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Po-Ren Hsueh

Publications and source records attributed to Po-Ren Hsueh.

At least 91 records · Page 5Linked to original sources
PubMed2005

Molecular evidence of recurrent histoplasmosis with 9-year latency in a patient with Addison's disease.

We present a case of fatal histoplasmosis in a patient with Addison's disease and long-term use of corticosteroid. The patient acquired Histoplasma capsulatum in China and initially presented with a laryngeal mass. He developed fulminant pneumonia and respiratory failure 9 years later. Nucleotide sequences of internal transcribed spacer regions of rRNA genes of the H. capsulatum isolate recovered from biopsied lung tissue and of the extracted fungal DNA from the laryngeal lesion were identical, indicating the recurrent nature of infection.

Addison Disease↗
PubMed2005

Mycobacterium tuberculosis inducing disseminated intravascular coagulation.

Disseminated intravascular coagulation (DIC) can develop infrequently in patients with tuberculosis and has a very high mortality rate. We conducted a retrospective study to evaluate the incidence of tuberculosis-induced DIC and to investigate the clinical manifestation, outcome, and prognostic factors of such patients. From January 2002 to December 2003, all culture-proven tuberculosis patients who developed DIC before starting anti-tuberculosis treatments were selected for this study. Patients who had other clinical conditions or were infected by other pathogens that may have been responsible for their DIC were excluded. Survival analysis was performed for each variable with possible prognostic significance. Our results showed that 27 (3.2%) out of the 833 patients with culture-proven tuberculosis had tuberculosis-induced DIC with a mortality rate of 63.0%. The most common clinical manifestations were fever (63.0%) and multiple patches of pulmonary consolidation (59.3%). Seven (25.9%) patients had disseminated tuberculosis. Twelve (44.4%) developed acute respiratory distress syndrome and three (11.1%) were associated with hemophagocytosis. Twenty-four (88.9%) patients had findings that were unusual for an acute bacterial infection, such as positive acid-fast smear, miliary pulmonary lesions, lymphocytotic exudative pleural effusion, and mediastinal lymphadenopathy. Early anti-tuberculosis treatment significantly improved survival. In conclusion, tuberculosis can cause DIC. Patients with non-miliary, non-disseminated tuberculosis could also develop the rare clinical manifestation. Since the prognosis was very poor in patients not treated at an early stage, a high index of suspicion is required, especially in those with clinical findings suggestive of tuberculosis.

Adult↗
PubMed2005

Evolution of pulmonary pathology in severe acute respiratory syndrome.

BACKGROUND AND PURPOSE: Severe acute respiratory syndrome (SARS) is characterized by fever with rapid progression to acute respiratory distress and it is associated with substantial morbidity and mortality. Transmission patterns suggest spread by respiratory droplet or close person-to-person contact. To elucidate the correlation of clinical presentation to the pathogenesis and course of the disease, we reviewed the pulmonary pathologic specimens of SARS patients taken at different stages of the disease. METHODS: Four "probable" cases of SARS were studied. SARS-associated coronavirus (SARS-CoV) infection was demonstrated using reverse transcriptase-polymerase chain reaction in all 4 patients. The pulmonary specimens were taken on day 7 after symptom onset in patient 1, day 11 in patient 2, day 17 in patient 3, and day 21 in patient 4. RESULTS: The autopsy lung tissue from patient 1, who died 7 days after symptoms onset due to the complication of acute myocardial infarction, revealed mild histologic change in the lung. Only focal pulmonary edema or hemorrhage was seen. In the second patient, who died 11 days after symptom onset, severe acute alveolar damage was characterized by patchy or diffuse lung edema, hyaline membrane formation, and scarce lymphocytic infiltration. The lymphocytes were mostly CD3-positive and CD20-negative. In the third patient, biopsy specimen taken 17 days after symptom onset showed patches of organizing pneumonia with reactive fibroblastic proliferation, more abundant type II pneumocytes and clustering of CD68-positive macrophages within the alveolar spaces. Few CD68-positive syncytial multinucleated giant cells were also seen in the specimens but no viral inclusion body could be identified in these cells. The lung biopsy specimen from patient 4 taken 21 days after symptom onset showed characteristics of the fibrotic stage, with significant myofibroblastic proliferation in the alveolar space and interstitium resulting in loss of pulmonary architecture. The number of CD3-positive lymphocytes and of CD68-positive macrophages in this specimen from a patient in the fibrotic phase of diffuse alveolar damage (DAD) whose condition deteriorated was less than in the specimen from case 3 who was in the early proliferative phase of DAD and eventually recovered. CONCLUSIONS: The histologic evolution of SARS coincided with the different stages of DAD: acute, proliferative organizing, and fibrotic stages. SARS cannot be differentiated from the other etiologies of DAD by morphologic examination alone. The absence of DAD does not rule out the possibility of SARS-CoV infection, particularly in the early stage of the disease.

