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[English]
Current and emerging treatment strategies for Mycobacterium avium complex pulmonary disease: a narrative review
Chiwook Chung
Received February 23, 2025  Accepted March 14, 2025  Published online March 26, 2025  
DOI: https://doi.org/10.12771/emj.2025.00080    [Epub ahead of print]
The Mycobacterium avium complex (MAC), comprising M. avium and M. intracellulare, constitutes the predominant cause of nontuberculous mycobacterial pulmonary disease (NTM-PD) in Korea, followed by the M. abscessus complex. Its global prevalence is increasing, as shown by a marked rise in Korea from 11.4 to 56.7 per 100,000 individuals between 2010 and 2021, surpassing the incidence of tuberculosis. Among the older adult population (aged ≥65 years), the prevalence escalated from 41.9 to 163.1 per 100,000, accounting for 47.6% of cases by 2021. Treatment should be individualized based on prognostic indicators, including cavitary disease, low body mass index, and positive sputum smears for acid-fast bacilli. Current therapeutic guidelines recommend a 3-drug regimen—consisting of a macrolide, rifampin, and ethambutol—administered for a minimum of 12 months following culture conversion. Nevertheless, treatment success rates are only roughly 60%, and over 30% of patients experience recurrence. This is often attributable to reinfection rather than relapse. Antimicrobial susceptibility testing for clarithromycin and amikacin is essential, as resistance significantly worsens prognosis. Ethambutol plays a crucial role in preventing the development of macrolide resistance, whereas the inclusion of rifampin remains a subject of ongoing debate. Emerging therapeutic strategies suggest daily dosing for milder cases, increased azithromycin dosing, and the substitution of rifampin with clofazimine in severe presentations. Surgical resection achieves a notable sputum conversion rate of approximately 93% in eligible candidates. For refractory MAC-PD, adjunctive therapy with amikacin is advised, coupled with strategies to reduce environmental exposure. Despite advancements in therapeutic approaches, patient outcomes remain suboptimal, highlighting the urgent need for novel interventions.
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[English]

The rise of multidrug-resistant organisms represents a serious global public health concern. In Korea, the increasing prevalence of carbapenem-resistant Enterobacterales (CRE) is particularly concerning due to the difficulties associated with treatment. Data from the Korea Global Antimicrobial Resistance Surveillance System indicate a yearly increase in CRE cases, with carbapenemase-producing Enterobacterales being the predominant type. The capacity of CRE to resist multiple broad-spectrum antibiotics leads to higher medical costs and mortality rates, underscoring the need for urgent action. Effective prevention is crucial to curbing CRE outbreaks and transmission. Antimicrobial stewardship programs (ASPs) play a key role and require commitment from healthcare professionals to minimize unnecessary antibiotic use, as well as from policymakers to ensure adherence to ASP guidelines. Given the complexity of CRE transmission, ASP efforts must be integrated with infection control strategies for maximum effectiveness. These strategies include adherence to standard and contact precautions, environmental disinfection, preemptive isolation, and comprehensive education and training for healthcare personnel. Additionally, surveillance testing for patients at high risk for CRE and the use of real-time diagnostic kits can facilitate early detection and reduce further transmission. Strategies for the prevention of CRE infection should be tailored to specific healthcare settings. Ongoing research is essential to update and refine infection control guidelines and effectively prevent CRE outbreaks.

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  • Unresolved policy on the new placement of 2,000 entrants at Korean medical schools and this issue of Ewha Medical Journal
    Sun Huh
    The Ewha Medical Journal.2024;[Epub]     CrossRef
  • 107 View
  • 3 Download
  • 1 Web of Science
  • 1 Crossref

Case Report

[English]
Nontuberculous mycobacterial infection in a sporotricoid distribution in Korea: a case report
Jin Ju Lee, Yoon Jin Choi, Ji Yeon Byun, You Won Choi, Joo Young Roh, Hae Young Choi
Ewha Med J 2024;47(2):e29.   Published online April 30, 2024
DOI: https://doi.org/10.12771/emj.2024.e29

