ro13-9904 and Ulcer

Actinomycotic infections involving the oesophagus are uncommon but have been reported in both immunocompromised and immunocompetent individuals. We report a case of actinomycosis oesophagitis in a patient with lung cancer who received chemo- and radiotherapy. This patient was admitted with severe dysphagia and odynophagia and biopsy from an oesophageal ulcer found on oesophagogastroduodenoscopy (EGD) revealed actinomycosis. The patient was treated with intravenous penicillin G followed by ceftriaxone with clinical improvement and repeat EGD showed reduction in the size of the oesophageal ulcer, but he relapsed due to non-compliance. We review the English literature regarding the clinical features, diagnosis, and management of actinomycotic infections of the oesophagus.

Topics: Actinomyces; Actinomycosis; Anti-Bacterial Agents; Ceftriaxone; Drug Therapy, Combination; Endoscopy, Digestive System; Esophageal Diseases; Esophagus; Humans; Male; Middle Aged; Penicillin G; Recurrence; Treatment Outcome; Treatment Refusal; Ulcer

We conducted a randomized, unblinded, prospective study designed to determine the efficacy of single-dose azithromycin for the treatment of chancroid. Men and women 16 years of age and older who had darkfield-negative genital ulcers that were clinically suspected to be caused by Haemophilus ducreyi and who attended urban sexually transmitted disease clinics or presented to hospital emergency departments were enrolled in the study. Patients were randomized to receive 250 mg of ceftriaxone im or 1 g of azithromycin orally, both given as a single dose. They were followed for up to 23 days after treatment. For 65 patients, cultures were positive for H. ducreyi; there were 68 patients whose cultures were negative for both H. ducreyi and herpes simplex virus and who had no evidence of syphilis. All 133 patients returned for at least one follow-up visit. At the time of the last follow-up visit, all 32 patients whose cultures were positive for H. ducreyi and who were treated with azithromycin were clinically cured. In all 33 culture-positive cases in which ceftriaxone was used, there was either clinical improvement or cure at the time of the patient's last follow-up visit. In addition, azithromycin and ceftriaxone were equally effective in healing ulcers for which cultures were negative. We conclude that a single 1-g oral dose of azithromycin is as effective as a 250-mg im dose of ceftriaxone for the treatment of chancroid.

Topics: Administration, Oral; Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Cephalosporins; Chancroid; Female; Genital Diseases, Female; Genital Diseases, Male; Humans; Injections, Intramuscular; Male; Prospective Studies; Treatment Outcome; Ulcer

Gonococcal infection of the penile raphe is rarely encountered in the clinical setting. The study aimed to understand the incidence, sites, clinical manifestations, and treatment of gonococcal infection of the penile raphe.. We enrolled men with gonococcal infection of the penile raphe and men with urethral gonorrhea from January 2010 to December 2021. All patients' demographic data and clinical characteristics were recorded. All patients were treated with ceftriaxone. Incision and drainage were performed in patients with non-ruptured abscesses. Nodules and sinus tract-like lesions that did not resolve after 1 month of treatment were excised.. Among 2,736 men who presented with urethral gonorrhea from January 2010 to December 2021, 5 (0.18%) had accompanying gonococcal infection of the penile raphe. An additional two men presented with gonococcal infection of the penile raphe without urethritis. Thus, 7 (0.26%; confidence interval, 0.11-0.56%) of 2,738 men had urethral gonorrhea or gonococcal infection of the penile raphe confirmed both clinically and by laboratory testing. Lesions were present in the frenulum of the prepuce and at the median aspect, proximal end, distal end, and both the proximal and distal ends of the penile raphe. The lesions manifested as abscesses, ulcers, a nodule, and a nodule with a sinus-like lesion. All lesions exhibited tenderness. All seven patients were cured after treatment.. Gonococcal infection of the penile raphe is a rare, atypical type of involvement of the male urogenital tract by Neisseria gonorrhoeae. It may be a local complication of urethral gonorrhea or an independent primary infection. The proximal end, distal end, and median aspect of the penile raphe can be infected by N. gonorrhoeae. Cutaneous lesions present as abscesses, ulcers, nodules, and sinus-like lesions. Ceftriaxone is effective, but sinus-like lesions require surgery.

