trimethoprim--sulfamethoxazole-drug-combination and Actinomycetales-Infections

"Mycetoma" means a fungal tumor. Mycetoma is a chronic, granulomatous, subcutaneous tissue infection caused by both bacteria (actinomycetoma) and fungi (eumycetoma). This chronic infection was termed Madura foot and eventually mycetoma, owing to its etiology. Inoculation commonly follows minor trauma, predominantly to the foot and hence is seen more among the barefoot-walking populations, common among adult males aged 20 to 50 years. The hallmark triad of the disease includes tumefaction, fistulization of the abscess, and extrusion of colored grains. The color of these extruded grains in the active phase of the disease offers a clue to diagnosis. Radiology, ultrasonology, cytology, histology, immunodiagnosis, and culture are tools used in diagnosis. Recently, DNA sequencing has also been used successfully. Though both infections manifest with similar clinical findings, Actinomycetoma has a rapid course and can lead to amputation or death secondary to systemic spread. However, actinomycetomas are more responsive to antibiotics, whereas eumycetomas require surgical excision in addition to antifungals. Complications include secondary bacterial infections that can progress to full-blown bacteremia or septicemia, resulting in death. With extremely disfiguring sequelae, following the breakdown of the nodules and formation of discharging sinuses, it poses a therapeutic challenge.

Topics: Actinomycetales Infections; Actinomycosis; Amikacin; Anti-Bacterial Agents; Humans; Mycetoma; Nocardia Infections; Trimethoprim, Sulfamethoxazole Drug Combination

A 55-year old man developed a hemorrhagic pneumonia, likely due to infection with Kytococcus sedentarius during neutropenia following induction chemotherapy for acute myeloid leukemia. Severe mucosal barrier injury and the selective pressure of broad-spectrum antibiotics probably made it possible for this normally harmless commensal to penetrate the gut, spread through the blood stream, and invade the lungs.

Topics: Actinomycetales; Actinomycetales Infections; Acyclovir; Antineoplastic Combined Chemotherapy Protocols; Bacteremia; Bacterial Translocation; Cefepime; Cephalosporins; Clostridium Infections; Colistin; Cytarabine; Daunorubicin; Drug Therapy, Combination; Etoposide; Fatal Outcome; Hemoptysis; Humans; Hydroxyurea; Immunocompromised Host; Intestinal Mucosa; Leukemia, Myeloid, Acute; Male; Metronidazole; Middle Aged; Neutropenia; Pneumonia, Bacterial; Superinfection; Teicoplanin; Trimethoprim, Sulfamethoxazole Drug Combination

We report 12 cases of Whipple disease in patients with prominent neurologic symptoms, along with 122 cases of Whipple disease with nervous system involvement reported in the literature. We analyzed the clinical signs and results of additional examinations in 2 groups: the first group included patients with predominantly but not exclusively neurologic signs, and the second included patients with clinically isolated neurologic presentation of the disease. Whipple disease is a multisystemic infectious disease due to Tropheryma whippelii that may present with prominent or isolated symptoms of either the central or the peripheral nervous system. Recent reports stress the importance of polymerase chain reaction (PCR) analysis of cerebrospinal fluid, magnetic resonance imaging (MRI) during follow-up, and prolonged antibiotic therapy with drugs able to cross the blood-brain barrier. Cerebrospinal fluid should be analyzed repeatedly during follow-up, and treatment should be discontinued only when the results of PCR assay performed on cerebrospinal fluid are negative. Other examinations to be done include searching for gastrointestinal tract involvement with multiple duodenal biopsies and searching for systemic involvement with lymph node biopsies, which should be analyzed with light microscopy, electron microscopy, and PCR. When all examinations are negative, if Whipple disease is suspected and a lesion is found on brain MRI, a stereotactic cerebral biopsy should be performed. Treating Whipple disease with long-term trimethoprim-sulfamethoxazole is usually effective, but the use of third-generation cephalosporins in case of incomplete response deserves further attention.

Topics: Actinomycetales Infections; Adult; Aged; Anti-Bacterial Agents; Anti-Infective Agents; Biopsy; Blood-Brain Barrier; Central Nervous System Diseases; Cephalosporins; Female; Humans; Lymph Nodes; Magnetic Resonance Imaging; Male; Middle Aged; Peripheral Nervous System Diseases; Polymerase Chain Reaction; Stereotaxic Techniques; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Whipple Disease

Rhodococcus equi brain abscesses usually occur in immunocompromised patients with prolonged and refractory pulmonary infections. Herein we report a case of R. equi brain abscess in a 67-y-old man without immunodepression. Our patient recovered after neurosurgical resection and prolonged antimicrobial therapy with vancomycin and trimethoprim-sulfamethoxazole.

