• Archives of Plastic Surgery
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• 제41권6호
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• pp.759-767
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• 2014

Background Infection caused by nontuberculous mycobacteria (NTM) has been increasing. Awareness of this infection is crucial yet problematic. Delayed management may lead to destructive results. We empirically treated a series of patients with clinical suspicion of NTM infection prior to the identification of the pathogen. Methods A total of 12 patients who developed surgical site infections between January 2011 and February 2014 were reviewed. Patients with a skin and subcutaneous infection resistant to standard management over two weeks, and previous history of aesthetic procedures within three months were regarded as highly suspected of having an NTM infection. A variety of diagnostic modalities were examined simultaneously, along with starting empirical treatment including a combination of clarithromycin and moxifloxacin, and surgical debridement. Results All wounds healed completely within 4 weeks. The mean follow-up duration was 7.2 months, and none of the patients developed relapse. Specific NTM pathogens were identified in six patients. Eight patients showed caseating granuloma implying an NTM infection. One patient showed an uncommon Stenotrophomonas infection, which was successfully treated. Three patients had no evidence of a pathogen despite repeated microbial tests. Complications such as scarring, pigmentation, and disfigurement were common in all the patients. Conclusions NTM should be considered in the differential diagnosis of an unusual skin and soft-tissue infection. We propose an empirical regimen of clarithromycin and moxifloxacin as an efficient treatment option for an NTM infection.

• BMB Reports
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• 제40권6호
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• pp.911-920
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• 2007

Tuberculosis, caused by Mycobacterium tuberculosis, continues to be one of the leading infectious diseases to humans. It is urgent to discover novel drug targets for the development of antitubercular agents. The 2-C-methyl-Derythritol-4-phosphate (MEP) pathway for isoprenoid biosynthesis has been considered as an attractive target for the discovery of novel antibiotics for its essentiality in bacteria and absence in mammals. MEP cytidyltransferase (IspD), the third-step enzyme of the pathway, catalyzes MEP and CTP to form 4-diphosphocytidyl-2-C-methylerythritol (CDP-ME) and PPi. In the work, ispD gene from M. tuberculosis H37Rv (MtIspD) was cloned and expressed. With N-terminal fusion of a histidine-tagged sequence, MtIspD could be purified to homogeneity by one-step nickel affinity chromatography. MtIspD exists as a homodimer with an apparent molecular mass of 52 kDa. Enzyme property analysis revealed that MtIspD has high specificity for pyrimidine bases and narrow divalent cation requirements, with maximal activity found in the presence of CTP and $Mg^{2+}$. The turnover number of MtIspD is $3.4 s^{-1}$. The Km for MEP and CTP are 43 and $92{\mu}M$, respectively. Furthermore, MtIspD shows thermal instable above $50^{\circ}C$. Circular dichroism spectra revealed that the alteration of tertiary conformation is closely related with sharp loss of enzyme activity at higher temperature. This study is expected to help better understand the features of IspD and provide useful information for the development of novel antibiotics to treat M. tuberculosis.

• Investigative Magnetic Resonance Imaging
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• 제13권2호
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• pp.146-151
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• 2009

목적: 비수술적 치료를 시행한 결핵성 척추염 환자의 MRI의 특징과 임상결과에 따른 MRI특징을 알아보고자 하였다. 대상과 방법: 2000년부터 2007년까지 임상적으로 결핵성 척추염을 진단 받은 환자 중 3개월 내에 수술적 치료를 받지 않은 환자를 대상하였으며 이중 최소한 3회 이상, 처음, 3개월 혹은 6개월 그리고 치료 종료시점상 MRI 검사를 시행한 환자를 연구군에 포함하여 후향적 분석을 시행하였다. 두 명의 영상의학과 의사가 모든 MR검사를 분석하였으며 임상결과와의 상관관계를 분석하였다. 결과: 열명(남:여=6:4, 평균나이=45세)의 환자가 연구대상 군에 포함되었으며 MR검사의 평균 추적검사기간은 10.1개월(4-17개월)이었다. 6명의 환자는 임상적으로 결핵성 척추염의 완치판정을 받았으며 4명의 환자는 3개월 이상 약물치료를 시행 받았으나 약물치료만으로는 완치되지 않아 추가적인 수술적 치료를 시행하였다. 모든 환자는 임상적 경과에 따라 두 군으로 분류하였으며 위의 6명은 완전 치료 군 4명은 불완전 치료 군으로 분류하였다. 완전 치료군의 MR특징은 결핵성 농의 인대 하 파급 및 농 자체의 크기감소, 척추체의 붕괴소견 없음 그리고 감염된 척추체의 지방변성이었음. 불 완전 치료군의 MR특징은 골수부종과 결핵성 농의 확장과 척추체의 붕괴였다. 결론: 결핵성 척추염의 비수술적 치료에 있어서 MRI는 치료반응을 예견하는데 한 역할을 담당할 것으로 생각된다.