M. abscessus는 자연환경에 널리 분포되어 있으며 면역 저하 환자에게 심각한 감염증을 일으킬 수 있는 병원균이다. 국내에서는 M. abscessus에 의해 발생한 복막투석 관련 복막염이 보고되어 있지 않지만 세균 배양에서 병원균이 동정되지 않거나 경험적 항생제 치료에 호전되지 않는 복막투석 관련 복막염 환자에서 고려해야 할 감염 원인 균주 중의 ...하나이다. 저자들은 지속적 외래 복막투석을 시행하는 환자에서 M. abscessus에 의해 발생한 복막염을 경험하여 문헌고찰과 함께 보고하는 바이다.
Mycobacterium abscessus has been reported to cause opportunistic infections in immunocompromised patients. It is a very rare pathogen in continuous ambulatory peritoneal dialysis (CAPD)-associated peritonitis. However, we experienced a single case of peritonitis caused by M. abscessus in a patient on CAPD in South Korea. A 52-year-old female on CAPD for 9 years with a past history of recurrent CAPD-associated peritonitis presented with fever, abdominal pain and turbid peritoneal dialysate. CAPD-associated peritonitis did not improve with broad-spectrum antibiotic treatment, and pathogens were not detected in a routine peritoneal fluid bacterial culture. M. abscessus was isolated from a peritoneal fluid mycobacterial culture. The patient recovered after treatment with clarithromycin and levofloxacin for 24 months. (Korean J Med 2014;87:110-114)
Abstract
Background: There have been various efforts to identify less costly but still accurate methods for monitoring the response to HIV treatment. We evaluated a pooling method to determine if ...this could improve screening efficiency and reduce costs while maintaining accuracy in Seoul, South Korea. Methods: We conducted the first prospective study of pooled nucleic acid testing (NAT) using a 5 minipool + algorithm strategy versus individual viral load testing for patients receiving antiretroviral therapy (ART) between November 2011 and August 2012 at an urban hospital in Seoul, South Korea. The viral load assay used has a lower level of detection of 20 HIV RNA copies/ml, and the cost per assay is US$ 136. The 5 minipool +algorithm strategy was applied and 43 pooled samples were evaluated. The relative efficiency and accuracy of the pooled NAT were compared with those of individual testing. Results: Using the individual viral load assay, 15 of 215 (7%) plasma samples had more than 200 HIV RNA copies/ml. The pooled NAT using the 5 minipool + algorithm strategy was applied to 43 pooled samples; 111 tests were needed to test all samples when virologic failure was defined at HIV RNA ≥ 200 copies/ml. Therefore, 104 tests were saved over individual testing, with a relative efficiency of 0.48. When evaluating costs, a total of US$ 14,144 was saved for 215 individual samples during 10 months. The negative predictive value was 99.5% for all samples with HIV RNA ≥ 200 copies/ml. Conclusions: The pooled NAT with 5 minipool + algorithm strategy seems to be a very promising approach to effectively monitor patients receiving ART and to save resources.
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