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Biomedical subjects

C T Fang

Publications and source records attributed to C T Fang.

At least 19 recordsLinked to original sources
PubMed2006

Sparing immunosuppression in heart transplant recipients with severe sepsis.

This study described an analysis of severe sepsis among heart transplantation recipients who were treated by sparing all immunosuppressants. Sepsis leading to multiple organ failure (MOF) in heart transplantation has a high mortality. This retrospective study of 190 patients who underwent heart transplantation from 1993 to 2004 included 12 who had severe sepsis with MOF who were treated by sparing all immunosuppressants. Half of them survived after sparing all immunosuppressants with intensive endomyocardial biopsy. Only one case needed pulse therapy for an acute rejection episode. The most common bacterial infectious episodes were caused by methicillin-resistant Staphylococcus aureus (n = 3). All sepsis episodes occurred in the first month after heart transplantation except in one case, which occurred 6 years after heart transplantation. There was a 50% survival rate of heart transplantation recipients who experienced MOF due to severe sepsis and were treated by sparing all immunosuppressants under a program of intensive endomyocardial biopsy.

Bacterial Infections↗
PubMed2003

Human immunodeficiency virus-1 and hepatitis C virus RNA among South African blood donors: estimation of residual transfusion risk and yield of nucleic acid testing.

BACKGROUND AND OBJECTIVES: South Africa is an endemic area for human immunodeficiency virus 1 (HIV-1) infection, which has an impact on the safety of the blood supply. We studied the presence of HIV-1 and hepatitis C virus (HCV) RNA, and recent HIV seroconversion, in blood donors in order to estimate transfusion risk and to determine whether nucleic acid testing (NAT) could effectively improve blood safety. MATERIALS AND METHODS: Unlinked samples collected in 1999 from 9077 HIV-low prevalence (LP) and 10,632 HIV-high prevalence (HP) donors were studied. Donor demographic information and serology results were collected prior to breaking the linkage. All samples were individually tested using a multiplex NAT assay for HIV-1 and HCV RNA. HIV antibody-positive samples were further tested using a 'detuned' (less sensitive) enzyme immunoassay (EIA) procedure to determine whether a donor had recently acquired infection. Data were used to estimate the residual transfusion risk and to project NAT yield. RESULTS: HIV was 45 times more prevalent in the HP- than in the LP donor group; and among the HP group, female donors had a significantly higher prevalence of HIV than male donors. All seven HIV-1 p24 antigen-positive samples in the study were also HIV NAT positive. Two HIV NAT-positive samples were anti-HIV negative; both of these samples were from HP donors. Assuming that 10% of the 900,000 annual donations in South Africa are from the HP group, we projected an annual NAT yield of 8.5 cases over the current screening of antibody and p24 antigen. However, if p24 antigen testing were to be eliminated, this number would be increased to 17 cases per year. Based on 'detuned' EIA results, the incidence rate for HIV infection was estimated at 1.29 and 51.12 per 10,000 per year for the LP and HP donor groups, respectively. Assuming a 15-day earlier detection by HIV NAT compared with antibody tests, these incidence rates project that NAT may intercept an additional 23 (95% confidence interval: 15-33) HIV-positive donations per year. For HCV, two viral RNA and antibody-positive samples (one from the LP group and one from the HP group) and no NAT yield cases were found in the study. CONCLUSIONS: Implementation of routine NAT blood screening would allow elimination of HIV-1 p24 antigen testing and improve the safety of the blood supply in South Africa. However, the cost-benefit ratio of introducing such an expensive technology in a country with a limited health budget will have to be carefully considered.

Adult↗
PubMed2002

Validation of the World Health Organization quality of life instrument in patients with HIV infection.

We studied the reliability and validity of the World Health Organization quality of life (WHOQOL) assessment instrument in patients with human immunodeficiency virus (HIV) infection. WHOQOL-BREF was used to assess 136 HIV-infected outpatients. The results were analyzed and compared with data from 213 healthy persons. The Cronbach's alpha for internal consistency ranged from 0.74 to 0.85 across domains in HIV-infected patients. The test-retest reliability ranged from 0.64 to 0.79 across domains at average 4-week retest interval. Factor analysis identified four major factors: social, psychological, environment, and physical, consistent with the four domains of the instrument. The scores of all four domains correlated positively with self-evaluated health status and happiness (r range: 0.52-0.60 and 0.55-0.73 across domains, respectively), and correlated negatively with the number and severity of symptoms (r range: -0.40 to -0.47 and -0.41 to -0.52, respectively). The scores of physical, psychological and social domains, but not the environment domain, discriminated between healthy persons and HIV-infected patients (all p < 0.01). We conclude that the WHOQOL-BREF can be a useful quality-of-life instrument in patients with HIV infection.

Adult↗
PubMed2001

Reconstituted immunity against persistent parvovirus B19 infection in a patient with acquired immunodeficiency syndrome after highly active antiretroviral therapy.

We discovered a patient with AIDS with persistent B19 infection who had slow resolution of anemia after he commenced receiving HAART without intravenous immunoglobulin. The patient's anemia recurred when the initial course of HAART failed, but it remitted slowly after salvage therapy was instituted. However, circulating B19 was still detectable by nested polymerase chain reaction 1 year after commencement of salvage therapy. Immunoglobulin G and immunoglobulin M antibodies against B19 were not detected by means of enzyme-linked immunosorbent assay when the anemia initially resolved, but they were detected after the patient commenced receiving salvage therapy. The absence of antibody response after the initial remission of parvovirus B19 infection suggested that cellular immunity was an important component of reconstituted immune function against B19 after the patient received HAART. The humoral response that was restored later was abnormal; it had strong reactivity to nonstructural protein NS-1 and poor generation of neutralizing antibodies against linear epitopes unique to minor capsid protein VP1.

AIDS-Related Opportunistic Infections↗
PubMed2001

Candida albicans spinal epidural abscess secondary to prosthetic valve endocarditis.

A 56-year-old woman, with underlying rheumatic heart disease status post mitral valve replacement, presented with fever, low back pain radiating to right leg, and congestive heart failure. Magnetic resonance imaging detected an L5-S1 spinal epidural abscess. A vegetation on prosthetic mitral valve was found by transesophageal echocardiography. Cultures of epidural aspirate, surgical specimen, and blood all grew Candida albicans. She received surgical drainage of the spinal epidural abscess and i.v. amphotericin B 1 mg/kg/day for eight weeks. Clinical symptoms improved gradually and she was discharged without neurologic sequelae. She remained well and continued to lead an active life two years after discharge.

Amphotericin B↗
PubMed2001

In vitro activity of linezolid against clinical Gram-positive bacterial isolates from Taiwan: an area with a high prevalence of antibiotic resistance.

The prevalence of antibiotic-resistant bacteria in Taiwan is due to the heavy use of antimicrobial agents in both animal husbandry and clinical practice over the past decades. Minimum inhibitory concentrations (MICs) of linezolid were established for 371 clinical isolates of staphylococci, pneumococci, enterococci and group A streptococci from Taiwan. All isolates tested including those resistant to beta-lactams, erythromycin, vancomycin and quinupristin-dalfopristin were uniformly susceptible to linezolid, with MICs ranging from 0.125 to 2 mg/l. Our data support the observation that there is no cross-resistance between linezolid and other classes of antimicrobial substances.

Acetamides↗
PubMed2001

Intraoperative mitomycin C in dacryocystorhinostomy.

PURPOSE: To assess the efficacy of intraoperative mitomycin C (MMC) in external dacryocystorhinostomy (EXT-DCR). METHODS: Forty-six cases (50 lacrimal drainage systems [LDS]) with nasolacrimal duct obstruction were randomized into three groups. In the control group, a standard EXT-DCR procedure was performed. In the two MMC groups, a piece of cotton soaked with 0.2 mg/ml MMC (group 1) or 0.5 mg/ml MMC (group 2) was applied to the nasal mucosa and the mucosa of the lacrimal sac in the osteotomy site for 5 minutes. RESULTS: The dacryocystorhinostomy in all patients was patent by irrigation 2 to 3 weeks postoperatively. After a mean follow-up interval of 35.2 +/- 5.3 months, the dacryocystorhinostomy was patent in 15 (83%) of 18 LDS in the control group, 16 (100%) of 16 LDS in group 1, and 15 (94%) of 16 LDS in group 2. The mean ostium sizes were 22.2 +/- 5.0 mm2 in group 1, 20.6 +/- 4.5 mm2 in group 2, and 13.2 +/- 2.7 mm2 in group 3 at the final follow-up visit; the difference between the patients treated with MMC and the control group was statistically significant. There was no statistically significant difference between the two MMC groups, however. No surgical complications occurred. CONCLUSIONS: Intraoperative MMC in DCR is a safe and effective adjuvant that helps achieve favorable long-term success rates.

Adolescent↗
PubMed2001

Life-threatening refeeding syndrome in a severely malnourished anorexia nervosa patient.

Overzealous refeeding in chronically malnourished anorexia nervosa patients may cause life-threatening complications. We describe a 14-year-old girl with anorexia nervosa who had a decrease in body weight from 45 kg to 25.5 kg over an 18-month period. She received 40 kcal.kg-1.d-1 carbohydrate-rich nutrition via enteral and parenteral routes. Her serum phosphate concentration dropped from a baseline of 1.39 mmol/L (4.3 mg/dL) to 0.19 mmol/L (0.6 mg/dL) on Day 4 of refeeding. Concurrent with the development of hypophosphatemia, she became drowsy and developed generalized muscle weakness, impaired myocardial contractility, thrombocytopenia, and gastrointestinal bleeding. Fluid overload with pulmonary edema complicated her recovery from these adverse events. After intravenous phosphate supplementation and fluid restriction, the symptoms of refeeding syndrome gradually resolved within 2 weeks. In chronically malnourished anorexia nervosa patients, nutritional support should be instituted gradually to avoid rapid electrolyte shifts and fluid overload. Serum phosphate concentrations, fluid status, and blood cell counts should be closely monitored.

Adolescent↗
PubMed2001

Invasive infections due to vancomycin-resistant enterococci in adult patients.

Since 1990, vancomycin-resistant enterococci have emerged as important nosocomial pathogens. Invasive infections caused by these organisms have challenged most physicians because they are resistant to multiple antibiotics. We analyzed the clinical characteristics of adult patients with invasive vancomycin-resistant enterococci infections in the National Taiwan University Hospital from January 1993 through December 2000. A total of 11 adult patients were identified, 9 of whom had bacteremia (7 caused by vancomycin-resistant Enterococcus faecalis and 2 by vancomycin-resistant Enterococcus faecium) and one each had thoracic empyema (vancomycin-resistant E. faecium) and peritonitis (vancomycin-resistant E. faecium). Five patients had rectal swab cultures positive for vancomycin-resistant enterococci; 4 of them had underlying malignancies. The majority (91%) of these patients had prolonged hospitalization and prior long-term use of broad-spectrum cephalosporins (ceftriaxone, ceftazidime, or cefepime) or anti-anaerobic agents (clindamycin or metronidazole). The crude mortality rate was 64%. In conclusion, invasive infection caused by vancomycin-resistant enterococci is an emerging problem among hospitalized patients in Taiwan, particularly those with severe underlying diseases and exposure to multiple antibiotics.

Adult↗
PubMed2000

Spontaneous bacterial empyema caused by Aeromonas veronii biotype sobria.

Spontaneous bacterial empyema is a complication of hepatic hydrothorax in cirrhotic patients. The pathogen, clinical course and treatment strategy are different to the empyema secondary to pneumonia. A 54-year-old man, who was a cirrhotic patient with hepatic hydrothorax, was admitted to National Taiwan University Hospital for fever, dyspnea and right side pleuritic pain. The image study revealed massive right pleural effusion and no evidence of pneumonia. The culture of pleural effusion yielded Aeromonas veronii biotype sobria. The diagnosis of spontaneous bacterial empyema caused by Aeromonas veronii biotype sobria was established. To our best knowledge, Aeromonas veronii biotype sobria had never been reported in English literature as the causative pathogen of spontaneous bacterial empyema.

Aeromonas↗
PubMed2000

Klebsiella pneumoniae isolates causing liver abscess in Taiwan.

Klebsiella pneumoniae has been the leading cause of pyogenic liver abscess in Taiwan during the period from 1985 to 1999, which is different from other countries. The present study investigated the in vitro antimicrobial susceptibilities of 51 K. pneumoniae isolates collected from blood cultures of patients with liver abscess in Taiwan during the period from 1993-1997, and typed by pulsed-field gel electrophoresis (PFGE). All 51 isolates were resistant to ampicillin, but susceptible to other antimicrobial agents. The minimum inhibitory concentrations (MICs) were less than 1 microg/ml for the third- and fourth-generation cephalosporins, monobactam, carbapenems, and ciprofloxacin. In comparison, 62 isolates of K. pneumoniae from community-acquired bacteremic patients without liver abscess had similar antimicrobial susceptibilities, while 142 isolates from patients with hospital-acquired bacteremia without liver abscess were much less susceptible to all of the tested antimicrobial agents. PFGE molecular epidemiologic analysis found 20 out of 51 isolates belonged to eight clusters of genetically related strains, with two or three isolates in each clusters. The other 31 isolates were genetically distinct strains. This study demonstrated that K. pneumoniae isolates which cause liver abscess in Taiwan remained susceptible to a wide range of antimicrobial agents and that they were not genetically related.

Abscess↗
PubMed2000

Klebsiella pneumoniae meningitis: timing of antimicrobial therapy and prognosis.

We analysed the clinical course of 30 adult patients with Klebsiella pneumoniae meningitis, 18 community-acquired and 12 hospital-acquired, to assess whether the timing of appropriate antimicrobial therapy had a major effect on prognosis. Of the 30 patients, 29 received appropriate antibiotics. The time from initial symptoms to the start of appropriate therapy, antibiotic resistance of K. pneumoniae isolates, underlying disease severity, diabetes mellitus, age, gender, and acquisition settings were all not significantly correlated with outcome. However, a Glasgow coma scale (GCS) score of 7 points or less at the start of appropriate antimicrobial therapy was a valid predictor of death or a permanent vegetative state (sensitivity 82%, specificity 93%, p=0.005), even after adjusting for the effect of confounding variables by logistic regression. Timing of appropriate antimicrobial therapy, as defined by consciousness level but not by symptom duration, is a major determinant of survival and neurological outcome for patients with K. pneumoniae meningitis, and the first dose of an appropriate antibiotic should be administrated before their consciousness deteriorates to a GCS score of 7 points or less.

Adolescent↗
PubMed2000

Pulmonary infection in human immunodeficiency virus-infected patients in Taiwan.

BACKGROUND: Pulmonary infection is a major cause of morbidity and mortality in human immunodeficiency virus (HIV)-infected patients. METHODS: We conducted a retrospective analysis of the pathogens causing pulmonary infection in 272 HIV-infected patients admitted to a university hospital from January 1993 through December 1998. RESULTS: A total of 158 (58%) patients had pulmonary complications, all but two of whom had acquired immunodeficiency syndrome (AIDS). There were 156 episodes of pulmonary infection, involving 124 patients. The most common pulmonary infection was Pneumocystis carinii pneumonia (PCP): 66 patients had 77 episodes of PCP, all of which occurred in patients with CD4+ lymphocyte counts below 0.2 x 10(9)/L (200/microL). Pulmonary tuberculosis (TB), diagnosed in 47 patients, was the second most common pulmonary infection. Twenty TB patients had open TB. HIV-infected patients who were immigrants from Southeast Asia (9/23, 39%) had a higher risk of developing pulmonary TB than nonimmigrants (38/249, 15%) (p = 0.004). Only one of 17 episodes of community-acquired bacterial pneumonia was caused by Streptococcus pneumoniae. Less common opportunistic pulmonary pathogens included cytomegalovirus (5 cases), Aspergillus species (3), Cryptococcus neoformans (3), Mycobacterium avium complex (2), Penicillium marneffei (1), Nocardia species (1), and Rhodococcus equi (1). CONCLUSIONS: PCP and pulmonary TB are the two leading pulmonary infections in Taiwanese HIV/AIDS patients. These findings should be taken into consideration when developing management strategies and public health policies.

Adolescent↗
PubMed2000

Microbiologic features of adult community-acquired bacterial meningitis in Taiwan.

