Infect Dis 2008;15:162-166)

소아에서 마이코플라즈마 폐렴의 예기적 진단

이창언,박수진,김원덕 영남대학교 의과대학 2012 Yeungnam University Journal of Medicine Vol.29 No.2

Background: As Mycoplasma pneumoniae pneumonia has increased in Korea, its relevance to infants, toddlers, and adolescents has magnified as well as. However, it is difficult to perform the serological test and PCR test routinely for diagnosis in actual clinical practice. Thus, the authors conducted this study to help clinicians do presumptive diagnosis of Mycoplasma pneumoniae pneumonia using clinical, radiological, and hematological findings. Methods: The study population consisted of 224 children between 1 month and 14 years old, hospitalized for radiographically confirmed pneumonia. Patients were divided into two groups of 100 children with Mycoplasma pneumoniae pneumonia, as diagnosed using the ELISA method. Groups with negative result in Mycoplasma IgM antibody test were classified into the viral group (98 patients with respiratory virus) and the bacterial group (46 patients with the bacteria detected in the blood sputum culture or antibiotic treatment except macrolide improved the patient's condition). These groups were compared and analyzed using clinical, hematological,and radiographic differences and scoring system. Results: Clinical, hematological, and radiographic characteristics of Mycoplasma pneumoniae pneumonia have shown the intermediate level results between bacterial pneumonia and viral pneumonia. In terms of scoring system, the mean score of Mycoplasma pneumoniae pneumonia was 4.23, which was the intermediate level between bacterial pneumonia (mean score=6.67) and viral pneumonia (mean score=1.48). Conclusion: Results suggest that the combination of the scoring system information can increase the accuracy in the diagnosis even if they may have difficulties on diagnosis, because clinical manifestations, hematological, and radiographic findings are nonspecific.

늑막삼출 유무에 따른 마이코플라즈마 폐렴의 임상 양상의 비교

변신연 ( Shin Yun Byun ),배윤진 ( Yun Jin Bae ),유재호 ( Jae Ho Yoo ),정진아 ( Jin A Jung ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2006 소아알레르기 및 호흡기학회지 Vol.16 No.4

목적: Mycoplasma pneumoniae는 학동기 소아에서 호흡기 감염의 주된 원인균이며, 마이코플라즈마 폐렴의 호흡기 합병증으로는 무기폐, 늑막 삼출, 폐농양, 폐기종, 기관지 확장증 등이 있다. 이번 연구에서는 마이코플라즈마 폐렴에서 늑막 삼출 유무에 따른 임상 양상의 특징을 비교해보고자 하였다. 방법: 2000년 1월부터 2004년 12월까지 동아대학교의료원 소아과에 입원한 마이코플라즈마 폐렴 환자 210명을 대상으로 입원 기록을 후향적으로 비교분석하였다. 마이코플라즈마 폐렴의 진단기준은 항 마이코플라즈마 항체역가가 1:320 이상인 경우로 하였으며 늑막 삼출을 동반한 경우(A군)와 동반하지 않은 경우(B군)로 나누어 성별, 연령, 발생시기, 증상, 이학적 소견, 검사 소견, 흉부 방사선 소견을 비교하였다. 결과: A군과 B군 간의 연령, 성별, 발생시기, 증상 및 청진 소견에서는 유의한 차이는 없었다. 발열기간과 입원기간은 A군이 B군보다 의미있게 길었다.(P<0.001) 적혈구 침강속도는 A군에서 49.6±32.9㎜/hr로, B군의 28.7±20.4㎜/hr보다 의미있게 높았으며(P=0.001), C-반응성 단백은 A군에서 23.0±60.4㎎/dL로, B군의 8.7±30.9㎎/dL보다 의미있게 높았고(P=0.004), SGOT와 SGPT는 A군이 각각 67±74.2 IU/L와 53.6±60.0 IU/L로, B군의 37.4±18.6 IU/L와 26.2±16.9 IU/L보다 의미있게 높았다. (P<0.001) 늑막 삼출 유무와 항 마이코플라즈마 항체역가 사이의 유의성은 없었다. 결론: 늑막 삼출이 동반된 마이코플라즈마 폐렴군에서 발열기간, 입원기간, 적혈구 침강속도, C-반응성 단백, SGOT, SGPT가 늑막 삼출이 동반되지 않은 군에 비해 유의하게 증가되어 있어, 이러한 검사 소견들을 통하여 치료 경과를 예측할 수 있을 것으로 생각한다. Purpose: Mycoplasma pneumoniae (M. pneumoniae) is a major cause of respiratory infections in school-aged children. Complications of M. pneumoniae pneumonia include atelectasis, pleural effusion, empyema, pneumothorax and bronchiectasis. We evaluated the clinical characteristics of M. pneumoniae pneumonia with pleural effusion. Methods: A total of 210 medical records of children who were admitted to the Dong-A University hospital due to M. pneumoniae pneumonia from 2000 to 2004 were retrospectively analyzed. Diagnosis of M. pneumoniae pneumonia was based on the single titer of antimycoplasmal antibody higher than 1:320. Enrolled children were divided into Group A (with pleural effusion) and Group B (without effusion). We analysed the differences between the two groups according to sex, age, onset, symptoms, clinical manifestations, laboratory findings and chest x-rays. Results: There were no significant differences in age, sex and clinical manifestations between the two groups. Group A had longer fever durations (9.3±7.8 days vs 5.0±3.7 days), and a longer duration of hospitalization (10.4±6.3 days vs 6.9±6.3 days) compare to Group B. Also, compared to the Group B, Group A had higher ESR (49.6±32.9㎜/hr vs 28.7±20.4㎜/hr), CRP (23.0±60.4㎎/dL vs 8.7±30.9㎎/dL), SGOT (67±74.2 IU/L vs 53.6±60.0 IU/L), SGPT (37.4±18.6 IU/L vs 26.2±16.9 IU/L). There was no significance between antimycoplasmal antibody titer and pleural effusion. Conclusion: This study shows that M. pneumoniae pneumonia with pleural effusion has a longer duration of fever and hospitalization, higher ESR, CRP, SGOT, SGPT compare to the M. pneumoniae pneumonia without pleural effusion. We conclude that these findings could be used as the prognostic factors in M. pneumoniae pneumonia with pleural effusion. [Pediatr Allergy Respir Dis(Korea) 2006;16:327-334]

Low Thoracic Skeletal Mass is a Risk Factor for the Recurrence of Aspiration Pneumonia in Stroke Patients with Dysphagia Disorder

( Yu Jin Hong ),( Eung Gu Lee ),( Bo Mi Gil ),( Yong Hyun Kim ),( Sun Im ),( Hye Seon Kang ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-

Ojbectives This study aimed to investigate whether thoracic skeletal muscle mass index at the diagnosis of aspiration pneumonia is a predictor for the recurrence of aspiration pneumonia and to explore predicting factors for the recurrence of aspiration pneumonia in stroke patients with dysphagia disorder. Methods We retrospectively reviewed the data of patients with aspiration pneumonia who diagnosed with dysphagia disorder due to stroke from Jan. 2014 to Jul. 2020 in The Catholic University of Korea Bucheon St. Mary’s Hospital. Aspiration pneumonia was defined based on clinical signs of symptoms suggestive of pneumonia and radiologic findings of pneumonic infiltrations in the dependent portion of lung. We measured thoracic muscle volume by using the cross-sectional area (CSA) of the erector spinae muscle (ESMCSA , cm2) at the 12th vertebral region. CT scans at the time of diagnosis of aspiration pneumonia were used for analysis and respective CSA were divided by height squared (m2) to yield the muscle index at T12 (T12MI, cm2/m2) to normalize for stature. Multivariate logistic regression models were performed to investigate relationships between clinical parameters and recurrence of aspiration pneumonia. Results During study period, a total of 268 stroke patients with dysphagia disorder and developed aspiration pneumonia were analyzed. Mean T12MI of patients with and without recurrence of aspiration pneumonia was 708.1±229.9 cm2/m2 and 622.3±184.1 cm2/m2, respsectively (P=0.001). Multivariate logistic regression revelaed that lower T12MI (P=0.038) and older age (P=0.007) were the independent predictor of recurrence of aspiration pneumonia in stroke patients with dysphagia disorder. Conclusion Low thoracic muscle index at the diagnosis of aspiration pneumonia predicts recurrence of aspiration pneumonia in stroke patients with dysphagia disorder.

Diagnosis of Pneumococcal Pneumonia: Current Pitfalls and the Way Forward

송준영,은병욱,Moon H. Nahm 대한감염학회 2013 Infection and Chemotherapy Vol.45 No.4

Streptococcus pneumoniae is the most common cause of community-acquired pneumonia. However, it can also asymptomaticallycolonize the upper respiratory tract. Because of the need to distinguish between S. pneumoniae that is simply colonizingthe upper respiratory tract and S. pneumoniae that is causing pneumonia, accurate diagnosis of pneumococcal pneumonia is achallenging issue that still needs to be solved. Sputum Gram stains and culture are the first diagnostic step for identifying pneumococcalpneumonia and provide information on antibiotic susceptibility. However, these conventional methods are relativelyslow and insensitive and show limited specificity. In the past decade, new diagnostic tools have been developed, particularlyantigen (teichoic acid and capsular polysacc arides) and nucleic acid (ply, lytA, and Spn9802) detection assays. Use of the pneumococcal antigen detection methods along with biomarkers (C-reactive protein and procalcitonin) may enhance the specificity of diagnosis for pneumococcal pneumonia. This article provides an overview of current methods of diagnosing pneumococcal pneumonia and discusses new and future test methods that may provide the way forward for improving its diagnosis. Streptococcus pneumoniae is the most common cause of community-acquired pneumonia. However, it can also asymptomatically colonize the upper respiratory tract. Because of the need to distinguish between S. pneumoniae that is simply colonizingthe upper respiratory tract and S. pneumoniae that is causing pneumonia, accurate diagnosis of pneumococcal pneumonia is a challenging issue that still needs to be solved. Sputum Gram stains and culture are the first diagnostic step for identifying pneumococcal pneumonia and provide information on antibiotic susceptibility. However, these conventional methods are relatively slow and insensitive and show limited specificity. In the past decade, new diagnostic tools have been developed, particularlyantigen (teichoic acid and capsular polysaccharides) and nucleic acid (ply, lytA, and Spn9802) detection assays. Use of the pneumococcal antigen detection methods along with biomarkers (C-reactive protein and procalcitonin) may enhance the specificity of diagnosis for pneumococcal pneumonia. This article provides an overview of current methods of diagnosing pneumococcal pneumonia and discusses new and future test methods that may provide the way forward for improving its diagnosis.

Laboratory Investigation of Trends in Bacterial Pneumonia in Cheonan, Korea, from January 2008 to September 2017

( Young-sam Yook ),( Jae-sik Jeon ),( Ji On Park ),( Jae Kyung Kim ) 한국미생물생명공학회(구 한국산업미생물학회) 2018 Journal of microbiology and biotechnology Vol.28 No.10

Bacterial pneumonia is one of the most common causes of mortality in Korea. In 2016, the mortality rate from pneumonia was 16,476 deaths per 100,000, which was an 11% increase from the previous year. The aim of our study was to determine the distribution of the bacterial pathogens causing respiratory symptoms in different age groups over a 10-year period. Between January 2008 and September 2017, 1,861 specimens from 1,664 patients admitted to Dankook University Hospital with respiratory symptoms were examined. We used multiplex polymerase chain reaction (PCR) to detect six bacterial pneumonia pathogens: Bordetella pertussis, Chlamydophila pneumoniae, Haemophilus influenzae, Legionella pneumophila, Mycoplasma pneumoniae, and Streptococcus pneumoniae. We detected bacterial pneumonia pathogens in 1,281 (68.83%) specimens. Of the 1,709 pathogens detected, S. pneumoniae was the most common (48.57%; n = 830) followed by H. influenzae (40.08%; n = 685). Most infections were found among children younger than 10 years (92.69%; n = 1,584). Although S. pneumoniae was the most common pathogen detected in all age groups, M. pneumoniae infection increased in prevalence with age (p < 0.05). The rate of co-infection was also high among these patients (31.1%; n = 399), which peaked in 2015 (54.55%; n = 42/77). The prevalence of bacterial pneumonia in Cheonan, along with the proportion of co-infections among patients increased over the 10-year study period. The findings will aid the development of treatment and prevention guidelines.