Topics: Actinomycetales Infections; Adolescent; Adult; Aged; Brain Abscess; Drug Resistance; Female; Humans; Immunocompetence; Male; Middle Aged; Rhodococcus equi; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

Trueperella pyogenes is one of the most important microorganisms causing metritis in post-partum cattle. Co-infection with other bacterial species such as Escherichia coli or Fusobacterium necrofurom increases the severity of the disease and the persistence of bacteria in utero. The aim of this study was to investigate the frequency of T. pyogenes strains, and their virulence and antimicrobial resistant profiles in metritis cases. The study was carried out on 200 samples obtained from metritis discharges of postpartum cattle on 18 farms around Tehran, Iran. Sixty-five T. pyogenes isolates (32.5%) were identified, of which 16 isolates were detected as pure cultures and the other 49 isolates from cultures most commonly mixed with E. coli or F. necrofurom. In terms of diversity in biochemical characteristic of T. pyogenes strains, 8 different biotypes were identified among the isolates. Single or multi antimicrobial resistance was observed in 48 isolates (73.9%), which was mostly against trimethoprim sulfamethoxazole, azithromycin, erythromycin and streptomycin. The tetracycline resistance gene tetW and macrolide resistance genes ermB and ermX were detected in 30, 18 and 25 isolates, respectively. In the screening of genes encoding virulence factors, fimA and plo genes were identified in all tested isolates. Genes encoding nanP, nanH, fimC, fimG, fimE and cbpA were detected in 50, 54, 45, 40, 50 and 37 of isolates, respectively. Thirteen different genotypes were observed in these T. pyogenes isolates. A significant association between clonal types and virulence factor genes, biochemical profile, CAMP test result, severity of the disease and sampling time was detected.

Topics: Actinomycetaceae; Actinomycetales Infections; Animals; Anti-Bacterial Agents; Azithromycin; Bacterial Typing Techniques; Cattle; Clone Cells; Drug Resistance, Multiple, Bacterial; Erythromycin; Escherichia coli; Escherichia coli Infections; Female; Fusobacterium; Fusobacterium Infections; Genes, Bacterial; Iran; Parturition; Puerperal Infection; Streptomycin; Trimethoprim, Sulfamethoxazole Drug Combination; Uterus; Virulence Factors

Pseudoclavibacter has rarely been documented as an etiologic agent of infection in humans. We presented the first case report of Pseudoclavibacter otitis media in a boy with pulmonary and spinal tuberculosis.A 3-year-old boy was referred to our hospital due to prolonged fever and progressive paraplegia for 3 months. He had yellowish discharge from both ear canals. The pleural fluid culture was positive for Mycobacterium tuberculosis. The discharge from both ears culture yielded yellow colonies of gram-positive bacilli with branching. This organism was positive for modified acid-fast bacilli stain but negative for acid-fast bacilli stain. Biochemical characteristics of this isolate were positive for catalase test but negative for oxidase, nitrate, esculin, and sugar utilization tests. The organism was further subjected to be identified by 16S ribosomal deoxyribonucleic acid gene sequencing. The result yielded Pseudoclavibacter species (99.4% identical), which could be most likely a potential pathogen in immunocompromised host like this patient. He responded well with intravenous trimetroprim-sulfamethoxazole for 6 weeks.This is the first case report of Pseudoclavibacter otitis media in children, and this case could emphasize Pseudoclavibacter species as a potential pathogen in immunocompromised host.

Topics: Actinomycetales; Actinomycetales Infections; Child, Preschool; Humans; Male; Mycobacterium tuberculosis; Otitis Media; Trimethoprim, Sulfamethoxazole Drug Combination; Tuberculosis, Pulmonary; Tuberculosis, Spinal

Topics: Actinomycetales; Actinomycetales Infections; Actinomycosis; Anti-Bacterial Agents; Ciprofloxacin; Cutaneous Fistula; Diagnosis, Differential; Foot Dermatoses; Foot Ulcer; Guatemala; HIV Seronegativity; Humans; Immunocompetence; Male; Middle Aged; Mycetoma; Nocardia Infections; Osteitis; RNA, Ribosomal, 16S; Travel; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Actinomycetales Infections; Anti-Bacterial Agents; Anticoagulants; Doxycycline; Drug Therapy, Combination; Edema, Cardiac; Endocarditis, Bacterial; Fever; Heart Valve Diseases; Humans; Hydroxychloroquine; Male; Middle Aged; Polymerase Chain Reaction; Shock, Cardiogenic; Stroke; Trimethoprim, Sulfamethoxazole Drug Combination; Tropheryma

Kytococcus schroeteri, a saprophyte of the human skin, may cause serious infections in the immunocompromised host. Here, we describe a case of pneumonia and bacteremia due to Kytococcus schroeteri in an immunocompromised patient, successfully treated with linezolid and trimethoprim-sulfamethoxazole.