BACKGROUND AND PURPOSE: Community-acquired bacterial meningitis (CABM) is a life-threatening disease that requires prompt initiation of appropriate antibiotic therapy. The purpose of this study was to determine the causative microorganisms of CABM and their antimicrobial susceptibility patterns at a major teaching hospital in Taipei from 1993 to 1998. METHODS: A review of medical records and microbiologic data was used to identify cases of CABM and causative pathogens. Antimicrobial susceptibility testing for bacterial isolates was performed by the disk diffusion method. RESULTS: Among the 48 adult patients with a diagnosis of CABM during the study period, the causative pathogens were identified in 36 cases. Unlike reports from other countries, Klebsiella pneumoniae was the leading causative pathogen (33%), followed by Streptococcus pneumoniae (28%), Listeria monocytogenes (11%), Neisseria meningitidis (6%), Staphylococcus aureus (6%), streptococci (6%), and Pseudomonas aeruginosa (6%). The incidence of CABM due to K. pneumoniae increased during the study period (p = 0.012, Poisson regression), while the incidence of CABM due to other pathogens remained stable. All of the CABM-associated K. pneumoniae isolates were susceptible to cefotaxime but 25% of the CABM-associated S. pneumoniae strains were not susceptible to penicillin G. CONCLUSIONS: Penicillin G alone was not an appropriate empiric therapy for adult CABM because a high percentage of cases were due to K. pneumoniae or penicillin nonsusceptible S. pneumoniae. While the recommendations for the initial empiric regimen for CABM due to S. pneumoniae in Taiwan remain to be developed, third-generation cephalosporins appear to be an appropriate initial empiric regimen for the treatment of CABM due to K. pneumoniae.

Adolescent↗
PubMed2000

Fatal outcome of Erysipelothrix rhusiopathiae bacteremia in a patient with oropharyngeal cancer.

Bacteremia due to Erysipelothrix rhusiopathiae is rare; the most common presentation reported in the literature is endocarditis. We report a 32-year-old man with oropharyngeal cancer who developed aspiration pneumonia and E. rhusiopathiae bacteremia, and presented with fever, chills, dyspnea, and productive cough with purulent sputum. Despite treatment with amoxicillin/clavulanate and nutritional support for 9 days, he died of respiratory failure. He had no clinical evidence of endocarditis. He had no history of animal or occupational exposure, and might have been colonized with E. rhusiopathiae in the oral cavity, followed by aspiration pneumonia and bacteremia. A fatal outcome in a patient with bacteremia due to E. rhusiopathiae without endocarditis is rare.

Adult↗
PubMed1999

Invasive amoebiasis: an emerging parasitic disease in patients infected with HIV in an area endemic for amoebic infection.

OBJECTIVES: To describe the incidence and presentations of invasive amoebiasis (IA) in patients with HIV infection in an area endemic for amoebic infection and to assess the role of the indirect haemagglutination (IHA) assay in the diagnosis of IA in HIV-infected patients. DESIGN: Retrospective study of 18 cases of IA and HIV infection. SETTING: A university hospital, the largest centre for management of HIV-associated complications in Taiwan. METHODS: Medical, microbiological and histopathological records of 296 HIV-infected patients and serological data of IHA assay of 126 HIV-infected patients were reviewed to identify cases of IA from 23 June 1994 to 31 March 1999. An IHA titre > or = 1 : 128 was considered positive. Clinical characteristics of HIV-infected patients with IA and without IA were compared. RESULTS: Eighteen of the 296 patients (6.1%) with HIV infection were diagnosed with IA: 12 patients were diagnosed with definite IA and six with probable IA. The clinical manifestations included amoebic colitis (13 patients), amoebic liver abscess (nine), both colitis and abscess (four), and pleural effusion (two). IA was the initial presentation of HIV infection in nine patients. Co-infection with other enteric pathogens was diagnosed in six patients with IA. Compared with the 161 patients without IA who were newly diagnosed with HIV infection, the nine patients with IA had a higher median CD4+ lymphocyte count (202 x 10(6)/l versus 33 x 10(6)/l; P = 0.0017), were less likely to be diagnosed with AIDS (55.6% versus 85.4%; P = 0.039), and had fewer concurrent AIDS-defining illnesses (median number 0 versus 2; P = 0.003). Estimated mean survival duration was not significantly different between the two groups (597 days versus 611 days). Fourteen out of 126 patients (11.1%) had an IHA titre > or = 1 : 128. Of the 18 patients diagnosed with IA, 13 had a titre > or = 1 : 128. The sensitivity of IHA assay in the diagnosis of IA was 72.2% (13 out of 18) and the specificity was 99.1% (107 out of 108). The positive predictive value of IHA test for IA of this patient population was 92.9% (13 out of 14) whereas the negative predictive value was 95.5% (107 out of 112). CONCLUSION: IA is an increasingly important parasitic disease among patients with HIV infection in Taiwan. IHA assay has a good specificity and high negative predictive value in diagnosis of IA.

AIDS-Related Opportunistic Infections↗