Nontuberculous mycobacterial infections, which are often acquired from environmental sources such as water and soil, exhibit a variety of cutaneous manifestations that frequently lead to misdiagnoses and delays in treatment. A 77-year-old woman presented with multiple skin lesions in a sporotricoid distribution on her right leg, which persisted despite standard antibiotic treatments. Based on the skin biopsy, revealing granulomatous inflammation with acid-fast bacilli, and PCR testing, a nontuberculous mycobacterial infection was diagnosed. Antimycobacterial drug combinations, including clarithromycin, isoniazid, and rifampicin for 4 months, complete the skin lesion's clearance. This case underscores the need for heightened suspicion and the use of appropriate diagnostic techniques, including tissue biopsies and molecular methods such as PCR.

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  • Clarithromycin

    Reactions Weekly.2024; 2014(1): 180.     CrossRef
  • 73 View
  • 0 Download
  • 1 Crossref

Invited Review

[English]
Antimicrobials and Antimicrobial Resistant Superbacteria
Eunju Shin
Ewha Med J 2017;40(3):99-103.   Published online July 28, 2017
DOI: https://doi.org/10.12771/emj.2017.40.3.99

Antimicrobials were one of the great invention of modern era. However, the abuse of antimicrobial both in human and animals has led to a high rate of occurrence of antimicrobial resistant microbes. Disease treatment caused by antimicrobial resistant microbes including superbacteria has emerged as critical issue worldwide. Communication and cooperation among researchers in diverse fields are needed to solve the resistance to antimicrobials. Culture Collection of Antimicrobial Resistant Microbes (CCARM) has taken a leadership role an intermediary among various research fields by providing certified antimicrobial resistant microbes with their information since 1999. CCARM collects antimicrobial resistant microbes from clinical, agricultural animals and products, and environmental fields, and classifies and stores them according to their origins, species and antimicrobial resistance mechanisms. CCARM is performing the roles (collection, deposit, preservation, distribution, service, and consulting) of Biological Resource Center designated by Organisation for Economic Co-operation and Development.

