trimethoprim--sulfamethoxazole-drug-combination and Anemia--Sickle-Cell

A patient with the acquired immunodeficiency syndrome (AIDS) and sickle cell anemia presented to the University of Wisconsin Hospital on two separate occasions with pneumocystis carinii pneumonia (PCP). On both occasions he was treated with high-dose intravenous trimethoprim/sulfamethoxazole (TMP/SMX). Several days into each treatment course he developed hyperkalemia and systemic acidosis consistent with hyperkalemic renal tubular acidosis (RTA). The abnormalities resolved in the first instance with the addition of amphotericin B while continuing TMP/SMX, and in the second upon discontinuation of the TMP/SMX. While an increasing number of cases with TMP/SMX-induced hyperkalemia have been reported, hyperkalemic RTA is an uncommon complication of TMP/SMX therapy, occurring in patients with predisposing factors for acidosis such as aldosterone defects, medullary dysfunction and renal insufficiency.

Topics: Acidosis, Renal Tubular; Adult; AIDS-Related Opportunistic Infections; Anemia, Sickle Cell; Anti-Infective Agents; Drug Therapy, Combination; HIV-1; Humans; Hyperkalemia; Male; Pneumonia, Pneumocystis; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Africa; Anemia, Sickle Cell; Child; Humans; Longitudinal Studies; Patient Discharge; Trimethoprim, Sulfamethoxazole Drug Combination

This observational study recorded the malaria and sickle cell disease (SCD) profile of people living with HIV/AIDS (PLHA) and determined whether prophylactic co-trimoxazole (CTX) and the haemoglobin S (Hb S) allele influenced malaria episodes.. Sickling status, malaria episodes, and HIV type, as well as other data, were extracted retrospectively from the clinical records of 1001 patients attending the antiretroviral therapy clinic at Ridge Regional Hospital in Accra, Ghana between 2010 and 2015. Finger-prick capillary blood of returning patients (n=501) was tested for the haemoglobin (Hb) level and malaria, after information on malaria prevention methods was obtained through the administration of a questionnaire.. The use of insecticide-treated mosquito nets was low (22.8%). CTX prophylaxis showed no significant influence on the overall number of malaria episodes from 2010 to 2015; however, it did show a statistically significant relationship (p=0.026) with the time elapsed since the last malaria episode. Even though 19% of participants possessed Hb S, it had no influence on malaria episodes.. Hb S did not influence malaria in PLHA. Further studies in Hb SS and Hb SC are needed, as there are suggestions of increased frequency and severity of malaria. The impact of CTX prophylaxis on this cohort will be insightful.

Topics: Adult; AIDS-Related Opportunistic Infections; Anemia, Sickle Cell; Antibiotic Prophylaxis; CD4 Lymphocyte Count; Female; Ghana; HIV Infections; Humans; Malaria; Male; Middle Aged; Retrospective Studies; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

The gene for sickle cell disease is carried by 8% of the African-American population in the United States. The primary care physician is often called upon to recognize and treat one of the major sequelae of sickle cell disease--vaso-occlusive pain crisis. An injectable nonsteroidal anti-inflammatory drug has recently become available and may offer some improvement in outcome of vaso-occlusive pain crises. We present five case reports reviewing various current therapeutic options, including newer pharmacologic agents, and comment on alternatives to impatient management of pain crises. The use of the emergency department short-term observation unit as an alternative to hospitalization is discussed.

Topics: Acetaminophen; Adolescent; Adult; Amitriptyline; Analgesics; Anemia, Sickle Cell; Anti-Inflammatory Agents, Non-Steroidal; Emergency Service, Hospital; Female; Humans; Ketorolac; Male; Meperidine; Oxycodone; Pain; Promethazine; Tolmetin; Trimethoprim, Sulfamethoxazole Drug Combination; Vascular Diseases

Topics: Anemia, Sickle Cell; Cefazolin; Child, Preschool; Drug Therapy, Combination; Escherichia coli Infections; Female; Gentamicins; Humans; Metacarpus; Osteomyelitis; Trimethoprim, Sulfamethoxazole Drug Combination

A 26-year-old black male with sickle-cell disease developed a Salmonella septic arthritis in one knee and an acute, aseptic arthritis in the other knee. Salmonella is showing increasing resistance to many antibiotics. In this patient, optimal antibiotic treatment of his uncommon infection was delayed by a rare resistance to trimethoprim-sulfamethoxazole. Two pathophysiologic mechanisms could account for his acute, aseptic arthritis: sickle-cell disease with presumed synovial ischemia from sickling and reactive arthritis precipitated by a remote Salmonella infection elsewhere in the body. The authors could find no previous discussion of either of these processes in the orthopedic literature. Acute arthritis in a patient with sickle-cell disease can be a complex diagnostic and therapeutic problem.

Topics: Adult; Anemia, Sickle Cell; Arthritis; Arthritis, Infectious; Ceftriaxone; Humans; Knee Joint; Male; Salmonella enteritidis; Salmonella Infections; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination