WCIM 2014 SEOUL KOREA 149
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0389 Infectious Disease
Vasculitis Caused by Infectious Agent or Allergic Reac- tion
Armando LOPES BRAZ1, Tiago MASCARENHAS1, Conceição QUADRADO1, José BRAZ NOGUEIRA1
Hospital Santa Maria, Portugal1
The clinical case is about a 44 years old male patient who was transferred to our hos- pital due to vasculitis. He was living in Angola for 8 years, being healthy until 2 weeks before being transferred. He started to feel abdominal cramps, muscular and joint pain over a period of 3 days. He was admitted in a clinic suspecting of malaria, starting an- timalarial medication. On the 3rd day, the blood results for infectious diseases and ma- liaria were negative. He stooped the treatment and was discharged. After 4 days the patient started to complain of the same symptoms aggravated with asthenia, tiredness and diarrhea. He was readmitted and treated with antibiotics. Three days later some petequial lesions appeared in the lower limbs, getting spread arms and ears. These lesions got bigger over the next 2 days becoming macules and then changed to penfi - goid lesions with central necroses. The lesions covered the all lower limbs and part of the upper limbs, spearing the trunk. Corticosteroids were added to the treatment but he got worse, being later transferred to our hospital. The fi rst evaluation revealed a severe lower limbs edema, hypoalbuminemia and renal failure. All the treatment was stooped apart of pain killers and done some skin biopsies. The result was positive for leukocytoclastic vasculitis. Because of the GIT symptoms an endoscopy and colonos- copy was performed. The gut was covered with extense ulcerative lesions and was identifi ed inside them CMV. The body CT and Abdominal ultrasound were normal. The patient started the treatment with Valaciclovir during 15 days, followed with 6 weeks of Ganciclovir. This case still covered in dough, because it’s impossible to know if the hypersensibility reaction to the anti-malary drugs started the vasculites, triggering the CMV infection or the CMV developed the vasculitis.
PS 0390 Infectious Disease
Clinical Characteristics and Effect of Empirical Therapy in Cirrhotic Adults with Community-Onset Bacteremia Visiting the Emergency Department(ED)
Ching-Chi LEE1, Ming-Yuan HONG2, Wen-Chien KO3
National Cheng Kung University Hospital, Taiwan R.O.C1, National Cheng Kung University Hospital, Tai- wan R.O.C2, National Cheng Kung University Medical College, Taiwan R.O.C3
Background: Bacteremia, a indicative of a severe bacterial infection, has been asso- ciated with varied mortality rate, up to 37% in cirrhotic patients. This study was to investigate the clinical characteristics of community-onset bacteremia in cirrhotic adults and the clinical impact of appropriate empirical antibiotics on their outcome.
Methods: Cirrhotic adults with community-onset bacteremia visiting the ED from January 2005 to December 2009 were identifi ed retrospectively. Demographic char- acteristics, severity, pathogens, port of entry, antibiotic therapy and clinical outcome were collected form the chart record. The susceptibility were determined by the broth microdilution method.
Results: Of a total 246 episodes in cirrhotic patients, the mean age was 62.7 years, and 167 patients (67.9%) were male. The major resource of bacteremia included intra-abdom- inal infections (112 patients, 45.5%), primary bacteremia (43, 17.5%), urinary tract infec- tion (39, 15.9%) and soft-tissue infection (22, 8.9%).Of a total 258 bacteremia-causing microorganisms, Enterobactericaeae and Gram-negative isolates account for 72.1% (186 isolates) and 76% (196), respectively; Escherichia coli (82 isolate, 31.8%) and Klebsiella species (61, 23.6%) were the most frequently encountered microorganisms. The in vitro susceptibility rate of each drug for Gram-negative and total isolates were demonstrated in Table 1. In multivariate analyses, the following variables were associated independently with 28-day mortality: the length of delayed appropriateness >72 hours (odds ratio [OR], 4.29; P=0.003); high serum creatinine (>1.5 mg/dL; OR, 3.12 ; P=0.005) in the ED; severe sepsis (OR, 3.61; P=0.01); high Piitt score(= 4; OR, 2.66 ; P=0.04); pneumonia (OR, 5.44;
P=0.02); and diabetes (OR, 3.54; P=0.004).
Conclusions: For cirrhotic adults with community-onset bacteremia in the ED, the clinical characteristics of bacteremia was demonstrated. In practice, their outcomes were superior following treatment with appropriate antibiotics compared to treatment with inappropriate antibiotics empirical.