Citations

Citations to this article as recorded by  
  • Improved Adhesion and Biocompatibility of Chitosan-Coated Super-Hydrophilic PVC Polymer Substrates for Urothelial Catheters
    Alenka Vesel, Helena Motaln, Miran Mozetič, Dane Lojen, Nina Recek
    International Journal of Molecular Sciences.2025; 26(5): 2128.     CrossRef
  • Antibacterial and Cytotoxic Evaluation of Lespedeza cuneata Extract Against Periodontal Pathogens and Human Gingival Cells: A Novel Option for Periodontal Therapy
    Hyo-Ju Yoon, Gyoo-Cheon Kim, Seoul-Hee Nam
    Applied Sciences.2024; 15(1): 190.     CrossRef
  • Tetrahedral DNA Enhanced Antibacterial Effect of Lysozyme
    Yingqi Zhang, Wei Feng, Wenke Zhang
    ACS Materials Letters.2024; 6(6): 2409.     CrossRef
  • Establishment of analysis method for the quantification of residues of halquinol and its metabolites in livestock and fishery products using liquid chromatography–tandem mass spectrometry
    Tae Ho Lee, Sun Young Park, Ji Young Kim, Jang-Duck Choi, Guiim Moon
    Applied Biological Chemistry.2023;[Epub]     CrossRef
  • Development and Validation of an Analytical Method for β-Agonists in Livestock and Fishery Products Using LC-MS/MS
    Tae Ho Lee, Yu Ra Kim, Su Jeong Park, Ji Young Kim, Jang Duck Choi, Gui Im Moon
    Korean Journal of Environmental Agriculture.2022; 41(2): 135.     CrossRef
  • Potential of Antimicrobial Peptide-Overexpressed Tenebrio molitor Larvae Extract as a Natural Preservative for Korean Traditional Sauces
    Dooseon Hwang, Seung Lee, Tae-Won Goo, Eun-Young Yun
    Insects.2022; 13(4): 381.     CrossRef
  • Research Progress on Bacterial Membrane Vesicles and Antibiotic Resistance
    Xiaofei Liu, Jinyang Xiao, Shuming Wang, Jinxia Zhou, Jiale Qin, Zhibo Jia, Yanfeng Wang, Zhigang Wang, Yongmin Zhang, Huifang Hao
    International Journal of Molecular Sciences.2022; 23(19): 11553.     CrossRef
  • Membrane vesicles from antibiotic-resistant Staphylococcus aureus transfer antibiotic-resistance to antibiotic-susceptible Escherichia coli
    Ae Rin Lee, Seong Bin Park, Si Won Kim, Jae Wook Jung, Jin Hong Chun, Jaesung Kim, Young Rim Kim, Jassy Mary S. Lazarte, Ho Bin Jang, Kim D. Thompson, Myunghwan Jung, Min Woo Ha, Tae Sung Jung
    Journal of Applied Microbiology.2022; 132(4): 2746.     CrossRef
  • Anti-Hemolytic and Antimicrobial Effects against Multidrug-Resistant Bacteria of Enterococcus faecalis Isolated from Human Breast Milk
    Eun-Ji Yi, Jeong-eun Lee, So-Yeon Jo, Soo-bin Kim, Du-na Yu, Moochang Kook, Ae Jung Kim
    Microbiology and Biotechnology Letters.2021;[Epub]     CrossRef
  • Smarter cures to combat COVID-19 and future pathogens: a review
    Han Dai, Jie Han, Eric Lichtfouse
    Environmental Chemistry Letters.2021; 19(4): 2759.     CrossRef
  • Lactobacillus paraplantarum THG-G10 as a potential anti-acne agent with anti-bacterial and anti-inflammatory activities
    HyeMin Cha, Su-Kyung Kim, MooChang Kook, Tae-Hoo Yi
    Anaerobe.2020; 64: 102243.     CrossRef
  • Analysis of factors affecting antibiotic use at hospitals and clinics based on the defined daily dose
    Eun Jee Lee, GeunWoo Lee, Juhee Park, Dong-Sook Kim, Hyeong Sik Ahn
    Journal of the Korean Medical Association.2018; 61(11): 687.     CrossRef
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  • 4 Download
  • 12 Crossref
Original Article
[English]
Comparative Study of Fungus Ball and Chronic Bacterial Sinusitis
Eun Hee Park, Seung-Sin Lee
Ihwa Ŭidae chi 2008;31(2):93-98.   Published online September 30, 2008
DOI: https://doi.org/10.12771/emj.2008.31.2.93
Background and Objectives

The pathogenesis of fungus ball has been unclear yet. This study was performed to find a clue to the pathogenesis of fungus ball and to clarify the role of ostiomeatal unit(OMU) obstruction in the fungus ball through the comparative study of fungus ball and chronic bacterial sinusitis.

Subjects and Method

35 patients with fungus ball(fungus group) and 42 patients with chronic unilateral bacterial sinusitis(bacteria group) were analyzed in terms of radiologic findings and endoscopic findings.

Results

Fungus ball was observed in older patients than chronic bacterial sinusitis(59.7 vs. 41.1). The total Lund scores of bacteria group were higher than those of fungus group(6.0 vs. 4.6)(p=0.009). Lund scores of frontal and anterior ethmoid sinuses and OMU were 0 in fungus group with partial opacity of maxillary sinus. Lund scores of frontal and anterior ethmoid sinuses and OMU in bacteria group were higher than in fungus group regardless of disease severity of maxillary sinus. There was no difference of anatomical variants between lesion side and healthy side in both groups. There was no statistical difference in the scores of endoscopic findings of two groups.

Conclusion

This study may suggest that fungus ball is not associated with the obstruction of OMU comparing with chronic bacterial sinusitis and that fungus ball has another pathogenic mechanism different from that of bacterial sinusitis.

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