Extensively Drug-Resistant Streptococcus pneumoniae,South Korea, 2011–2012

To better understand extensively drug resistant Streptococcus pneumoniae, we assessed clinical and microbiological characteristics of 5 extensively drug-resistant pneumococcal isolates. We concluded that long-term care facility residents who had undergone tracheostomy might be reservoirs of these pneumococci; 13- and 23-valent pneumococcal vaccines should be considered for high-risk persons; and antimicrobial drugs should be used judiciously.     

Reemergence of Foot-and-Mouth Disease,South Korea, 2000–2011

Five outbreaks of foot-and-mouth disease have occurred in South Korea during 2000–2011. Macro-analysis of these outbreaks showed a correlation with outbreaks in countries in eastern Asia. Genetic analyses of food-and-mouth disease viruses in South Korea showed a correlation with viruses that are prevalent in neighboring countries.     

Macrolide-Resistant Mycoplasma pneumoniae in Humans,Ontario, Canada, 2010–2011

Antimicrobial drug resistance rates for Mycoplasma pneumoniae was determined in clinical specimens and isolates obtained during 2011–2012 in Ontario, Canada. Of 91 M. pneumoniae drug-resistant specimens, 11 (12.1%) carried nucleotide mutations associated with macrolide resistance in the 23S rRNA gene. None of the M. pneumoniae specimens were resistant to fluoroquinolones or tetracyclines.     

Mycoplasma pneumoniae and Chlamydia spp. Infection in Community-Acquired Pneumonia,Germany, 2011–2012

Mycoplasma pneumoniae and Chlamydia spp., which are associated with community-acquired pneumonia (CAP), are difficult to propagate, and can cause clinically indistinguishable disease patterns. During 2011–2012, we used molecular methods to test adult patients in Germany with confirmed CAP for infection with these 2 pathogens. Overall, 12.3% (96/783) of samples were positive for M. pneumoniae and 3.9% (31/794) were positive for Chlamydia spp.; C. psittaci (2.1%) was detected more frequently than C. pneumoniae (1.4%). M. pneumoniae P1 type 1 predominated, and levels of macrolide resistance were low (3.1%). Quarterly rates of M. pneumoniae–positive samples ranged from 1.5% to 27.3%, showing a strong epidemic peak for these infections, but of Chlamydia spp. detection was consistent throughout the year. M. pneumoniae–positive patients were younger and more frequently female, had fewer co-occurring conditions, and experienced milder disease than did patients who tested negative. Clinicians should be aware of the epidemiology of these pathogens in CAP.     

Epidemiological Characteristics of Serologically Confirmed Q Fever Cases in South Korea, 2006–2011

ObjectivesQ fever has been reported worldwide; however, there was almost no official report of Q fever in Korea. In this study, we describe the current status of human Q fever occurrence in Korea.MethodsDemographic data of Q fever patients were collected from the National Notifiable Diseases Surveillance System from 2006 to 2011. Case investigation reports from regional public health departments were used for additional information, like risk factors and clinical manifestation, of the patients since 2008.ResultsThere were 65 serologically confirmed cases during the study period. The annual notification rate of Q fever was 0.22 cases per million persons. The majority of cases were men (87.7%), adults (98.5%), and urban inhabitants (67.7%). Relevant exposures to risk factors were identified in 45.7% of patients. The most common symptoms of acute Q fever were fever (89.3%), myalgia (67.9%) and asthenia (53.6%). Two cases with endocarditis were identified in chronic Q fever.ConclusionThis study suggests that Q fever has a low endemicity in Korea. However, management and research at national level is required for prevention of a future epidemic.     

Accuracy of Diagnostic Methods and Surveillance Sensitivity for Human Enterovirus,South Korea, 1999–2011

The epidemiology of enteroviral infection in South Korea during 1999–2011 chronicles nationwide outbreaks and changing detection and subtyping methods used over the 13-year period. Of 14,657 patients whose samples were tested, 4,762 (32.5%) samples were positive for human enterovirus (human EV); as diagnostic methods improved, the rate of positive results increased. A seasonal trend of outbreaks was documented. Genotypes enterovirus 71, echovirus 30, coxsackievirus B5, enterovirus 6, and coxsackievirus B2 were the most common genotypes identified. Accurate test results correlated clinical syndromes to enterovirus genotypes: aseptic meningitis to echovirus 30, enterovirus 6, and coxsackievirus B5; hand, foot and mouth disease to coxsackievirus A16; and hand, foot and mouth disease with neurologic complications to enterovirus 71. There are currently no treatments specific to human EV infections; surveillance of enterovirus infections such as this study provides may assist with evaluating the need to research and develop treatments for infections caused by virulent human EV genotypes.     

