Streptococcus pyogenes의 소아에서의 감염 양상 및 항균제 감수성

이환종,박수은,정혜선,김의종,김제학 대한감염학회 1998 감염 Vol.30 No.5

목적: Streptococcus pyogenes에 의한 침습성 감염이 1980년대에 들어와서 다시 증가하는 소견과 함께 세균성 인두염 치료시 penicillin의 부작용을 우려하여 처방되는 erythromycin과 그 외의 macrolide의 사용 빈도 또한 증가하는 추세이다. 최근 erythromycin을 많이 사용하는 지역에서는 이에 대한 내성 S. pyogenes 비율이 높다는 여러 보고가 있다. 연구자들은 한국에서의 S. pyogenes의 감염 양상 및 항균제 감수성을 조사하고자 하였다. 방법: 1991년 10월부터 1998년 4월까지 서울대학교 소아병원에서 각종 임상 검체로부터 S.pyogenes가 분리되었던 28명의 환아들을 대상으로 하여 의무기록을 후향적으로 검토하였다. S. pyogenes 31주에 대한 penicillin, ceftriaxone, vancomycin, clindamycin, erythromycin, roxythromycin, clarithromycin의 최소 억제 농도를 한천 희석법 또는 E-test로 측정하였다. 결과: S. pyogenes의 감염 양상으로는 연조직 감염과 인후염이 가장 흔하였다. 그 외에 패혈증, 폐렴, 질염, 림프절염, 신생아 제대염, 원발성 복막염, 심염을 동반한 류마티스성 열, 성홍열, 급성 중이염 및 전신성 감염 등의 임상 양상을 보였다. Penicillin, ceftriaxone 및 vancomycin에 대하여 100%의 균주가 감수성을 보인 반면, clindamycin에는 10%가, 그리고 erythromycin에는 16%가 내서을 보였으며, erythromycin에 내성인 주는 clarithromycin과 roxythromycin에도 교차 내성을 보였다. 결론: S. pyogenes는 상기도 감염과 이에 따르는 후유증 외에도 다양한 양상의 침습성 질환을 일으키는 중요한 세균이다. 국내에서 S. pyogenes에 의한 감염의 치료제로 항균제를 선택할 때 macrolide 및 clindamycin에 대한 내성균이 출현하고 있음을 주의해야 하며, 이러한 내성균의 출현에 대한 지속적인 감시가 필요하다. Background: Streptococcus pyogenes causes most often pharyngistis or tonsillitis but may also be responsible for severe diseases including bacteremia and pneumonia. Recent publications from several geographic areas showed high rates of resistance to erythromycin and newer macrolides, often used in patients allergic to penicillin, in clinical isolates of S. pyogenes. Methods: Minimum inhibitory concentration of 31 strains of S. pyogenes, isolated at the Seoul National University Children's Hospital from October 1991 through April 1998, were determined for penicillin, ceftriaxone, vancomycin, clindamycin, erythromycin, roxythromycin, and clarithromycin by agar dilution method or E-test. In addition, clinical features of the patients from whom the organisms were isolated were reviewed retrospectively. Results: Of the 28 patients whose medical records were reviewed, the most common clinical presentations were soft-tissue infection (8 cases) and pharyngitis (5 cases). Other presentations included bacteremia without focus, pneumonia, vaginitis, lymphadenitis, omphalitis(two of each); primary peritonitis, rheumatic fever with carditis, scarlet fever, acute otitis media, and disseminated disease (one of each). All of the isolates were susceptible to penicillin, ceftriaxone, and vancomycin. However, 5 isolates (16%) were resistant to erythromycin, and all of the erythromycin-resistant to erythromycin, and all of the erythromycin-resistant strains were resistant to roxythromycin and clarithromycin as well. Three of these erythromycin-resistant strains were also resistant to clindamycin. Conclusion: S. pyogenes may cause serious infections in children. Emergence of resistance in clinical isolates of S. pyogenes to macrolides and clindamycin should be considered in empirical antimicrobial therapy of suspected group A streptococcal infections and in establishment of antibiotic policy in Korea.

