Biomedical subjects

Hsieh-Shong Leu

Publications and source records attributed to Hsieh-Shong Leu.

17 recordsLinked to original sources

PubMed2006

Lymphocyte subsets and viral load in male AIDS patients with major depression: naturalistic study.

This study investigated the relationships between lymphocyte subsets and viral load in AIDS patients with and without major depression. During a 7-year period, a total of 60 male hospitalized AIDS patients were recruited in this study. The diagnosis of major depression in patients was made by the same psychiatrist according to the 4th edition of the Diagnostic and Statistical Manual for Mental Disorders criteria. All patients had data for CD4, CD8 and CD4/CD8, and only 42 patients had viral load data. Of 60 AIDS patients, 32 patients had received highly active antiretroviral therapy and received subsequent assessment of lymphocyte cell counts 1 month later. Using ancova with age adjustment, the authors found that patients with major depression (n = 22) had significantly lower CD8 cell counts than patients without major depression (n = 38). However, CD4 cell counts and CD4/CD8 ratios were not significantly different between these two groups. In addition, there was no significant difference in viral load between patients with major depression (n = 16) and patients without major depression (n = 26). Of 32 patients received highly active antiretroviral therapy, 14 patients with an antidepressant (e.g. fluoxetine 20 mg/day) had significantly decreased CD4 and not CD8 cell counts and significantly reduced CD4/CD8 ratios during a period of 1 month. In conclusion, these results suggest that AIDS patients with major depression had significantly lower CD8 cell counts and might have a more severe inflammation/immunity reaction than patients without major depression.

Acquired Immunodeficiency Syndrome↗

PubMed2006

Bacteremia due to extended-spectrum beta-lactamase-producing Enterobacteriaceae other than Escherichia coli and Klebsiella.

BACKGROUND AND PURPOSE: Carbapenems are considered the drugs of choice for the treatment of serious infections caused by extended-spectrum beta-lactamase (ESBL)-producing Klebsiella and Escherichia coli. However, controversy exists about the antibiotic choice for infections due to ESBL-producing organisms of other genera. METHODS: This retrospective study evaluated the risk factors and outcomes of 54 adult patients with bacteremia due to ESBL-producing Enterobacteriaceae other than Klebsiella spp. or E. coli treated at a tertiary care hospital in northern Taiwan from January 2001-December 2003. Patients were categorized into carbapenem (n = 22) and non-carbapenem (n = 32) treatment groups. All patients had at least one positive blood culture together with fever or other clinical features compatible with systemic infection. RESULTS: Higher Acute Physiology and Chronic Health Evaluation II score, glucocorticoid use, and presentation of septic shock were significant risk factors for mortality (p<0.05). Patients treated with a carbapenem had a better 14-day or overall survival rate (i.e., survived to discharge) than those treated with non-carbapenem antibiotics, although this difference was not significant. Among patients in the non-carbapenem group, the overall survival rates of ciprofloxacin, aminoglycoside, and ceftazidime were 70% (14/20), 62.5% (5/8), and 50% (2/4), respectively (p=0.877). The overall survival rates of the carbapenem (72.7%) and ciprofloxacin (70.0%) groups were similar. CONCLUSIONS: The results suggest that ciprofloxacin, when indicated based on antimicrobial susceptibility testing, may serve as an alternative choice for infections caused by ESBL-producing Enterobacteriaceae other than E. coli or Klebsiella spp. and may not affect the clinical outcome at discharge.

Adult↗

PubMed2005

Risk factors for spontaneous rupture of liver abscess caused by Klebsiella pneumoniae.