PS 0391 Infectious Disease
Profi le of Dengue Viral Load in Patients with Confi rmed Mild Dengue Infection in Surabaya, Indonesia
Musofa RUSLI1, Bramantono SOEKARMAN1, M. Vitanata ARFIJANTO1, NASRONUDIN NASRONUDIN2, Maria I LUSIDA2, Muhammad A ISFANDIARI2, Evhy APRYANI2, SISWANTO SISWANTO3, MJ REYNOLDS4, Umar F ACHMADI5
Faculty of Medicine, Airlangga University, Indonesia1, Institute of Tropical Disease, Airlangga University, Indonesia2, National Institute of Health Research and Development (NIHRD), Indonesia3, Center for Environment and Population Health, Griffith University, Australia4, Faculty of Public Health, Universitas Indonesia, Indonesia5
Background: Endemicity of dengue infection is still an important in Indonesia. The hall- mark of dengue infection is the posibility to progress to fatal disease. Dengue viral load has some role in the pathogenesis and acute clinical manifestation of dengue. The aim of study was to describe dengue viral load profi le in patients with dengue infection.
Methods: This study design was cross-sectional study and conducted from January 2012 to November 2013. The subjects were dengue patients with 10 years-old of age or above, with fever on day-1 or day-2, suspected dengue infection according to WHO criteria, showed positive result either by NS-1, and or IgM – IgG. Complete blood count, clinical chemistry, and dengue viral load were performed on the fi rst day of admission. Correlations were analyzed with Spearman test.
Results: We recruited 100 subjects with positive result either by Dengue NS-1, and or IgM – IgG, and positive viral load. The results were: fever 38±1.03℃, hemoglobin 13.57±1.45 g/dL, hematocrite 39.44±4.16 %, leucocyte 3.82x10³ cells/mm3, thrombocyte 98 (min-max 19-312)x10³ cells/mm3, dengue viral load 423 (min-max 1-41.7x106) copies. The clinical diagnosis were dengue fever, DHF grade I, and DHF grade II; with proportions: 52.5%, 42.6% and 4%, respectively. There were no correlation between dengue viral load with body temperature, hemoglobin, leucocyte, or thrombocyte level. There were signifi cant weak correlation between dengue viral load with thrombocytopenia <0.05).
Conclusions: We reported signifi cant weak correlation between viral load with throm- bocytopenia, and signifi cant weak negative correlation between dengue viral load with hemoconcentration, hematocrit and severity grading of dengue infection.
PS 0392 Infectious Disease
Profi le of Vcam in Patients with Confi rmed Mild Den- gue Infection in Surabaya, Indonesia
M Vitanata ARFIJANTO1, Musofa RUSLI1, Nasronudin NASRONUDIN2, Maria I LUSIDA2, Muhammad A ISFANDIARI2, Evhy APRYANI2, Siswanto SISWANTO3, MJ REYNOLDS4, Umar F ACHMADI5
Faculty of Medicine, Airlangga University, Indonesia1, Institute of Tropical Disease, Airlangga University, Indonesia2, National Institute of Health Research and Development (NIHRD), Indonesia3, Center for Environment and Population Health, Griffith University, Australia4, Faculty of Public Health, University of Indonesia, Indonesia5
Background: Dengue infection is still an endemic disease in Indonesia. The hallmark of dengue infection is the posibility to progress to fatal disease. VCAM is known for some role in the pathogenesis of dengue. The aim of the study was To describe VCAM profi le in patients with dengue infection
Methods: This study design was cross-sectional study and conducted from January 2012 to November 2013. This study has been approved by Ethical Committee. The subjects were dengue patients with 10 years-old of age or above, with fever on day-1 or day-2, suspect- ed dengue infection according to WHO criteria, showed positive result either by NS-1, and or IgM – IgG. Complete blood count, clinical chemistry, and VCAM were performed on the fi rst day of admission. Correlations were analyzed with Spearman test.
Results: We recruited 100 subjects with positive result either by NS-1, and or IgM – IgG, and positive viral load showed. Clinical profi le and laboratory of the subjects were:
fever 38±1.03 ℃, hemoglobin 13.57±1.45 g/dL, hematocrite 39.44±4.16 %, leucocyte 3.82x10³ cells/mm3, thrombocyte 98 (min-max 19-312)x10³ cells/mm3, lymphocyte 28.58±12.69%, serum albumin 3.79±0.54 g/dL, VCAM 233 (min-max 60.5-938) ng/
dL. The proportion of thrombocytopenia, hemoconcentration and hypoalbuminemia were 38.6%, 46.5% and 24.8%, respectively. The clinical diagnosis were dengue fever, DHF grade I, and DHF grade grade II; with proportions: 52.5%, 42.6% and 4%, respec- tively. There were no subject progressing to severe dengue. There were no correlation between VCAM with severity grading, thrombocytopenia, hemoconcentration, hypoal- buminemia, or hemorrhagic events. There were signifi cant weak correlation between VCAM level and body temperature level (r=0.21, p <0.05).
Conclusions: We reported VCAM profi le of subjects with mild dengue infection. Sig- nifi cant weak correlation between VCAM level and body temperature level was found in the subjects.