Topics: Abscess; Ceftriaxone; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Ulcer

Topics: Anti-Bacterial Agents; Ceftriaxone; Chancre; Colonoscopy; Doxycycline; Humans; Lymphadenopathy; Magnetic Resonance Imaging; Male; Middle Aged; Rectal Diseases; Retreatment; Ulcer

Typhoid fever is caused by enteroinvasive Gram-negative organism Salmonella typhi. The well-known complications of typhoid fever are intestinal haemorrhage and perforation. In the pre-antibiotic era, these complications were quite common, but in the current antibiotic era the incidence of these complications is on the decline. We report a case of a patient with typhoid fever who developed haematochezia during the hospital stay and was found to have caecal ulcer with an adherent clot on colonoscopy. He was managed successfully with conservative measures without endotherapy and there was no rebleed.

Topics: Anti-Bacterial Agents; Blood Transfusion; Cecal Diseases; Ceftriaxone; Colonoscopy; Gastrointestinal Hemorrhage; Humans; Male; Typhoid Fever; Ulcer; Young Adult

Human bite injuries, while less frequent than cat or dog bites, usually stem from aggressive behavior, sports, or sexual activity. It has been thought that human bites have a higher rate of infection than animal bites, but this view is likely skewed because of the frequency of closed fist injuries presenting to emergency rooms. Human bites to the genitalia also occur, but are not often reported because of embarrassment.. We report a genital ulceration after a human bite to the penis and review appropriate diagnostic and therapeutic maneuvers.. This article reports the development of a severe genital ulcer associated with a human bite to the penis secondarily infected, as verified by culture, with an oral flora organism Eikenella corrodens.. The genital ulceration healed after appropriate antibiotic therapy.. Treatment of human bites focuses on obtaining an accurate history and performing a salient physical examination, as well as early irrigation and debridement. Transmission of communicable disease should be considered as a possible consequence. Prophylactic antibiotic treatment and primary closure of wounds continue to be areas of controversy.

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Bites, Human; Ceftriaxone; Drug Therapy, Combination; Eikenella corrodens; Gram-Negative Bacterial Infections; Humans; Male; Penile Diseases; Penis; Ulcer

Topics: Anti-Bacterial Agents; Azithromycin; Breast Feeding; Ceftriaxone; Chancroid; Ciprofloxacin; Contraindications; Erythromycin; Female; Genital Diseases, Female; Genital Diseases, Male; Haemophilus ducreyi; Humans; Male; Pregnancy; Pregnancy Complications, Infectious; Ulcer

We report the sensitivity and specificity of physical examination findings for diagnosing primary syphilis, chancroid, and genital herpes. The physical features of genital ulcers in 446 men were measured in accordance with a quantitative scale. Two hundred-twenty of these men had an established, single microbiological diagnosis. Forty-five (20%) had primary syphilis, 118 (54%) had chancroid, and 57 (26%) had genital herpes. There was considerable overlap in the clinical presentation of these three diseases. The classic clinical sign complex attributed to primary syphilis (painless, indurated, clean-based ulcers) was only 31% sensitive but 98% specific. The classic presentation of a chancroid ulcer (a deep, undermined, purulent ulcer) was only 34% sensitive but 94% specific. The classic description of genital herpes ulcers (multiple, shallow, tender ulcers) was only 35% sensitive but 94% specific. Inguinal lymph node findings did not contribute significantly to clinical diagnostic accuracy. These data indicate that the clinical diagnosis of genital ulcer disease can be made with reasonable certainty only for a minority of patients. Rapid, sensitive, and specific diagnostic tests for syphilis, chancroid, and genital herpes are needed.

Topics: Adolescent; Adult; Aged; Ceftriaxone; Cephalosporins; Chancre; Chancroid; Genitalia, Male; Herpes Genitalis; Humans; Male; Middle Aged; Penicillin G; Penicillins; Predictive Value of Tests; Sensitivity and Specificity; Sexually Transmitted Diseases; Syphilis; Ulcer