Topics: Acetamides; Actinomycetales; Actinomycetales Infections; Adult; Anti-Bacterial Agents; Bacteremia; Female; Humans; Immunocompromised Host; Linezolid; Oxazolidinones; Pneumonia, Bacterial; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Mycetoma is a chronic, granulomatous, subcutaneous, inflammatory lesion caused by true fungi (eumycetoma) or filamentous bacteria (actinomycetoma). Mycetoma commonly affects young people between 20 and 40 years old. The most common affected site is the foot. The characteristic clinical triad is tumefaction, draining sinuses and discharging grains. We report a healthy 31-year-old male, with a 6-year history of a progressive inflammatory tumor associated with sinus tracts and granules on his left sole. Actinomycetoma was suspected. The clinical diagnosis was confirmed by microbiological and histopathological study. Polymerase chain reaction and DNA sequencing identified Actinomadura madurae. To our knowledge, this is the second case of mycetoma reported in Chile. Our report emphasizes the need to consider this diagnosis in patients with chronic granulomatous disease associated with sinus tracts, fistulas and grains.

Topics: Actinomycetales Infections; Adult; Anti-Bacterial Agents; Biopsy; Foot Dermatoses; Humans; Male; Mycetoma; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Mycetoma is chronic inflammatory process characterized by areas of tumefaction with draining sinus tracts. It affects the foot in 80% of cases. The purpose of this report is to describe a case that posed a diagnostic challenge due to unusual scalp location and clinical presentation.. A 23-year-old woman residing in a rural zone of Senegal consulted for indolent lesions ongoing on the scalp for 2 years. Physical examination showed two soft tumid lesions measuring about 3 cm in diameter on the vertex. The surface of the lesions was crusty but showed no sign of granules. Skull x-ray was normal. Skin biopsy demonstrated a polymorphous granulomatous infiltrate with foci of suppuration circumscribing small, irregular grains with radiating filaments. Mycological culture on Lowenstein medium demonstrated Actinomadurella pelletiere. Treatment with cotrimoxazole for 8 months led to significant regression of the lesions.. The mycetoma described in this report posed a diagnostic challenge because of its unusual scalp location and especially its tumoral or pseudo-cystic presentation. This clinical form of mycetoma must be taken into account for diagnosis in any patient from endemic areas.

Topics: Actinomycetales; Actinomycetales Infections; Adult; Anti-Infective Agents; Female; Humans; Mycetoma; Scalp Dermatoses; Time Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Actinomycetales; Actinomycetales Infections; Anti-Bacterial Agents; Anti-Infective Agents; Drug Therapy, Combination; Female; Foot Dermatoses; Humans; Middle Aged; Mycetoma; Streptomycin; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Actinomycetales; Actinomycetales Infections; Corneal Stroma; Corneal Ulcer; DNA, Bacterial; DNA, Ribosomal; Eye Infections, Bacterial; Gram-Negative Bacterial Infections; Humans; Keratoplasty, Penetrating; Male; Middle Aged; Polymerase Chain Reaction; RNA, Ribosomal, 16S; Sequence Analysis, DNA; Stenotrophomonas maltophilia; Trimethoprim, Sulfamethoxazole Drug Combination

A 29-year-old woman presented with multiple painful swelling with discharging sinuses over the scalp. Histopathological examination of the biopsy tissue was suggestive of actinomycotic mycetoma. Streptomyces spp. was isolated from blood culture. The patient was successfully treated with trimethoprim-sulfamethoxazole and crystalline penicillin. This case is reported because of the rare occurrence of bacteremia by Streptomyces spp. secondary to subcutaneous actinomycotic mycetoma. Moreover, an interesting association between successive two pregnancies and occurrence of mycetoma of the scalp was observed in this case.

