From a total of 71 laboratory-confirmed cases, three presymptomatic patients and 10 patients with entirely asymptomatic infections were identified. In two of the three incubation period patients, the viral titer in the presymptomatic period was very high (Ct value < 20). The median number of days to first negative RT-PCR in the asymptomatic carriers was 4.5 (range 2.5-9), and all asymptomatic carriers reached a first RT-PCR Ct > 35 within 14 days after diagnosis. Patients who have COVID-19 may already be infectious before there are symptoms, and 14 days of isolation after diagnosis may be sufficient in entirely asymptomatic cases.

This multinational study from Asia revealed that reduced susceptibility to ciprofloxacin (MIC, 0.125 to 1 g/ml) in nontyphoid Salmonella isolates was common in Taiwan (48.1%) and Thailand (46.2%) and in S. enterica serotype Choleraesuis (68.8%) and S. Virchow (75.0%) from all countries. Reduced susceptibility to ceftriaxone (MIC, 2 to 8 g/ml) remained uncommon in Asia, except in Taiwan (38.0%) or in S. Typhimurium (25.0%) from all countries.Nontyphoid Salmonella bacteria, with more than 2,500 serotypes, usually cause diarrheal diseases in humans that may be complicated by extraintestinal infections, such as bacteremia, meningitis, and osteomyelitis (11). Resistance to antimicrobial agents, including fluoroquinolones and expanded-spectrum cephalosporins, has been a serious problem worldwide. Nontyphoid salmonellosis has been rampant in Asia (7); however, data on the antimicrobial susceptibilities, as well as the prevalence, of various serotypes in many Asian countries after 2000 have been lacking.During 2003 to 2005, 400 clinical isolates of nontyphoid Salmonella bacteria were randomly collected from 11 medical centers in seven Asian countries (Table 1) and transported to the central laboratory in Samsung Medical Center, Seoul, Korea, for serogrouping and serotyping using O and H antisera, respectively (Difco Laboratories, Detroit, MI). Susceptibilities to ciprofloxacin, tetracycline, ceftriaxone, ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole were determined by a broth microdilution method, and the results were interpreted according to the breakpoints for MICs suggested by the NCCLS (10). For statistical analysis, isolates in the "intermediate" category were deemed "resistant" in this study. Concomitant resistance to at least three of the six antibiotics tested was defined as multidrug resistance (MDR). Isolates with ciprofloxacin MICs of 0.125 to 1 g/ml were defined as having "reduced susceptibility" to ciprofloxacin (9). Similarly, "reduced susceptibility" to ceftriaxone was defined as isolates showing ceftriaxone MICs of 2 to 8 g/ml (14). These definitions were proposed in previous reports to reflect the clinical therapeutic responses (9, 14). The 2 test and Student's t test were used to determine the significance of differences, and a P value of Ͻ0.05 was considered statistically significant.A total of nine serogroups (B, C1, C2, D, E, G, I, K, and M) and 82 serotypes were identified among the isolates tested. Serogroups B (34.8%) and D (25.0%) were the two leading serogroups in all areas except Philippines, where serogroup E (25 isolates, 53.2%) was most prevalent. The distribution of major serotypes among the countries is shown in Table 1. Overall, S. enterica serotype Enteritidis and S. Typhimurium were the two most-prevalent serotypes except in Philippines, Singapore, and Thailand, where S. Weltevreden was either the most-or second-most-prevalent serotype. In Sri Lanka and Thailand, the most-prevalent serotypes were S. Agona and S. Stanley, respectively. S. Choleraesuis was relatively mor...

Carbapenem-resistant Acinetobacter species are increasingly recognized as major nosocomial pathogens, especially in patients with critical illnesses or in intensive care. The ability of these organisms to accumulate diverse mechanisms of resistance limits the available therapeutic agents, makes the infection difficult to treat, and is associated with a greater risk of death. In this review, we provide an update on the epidemiology, resistance mechanisms, infection control measures, treatment, and outcomes of carbapenem-resistant Acinetobacter infections.

Previously, Pseudomonas putida was considered a low-virulence pathogen and was recognized as a rare cause of bacteremia. Recently, however, multidrug-resistant and carbapenem-resistant P. putida isolates have emerged, causing difficult-to-treat nosocomial infections in seriously ill patients. Currently, the outcome of multidrug-resistant or carbapenem-resistant P. putida bacteremia remains uncertain. Here, we report 18 cases of P. putida bacteremia with high rates of carbapenem resistance and mortality. From January 2005 through December 2011, all cases of nosocomial P. putida bacteremia were identified and analyzed at Chonnam National University Hospital and Chonnam National University Hwasun Hospital. Electronic medical records were reviewed retrospectively. Four (22%) and five (23%) of 18 P. putida isolates were resistant to imipenem and meropenem, respectively. Common primary infection sites were central venous catheter (7, 39%), pneumonia (5, 28%), and cholangitis (2, 11%). Fourteen (78%) patients had indwelling devices related to the primary site of infection. The 30-day mortality rate was 39% (7/18): 40% (2/5) in patients with carbapenem-resistant P. putida bacteremia vs. 38% (5/13) in patients with carbapenem-susceptible P. putida bacteremia. Nosocomial P. putida bacteremia showed high resistance rates to most potent β-lactams and carbapenems and was associated with high mortality rates.

Primary hepatic leiomyosarcoma are rare tumors with less than 30 cases reported in the English literature. Non specific presentations and often diagnosis delayed until they reach a large size, is the norm with therapy leading to an often dismal prognosis. A 67-year-old man presented complaining of abdominal pain and a palpable abdominal mass since Jan 2010. Abdominal ultrasonography and abdominal computed tomography revealed a large tumor in the left lobe of the liver. Surgical exploration was undertaken and an extended left hepatectomy with extension onto the dorsal part of segment 8 preserving the MHV with partial resection of segment 6 was undertaken. The weight of the resected specimen was 1300 g of the left lobectomy specimen and 8 g of the segment 6 partial resection specimen. The pathology report confirmed the diagnosis of leiomyosarcoma. On immunohistochemistry, the tumor cells were positive for smooth muscle actin stain. The patient is on regular follow up and is currently 9 mo post resection with no evidence of recurrence. We report the case of a resected primary hepatic leiomyosarcoma and emphasize the need for a global database for these rare tumors to promote a better and broader understanding of this less understood subject.

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Necrotizing fasciitis is a life-threatening soft-tissue infection. It is useful to know the etiology of this disease in each community and region because this information can facilitate early diagnosis and treatment. We reviewed medical records of 217 consecutive patients with necrotizing fasciitis in South Korea. Etiologic organisms were documented in 171 (78.8%) patients. Gram-negative marine bacteria were the most common organisms (68.4%). Seasonal variation in incidence occurred during warmer periods. Liver cirrhosis and alcoholism were common underlying illnesses. Gastrointestinal symptoms were more common in persons infected with gram-negative marine bacteria (56.4% versus 29.6%). Gram-negative bacteria were the predominant pathogens in multiple site involvement. Acute Physiology and Chronic Health Evaluation II scores, marine bacteria, and medical treatment without surgery affected mortality. When necrotic areas included less than three extremities, fasciotomy improved the survival rate. In coastal areas, gram-negative marine bacteria are the most common pathogens associated with necrotizing fasciitis. Fasciotomy can improve survival of patients with necrotic areas that involve less than three sites in necrotizing fasciitis.

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