To identify risk factors for spontaneous rupture of liver abscess (SRLA), a retrospective study on patients with liver abscess caused by Klebsiella pneumoniae was performed. Of the 140 enrolled patients with liver abscess caused by K. pneumoniae, 8 (5.7%) experienced SRLA. In comparison to those with nonruptured liver abscess (NRLA), patients with SRLA were found to have significantly higher proportions of diabetic mellitus (100% versus 62.1%, P = 0.003), larger abscess size (mean of maximal diameter 7.8 versus 6.1 cm, P = 0.043), gas formation in abscess (87.5% versus 23.5%, P < 0.001), and left hepatic lobe involvement (50.0% versus 16.5%, P = 0.018). K. pneumoniae serotypes K1 and K2 were the predominant microorganisms isolated in both patients with NRLA and SRLA. Pulsed-field gel electrophoresis-generated fingerprinting of K. pneumoniae isolates from patients with SRLA revealed that these pathogens were nongenetically related.

Aged↗

PubMed2005

An evaluation of the effects of a manual on management of HIV/AIDS symptoms.

The purposes of this study were to develop a symptom management manual for persons living with HIV disease and to evaluate the effects of the manual on symptom management and quality of life. After a careful review of the research literature and integrating related findings, a manual for managing HIV/AIDS symptoms was developed. A one-group pretest-posttest design was used with 31 HIV/AIDS patients recruited from one hospital in Taiwan that provides care for people with HIV/AIDS. Subjects were instructed on use of the manual, and completed the Chinese version of the Sign and Symptom Checklist for Persons with HIV and the HIV/AIDS Targeted Quality of Life Instrument for the pretest and two posttests (at one month and three months after the initial session). Results indicated that these participants' symptom intensity was significantly improved at posttest, but their quality of life did not show significant changes at either posttest. Based on the results of this study, the symptom management manual can be used as a teaching tool for clinical health-care providers to decrease these patients' symptom distress.

Adult↗

PubMed2005

Diagnosis of tuberculous pericarditis and treatment without corticosteroids at a tertiary teaching hospital in Taiwan: a 14-year experience.

Tuberculous (TB) pericarditis is a rare but life-threatening form of extrapulmonary tuberculosis. The diagnostic strategy and optimal therapy for TB pericarditis are not well established. We retrospectively analyzed the diagnostic data, clinical characteristics, treatment and outcome in a total of 19 patients with TB pericarditis treated from January 1988 to July 2002. Based on the finding of echocardiography, 8 of these patients were classified as having early stage and 11 as having advanced-stage disease. There were 15 men and 4 women, with a mean age of 65 years (range, 34 to 80 years). All patients received antituberculosis chemotherapy, and all but 2 underwent at least 1 of the following procedures: pericardiocentesis and biopsy, pericardial window placement, and pericardiectomy. None of the patients received corticosteroids concurrently. Of the 8 patients with early-stage TB pericarditis, 3 (37.5%) developed constrictive pericarditis, while of the 7 patients with advanced-stage disease (excluding 4 who had already developed TB constrictive pericarditis at diagnosis), 6 (85.7%) subsequently developed constriction. These findings underscore the importance of pericardiectomy in patients with advanced-stage TB pericarditis. To avoid potentially lethal cardiac tamponade and constrictive cardiomyopathy, clinicians should have a high index of suspicion of TB pericarditis when encountering a patient with pericardial effusion. Histopathologic study of pericardial tissue sample is the key to timely diagnosis of TB pericarditis. The favorable outcomes of patients in this series suggest that a combination of antituberculosis chemotherapy and timely pericardiectomy may be the optimal therapy for patients with TB pericarditis.

Adrenal Cortex Hormones↗

PubMed2005

Characteristics of Achromobacter xylosoxidans bacteremia in northern Taiwan.

There were 40 cases of Achromobacter xylosoxidans bacteremia during a 6-year period in a medical center in northern Taiwan. Males outnumbered females (72.5% vs 27.5%). Common underlying diseases and conditions in these 40 bacteremic patients were malignancies (57.5%), central venous catheter implants (55%), surgery (35%), neutropenia (30%) and use of steroids (25%). Recurrent bacteremia occurred in 4 patients (10%), all of whom had a central venous catheter implant which was considered the most probable source of infection. More than one-quarter (27.5%) of the cases were community acquired. The mortality rate due to A. xylosoxidans bacteremia was 47.5%. Risk factors significantly associated with mortality were nosocomial acquisition and polymicrobial bacteremia. Disk susceptibility testing showed that these isolates were resistant to aminoglycosides and most cephalosporins but were susceptible to piperacillin, imipenem, ceftazidime and trimethoprim-sulfamethoxazole.

Achromobacter denitrificans↗

PubMed2005

Pyogenic spondylitis presenting with skip lesions.

We report on a 65-year-old man who presented with a 1-month history of aggravating backache and low-grade fever. He suddenly became paraplegic (Frankel B). Muscle power was grade 0 approximately 1 over the bilateral lower limbs. X-ray films showed disc space narrowing and end-plate blurring at the T9 approximately T11 and L4 approximately L5 levels. Magnetic resonance imaging showed an infectious lesion at T9 approximately T11 and another at L4 approximately L5. An emergent operation was performed under the impression of pyogenic spondylitis with spinal cord compression. The patient showed a significant recovery (Frankel D) after the thoracic and lumbar spinal surgeries. Pyogenic spondylitis usually presents as a vertebra-disc-vertebra lesion spreads to the contiguous vertebra-disc-vertebra unit. The current patient had pyogenic spondylitis with coexistent thoracic and lumbar lesions. This kind of skip lesion is common in spinal malignant metastasis, but rare in spinal infections. Awareness of the possibility of multiple lesions or skip lesions will facilitate the diagnosis and treatment of this condition.

Aged↗

PubMed2004

Variable resistance patterns of integron-associated multidrug-resistant Acinetobacter baumannii isolates in a surgical intensive care unit.

Between 1998 and 2000, we characterized 91 nosocomial isolates of Acinetobacter baumannii by antibiotyping and genotyping. A total of 25 ribotypes were obtained among these 91 isolates. When the isolates from surgical intensive care units (ICUs) and other wards were compared, multiresistant A. baumannii isolates with the same ribotype 25 (R-25) were significantly more prevalent in nosocomial infections among the surgical patients. Further subtyping of the strains by pulsed-field gel electrophoresis confirmed that strains of the same ribotype in surgical ICUs and a few isolates from other wards were identical or clonally related. Different antibiotic resistance profiles were observed among these R-25 isolates. All R-25 isolates contained intI1 integrase, and two clusters of integron cassettes were found. These clusters of cassettes were encoded by an open reading frame (ORF) of -5'CS-aac(3)Ia-aadA1a-unknown or f-3'CS or 5'CS-aacA4-aadA1-catB8-3'CS, indicating the involvement of different resistant genes. Two isolates contained bla (IMP-1), which was acquired from a conjugatively transferable plasmid and did not involve integron-associated resistance. In conclusion, an epidemic of nosocomial infections associated with A. baumannii strains that have different resistance profiles was identified. Resistance profiles can change by a combination of plasmid- and integron-associated acquisition, especially in a unit with high antibiotic selective pressures. Infectious control personnel should be alert to the change in resistance profiles during routine monitoring.

Acinetobacter Infections↗

PubMed2004

Splenic abscess in southern Taiwan.

The clinical characteristics and isolated pathogens from 49 cases of splenic abscess treated at a medical center in southern Taiwan between 1981 and 2001 were retrospectively analyzed. Male patients were predominant (63%). Mean age at presentation was 55 years (range, 19 to 78 years). The most common presentations were fever (95.9%, 47/49), abdominal pain confined to the left upper quadrant (67.3%, 33/49), left pleural effusion (55.1%, 27/49) and splenomegaly (55.1%, 27/49). Leukocytosis occurred in 39 patients (79.6%), and leucopenia in 3 (6.1%). Blood cultures were positive in 32 patients (65.3%). The most common pathogen was Klebsiella pneumoniae (16.3%, 8/54), a well-known Gram-negative bacillus causing liver abscess in Taiwan, followed by Escherichia coli and Salmonella spp. (each 11.1%, 6/54). Multiple splenic abscesses occurred predominantly in patients with underlying malignancies. Due to the rarity of splenic abscess and the increasing number of immunocompromised patients, multicenter study is needed to determine the epidemiological features and optimal management of this disease.