Adult↗
PubMed2005

Central venous catheter-associated fungemia due to Wangiella dermatitidis.

Central venous catheter-related Wangiella dermatitidis infection has been increasingly reported in the recent literature. We report a case of central venous catheter (Port-A-Cath)-related fungemia caused by W. dermatitidis in a 58-year-old woman with lung cancer. Two W. dermatitidis isolates were recovered from 2 blood samples drawn from a peripheral vein and the Port-A-Cath 4 months after its placement. The minimum inhibitory concentrations of 2 isolates to fluconazole and amphotericin B using the standard broth microdilution method were 48 microg/mL and 0.19 microg/mL, respectively. The Port-A-Cath was removed and the fungemia responded to amphotericin B treatment. W. dermatitidis should be categorized as a pathogen that can cause central venous catheter-associated fungemia, particularly in immunocompromised patients.

Catheterization, Central Venous↗
PubMed2005

Immunohistochemical study of severe acute respiratory syndrome-associated coronavirus in tissue sections of patients.

BACKGROUND AND PURPOSE: Severe acute respiratory syndrome (SARS) is a life-threatening and highly contagious disease caused by the novel SARS coronavirus (SARS-CoV). Immunohistochemical staining for SARS-CoV in the tissue sections of SARS patients is helpful in investigations of the biologic behavior of this virus in human tissue, and to determine the target cells of this virus in different organs. METHODS: We studied the pathologic specimens from 6 SARS patients by immunohistochemical staining using a specific antibody against SARS-CoV. RESULTS: Positive viral staining was only found in the lung tissue taken from the patients who died in the early stage of the disease, usually less than 10 days after symptom onset. No positive staining was found in the lung tissue specimens collected in the mid-to-late stage of the disease. The SARS-CoV-infected cells had a patchy distribution and tended to be present in the periphery of the lung. Immunohistochemically, these viral-infected cells were located mainly along the alveolar space, had a cuboidal appearance, and were reactive to cytokeratin and surfactant protein C. This suggested that type II pneumocytes are the main target cell of SARS-CoV in the lung. Occasional intra-alveolar macrophages were also weakly reactive to SARS-CoV antibody. In addition to the lung, positive viral staining was also found in the mucosal epithelium of the large intestine in another patient who had the clinical symptom of diarrhea. No evidence of viral staining was found in other organs including kidney, liver, lymph node and spleen. The skeletal muscle specimens of 2 patients who had rhabdomyolysis were also negative for SARS-CoV. CONCLUSIONS: SARS-CoV is mainly present in the cytoplasm of type II pneumocytes and can only be detected in the lung tissue during the early stage of the disease. In the patient who had symptoms of diarrhea, SARS-CoV staining was also identified in the mucosal epithelium of the colon.

Adult↗
PubMed2005

Streptococcus suis infection.

