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.
Background Combination therapy with a third-generation cephalosporin (TGC) and a tetracycline analogue is recommended for Vibrio vulnificus infection. The combination of a TGC and ciprofloxacin has synergistic in vitro bactericidal activity against V . vulnificus . No clinical study has compared the standard regimen with TGC plus ciprofloxacin therapy for V . vulnificus infection. Methods Patients with a confirmed V . vulnificus infection at two medical centers in Korea from 1991 to 2016 were enrolled in this study. The patients were grouped according to the type of antibiotic administered. A retrospective propensity-score-matched case-control study of patients treated with TGC plus doxycycline or TGC plus ciprofloxacin was performed. The clinical characteristics and outcomes of the patients were analyzed. Results A total of 218 patients were confirmed to have V . vulnificus septicemia during the study, and the 30-day survival rate was 39% (85/218). The patients were classified into the following six treatment groups: TGC monotherapy (n = 82), TGC plus doxycycline therapy (n = 42), TGC plus ciprofloxacin therapy (n = 39), ciprofloxacin monotherapy (n = 14), other β-lactam monotherapy (n = 10), and other (n = 31). The survival rates of these groups were as follows: TGC monotherapy (35%), TGC plus doxycycline (38%), TGC plus ciprofloxacin (54%), ciprofloxacin monotherapy (29%), other β-lactam (20%), and other (39%). The 30-day survival rate showed no significant difference between the TGC plus doxycycline and TGC plus ciprofloxacin groups (log-rank test, P = 0.18). Among the 81 patients treated with TGC plus doxycycline or TGC plus ciprofloxacin, 12 per treatment group were selected by propensity-score matching. There was no significant difference in the baseline characteristics or the frequency of fasciotomy between the two groups. The 30-day survival rate showed no significant difference between the TGC plus doxycycline (50%) and TGC plus ciprofloxacin (67%) groups (log-rank test, P = 0.46). Conclusion Our data suggest that the outcome of TGC plus ciprofloxacin therapy was comparable to that of TGC plus doxycycline therapy in patients with V . vulnificus septicemia.
Nationale: Trichosporon species are widely distributed in nature and are emerging opportunistic human pathogens. Trichosporon infections are associated with superficial cutaneous involvement in immunocompetent individuals to severe systemic disease in immunocompromised patients. Until now, there is no report in infective endocarditis by Trichosporon mucoides confirmed by molecular diagnostics Patient concerns: A 66-year-old man presented with a fever that had occurred for a period of 6 months. He had undergone aortic valve replacement 10 years prior. Transthoracic echocardiography showed vegetations on the prosthetic aortic valve and native mitral valve. T mucoides was detected in the cultures of blood and vegetations. Diagnosis: DNA sequencing using D/D2 region of rRNA and internal transcribed spacer were performed. Interventions: Infections were successfully controlled with valve replacement and voriconazole plus liposomal amphotericin B therapy. Outcomes: There has been no sign of recurrence for 18-months after treatment completion. Lessons: This is the first reported case of infective endocarditis due to T mucoides . Clinicians should consider Trichosporon species as causative agents of endocarditis in patients who have undergone cardiac surgery.
Measles elimination in South Korea was approved by the World Health Organization (WHO) in 2014.However, small sporadic outbreaks of measles continue to occur, mostly driven by imported cases [1].Measles introduced from abroad spreads to susceptible populations, such as infants or young adults who are insufficiently vaccinated or in cases where the vaccine effect has waned. The number of foreignborn individuals in South Korea has increased sharply (1,271,807 foreigners with long-term stay in 2019), of which approximately 10% are marriage migrants [2]. Marriage migration has increased rapidly since the mid-1990s as the government officially encouraged international marriages between foreign women and Korean men to resolve the rural bride shortage. Earlier, most foreign brides were Chosunjok (ethnic Koreans from China), but recently, their country of origin has diversified. As of January 2019, out of a total of 132,748 foreign-born women married to Korean men and living in South Korea, the most common country of origin was China (34.7%), followed by Vietnam (30.4%), Japan (9.4%), Philippines (8.6%), Cambodia (3.2%), Thailand (3.3%), and others (10.3%) [3]. Measles vaccination rates worldwide have increased over time, but are still lower in low-or middle-income countries than in developed countries. The estimated first-dose measles-containing vaccine (MCV1) coverage in Vietnam was 84.4% to 93.3% between 2000 and 2019, but the second-dose measlescontaining vaccine (MCV2) administration only started in 2007 [4,5]. The estimated MCV1 coverage in Cambodia was 63.7% to 91.1% between 200063.7% to 91.1% between and 201963.7% to 91.1% between , and MCV2 administration only started in 2012. These suboptimal measles vaccine coverage rates in the countries of origin of marriage migrant women suggest the possible influx of measles-susceptible populations into South Korea. Since marriage migrant women frequently become pregnant, give birth, take care of children, and travel overseas to their country of origin, immunity to measles becomes particularly important. However, thus far, there has been no information regarding measles immunity in marriage migrant women in South Korea.
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