Abscess↗

PubMed2003

Telithromycin- and fluoroquinolone-resistant Streptococcus pneumoniae in Taiwan with high prevalence of resistance to macrolides and beta-lactams: SMART program 2001 data.

There is a high prevalence of beta-lactam- and macrolide-resistant Streptococcus pneumoniae in Taiwan. To understand the in vitro susceptibilities of recent isolates of S. pneumoniae to fluoroquinolones and telithromycin (which is not available in Taiwan), the MICs of 23 antimicrobial agents for 936 clinical isolates of S. pneumoniae isolated from different parts of Taiwan from 2000 to 2001 were determined by the agar dilution method. Overall, 72% of isolates were not susceptible to penicillin (with 61% being intermediate and 11% being resistant) and 92% were resistant to erythromycin. Telithromycin MICs were >or=1 microg/ml for 16% of the isolates, and for 99% of these isolates the MICs of all macrolides tested were >or=256 microg/ml; all of these isolates had the constitutive macrolide-lincosamide-streptogramin B phenotype. Eighty-eight percent of the isolates were resistant to three or more classes of drugs. The ciprofloxacin MICs were >or=4 microg/ml for six (0.6%) isolates from five patients collected in 2000 and 2001, and the levofloxacin MICs were >or=8 microg/ml for five of these isolates. Seven isolates for which ciprofloxacin MICs were >or=4 microg/ml, including one isolate recovered in 1999, belonged to three serotypes (serotype 19F, five isolates; serotype 23A, one isolate; and serotype 23B, one isolate). The isolates from the six patients for which ciprofloxacin MICs were >or=4 microg/ml had different pulsed-field gel electrophoresis profiles and random amplified polymorphic DNA patterns, indicating that no clonal dissemination occurred over this time period. Despite the increased rate of fluoroquinolone use, the proportion of pneumococcal isolates for which ciprofloxacin MICs were elevated (>or=4 microg/ml) remained low. However, the occurrence of telithromycin resistance is impressive and raises concerns for the future.

Adult↗

PubMed2003

Telithromycin and quinupristin-dalfopristin resistance in clinical isolates of Streptococcus pyogenes: SMART Program 2001 Data.

This study evaluated the current status of antimicrobial resistance in clinical isolates of Streptococcus pyogenes in Taiwan as part of the SMART (Surveillance from Multicenter Antimicrobial Resistance in Taiwan) program. In 2001, 419 different isolates of S. pyogenes, including 275 from respiratory secretions, 87 from wound pus, and 31 from blood, were collected from nine hospitals in different parts of Taiwan. MICs of 23 antimicrobial agents were determined at a central location by the agar dilution method. All of the isolates were susceptible to penicillin (MIC at which 90% of the isolates were inhibited [MIC(90)], moxifloxacin > ciprofloxacin = levofloxacin = gatifloxacin > gemifloxacin) demonstrated potent activity against nearly all of the isolates of S. pyogenes tested. Thirty-two isolates (8%) were not susceptible to quinupristin-dalfopristin. Seventeen percent of isolates had telithromycin MICs of >or=1 microg/ml, and all of these isolates exhibited erythromycin MICs of >or=32 microg/ml. The high prevalence of resistance to telithromycin (which is not available in Taiwan) limits its potential use in the treatment of S. pyogenes infections, particularly in areas with high rates of macrolide resistance.

Anti-Bacterial Agents↗

PubMed2003

Extended epidemic of nosocomial urinary tract infections caused by Serratia marcescens.

In recent years a significant increase in the incidence of Serratia marcescens infections was noted at the Chang Gung Memorial Hospital, Taoyuan, Taiwan. A review of laboratory (1991 to 2002) and infection control (1995 to 2002) records showed the possibility of an extended epidemic of nosocomial urinary tract infections (UTIs) caused by S. marcescens. Therefore, in 1998 and 1999, 87 isolates were collected from patients with such infections and examined and another 51 isolates were collected in 2001 and 2002. The patients were mostly elderly or the infections were associated with the use of several invasive devices. S. marcescens was usually the only pathogen found in urine cultures in our study. Neither prior infections nor disseminated infections with the organism were observed in these patients. Resistance to most antibiotics except imipenem was noted. Two genotyping methods, pulsed-field gel electrophoresis and infrequent-restriction-site PCR, were used to examine the isolates. A total of 12 genotypes were identified, and 2 predominant genotypes were found in 72 (82.8%) of the 87 isolates derived from all over the hospital. However, 63.9% of the isolates of the two genotypes were from neurology wards. A subsequent intervention by infection control personnel reduced the infection rate greatly. The number and proportion of the two predominant genotypes were significantly reduced among the 51 isolates collected in 2001 and 2002. Thus, a chronic and long-lasting epidemic of nosocomial UTIs caused by S. marcescens was identified and a successful intervention was carried out. Both a cautious review of laboratory and infection control data and an efficient genotyping system are necessary to identify such a cryptic epidemic and further contribute to the quality of patient care.

Adolescent↗

PubMed2003

Independent prognostic factors for fatality in patients with invasive vibrio cholerae non-O1 infections.

To identify independent prognostic factors for fatality, 73 patients with a total of 75 episodes of invasive Vibrio. cholerae non-O1 infections treated from July 1998 through October 2001 at 2 medical centers were retrospectively studied. The demographic, laboratory, and clinical information of these patients were collected and analyzed. The overall mortality rate was 36%. Multivariate analysis revealed that severe liver cirrhosis (p=0.003; odds ratio [OR], 14.12, with 95% confidence interval [CI] 2.49-79.91), malignancy (p=0.034; OR, 3.9, with 95% CI 1.11-13. 7), and steroid use (p=0.011; OR, 12.37, with 95% CI 1.79-85.49) were independent risk factors for fatality. These findings suggest that patients at high risk of fatality should be hospitalized and aggressively treated when V. cholerae non-O1 infections develop, and that public education on how to avoid exposure to V. cholerae non-O1 is important for the high-risk population.

Adolescent↗

PubMed2003

Rhinocerebral mucormycosis in Taiwan.

To understand the demographic as well as clinical characteristics, and outcomes of patients with rhinocerebral mucormycosis in Taiwan, we retrospectively analyzed patients with this disease admitted to Chang Gung Memorial Hospital-Kaohsiung from 1988 through 2000. The 21 patients included 8 men (28%) and 13 women (62%). The median age was 60 years (range, 34-82 years). Twenty patients (95%) had underlying diabetes mellitus. The most common clinical feature at admission was ocular lesions, followed by headache, nostril lesions, and consciousness disturbance. Fifteen (94%) of 16 patients who received combined surgical debridement and therapy with amphotericin B survived, while only 1 (20%) of the 5 patients who received amphotericin B alone survived (p=0.004). The diagnosis of rhinocerebral mucormycosis was delayed in 4 patients (19%). Of the 16 patients who survived, 1 (6%) had delayed diagnosis, while of the 5 patients who died, 3 (60%) had delayed diagnoses (p=0.028). This series disclosed a higher proportion of patients with rhinocerebral mucormycosis in Taiwan had underlying diabetes mellitus, and ocular lesions were more frequent than nostril lesions at the time of admission. These results highlight the importance of the timely initiation of a combination of aggressive surgical debridement and treatment with amphotericin B in patients with rhinocerebral mucormycosis. Considering the high rate of delayed diagnosis, improved clinician's awareness of mucormycosis is extremely important and is in urgent need in Taiwan.

Adult↗

PubMed2002

Study of an outbreak of Enterobacter cloacae sepsis in a neonatal intensive care unit: the application of epidemiologic chromosome profiling by pulsed-field gel electrophoresis.