A recent outbreak of Streptococcus suis infection associated with the slaughter, preparation or consumption of pigs in Sichuan, China has led to concerns that similar outbreaks could occur in other Asian countries. Although the pig farming industry is flourishing in Taiwan, reports of S. suis infection remain rare. We report 2 cases of S. suis meningitis successfully treated with ceftriaxone and penicillin. Previous reports of S. suis infection from the English literature are reviewed and the clinical data of cases reported in Asian and European countries are summarized. In Europe, there was good correlation between clinical disease and porcine contact, while few cases in Asia reported this association. Meningitis remained the most common presentation of infection in both areas (84.6% and 75.2%, respectively), followed by sepsis (15.4% and 18.6%, respectively), which had a higher mortality rate, particularly for splenectomized patients. Other clinical presentations included enteritis, arthritis, endocarditis, pneumonia, spondylodiscitis, endophthalmitis, uveitis and peritonitis. Deafness was a distinct sequelae (50.5% in Europe and 51.9% in Asia) after recovery from S. suis infection, especially in patients with meningitis. Not all commercial identification systems for streptococci could offer adequate speciation for S. suis. When viridans group streptococci are isolated from patients with meningitis and sepsis, prompt and correct identification of isolates to the species level should be performed, especially in areas with a high prevalence of S. suis diseases.

Adolescent↗
PubMed2005

Community-acquired anaerobic bacteremia in adults: one-year experience in a medical center.

A prospective observational study was conducted to evaluate the clinical characteristics and outcome of community-acquired anaerobic bacteremia. From June 1 2001 through May 31 2002, 52 patients with community-acquired anaerobic bacteremia were enrolled at the emergency department in a teaching hospital. There were 19 patients (34%) with polymicrobial bacteremia and Escherichia coli was the most common copathogen (n = 6). Of 62 anaerobic isolates, species of the Bacteroides fragilis group were the most common isolates (n = 28, 45%), followed by Clostridium spp. (n = 11, 18%). Among the 52 patients enrolled, up to 27% had underlying malignancy and the gastrointestinal tract accounted for 48% of the sources of infection. Clinical manifestations suggesting anaerobic infections were common and three-quarters (n = 39) of 52 patients received adequate empirical antimicrobial treatment. Documentation of anaerobic bacteremia seldom influenced antimicrobial treatment. The 30-day mortality was 25%. Although univariate analysis revealed that underlying malignancy (p=0.003), leukopenia (p=0.044) and absence of fever (p=0.047) were associated with mortality, only malignancy (p=0.007) was an independent risk factor in the multivariate analysis.

Academic Medical Centers↗
PubMed2005

Characterization of a 411-bp fragment of the rpoB gene in clinical isolates of Mycobacterium tuberculosis in a university hospital in northern Taiwan.

BACKGROUND AND PURPOSE: This study analyzed rpoB gene mutation and its correlation with demographic and clinical data, and the drug resistance profile in 41 consecutive patients with rifampin (RIF)-resistant Mycobacterium tuberculosis isolated at National Taiwan University Hospital from 2000 to 2002. METHODS: The 411-bp fragment of the rpoB gene from 94 M. tuberculosis isolates (including 41 RIF-resistant and 53 RIF-susceptible isolates) was amplified and sequenced. RESULTS: Of the 41 RIF-resistant isolates, 87.8% (36/41) showed mutations in rpoB. The following mutations were identified: Ser531 (68.3%), His526 (9.8%), Ser522 (4.9%) and Gln513 (4.9%). No silent substitutions were observed. No mutation within the entire 411-bp fragment was found in 12.2% (5/41) of the RIF-resistant isolates and 100% (53/53) of the RIF-susceptible isolates. Patients whose RIF-resistant isolates did not have rpoB mutation had higher frequencies of the following characteristics: elderly, no previous history of tuberculosis, human immunodeficiency virus-negative, no extrapulmonary tuberculosis involvement and favorable prognosis. Drug resistance patterns in RIF-resistant M. tuberculosis strains were significantly correlated with isoniazid resistance, i.e., multidrug-resistant strains (90.2%). CONCLUSIONS: RIF-resistant M. tuberculosis isolates with rpoB mutation were clustered in the 69-bp core region in this study. Rapid detection of RIF resistance could be achieved by testing for rpoB mutation in Taiwan.