Topics: Actinomycetales Infections; Adult; Animals; Anti-Bacterial Agents; Bacteremia; Blood; Female; Humans; Mycetoma; Penicillins; Sinusitis; Skin Diseases, Bacterial; Streptomyces; Trimethoprim, Sulfamethoxazole Drug Combination

To assess the in vitro susceptibility of Actinobaculum schaalii to 12 antimicrobial agents as well as to dissect the genetic basis of fluoroquinolone resistance.. Forty-eight human clinical isolates of A. schaalii collected in Switzerland and France were studied. Each isolate was identified by 16S rRNA sequencing. MICs of amoxicillin, ceftriaxone, gentamicin, vancomycin, clindamycin, linezolid, ciprofloxacin, levofloxacin, moxifloxacin, co-trimoxazole, nitrofurantoin and metronidazole were determined using the Etest method. Interpretation of results was made according to EUCAST clinical breakpoints. The quinolone-resistance-determining regions (QRDRs) of gyrA and parC genes were also identified and sequence analysis was performed for all 48 strains.. All isolates were susceptible to amoxicillin, ceftriaxone, gentamicin, clindamycin (except three), vancomycin, linezolid and nitrofurantoin, whereas 100% and 85% were resistant to ciprofloxacin/metronidazole and co-trimoxazole, respectively. Greater than or equal to 90% of isolates were susceptible to the other tested fluoroquinolones, and only one strain was highly resistant to levofloxacin (MIC ≥32 mg/L) and moxifloxacin (MIC 8 mg/L). All isolates that were susceptible or low-level resistant to levofloxacin/moxifloxacin (n = 47) showed identical GyrA and ParC amino acid QRDR sequences. In contrast, the isolate exhibiting high-level resistance to levofloxacin and moxifloxacin possessed a unique mutation in GyrA, Ala83Val (Escherichia coli numbering), whereas no mutation was present in ParC.. When an infection caused by A. schaalii is suspected, there is a risk of clinical failure by treating with ciprofloxacin or co-trimoxazole, and β-lactams should be preferred. In addition, acquired resistance to fluoroquinolones more active against Gram-positive bacteria is possible.

Topics: Actinomycetaceae; Actinomycetales Infections; Amino Acid Sequence; Anti-Bacterial Agents; Ciprofloxacin; DNA Gyrase; DNA Topoisomerase IV; Drug Resistance, Bacterial; Fluoroquinolones; France; Humans; Microbial Sensitivity Tests; Molecular Sequence Data; Mutation; Sequence Analysis, DNA; Switzerland; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

We present a case of mycetoma by Actinomadura spp. on the foot of an Albanian young man arrived to our observation approximately 5 years after the first clinical manifestations (hard tumefaction, slightly painful upon weight-bearing and palpation and cutaneous fistulas that discharged an abundant granulomatous secretion). Direct microscopic analysis and culture of the white-yellowish grains included Gram staining, which showed extensively branched Gram-positive hyphae less than 1 mm in diameter, allowing to make a diagnosis of Actinomycetoma. Since Actinomycetoma is sensitive to drug treatment, the patient was given trimethoprim-sulfamethoxazole and amikacin twice daily for 45 days. After six months of chemotherapy, the patient's general condition improved, the swelling is slightly diminished and grain extrusion has ceased. The patient has been able to resume ambulation with normal footwear. Given the absence of liver and kidney functional alterations, the patient is scheduled to continue pharmacological treatment with trimethoprim-sulfamethoxazole.

Topics: Actinomycetales; Actinomycetales Infections; Albania; Amikacin; Anti-Infective Agents; Foot; Humans; Male; Middle Aged; Mycetoma; Radiography; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Actinomycetales Infections; Adult; Anti-Infective Agents; Bacterial Infections; Brain Diseases; Female; Granuloma; Humans; Radiography; Scalp; Trimethoprim, Sulfamethoxazole Drug Combination

Actinomycetoma is a chronic infection resulting from aerobic Actinomycetes. The major agents are Nocardia brasiliensis, Actinomadura madurae, and Streptomyces somaliensis. The most frequent topographies are the lower and upper limbs. The prognosis of this disease is determined by several factors, such as etiologic agent, clinical topography, and depth of disease (degree of involvement, visceral, and bone affection). The purpose of this paper was to present our experience with actinomycetoma of the perianal region.. This study comprises 20 cases of perianal actinomycetoma, all of which were clinically and microbiologically proven by direct examinations, cultures, and biopsies. Clinical responses to the two principal treatment regimes used [combination of trimethoprim-sulfamethoxazole (TMS/SMX) and diaminodiphenylsulfone (DDS) or amikacine plus TMS/SMX] are reported.. Most of the cases were male (17/20, 85%), the mean age was 42.1 years, and the farmers predominated (90%). The principal etiologic agent isolated was N. brasiliensis (85%).. Perianal actinomycetoma is a rare entity. Differential diagnosis with anal sinuses, hydroadenitis, and cutaneous tuberculosis must be made in endemic areas by performing mycologic tests and biopsies. Treatment depends on the etiologic agent involved and the patient's condition.