OBJECTIVE: From October 1996 to March 1997, a cluster of 11 cases of neonatal sepsis caused by Enterobacter cloacae with similar antimicrobial susceptibility patterns occurred in a neonatal intensive care unit. This outbreak prompted an investigation. METHOD: Twelve isolates obtained from 6 neonatal patients who developed E cloacae sepsis during the outbreak were analyzed. Four E cloacae isolates from 2 preterm neonates without E cloacae infection on the same ward, and 1 isolate from the hands of a nurse, were also examined. No E cloacae were isolated from the environment. Bacterial DNA digested with XbaI or NotI was analyzed with pulsed-field gel electrophoresis. RESULT: Three distinct banding patterns were identified by pulsed-field gel electrophoresis. Of the 6 preterm infants with sepsis, strain I was identified in 1, strain II in 2, a mixed infection of strains I and II in 2, and strain III was found in only 1 infant. An isolate from the hands of a nurse was identified as strain II, as were the 4 isolates from the 2 preterm neonates without E cloacae infection. Thus, this outbreak of sepsis was caused by 2 genotypes of E cloacae. CONCLUSION: This study demonstrates that pulsed-field gel electrophoresis with restriction enzyme digestion is a valuable tool for genetic characterization of multidrug-resistant E cloacae strains during outbreaks.

Bacterial Typing Techniques↗

PubMed2002

Outbreak of Acinetobacter baumannii bacteremia in a neonatal intensive care unit: clinical implications and genotyping analysis.

BACKGROUND: Outbreaks of sepsis associated with have been rarely reported in neonatal intensive care units (NICUs). We describe such an outbreak in a NICU, and the results of molecular epidemiologic investigations are presented. MATERIALS AND METHODS: Between August and September 2000, 6 premature infants hospitalized in a pediatric NICU developed sepsis. Three additional cases had infections during November and December. For an environmental culture survey, 94 environmental specimens and hand washings of all 43 health care workers involved in this unit were examined for the presence of this organism. Two genotyping methods, pulsed field gel electrophoresis of genomic DNA digested with I and infrequent restriction site polymerase chain reaction, were used to analyze the 9 bacteremic isolates and any isolates obtained from the environmental survey and the hand washings. Another 3 bacteremic isolates of collected in the same NICU in 1999 were incorporated as controls. RESULTS: The 9 infants were premature and had birth weights of <1,500 g. Before onset of sepsis 9 infants had received total parenteral nutrition, and 8 infants had had central venous catheters and received intrafat emulsion. Five (5.3%) environmental specimens and 10 (23.3%) hand washing specimens were positive for the organism. Except for the strain from Case 9, the results of both genotyping methods were concordant; 11 patterns were identified by infrequent restriction site polymerase chain reaction and 10 patterns by pulsed field gel electrophoresis. One major genotype was demonstrated in the first 6 bacteremic isolates as well as 3 hand washing isolates. The genotypes of the other 3 bacteremic isolates, the 3 control strains, the 5 environmental isolates and 7 other hand washing isolates were distinct from the genotype of outbreak strains. CONCLUSION: An outbreak of bacteremia in a NICU was clearly demonstrated by the molecular epidemiologic investigation and was possibly transmitted via the hands of health care workers.

Acinetobacter Infections↗

PubMed2002

Mycobacterium marinum infection in Taiwan.

Mycobacterium marinum often causes skin infections, tenosynovitis, arthritis, and osteomyelitis, and occasionally results in severe disseminated infections in immunocompromised patients. In this study, the clinical features of 14 cases of M. marinum infection were retrospectively analyzed. One patient had septic arthritis, the other 13 had skin infections and/or tenosynovitis. It usually took 2 months or longer for a definite diagnosis to be made in these patients. Three of the 14 patients were cured using clarithromycin alone or in combination with rifampin plus ethambutol. Most patients did not respond to conventional antituberculosis agents. Pulsed-field gel electrophoresis and infrequent-restriction-site polymerase chain reaction are efficient tools for the molecular typing of M. marinum. Both methods yielded a concordant result, and 4 of 12 isolates were genetically closely related to each other based on their banding patterns. This study indicates that these isolates were derived from the same clone. Because M. marinum infection is curable, early diagnosis is important. Poor healing of wounds after exposure to aquatic animals appears to be the most important clinical clue indicating the need for culture and inclusion of M. marinum infection in the differential diagnosis.

Adolescent↗