Adult↗
PubMed2005

Meningitis due to Histoplasma capsulatum and Mycobacterium tuberculosis in a returned traveler with acquired immunodeficiency syndrome.

Histoplasmosis has rarely been reported in Taiwan, and its clinical manifestations may be similar to those of tuberculosis. With increasing international travel, physicians need to be aware of the possibility of this disease when caring for patients with advanced human immunodeficiency virus (HIV) infection who have traveled to endemic areas. A 55-year-old Chinese male from Burma presented with concurrent histoplasmosis and tuberculous meningitis as the initial opportunistic infection of acquired immunodeficiency syndrome. Fever, altered mentation, pancytopenia, splenomegaly and marked elevations of serum lactate dehydrogenase (3601 U/L) and ferritin (>10(6) ng/mL) were noted. Despite treatment with amphotericin B and antituberculous therapy, the patient died on the 25th day of hospitalization. This case illustrates the complexity and challenges of management of opportunistic infections in travelers returning from Southeast Asia who are in the advanced stage of HIV infection.

AIDS-Related Opportunistic Infections↗
PubMed2005

Lymphadenitis caused by non-tuberculous mycobacteria in a university hospital in Taiwan: predominance of rapidly growing mycobacteria and high recurrence rate.

BACKGROUND AND PURPOSE: Lymphadenitis is the most common manifestation of infection due to non-tuberculous mycobacteria (NTM) in otherwise healthy children. This disease is rare in adults and its geographic variations in etiology and clinical manifestations remain unclear. The aim of this study was to describe the etiology, clinical presentation, treatment, and outcome of NTM lymphadenitis. METHODS: Medical records of patients with culture-proven NTM lymphadenitis treated at a university hospital in Taiwan from January 1997 through December 2004 were retrospectively reviewed. RESULTS: In total, 12 patients with NTM lymphadenitis were identified, including 6 males and 7 adults (> or = 16 years). The majority (83%) of patients presented with an enlarged palpable mass and 9 (75%) had preceding constitutional symptoms. The most common site of lymphadenitis was the cervical area (83%) and 8 patients (75%) had multiple lymph node involvement. Rapidly growing mycobacteria (RGM) accounted for 75% of the etiology of NTM lymphadenitis, followed by Mycobacterium avium complex (MAC) [2 patients]. A high recurrence rate (42%) after primary treatment was noted among those patients who received clarithromycin-containing regimens for a median of 6 months. CONCLUSIONS: This study found that both previously healthy children and adults were susceptible to NTM lymphadenitis. RGM was the most common etiology rather than MAC among NTM species causing lymphadenitis. Inadequate surgical excision of the diseased lymph nodes and insufficient coverage of antimycobacterial therapy both contributed to the high recurrence rate.

Adolescent↗
PubMed2004

Infected bronchogenic cyst due to Mycobacterium avium in an immunocompetent patient.

We present a patient with intermittent pain over the right chest for 2 years. Computed tomograph of the chest disclosed a cystic tumor over the right posterior basal lung. Pathological examinations of the excised tumor disclosed a granulomatous inflammation within the multilocular bronchogenic cysts and microbiological culture of the tissue yielded Mycobacterium avium. This is the first reported case of infected bronchogenic cyst caused by M. avium in humans.

Adult↗
PubMed2004

High prevalence of ciprofloxacin-resistant Neisseria gonorrhoeae in Northern Taiwan.

Among 55 preserved isolates collected in northern Taiwan from 1999 through 2003, ciprofloxacin resistance (minimum inhibitory concentration, >or=1 microg/mL) was found in 1 (25%) of 4 isolates obtained in 1999-2000 and in 27 (93.1%) of 29 isolates obtained in 2003. Pulsed-field gel electrophoresis analysis indicated that several clones predominated among the ciprofloxacin-resistant isolates.

Adult↗
PubMed2004

An Asian study on the prevalence of atypical respiratory pathogens in community-acquired pneumonia.

BACKGROUND: In many parts of Asia, the inaccessibility and high cost of diagnostic tests have hampered the study of community-acquired pneumonia (CAP) caused by atypical respiratory pathogens. OBJECTIVE: This surveillance study examined the frequency of infection with Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Legionella pneumophila in 1756 patients presenting with signs and symptoms of CAP at 12 medical centres in Asia, using standardised laboratory techniques and interpretation criteria in all participating centres. METHODS: Diagnosis of current infection was based on significant changes in antibody titer or persisting high antibody titers, together with the presence of bacterial DNA in respiratory secretions, in the case of M. pneumoniae and C. pneumoniae infections, or bacterial antigen in urine, in the case of L. pneumophila serogroup 1 infection. RESULTS: Using these criteria, results from 1374 patients with paired sera showed that, overall, 23.5% of CAP cases were associated with infection with atypical respiratory pathogens, with M. pneumoniae, C. pneumoniae, and L. pneumophila being found in 12.2%, 4.7%, and 6.6% of cases, respectively. Persisting high antibody titers indicative of past exposure to M. pneumoniae, C. pneumoniae, and L. pneumophila were seen in 10.2%, 4.8%, and 18.9% of patients, respectively. CONCLUSION: These data reflect the overall high prevalence of these atypical pathogens among Asian patients with CAP.

Adolescent↗
PubMed2004

Temporal relationship of viral load, ribavirin, interleukin (IL)-6, IL-8, and clinical progression in patients with severe acute respiratory syndrome.

Although viral replication and overwhelming immune responses are believed to contribute to the progression of severe acute respiratory syndrome (SARS), little is known about the temporal relationship between viral load, ribavirin, proinflammatory cytokines, and clinical progression. We report that ribavirin was not effective in reducing the SARS coronavirus load in 3 of 8 probable cases studied and that elevated levels of interleukin (IL)-6 and IL-8 subsequent to the peak viral load were found in 8 and 6 cases, respectively. The nadir lymphocyte count during lymphopenia, the peak level of lactate dehydrogenase, and the peak density of pulmonary infiltrates lag further behind the peak viral load by a median of 4, 5, and 3.5 days, respectively. These findings provide important information for therapeutic strategies to treat SARS.

Adult↗
PubMed2004

Disease-specific B Cell epitopes for serum antibodies from patients with severe acute respiratory syndrome (SARS) and serologic detection of SARS antibodies by epitope-based peptide antigens.

Severe acute respiratory syndrome (SARS) has emerged as a highly contagious, sometimes fatal disease. To find disease-specific B cell epitopes, phage-displayed random peptide libraries were panned on serum immunoglobulin (Ig) G antibodies from patients with SARS. Forty-nine immunopositive phage clones that bound specifically to serum from patients with SARS were selected. These phageborne peptides had 4 consensus motifs, of which 2 corresponded to amino acid sequences reported for SARS-associated coronavirus (SARS-CoV). Synthetic peptide binding and competitive-inhibition assays further confirmed that patients with SARS generated antibodies against SARS-CoV. Immunopositive phage clones and epitope-based peptide antigens demonstrated clinical diagnostic potential by reacting with serum from patients with SARS. Antibody-response kinetics were evaluated in 4 patients with SARS, and production of IgM, IgG, and IgA were documented as part of the immune response. In conclusion, B cell epitopes of SARS corresponded to novel coronavirus. Our epitope-based serologic test may be useful in laboratory detection of the virus and in further study of the pathogenesis of SARS.

Amino Acid Motifs↗