Topics: Actinomycetales Infections; Adult; Aged; Agricultural Workers' Diseases; Anti-Bacterial Agents; Anti-Infective Agents; Buttocks; Dapsone; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Skin Diseases, Bacterial; Streptomycin; Trimethoprim, Sulfamethoxazole Drug Combination

Culture of Tropheryma whippelii has been established only once, in human fibroblast cell lines from a heart valve inoculum. Molecular-based diagnostic techniques, although highly sensitive, may be less specific. New diagnostic tools involving isolation of bacteria from contaminated intestinal biopsies and immunohistological detection need to be developed.. To describe a novel method for detection and culture of T whippelii strains.. Laboratory analysis of duodenal biopsy specimens from a patient with typical relapsing Whipple disease with intestinal involvement, performed Marseille, France, in March 2000. Biopsy specimens were decontaminated with antimicrobial agents and inoculated onto cell cultures. Mouse anti-T whippelii polyclonal antibodies were used to detect T whippelii in fixed specimens taken from the patient before and after relapse, compared with specimens from 10 controls. The genotype of the isolate was determined by amplification and sequencing of 2 DNA fragments (ITS and 23S rRNA).. Isolation and genotyping of a new strain(s) of T whippelii from the case patient's biopsy specimens.. A strain was grown from the case patient's intestinal specimen that has a genotype different from the first strain isolated. During 2 episodes of Whipple disease, T whippelii bacteria were detected by immunochemistry in the patient's duodenal biopsy specimens, but not in controls.. A second strain of T whippelii has been isolated and a protocol for isolation from the intestine has been proven to be efficient. Immunodetection of T whippelii in intestinal biopsy specimens may provide a useful tool for the diagnosis and follow-up of patients with Whipple disease. Both techniques need further evaluation and confirmation.

Topics: Actinobacteria; Actinomycetales Infections; Adult; Anti-Bacterial Agents; Antibodies, Bacterial; Biopsy; DNA, Bacterial; Duodenal Diseases; Female; Genotype; Humans; Immunohistochemistry; Microscopy, Confocal; Microscopy, Fluorescence; Polymerase Chain Reaction; Recurrence; RNA, Ribosomal, 16S; Trimethoprim, Sulfamethoxazole Drug Combination; Whipple Disease

We describe a 64-year-old man with an actinomycetoma of the frontal region of the head caused simultaneously by two aetiological agents, Nocardia brasiliensis and N. asteroides. This case is presented due to the unusual body site affected and, above all, because two aetiological agents were isolated.

Topics: Actinomycetales Infections; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Dapsone; Drug Therapy, Combination; Facial Dermatoses; Humans; Male; Middle Aged; Naproxen; Nocardia; Nocardia asteroides; Treatment Refusal; Trimethoprim, Sulfamethoxazole Drug Combination

To describe the clinical presentation and course of Whipple disease in an adult.. A 34-year-old man with phthisis bulbi in the right eye secondary to uveitis-induced neovascular glaucoma presented with severe acute posterior uveitis in the left eye. He underwent esophagogastroduodenoscopy and jejunal biopsy for evaluation of anemia. The posterior uveitis was treated with a subtenon injection of triamcinolone.. The diagnosis of Whipple disease was confirmed by polymerase chain reaction analysis of the jejunal biopsy that demonstrated Tropheryma whippelii rDNA.. Although Whipple disease is typically evident with malabsorption, it can also present as uveitis without prominent gastrointestinal symptoms.

Topics: Actinobacteria; Actinomycetales Infections; Adult; Anti-Bacterial Agents; DNA, Bacterial; Drug Therapy, Combination; Endoscopy, Digestive System; Glucocorticoids; Humans; Jejunum; Male; Polymerase Chain Reaction; Triamcinolone Acetonide; Trimethoprim, Sulfamethoxazole Drug Combination; Uveitis, Posterior; Whipple Disease

Cranial mycetoma is not as rare as was believed. In the Sudan, the majority of cases are caused by S. somaliensis; no cases were found to be caused by Nocardia species. Cranial actinomycetoma proved to be potentially fatal and was the most difficult to treat. The best treatment results were achieved in cases of A. madurae infection.

Topics: Actinomycetales Infections; Adolescent; Adult; Child; Dapsone; Drug Combinations; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Mitosporic Fungi; Mycetoma; Radiography; Skull; Streptomycin; Sudan; Sulfamethoxazole; Temporomandibular Joint; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination