Osong Public Health and Research Perspectives

Mi-Sun Park

7 Articles

Evaluation and Comparison of Molecular and Conventional Diagnostic Tests for Detecting Tuberculosis in Korea, 2013: Sang-Hee Park, Chang-Ki Kim, Hye-Ran Jeong, Hyunjin Son, Seong-Han Kim, Mi-Sun Park; Osong Public Health Res Perspect. 2014;5(Suppl):S3-S7. Published online December 31, 2014; DOI: https://doi.org/10.1016/j.phrp.2014.10.006

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Abstract PDF: Objectives
A fast and accurate diagnosis is necessary to control and eliminate tuberculosis (TB). In Korea, TB continues to be a serious public health problem. In this study, diagnostic tests on clinical samples from patients suspected to have TB were performed and the sensitivity and specificity of the various techniques were compared. The main objective of the study was to compare various diagnostic tests and evaluate their sensitivity and specificity for detecting tuberculosis.
Methods
From January 2013 to December 2013, 170,240 clinical samples from patients suspected to have TB were tested with smear microscopy, acid-fast bacilli culture, and real-time polymerase chain reaction (PCR). The test results were compared and data were analyzed.
Results
A total of 8216 cultures tested positive for TB (positive detection rate, 4.8%). The contamination rate in the culture was 0.6% and the isolation rate of nontuberculous mycobacteria was 1.0%. The sensitivity and specificity of smear microscopy were 56.8% and 99.6%, respectively. The concordance rate between the solid and liquid cultures was 92.8%. Mycobacterium isolates were not detected in 0.4% of the cases in the liquid culture, whereas no Mycobacterium isolates were detected in 6.8% of the cases in the solid culture. The sensitivity and specificity of real-time PCR for the solid culture were 97.2% and 72.4%, respectively, whereas the corresponding data for the liquid culture were 93.5% and 97.2%.
Conclusion
The study results can be used to improve existing TB diagnosis procedure as well as for comparing the effectiveness of the assay tests used for detecting Mycobacterium tuberculosis isolates.

Utilization of Laboratory Tests for Tuberculosis and Mycobacterial Disease in Korea: Chang-Ki Kim, Sung Won Choi, Mi-Sun Park; Osong Public Health Res Perspect. 2014;5(Suppl):S24-S29. Published online December 31, 2014; DOI: https://doi.org/10.1016/j.phrp.2014.10.008

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Abstract PDF: Objectives
In Korea, a large portion of tuberculosis (TB) patients are diagnosed and treated in private institutes. Laboratory tests are crucial for TB control. There are many possible problems using laboratory tests in the private sector. In this study, we aimed to investigate the characteristics and trends of utilizing laboratory tests for TB and mycobacterial diseases in the private sector by analyzing the National Health Insurance (NHI) database.
Methods
After selecting TB or other mycobacteria-related test items, we searched the number and cost of each item on the website of the Health Insurance Review and Assessment Service using the code of each test from 2007 to 2012.
Results
Our data revealed that the number and cost of tests drastically increased between 2007 and 2012. Culture and molecular tests primarily contributed to the tremendous increases. For each year, concentrated smearing and fluorochrome staining were more commonly used. The number of serologic tests for latent TB infection stagnated, despite the expansion of contact investigation.
Conclusion
The NHI data could be considerably useful for understanding the utilization trends of laboratory tests for TB and mycobacterial diseases in Korea. Our data showed that TB laboratory systems have recently improved. In this study, many issues were noticed. Therefore, solutions to these issues are required and the continued monitoring of NHI data regarding laboratory diagnosis.

Enhanced Type III Secretion System Expression of Atypical Shigella flexneri II:(3)4,7(8): Sahyun Hong, Injun Cha, Nan-Ok Kim, Seong-Han Kim, Kyung-Tae Jung, Je-Hee Lee, Dong-Wook Kim, Mi-Sun Park, Yeon-Ho Kang; Osong Public Health Res Perspect. 2012;3(4):222-228. Published online December 31, 2012; DOI: https://doi.org/10.1016/j.phrp.2012.10.002

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Abstract PDF: Objectives
We aimed at evaluating the virulence of atypical Shigella flexneri II:(3)4,7(8) by DNA microarray and invasion assay.
Methods
We used a customized S. flexneri DNA microarray to analyze an atypical S. flexneri II:(3)4,7(8) gene expression profile and compared it with that of the S. flexneri 2b strain.
Results
Approximately one-quarter of the atypical S. flexneri II:(3)4,7(8) strain genes showed significantly altered expression profiles; 344 genes were more than two-fold upregulated, and 442 genes were more than 0.5-fold downregulated. The upregulated genes were divided into the category of 21 clusters of orthologous groups (COGs), and the “not in COGs” category included 170 genes. This category had virulence plasmid genes, including the ipa-mxi-spa genes required for invasion of colorectal epithelium (type III secretion system). Quantitative reverse-transcription polymerase chain reaction results also showed the same pattern in two more atypical S. flexneri II:(3)4,7(8) strains. Atypical S. flexneri II:(3)4,7(8) showed four times increased invasion activity in Caco-2 cells than that of typical strains.
Conclusion
Our results provide the intracellularly regulated genes that may be important for adaptation and growth strategies of this atypical S. flexneri.

Resistance to Fluoroquinolone by a Combination of Efflux and Target Site Mutations in Enteroaggregative Escherichia coli Isolated in Korea: Jun-Young Kim, Se-Mi Jeon, Hyungjun Kim, Nara Lim, Mi-Sun Park, Seong-Han Kim; Osong Public Health Res Perspect. 2012;3(4):239-244. Published online December 31, 2012; DOI: https://doi.org/10.1016/j.phrp.2012.11.002

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Abstract PDF: Objectives
Enteroaggregative Escherichia coli (EAEC) was recently reported as a major diarrheagenic pathogen in infant and adult travelers, both in developing and developed countries. EAEC strains are known to be highly resistant to antibiotics including quinolones. Therefore in this study we have determined the various mechanisms of quinolone resistance in EAEC strains isolated in Korea.
Methods
For 26 EAEC strains highly resistant to fluoroquinolone, minimal inhibitory concentrations for fluoroquinolones were determined, mutations in the quinolone target genes were identified by PCR and sequencing, the presence of transferable quinolone resistance mechanism were identified by PCR, and the contribution of the efflux pump was determined by synergy tests using a proton pump inhibitor. The expression levels of efflux pump-related genes were identified by relative quantification using real-time PCR.
Results
Apart from two, all tested isolates had common mutations on GyrA (Ser83Leu and Ser87Gly) and ParC (Ser80Gln). Isolates EACR24 and EACR39 had mutations that have not been reported previously: Ala81Pro in ParC and Arg157Gly in GyrA, respectively. Increased susceptibility of all the tested isolates to ciprofloxacin and norfloxacin in the presence of the pump inhibitor implies that efflux pumps contributed to the resistance against fluoroquinolones. Expression of the efflux pump-related genes, tolC, mdfA, and ydhE, were induced in isolates EACR 07, EACR 29, and EACR 33 in the presence of ciprofloxacin.
Conclusion
These results indicate that quinolone resistance of EAEC strains mainly results from the combination of mutations in the target enzyme and an increased expression of efflux pump-related genes. The mutations Ala81Pro in ParC and Arg157Gly in GyrA have not been reported previously the exact influence of these mutations should be investigated further.

A Contribution of MdfA to Resistance to Fluoroquinolones in Shigella flexneri: Jun-Young Kim, Se-Mi Jeon, Hyungjun Kim, Mi-Sun Park, Seong-Han Kim; Osong Public Health Res Perspect. 2011;2(3):216-217. Published online December 31, 2011; DOI: https://doi.org/10.1016/j.phrp.2011.11.049

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7 Citations

Abstract PDF: In this study, we measured the drug resistance conferred by mdfA mutations in two Shigella flexneri strains. A mutant in mdfA genes was constructed by polymerase chain reaction–based, one-step inactivation of chromosomal genes. The antimicrobial susceptibility of parent and mutant strains to fluoroquinolones was determined by minimal inhibitory concentration (MICs). The △mdfA mutants were somewhat more susceptible to fluoroquinolones than the parent strains. The low level changes in MICs of the △mdfA mutants suggest that mdfA contributed the fluoroquinolone resistance in S flexneri. This finding found that the increased expression level of an MdfA efflux pump mediated fluoroquinolone resistance, but it is not likely a major effecter of higher resistance levels.

Prevalence of Antibiotic Resistance in Escherichia coli Fecal Isolates From Healthy Persons and Patients With Diarrhea: Seung-Hak Cho, Yeong-Sik Lim, Mi-Sun Park, Seong-Han Kim, Yeon-Ho Kang; Osong Public Health Res Perspect. 2011;2(1):41-45. Published online June 30, 2011; DOI: https://doi.org/10.1016/j.phrp.2011.05.003

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10 Citations

Abstract PDF: Objectives
This study aimed to investigate the prevalence of antibiotic resistance in fecal Escherichia coli isolates from healthy persons and patients with diarrhea.
Methods
E. coli isolates (n = 428) were obtained from fecal samples of apparently healthy volunteers and hospitalized patients with diarrhea. Susceptibility patterns of isolates to 16 antimicrobial agents were determined by agar disc diffusion.
Results
Most E. coli isolates exhibited less than 10% resistance against imipenem, cefotetan, aztreonam, cefepime, cefoxitin, amikacin and netilamicin, although greater than 65% were resistant to ampicillin and tetracycline. No significant difference in resistance rates for all tested antibiotics was found between isolates from the healthy-and diarrheal-patient groups, including for multi-drug resistance (p = 0.22). The highest number of resistant antibiotics was 12 antibiotics. No significant differences in antibiotic resistance were found among the sex and age strata for isolates from healthy individuals. However, antibiotic resistance rates to cefoxitin, cefotaxime, amikacin, and netilamicin were significantly higher in the isolates of men than those of women (p < 0.05) in isolates from patients with diarrhea. Furthermore, isolates from patients with diarrhea older than 40-years of age showed higher resistance to cefepime and aztreonam (p < 0.05).
Conclusion
High resistance to the antibiotics most frequently prescribed for diarrhea was found in isolates from patients with diarrhea and apparently healthy individuals without any significant difference.

Distribution of Virulence Genes and Their Association of Serotypes in Pathogenic Escherichia coli Isolates From Diarrheal Patients in Korea: Seung-Hak Cho, Kyung-Hwan Oh, Seong-Han Kim, Hee-Bok Oh, Mi-Sun Park; Osong Public Health Res Perspect. 2010;1(1):29-35. Published online December 31, 2010; DOI: https://doi.org/10.1016/j.phrp.2010.12.008

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Abstract PDF: Objectives
To characterise the genetic and serological diversity of pathogenic Escherichia coli, we tested 111 E coli strains isolated from diarrhoeal patients in Korea between 2003 and 2006.
Methods
The isolates were tested through polymerase chain reaction (PCR) and slide agglutination method for the detection of virulence genes and serotypes, respectively. To compare the expression of Shiga toxin (stx)-1 and stx2 genes, real-time quantitative reverse-transcriptase PCR and rapid exprssion assay, reversed-passive latex agglutination, were performed.
Results
Forty-nine Shiga toxin-producing E coli (STEC) strains and 62 non-STEC strains, including 20 enteropathogenic E coli, 20 enterotoxigenic E coli, 20 enteroaggregative E coli, and 2 enteroinvasive E coli were randomly chosen from the strains isolated from diarrhoeal patients in Korea between 2003 and 2006. PCR analysis indicated that locus of enterocyte effacement pathogenicity island, that is, eaeA, espADB, and tir genes were present in STEC, enteropathogenic E coli, and enteroinvasive E coli. Quorum sensing-related gene luxS was detected in most of pathogenic E coli strains. Major serotypes of the STEC strains were O157 (26%) and O26 (20%), whereas the non-STEC strains possessed various serotypes. Especially, all the strains with serotype O157 carried stx2 and the tested virulence factors. Of the STEC strains, the data of real-time quantitative reverse-transcriptase PCR and reversed-passive latex agglutination tests showed that messenger RNA- and protein expression of stx2 gene were higher than those of stx1 gene.
Conclusion
Our results provide the epidemiological information regarding the trend of STEC and non-STEC infections in the general population and show the fundamental data in association of serotypes with virulence genes in diarrhoeagenic E coli strains from Korea.

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