pH Level as a Marker for Predicting Death among Patients with Vibrio vulnificus Infection,South Korea, 2000–2011

Vibrio vulnificus infection can progress to necrotizing fasciitis and death. To improve the likelihood of patient survival, an early prognosis of patient outcome is clinically important for emergency/trauma department doctors. To identify an accurate and simple predictor for death among V. vulnificus–infected persons, we reviewed clinical data for 34 patients at a hospital in South Korea during 2000–2011; of the patients, 16 (47%) died and 18 (53%) survived. For nonsurvivors, median time from hospital admission to death was 15 h (range 4–70). For predicting death, the areas under the receiver operating characteristic curves of the Acute Physiology and Chronic Health Evaluation (APACHE) II score and initial pH were 0.746 and 0.972, respectively (p = 0.005). An optimal cutoff pH of <7.35 had a sensitivity of 100% and specificity of 83%. Compared with the APACHE II score, the initial arterial blood pH level in V. vulnificus-infected patients was a more accurate predictive marker for death.Key words: Vibrio vulnificus, mortality, death, predictive marker, pH, APACHE score, bacteriaVibrio vulnificus is a motile, halophilic, rod-shaped gram-negative pathogen that lives in estuarine environments (1). During the last decade, the prevalence of V. vulnificus infection has increased worldwide (2–4). In the United States, the annual number of V. vulnificus infections reported to the 10-state Foodborne Disease Active Surveillance Network (http://www.cdc.gov/foodnet/) increased from 0.01 cases/100,000 persons in 1996 to 0.05 cases/100,000 persons in 2010 (5).V. vulnificus infections, which are mainly characterized by skin and soft-tissue infections or septicemia, can develop a fulminant course (1,6). The severe form of V. vulnificus soft-tissue infection, necrotizing fasciitis, often has adverse outcomes, including death. In such cases, death can occur within 48 h of hospital admission, especially if the infection is associated with the development of sepsis or septic shock, which increases the case-fatality rate to 26%–71% (7–11). For cases of V. vulnificus infection caused by the consumption of contaminated shellfish, the death rate is ≈53%, and the rate is higher (67%) among patients with liver disease (12). The death rate may increase to 100% in patients with septicemia if treatment is delayed for 72 h after symptom onset (13).Surgery, including fasciotomy, debridement, and limb amputation, early in V. vulnificus infection has been advocated by some as a means for improving patient outcomes (3,10,14). However, the proper timing for surgery is debatable: in the early stages of infection, patients may not be stable enough to be moved to the operating room, and patients may have little chance of surviving if surgery is delayed until a later stage of infection (3). Because V. vulnificus infections can be life threatening, it is critical for emergency/trauma department doctors, including surgeons who make decisions regarding surgery for necrotizing fasciitis, to have early knowledge of a patient’s prognosis.Some clinical data are available regarding the prognostic factors for patients with fatal V. vulnificus infection (10,15–17). Higher Acute Physiology and Chronic Health Evaluation (APACHE) II and Mortality in Emergency Department Sepsis (MEDS) scores have been reported to be significant prognostic indicators for V. vulnificus–infected patients (10,15). However, the APACHE II and MEDS scoring systems might be too complex to use quickly in an emergency setting. Thus, to find a marker to predict the risk for death among V. vulnificus–infected patients, we investigated the initial clinical and laboratory data available in hospital emergency departments. The aims of our study were to describe the clinical outcomes of V. vulnificus–infected patients and identify an accurate and simple predictive marker for death.     

Acute Lower Respiratory Tract Infections in Soldiers,South Korea,April 2011–March 2012

During April 2011–March 2012, we retrospectively reviewed medical records for South Korea soldiers to assess the etiology and epidemiology of acute viral lower respiratory tract infections. Adenovirus was the most commonly identified virus (63.2%) and the most common cause of pneumonia (79.3%) and hospitalization (76.6%); 3 soldiers died of adenovirus-related illness.     

Epidemiological Characteristics of Imported Shigellosis in Korea, 2010–2011

Shigellosis is a global disease as food poisoning by infection of Shigella spp (S. dysenteriae, S. flexneri, S. boydii and S. sonnei). In Korea, approximately 500 cases of shigellosis have reported every year since 2004, and imported shigellosis is increasing gradually from 2006 in particular. According to increase of numbers of overseas travelers, the numbers of patients diseased with imported shigellosis is also increasing. We need continuous surveillance studies network (SSN) for control of imported shigellosis. We studied epidemiological characteristic of imported shigellosis by using database of Korea Centers for Disease Control and Prevention (KCDC) from 2010 to 2011. The imported shigellosis is analyzed on correlation with variable factors such as sex, age, symptom, visited country as well as Shigella spp in the database. Total 399 patients diseased with shigellosis have been reported between 2010 and 2011, The 212 patients (53.1%) among them were disease with imported shigellosis and the 205 patients (96.7%) were diagnosed as definite shigellosis. Shigella sonnei (65.6%) and Shigella flexneri (20.3%) were isolated in order. Clinical symptoms of the shigellosis were diarrhea (96.5%), abdominal pain (54.7%), fever (52.8%), chill (31.6%), and weakness (21.7% etc) in order. Duration of diarrhea was 1 to 5 days, the number of diarrhea was mostly more than 10 times, and type of stool was almost yellow stool. Almost shigellosis was occurred in the travelers visited to Asia (98.1%). Particularly, the occurrence rate of shigellosis was highest in traveler visited to Southeast Asia which is India (21.7%), Cambodia (19.8%), Philippines (17.9%), and Vietnam (9.0%) in order. According to increase of traveler to Southeast Asia, imported Shigellosis also increased. We need to strengthen the public health and hygiene, which is infection prevention rules, eating properly-cook food, washing hands, drinking boiled water, for traveler to Asia. The quarantine and surveillance system to control imported shigellosis is need continually in Korea.     

Serological evidence of tick-borne encephalitis virus infection in South Korea, 2015–2018

No human cases of tick-borne encephalitis (TBE) have been reported in South Korea. We tested for TBE virus (TBEV)-IgM and -IgG in serum samples from healthy farmers during 2015–2018 using ELISA kits. Seroprevalence study revealed a 1.9 % prevalence of TBEV. A neutralizing test for TBEV-specific antibodies was not performed.     

Spatiotemporal Patterns of Schistosomiasis-Related Deaths,Brazil, 2000–2011

We analyzed spatiotemporal patterns of 8,756 schistosomiasis-related deaths in Brazil during 2000–2011 and identified high-risk clusters of deaths, mainly in highly schistosomiasis-endemic areas along the coast of Brazil’s Northeast Region. Schistosomiasis remains a neglected public health problem with a high number of deaths in disease-endemic and emerging focal areas.     

Drug Resistance–Associated Mutations in Mycoplasma genitalium in Female Sex Workers,Japan

Mycoplasma genitalium was detected in 21 (14.1%) of 149 vaginal swab samples and in 1 (0.7%) of 149 throat washing samples from female sex workers during 2013–2014 in Japan. Prevalences of M. genitalium with macrolide resistance–associated 23S rRNA mutations and fluoroquinolone resistance–associated parC alterations were 47.1% and 36.8%, respectively.     

Emergence of serotype 10A-ST11189 among pediatric invasive pneumococcal diseases,South Korea, 2014–2019

Replacement with nonvaccine serotypes (NVTs) among invasive pneumococcal diseases (IPDs) after the introduction of extended-valency pneumococcal conjugate vaccines varies in predominant serotypes across countries. This study analyzed changes in serotype distribution through serotyping, multilocus sequence typing, and antimicrobial susceptibility testing of 168 pediatric IPD isolates obtained from a multihospital-based surveillance system during 2014–2019 in South Korea. Vaccine serotypes (VTs) accounted for 16.1% (19A, 10.1%; 6A, 1.8%; and 19F 1.8%), 82.1% were NVTs (10A, 23.8%; 15A, 8.3%; 12F, 6.5%; 15C, 6.5%; and 15B, 6.0%), and three (1.8%) were nontypeable. Serotype 10A was the most common serotype, with a significant increase from 11.5% in 2014 to 33.3% in 2019 (p < 0.05 for the trend). Other NVTs decreased from 70.4% to 41.7% between 2015 and 2019, most notably in serotype 12F (from 14.8% to 0%). Almost all (95.0%) serotype 10A isolates were ST11189, which were multidrug resistant.