trimethoprim--sulfamethoxazole-drug-combination and Abnormalities--Multiple

Caudal regression syndrome (CRS) is a rare anomaly of the lower body pole that represents a continuum of congenital malformations ranging from isolated sacral agenesis to absence of the lumbosacral spine and major visceral anomalies. While the exact etiology of this syndrome is unclear, maternal diabetes, genetic factors, teratogens and vascular anomalies altering blood flow have been hypothesized to play a role in its pathogenesis.. A fetus had extreme hypotrophy of the caudal body pole, aplasia of the lower spine and complete renal agenesis diagnosed in the second trimester by ultrasound. Maternal history revealed the use of minoxidil solution for preventing hair loss for four years prior to and during gestation. Also, the mother had taken trimethoprim-sulfamethoxazole during the first trimester for treatment of upper respiratory disease. No maternal diabetes or history of familial genetic diseases was evident.. In an extreme form of CRS consisting of complete aplasia of the lower body pole and viscera and additional malformations, a possible drug-related etiology was suggested but should be confirmed by more studies.

Topics: Abnormalities, Multiple; Administration, Oral; Administration, Topical; Adult; Anti-Infective Agents; Female; Humans; Kidney; Leg; Lumbosacral Region; Minoxidil; Pregnancy; Sacrum; Spine; Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination; Vasodilator Agents

Three weak, recumbent neonatal foals with skin lesions, including a thin wooly coat, were born to mares being treated for equine protozoal myeloencephalitis. Mares received sulfadiazine or sulfamethoxazole-trimethoprim, pyrimethamine, folic acid, and vitamin E orally. Foals were anemic, leukopenic, azotemic, hyponatremic, and hyperkalemic. Serum folate concentrations in the 3 foals and 2 mares were lower than those reported in the literature for clinically normal brood mares. Treatment was unsuccessful. For each foal, necropsy revealed lobulated kidneys with thin cortices and a pale medulla, and the spleen and thymus were small. Histologic examination revealed marked epidermal necrosis without inflammatory cells, thin renal cortices, renal tubular nephrosis, lymphoid aplasia, and bone marrow aplasia and hypoplasia. These observations indicate that oral administration of sulfonamides, 2,4-diaminopyrimidines (pyrimethamine with or without trimethoprim), and folic acid to mares during pregnancy is related to congenital defects in newborn foals.

Topics: Abnormalities, Multiple; Administration, Oral; Animals; Animals, Newborn; Anti-Infective Agents; Bone Marrow; Encephalomyelitis; Female; Folic Acid; Folic Acid Antagonists; Horses; Kidney; Pregnancy; Pregnancy Complications, Parasitic; Protozoan Infections, Animal; Pyrimethamine; Skin Abnormalities; Sulfadiazine; Trimethoprim, Sulfamethoxazole Drug Combination; Vitamin E

The possible teratogenic effect of co-trimoxazole (sulfamethoxazole and trimethoprim, Bactrim [Roche], Septrin or Septra [Burroughs-Wellcome], Sumetrolim [EGIS]) was evaluated using the data set of the Hungarian Case-Control Surveillance of Congenital Anomalies. In the study period of 1980 through 1984, 1.25% of pregnant women who had healthy babies (negative control group) were treated with co-trimoxazole during pregnancy. In those who had babies with congenital anomalies the rate of co-trimoxazole use was 2.31%. The case-control analysis showed a significant increase of co-trimoxazole use only in the groups of cleft lip +/- cleft palate and hypospadias. However, drug use was not higher during the critical period in either of the congenital anomaly groups. The distribution of component congenital anomalies in 13 cases affected by multiple congenital anomalies did not show any characteristic pattern. Respiratory and urinary system diseases were mentioned significantly more frequently in pregnancies of index patients' mothers. This analysis did not indicate any teratogenicity of co-trimoxazole. The higher drug use can probably be explained by maternal disorders.

Topics: Abnormalities, Drug-Induced; Abnormalities, Multiple; Adult; Case-Control Studies; Female; Humans; Hungary; Infant, Newborn; Male; Pregnancy; Pregnancy Complications; Registries; Trimethoprim, Sulfamethoxazole Drug Combination