amoxicillin-potassium-clavulanate-combination and Arthritis--Rheumatoid

Actinomycosis is a rare chronic granulomatous infection caused by Gram-positive, non-acid-fast, anaerobic to microaerophilic bacteria.We report a case of cervicofacial actinomycosis in an 86-year-old woman undergoing immunosuppressive therapy with azathioprine and prednisone for rheumatoid arthritis. She underwent a dental treatment several months earlier. The diagnosis of culture-negative actinomycosis was based on histolopathology findings and the isolation of companion bacteria. The patient was treated with amoxicillin-clavulanic acid for 3 months, which produced complete clearance of her cervicofacial actinomycosis.Our case points out the pitfalls of diagnostic procedures in actinomycosis and the ability of this rare disease to mimic other medical conditions.

Topics: Actinomycosis, Cervicofacial; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Arthritis, Rheumatoid; Azathioprine; Diagnosis, Differential; Female; Humans; Immunocompromised Host; Immunosuppressive Agents; Prednisone

Mycobacterium chelonae is a ubiquitous, rapidly growing, opportunistic, non-tuberculous mycobacterium that can cause skin and bone tissue infections. We report a case of cutaneous infection due to M. chelonae following anti-TNF therapy.. A 70-year-old woman with a medical history of rheumatoid arthritis was admitted for several purple nodular cutaneous lesions on her right leg evolving for 2 months. At admission, she was on prednisone, methotrexate and adalimumab for her rheumatoid arthritis. Skin lesions appeared 5 days before etanercept, which was taken for 5 months before being discontinued for adalimumab. Both the histopathological examination and bacterial culture of involved skin showed the presence of M. chelonae. Adalimumab was immediately discontinued and a combination of amoxicillin-clavulanic acid and tigecyclin was started.. TNF-alpha plays a pivotal role in immune reaction to intracellular pathogens. Very few cases of cutaneous infection involving M. chelonae in association with an anti-TNF-alpha therapy have been reported in the literature. To our knowledge, this is the first case occurring during treatment with etanercept and symptoms worsened with the introduction of adalimumab. In addition, this case underlines the difficulties of effectively treating this mycobacterium.

Topics: Adalimumab; Aged; Amoxicillin-Potassium Clavulanate Combination; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Arthritis, Rheumatoid; Biopsy; Etanercept; Female; Humans; Immunoglobulin G; Immunosuppressive Agents; Methotrexate; Mycobacterium chelonae; Mycobacterium Infections, Nontuberculous; Prednisone; Receptors, Tumor Necrosis Factor; Skin; Tumor Necrosis Factor-alpha

To assess the cost effectiveness of antibiotic prophylaxis for haematogenous bacterial arthritis in patients with joint disease.. In a decision analysis, data from a prospective study on bacterial arthritis in 4907 patients with joint disease were combined with literature data to assess risks and benefits of antibiotic prophylaxis. Effectiveness and cost effectiveness calculations were performed on antibiotic prophylaxis for various patient groups. Grouping was based on (a) type of event leading to transient bacteraemia-that is, infections (dermal, respiratory/urinary tract) and invasive medical procedures-and (b) the patient's susceptibility to bacterial arthritis which was increased in the presence of rheumatoid arthritis, large joint prostheses, comorbidity, and old age.. Of the patients with joint disease, 59% had no characteristics that increased susceptibility to bacterial arthritis, and 31% had one. For dermal infections, the effectiveness of antibiotic prophylaxis was maximally 35 quality adjusted life days (QALDs) and the cost effectiveness maximally $52 000 per quality adjusted life year (QALY). For other infections, the effectiveness of prophylaxis was lower and the cost effectiveness higher. Prophylaxis for invasive medical procedures seemed to be acceptable only in patients with high susceptibility: 1 QALD at a cost of $1300/QALY; however, the results were influenced substantially when the level of efficacy of the prophylaxis or cost of prophylactic antibiotics was changed.. Prophylaxis seems to be indicated only for dermal infections, and for infections of the urinary and respiratory tract in patients with increased susceptibility to bacterial arthritis. Prophylaxis for invasive medical procedures, such as dental treatment, may only be indicated for patients with joint disease who are highly susceptible.

Topics: Adult; Age Factors; Aged; Amoxicillin-Potassium Clavulanate Combination; Antibiotic Prophylaxis; Arthritis, Infectious; Arthritis, Rheumatoid; Confidence Intervals; Cost-Benefit Analysis; Decision Support Techniques; Drug Therapy, Combination; Female; Humans; Logistic Models; Male; Middle Aged; Prostheses and Implants; Quality-Adjusted Life Years; Respiratory Tract Infections; Risk Factors; ROC Curve; Skin Diseases, Bacterial; Surgical Procedures, Operative; Urinary Tract Infections