응급실을 통한 입원 환자의 진균 감염에 대한 국내역학조사(2011~2013)

서영우,박준수,장태창 대한의진균학회 2016 대한의진균학회지 Vol.21 No.4

Background: Fungal infections are frequent encountered conditions presented in various clinical forms. The prevalence of fungal infection is gradually growing because of the increase in aged population and immune-compromised host which is susceptible factor of fungal infection. Broad array of studies of fungal infection have been published in Korea. However, epidemiologic study of fungal infection in admitted patients via emergency department has not been conducted. Objective: The purpose of this study is to generate background data for emergency department visits in relation to fungal infection for developing a subsequent management and control system. Methods: The data was collected from National Emergency Department Information System (NEDIS) in Korea from 2011 to 2013. Data analysis was done to evaluate the age distribution of admission, regional variance and sex of the patients with fungal infection. Results: The patients were divided into five groups according to their primary diagnosis which were skin fungal infection, subcutaneous mycoses, opportunistic mycoses, systemic mycoses and other mycoses. The annual admission ratio of general fungal infections increased from 2.15 persons per 100,000 in 2011 to 2.46 persons per 100,000 in 2013. The highest admission ratio was seen in opportunistic mycoses group followed by cutaneous fungal infections, other mycoses, subcutaneous mycoses and systemic mycoses groups. Conclusion: This study provides a basic set of data pertaining to fungal infections in emergency departments. Therefore, more systemically approached researches are required to implement sounder management and control systems of fungal infections presented in emergency departments.

P269 : Erythema annulare centrifugum in a patient with cutaneous fungal infection and other etiologic factors

( Sung Kyu Jung ),( Jae Beom Park ),( Byoung Joon So ),( Sang Geun Lee ),( Soo Hong Seo ),( Sang Wook Son ),( Il Hwan Kim ) 대한피부과학회 2013 대한피부과학회 학술발표대회집 Vol.65 No.2

Background: Erythema annulare centrifugum (EAC) is characterized by expanding erythematous rings. In most cases, underlying diseases such as infection, drug and pregnancy accompanied EAC. A previous study reported the pathogenesis of hypersensitivity reaction to fungal infection. In another study, fungal infection was evident in 48 of 66 patients with EAC. Objectives: The etiology and related disease in most cases of EAC is unknown. The purpose of this study was to analyze the relationship between EAC and underlying cutaneous fungal infections. Methods: In a retrospective study, 100 EAC patients confirmed by clinical or histopathological examination were enrolled. The patients` electronic medical records were reviewed. Results: 26 EAC patients had cutaneous fungal infection, such as tinea pedis and tinea unguium. Of them, 16 patients underwent fungal treatment. 9 of 16 patients showed improvement of EAC lesion with fungal treatment. 6 patients had history of other infections, 6 had endocrine disorders, 5 had drug history, 5 were pregnant and 1 had malignancy. Conclusion: EAC is thought to be associated with fungal infection. This study showed that the high prevalence of cutaneous fungal infection and the some response to fungal treatment in EAC patients. However, it was difficult to confirm a direct association in this study. In the future, there is a need for a larger cohort study including allergic confirmation test to prove causal association between EAC and fungal infection.

아토피피부염 환자에서의 표재성 진균증

유광호 ( Kwang Ho Yoo ),김지영 ( Ji Young Kim ),이갑석 ( Kap Sok Li ),서성준 ( Seong Jun Seo ),홍창권 ( Chang Kwun Hong ) 대한피부과학회 2009 大韓皮膚科學會誌 Vol.47 No.1

Background: It is well known that patients with atopic dermatitis are prone to cutaneous infections, and especially superficial fungal infection. However, a study on the relationship of superficial fungal infection in atopic dermatitis patients has not yet been performed in Korea. Objective: The purpose of this study is to evaluate the relationship of atopic dermatitis to superficial fungal infection in Koreans. Methods: We examined for evidence of superficial fungal disease in 2,153 atopic dermatitis patients and we compared the findings to those of 126,777 non-atopic dermatitis patients who visited the Department of Dermatology of Chung-Ang University from January 2003 to December 2007. Results: Superficial fungal infections were more common in the atopic dermatitis patients (6%) than in the controls (2.5%) (p<0.05) and especially in the age group of the 1st and 2nd decades (p<0.05). The seasonal prevalence of superficial fungal infection was high during summer for both groups (38% vs 44%, respectively). The most common site of fungal distribution was feet (Tinea pedis) for both groups (42.5% vs 28.1%, respectively). The prevalence of coexisting superficial fungal infection was not significantly different in both groups (38.3% vs 39.9%, respectively). The most common isolated organism was Trichophyton rubrum in both groups (52.7% vs 38%, respectively). Conclusion: The study shows that the prevalence of superficial fungal infection in atopic dermatitis patients is higher than that in controls. Therefore, we should consider the presence of combined superficial fungal infection in recalcitrant atopic dermatitis patients and use antifungal agents for treatment. (Korean J Dermatol 2009;47(1):1~5)

당뇨병 환자의 족부 진균 질환 유병률과 당뇨병성 족부 질환과의 상관성 조사

이광훈 ( Kwang Hoon Lee ),이주희 ( Ju Hee Lee ),이정덕 ( Jeong Deuk Lee ),조백기 ( Baik Kee Cho ),김형옥 ( Hyung Ok Kim ),김계정 ( Kea Jeung Kim ),김낙인 ( Nack In Kim ),송해준 ( Hae Jun Song ),손숙자 ( Sook Ja Son ),김상원 ( Sang 대한피부과학회 2003 대한피부과학회지 Vol.41 No.7

Object : The purpose of this study was to determine the prevalence of fungal infection and ulcer on the feet of diabetic patients and the existence of correlation between ulcer and fungal infection. Methods : A total 21,693 outpatients diagnosed as diabetes mellitus at the department of endocrinology of 32 hospitals were examined. The diabetic patients with foot problems were consulted to the department of dermatology. Physical examination and KOH preparation were performed. Results : 13,271 patients had certain kinds of foot problem, accounting for 61.2% of 21,693 diabetics examined. Of these, fungal foot disease were found in 10,403 that constituted 78.4% (48.0% of the entire diabetic population). Tinea pedis was the diagnosis in 6,496 (29.9%), onychomycosis in 7,783 (35.9%), and coexistence was in 3,883 (17.9%). Foot deformity was in 1,346 (6.2% of diabetics; 10.1% of foot disease), non-palpable pulse in 1,051 (4.8% ; 7.9%), and foot ulcer was in 425 (2.0% ; 3.2%), following in a descending order of frequency. Odds ratios for diabetic foot ulcer were 2.5 in patients with the foot deformity, 1.6 with fungal foot disease and 2.2 with non-palpable pulse. Conversely, Odds ratios for fungal foot disease were 2.5 with foot deformity, and 1.6 with foot ulcer. A total of 5,486 patients paid a visit to the department of dermatology. Of these, 4,519 patients were diagnosed with fungal infection through physical examination and KOH smear by dermatologists. The population comprised of 2,272 males and 2,247 females, showing similar prevalence between sexes. However, age did have positive correlation regarding prevalence of fungal foot disease. The number of diabetic patients with toenail problems was 3,847 patients (70%) and onychomycosis was proven mycologically in 3,276. Onychomycosis of distal subungal type was the most common clinical finding, most frequently involving the great toenails. Abnormal skin findings of the foot were seen in 3,885(70.8%) and tinea pedis was found in 3,209 (58.5%), most commonly involving the soles. Conclusion : This study showed that fungal infection might be regarded as a risk factor of foot ulcer. Treatment of fungal infection in diabetic patients might prevent diabetic foot disease such as ulcer and reduce the disability, morbidity and mortality in diabetic patients. (Korean J Dermatol 2003;41(7) : 908~915)

당뇨족 궤양에서 진균감염의 유병률

유연식,한승규,김우경 대한성형외과학회 2008 Archives of Plastic Surgery Vol.35 No.2

Purpose: In a diabetic foot ulcer, superficial fungal infection of the foot may disrupt the skin integrity and provide an avenue for bacterial infection. The prevalence of fungal infection in diabetic foot ulcer has been reported as 12-30% in Caucasian patients. However, no data are available for Korean patients. The purpose of the study was to examine the prevalence of fungal infection in diabetic foot patients admitted in our clinic.Methods: This study included consecutive 30 diabetic foot ulcer patients(24 males and 6 females) admitted from May 2007 to July 2007. The mean age was 60.5 years. All patients underwent mycological examination including direct microscopic examination in KOH and culturing on slants and tubes with Sabouraud’s glucose agar.Results: Clinical signs of presumed fungal infection, which were examined by dermatologists, were found in all patients included in this study. Direct microscopic examination was positive for the specimens of the skin and the toenails in 28(93.3%) and 25(83.3%) patients, respectively. In addition, culture result was positive for the specimens of the skin and the toenails in 5(16.73%) and 7(23.3%) patients, respectively. Conclusion: The prevalence of fungal infection in diabetic foot ulcer patients admitted in our clinic is much higher than that in Caucasian patients(83.3-93.3% vs 12-30%).

Relationship Between Acanthosis Nigricans and Fungal Infection: Clinical and Histopathological findings

정준우,홍은혜,박은주,김광중,김광호 대한의진균학회 2021 대한의진균학회지 Vol.26 No.1

Background: Acanthosis nigricans (AN) is a skin condition that presents clinically with hyperpigmented, hyperkeratotic, and velvety skin changes, especially in the intertriginous areas. The intertriginous areas are also susceptible to superficial cutaneous fungal infections. The potential relationship between AN and cutaneous fungal infection has not been investigated. Objective: The aim of this study was to determine the relationship, if any, between AN and fungal infection, both clinically and pathologically. Methods: A retrospective review was performed using electronic medical records and histology of biopsy slides obtained from 29 patients who were diagnosed with AN by two dermatopathologists. Comparison was made between the clinical and pathological findings of AN with fungal infection (ANFI+) and AN without fungal infection (ANFI-). Results: Among the 29 patients with AN, fungal spores were detected on the biopsy slides of 18 patients (62.1%) and appeared in the epidermal furrow more often than in the epidermal ridge. No significant clinical difference was found between the ANFI+ and ANFI- groups; however, in the ANFI+ group, lesions were more prevalent in the neck area (p = 0.048). In addition, the ANFI+ biopsy slides revealed more papillomatosis than ANFI- biopsy slides (p = 0.006). Conclusion: Fungal infection tends to appear in combination with AN when more severe papillomatosis is also present.

피부와 외래환자와 일반인의 진균질환 역학조사

문현주,문재동,이지범,김성진,원영호,이승철 全南大醫大 2001 전남의대학술지 Vol.37 No.4

누에에서 곰팡이(Aspergillus niger) 감염에 의해 유도 발현되는 유전자의 클로닝과 동정

Jin-Sung Lee(이진성),Su-young Hong(홍수영),Ki Hwa Lee(이기화) 한국생명과학회 2010 생명과학회지 Vol.20 No.6

본 연구는 곤충으로부터 새로운 항 진균 단백질을 발굴하기 하기 위한 목적으로 누에를 대상으로 Aspergillus niger의 감염을 유도하였을 때 발현되는 유전자의 특성을 분석한 것이다. Annealing control primer 법에 기초한 GeneFishing Kit를 사용하여 A. niger를 약 6×10? colony per unit로 5령기 누에 유충의 체강에 감염시킨 후, 6시간 경과한 다음에 유도 발현되는 유전자(differentially expressed genes, DEGs)를 분석 한 결과, 10개의 유도 발현되는 유전자를 분리하였고 RT-PCR을 통해서 lysozyme, enbocin 그리고 한 개의 기능이 알려지지 않는 유전자등 3개의 유전자가 A. niger의 감염에 의해서 유의하게 과 발현된다는 것을 검증하였다. 일반적으로 그람 음성 및 양성 세균의 감염에 의해 유도된다고 알려진 enbocin 유전자가 A. niger의 감염에서도 과 발현이 유도되는 본 연구의 결과는 앞으로 enbocin 유전자의 항 진균 활성 연구에 중요한 기초 자료로 활용될 수 있을 것이다. We tried to identify differentially expressed genes (DEGs) from a silkworm, Bombyx mori, involved in fungal (Aspergillus niger) infection. A total RNA purified from fungal-induced and normal B. mori (5<SUP>th</SUP> instar larvae) was used for the cDNA synthesis. Differentially expressed genes were screened by annealing control primer (ACP)-based PCR technique. Comparing the gene expression profiles between fungal infection and control silkworm, we detected 10 genes that were differentially expressed in fungal induction and performed molecular cloning and nucleotide sequencing of the 10 genes. We confirmed the expression patterns of 3 DEGs by RT-PCR. The 3 DEGs over-expressed in fungal infection were identified as lysozyme, enbocin and an unknown gene. They were first identified to be genes induced by fungal infection. Although the detailed functions of 3 genes and their products remain to be determined, the genes will provide insight into the molecular mechanisms of insect-immune systems induced by fungal infection.

신생아 집중치료실에서 진균감염의 예방

최영륜 대한신생아학회 2013 Neonatal medicine Vol.20 No.3

Although advances in neonatal intensive care have led to an improved survival rate of extremely low birth weight infants, prolonged hospitalization of these critically ill infants has rendered them to be vulnerable to fungal infection in NICU. Because the incidence of fungal infection with related mortality and morbidity is inversely related to gestational age and birth weight, preventive measure is imperative to improve the survival rate and the outcome. There are many evidence-based reports for antifungal prophylaxis with fluconazole target infants <1,000 g and/or ≤27 weeks, because this group has a high infection-related mortality and neurodevelopmental impairment among survivors. However, interventions should begin with prenatal initiatives,with women being treated for vaginal candidiasis, especially with preterm labor. Furthermore, policies for restrictive use of third-generation cephalosporins, H2-antagonists, proton pump inhibitors, and postnatal dexamethasone; follow of the guideline for central venous catheter care and removal; and feeding practices, with promotion of early feedings and breast milk, and supplementation with lactoferrin and or probiotics, may reduce the fungal infection. In conclusion, prophylactic systemic antifungal therapy along with comprehensive infection control measures,restrictive use of drugs and proper feeding practice reduce the incidence of invasive fungal infection in high risk very low birth weight infants in NICU. However, further study is needed for the routine use of prophylactic antifungal therapy because the effect on mortality rate was not significant and the data on the long-term neurodevelopmental consequences were limited. In addition, further data on the emergence of resistant organisms and Malassezia colonization are needed.

Immune Response to Fungal Pathogens

김수민,박창욱 대한의진균학회 2020 대한의진균학회지 Vol.25 No.1

Fungi rarely cause disease in individuals with normal immunity. However, fungi present in the normal biota of the skin, mucous membranes, intestinal tract, and fungi in the environment that are normally non-pathogenic, can cause life-threatening infections in individuals with suppressed immunity. In the past decades, the prevalence of opportunistic fungal infections has increased, and these are associated with lowered immunity due to chemotherapy, HIV infection, and aging. The development of traditional antifungal agents has not kept pace with the increasing prevalence of invasive fungal infections, and the resistance to antifungal agents has become a major problem. Fortunately, study of the molecular and cellular mechanisms of the host immune response to fungi is increasing day-by-day. These studies indicate that fungal-specific mechanisms exist in the human body, including maintenance of immunological homeostasis in tissues, destruction of homeostasis by fungal infections, elimination of fungi by the host immune response, and recovery of homeostasis. Research into the mechanisms of fungal infection in humans suggests a new treatment paradigm that goes beyond traditional antifungal agents. Vaccines against fungi and immunotherapy using the host immune mechanism against fungi have recently been developed and are nearing use in the clinic.