임상 검체에서 분리된 Streptococcus pyogenes의 T 혈청형과 항균제 감수성

김윤정,김선주 대한임상병리학회 2000 대한임상병리학회지 Vol.20 No.1

肺炎 誘發菌의 生育을 抑制하는 韓藥材 探索에 關한 硏究

정병운,서운교,정지천,한영환 동국대학교 한의학연구소 1999 東國韓醫學硏究所論文集 Vol.7 No.2

韓藥材 중 肺炎의 치료효과가 기대되는 淸熱化痰, 止咳平喘藥을 중심으로 23種의 藥材를 사용하여 肺炎을 유발하는 K. pneumoniae, S. pyogenes 및 S. pneumoniae 세균의 생육을 억제하는 藥材를 탐색하고, 탐색된 藥材의 추출물에 대한 세균의 最小生育抑制濃度를 측정하였다. 韓藥材의 水溶性 추출물 중 黃連, 胡黃蓮, 敗醬, 黃芩이 K. pneumoniae에서, 黃連이 S. pyogenes에 대해서 생육억제 효과가 있었으며, S. pneumoniae에 대한 比較沮止環의 直徑은 黃連, 鳥梅, 五味子, 黃芩이 우수하였으나 黃連 추출물 사용시 병원균 모두에서 生育沮止環의 크기가 가장 크게 나타났으며 對照群로 사용된 大腸菌과 枯草菌에서도 어느 정도의 抗細菌 효과를 볼 수 있었다. 에탄올 추출물에서는 敗醬, 黃芩, 五味子, 鳥梅가 K. pneumoniae 세균의 생육을 억제하였으며, S. pyogenes 세균은 黃連, 五味子, 鳥梅, 馬兜鈴찾, 黃芩에 의하여 생육이 억제되어 黃連은 水溶性 및 에탄올 溶解性 주출물에서 모두 우수한 抗細菌 효과를 보여주고 있다. 각 세균에 대한 最小生育沮止濃度(MIC)는 K. pneumoniae 세균일 경우 黃連 및 黃芩의 水溶性 추출물과 鳥梅 및 敗醬의 에탄올 溶解性 추출물이 유의성을 보였으며, S. pyogenes 세균은 黃連의 水溶性 및 에탄올 溶解性 추출물과 鳥梅의 에탄올 溶解性 추출물, S. pneumoniae 세균은 黃連과 鳥梅의 水溶性 및 에탄올 溶解性 주출물에서 유의성이 나타났다. 이상의 결과를 통하여 黃連, 五味子, 鳥梅, 黃芩, 胡黃蓮, 敗醬의 水溶性 및 에탄올 溶解性 추출물이 肺炎 誘發菌f K. pneumoniae, S. pyogenes, S. pneumoniae에 對하여 우수한 生育抑制 作用을 나타냄을 알 수 있었다. The various oriental herbal medicines, which have usually been used for treatment of reducing fever, purging intense heat and detoxication, were screened to determine the antibacterial activity and the minimal inhibitory concentration against pulmonary disease-causing Klebsiella pneumoniae, Streptococcus pyogenes, and Streptococcus pneumoniae. The results obtained were as follows: 1. Among the 23 oriental medicines tested, the water-soluble extracts of Coptis japonica, Scutellaria baicalensis and Picrorrhiza kurroca showed the antibacterial activity against K. pneumoniae and that of C. japonica against S. pyogenes. The antibacterial activities of C. japonica, Prunus mume, Schizandra chinesis, Scutellaria baicalensis were also found against S. pyogenes. When C. japonica was used, the high antibacterial activity was shown against Bacillus subtilis and other extracts showed a little activity against B. subtilis and E. coli as a control. 2. The ethanol-soluble extracts of Patrinia scabriosaefolia, P. mume, S. baicalensis, S. chinensis showed the antibacterial activity against K. pneumoniae and those of S. baicalensis, C. japonica, S. chinensis P. mume against S. pyogenes and S. pneumoniae. However, those extract showed a little antibacterial activity against B. subttilis and E. coli except for that the extract of C. japonica showed comparatively high growth inhibition of B. subtilis. 3. Among the medicinal herbs tested, the water- and ethanol extracts of C. japonica showed very extcellent antibacterial activity against the pathogenic bacteria and controls. 4. When the water-soluble extracts of C. japonica and S. baicalensis, minimal inhibitory concentrations (MICs) against K. pneumoniae were 10 ㎎/㎖ and 22 ㎎/㎖, respectively. The MICs of the ethanol-soluble extracts of P. mume and P. scabriosaefolia were 5 ㎎/㎖ and 20 ㎎/㎖, respectively. 5. For the MICs against S. pyogenes, C. japonica showed 15 ㎎/㎖ with the water-soluble extract and P. mume and C. japonica with the ethanol-souble extract did 5 ㎎/㎖ and 10 ㎎/㎖, respecitively. 6. For the MICs against S. pneumoniae, C. japonica and P. mume with the water- and ethanol-souble extract showed 5 ㎎/㎖ and 10 ㎎/㎖, respecitively. As a result, the highest antibacterial activity was found in the water- and ethanol-soluble extracts of C. Japonica against pulmonary disease-causing bacteria, K. pneumoniae, S. pyogenes, and S. pneumoniae. Also, the water- and ethanol-soluble extracts of S, chinensis, P. mume, S. baicalensis and P. kurrooa showed high antibacterial activities.

인두편도염 환아와 보균자에서 분리된 Streptococcus pyogenes의 T 단백 혈청형 및 항균제 감수성 검사

차성호,조병수,서진태,황규잠,배송미,이영희 대한감염학회 1999 감염 Vol.31 No.4

2004년 진주지역에서 분리된 Streptococcus pyogenes의 Erythromycin 내성률 감소

고은하,맹국영,김선주,정현주,이남용 대한임상미생물학회 2006 Annals of clinical microbiology Vol.9 No.1

Background: The erythromycin (EM) resistance rates and emm genotypes of Streptococcus pyogenes could vary by geographical location and study period. The purpose of this study, involving a large number of children, was to determine EM resistance rate and its resistance mechanism of S. pyogenes, and to compare these results with those of previous studies performed at the same area. Methods: Throat cultures were taken from 2,351 healthy children of four elementary schools from October through December, 2004 in Jinju. A total of 328 strains of S. pyogenes were isolated. Antimicrobial susceptibility test was performed by the agar dilution method against six antimicrobial agents. The phenotypes of EM resistance were evaluated by the double-disk diffusion test and the frequency of ermB and mefA genes was determined by polymerase chain reaction. Results: Resistance rates of S. pyogenes to EM, clindamycin and tetracycline were 9.8%, 8.8% and 18.3%, respectively. Almost all isolates were susceptible to ofloxacin, levofloxacin and chloramphenicol. Constitutive resistance (CR) was observed in 87.5%, M phenotype in 9.4%, and inducible resistance only in 3.1%. The ermB and mefA genes were present in 90.6% and 9.4% of the isolates, respectively. Conclusion: The resistance rate to EM of S. pyogenes was 9.8% in 2004, which was a large drop from the 51% shown in 2002. CR with the ermB gene was predominant, suggesting that most of the EM resistant isolates have a high level of resistance.

Rapid Development of Brain Abscess Caused by Streptococcus Pyogenes Following Penetrating Skull Injury via the Ethomoidal Sinus and Lamina Cribrosa

Gulsen, Salih,Aydin, Gerilmez,Comert, Serhat,Altinors, Nur The Korean Neurosurgical Society 2010 Journal of Korean neurosurgical society Vol.48 No.1

Objective : Streptococcus pyogenes is a beta-hemolytic bacterium that belongs to Lancefield serogroup A, also known as group A streptococci (GAS). There have been five reported case in terms of PubMed-based search but no reported case of brain abscess caused by Streptococcus pyogenes as a result of penetrating skull injury. We present a patient who suffered from penetrating skull injury that resulted in a brain abscess caused by Streptococcus pyogenes. Methods : The patient was a 12-year-old boy who fell down from his bicycle while cycling and ran into a tree. A wooden stick penetrated his skin below the right lower eyelid and advanced to the cranium. He lost consciousness on the fifth day of the incident and his body temperature was measured as $40^{\circ}C$. While being admitted to our hospital, a cranial computed tomography revealed a frontal cystic mass with a perilesional hypodense zone of edema. There was no capsule formation around the lesion after intravenous contrast injection. Paranasal CT showed a bone defect located between the ethmoidal sinus and lamina cribrosa. Results : Bifrontal craniotomy was performed. The abscess located at the left frontal lobe was drained and the bone defect was repaired. Conclusion : Any penetrating lesion showing a connection between the lamina cribrosa and ethmoidal sinus may result in brain abscess caused by Streptococcus pyogenes. These patients should be treated urgently to repair the defect and drain the abscess with appropriate antibiotic therapy started due to the fulminant course of the brain abscess caused by this microorganism.

Streptococcus pyogenes 근염에 심부 정맥 혈정즌이 동반한 1례

이재숙,장태영,안영민 대한소아감염학회 2009 Pediatric Infection and Vaccine Vol.16 No.1

A 5-year-old boy was admitted to the hospital with a high fever and abnormal gait. Magnetic resonance imaging showed extensive swelling of the quadriceps and adductor muscles around the right hip and anterior thigh. A duplex scan demonstrated a thrombus from the external iliac vein to below the popliteal vein. The blood culture revealed Streptococcus pyogenes. The patient was immediately treated with antibiotics and anticoagulants. Follow-up sonography demonstrated complete disappearance of the venous thrombosis. We report a case of streptococcal myositis complicated by deep vein thrombosis. 세균성 근염은 화농성 관절염, 봉와직염, 골수염, 혈전 정 맥염, 다발성 근염, 혈종, 좌상, 종양과 감별이 필요하며 진단 에 MRI가 도움이 된다. 저자들은 A군 사슬알균에 의한 화농성 근염을 조기에 진단하여 clindamycin으로 치료하였고 심부 정맥 혈전증까지 합병되었던 환자를 경험하였다. 성인에서는 증례로 보고된 바가 있지만 국내에서는 아직 보고가 없어 이를 보고하는 바이다.

A Case of Streptococcus pyogenes Pneumonia with Rhabdomyolysis

Shin, Joonbeom,Moon, Soo-youn,Maeng, Chi Hoon,Lee, Mi Suk,Lee, Sangho,Lee, Hee Joo,Lee, Sang Oh 대한감염학회 2007 감염과 화학요법 Vol.39 No.5

We describe a case of Streptococcus pyogenes pneumonia in a 63-year-old man presenting with rhabdomyolysis and acute renal failure. The patient completely recovered following treatment with mechanical ventilation, continuous venovenous hemodiafiltration, and intravenous antimicrobial agents. 저자들은 제2형 당뇨병으로 진단 받고 인슐린으로 당뇨조절 중이던 68세 남자에서 횡문근융해증이 동반된 Streptococcus pyogenes에 의한 지역사회폐렴 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

서울 국민학생 인두에서 베타용혈성 연쇄구균 분리 : Compared with the Results of Children in Kangwon and Chungnam Province 강원도, 충남 국민학생의 분리율과 비교

김선주 대한감염학회 1994 감염 Vol.26 No.2

목적 : 서울 아동의 인두에서 BHS와 S. pyogenes 보균을 구하고, 이미 보고한 바 있는 강원도와 충남 아동의 결과와 비교하고자 했다. 방법 : 상기도 감염 증상이나 징후가 없는 590명의 아동에 대한 인두배양을 시행하고, bacitracin 디스크와 라텍스 응집법으로 동정하였다. 결과 : 대상 아동 중 103명 (17.5%)에서 BHS가 분리되었고, 76명(12.9%)에서 S. pyogenes가 분리되었다. 18명은 G군, 4명은 C군, 2명 B군이었으며, 나머지 3명은 비 A,B,C,G 군을 가지고 있었다. 결론 : 본 연구 결과와 강원도 및 충남 아동의 인두 배양결과를 종합해보면, 우리나라 국민학교 아동의 겨울철 BHS 보균율은 약 15%, S. pyogenes 보균율은 약 10%라고 볼 수 있다. Background : The carrier rates of beta-hemolytic streptococci (BHS) and Streptococcus pyogenes of the children in Seoul were investigated epidemiologically and compared with those of Kangwon and Chungnam Province previously reported. Methods : Throat cultures were taken from the healthy 590 elementary school children who had no symptoms or signs of upper respiratory tract infection, and the beta-hemolytic colonies were identified with bacitracin disk and latex agglutination test. Results : Of those children, 103 (17.5%) yielded BHS and 76(12.9%) did S.pyogenes. Eighteen strains (6.0%) of BHS were identified as group G, 4 ones (1.3%) as gorup C, 2 ones (0.8%) as group B,andtheotherthree(1.0%)wereclassified as non-group A,B,C,G. Conclusion : Including the results of Kangwon and Chungnam Province, BHS from the throats of healthy elementary school children in winter were similarly isolate from about 15% and S. pyogenes from about 10% respectively regardless of geographical differences.

2006년 진주지역 초등학생에서 분리된 Streptococcus pyogenes의 T 항원형과 emm 유전자형 및 항생제 내성

고은하,김인숙,김선주 대한임상미생물학회 2009 Annals of clinical microbiology Vol.12 No.1

Background: Streptococcus pyogenes is the most common cause of bacterial pharyngitis. T antigens and emm genotypes are essential markers for an epidemiological study of S. pyogenes. Macrolide resistance of S. pyogenes is a serious obstracle to successfully treating a sore throat. Methods: One-hundred forty-seven strains of S. pyogenes isolated from healthy school children in 2006 were subjected to T typing and emm genotyping. A disk diffusion method was applied for several antibiotics. A double disk diffusion test was performed to evaluate the phenotype distribution of macrolide resistance. Results: Among T antigens and emm genotypes, T11 (19.7%) and emm78 (16.7%), respectively, were the most common in 2006. Both T5/27/44 (2.3%) and emm44/61 (9.1%) declined to a great extent from about 29% in 2004. The rate of resistance to antibiotics were 11.6% to erythromycin, 4.8% to clindamycin, 21.8% to tetracycline, and 7.5% to ofloxacin. M and cMLSB phenotypes were 52.9% and 41.2% respectively. Conclusion: T typing and emm genotyping proved a dynamic change in their distribution in 2006 compared to the results of 2004. Erythromycin and clindamycin resistance remained low as in 2004, whereas ofloxacin resistance increased slightly. M and cMLSB phenotypes were equivalent in 2006, whereas cMLSB was predominant in 2004.