trimethoprim--sulfamethoxazole-drug-combination and Aortic-Valve-Insufficiency

Topics: Aortic Valve Insufficiency; Disease Susceptibility; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Endocarditis, Bacterial; Gram-Negative Bacterial Infections; HIV Infections; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Mouth; Ofloxacin; Rheumatic Heart Disease; Risk Factors; Stenotrophomonas maltophilia; Substance Abuse, Intravenous; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Bacterial Agents; Antibodies, Bacterial; Aortic Valve Insufficiency; Biopsy; Disease Progression; Doxycycline; Duodenum; Follow-Up Studies; Heart Valve Prosthesis Implantation; Humans; Hydroxychloroquine; Hypertension, Pulmonary; Immunoenzyme Techniques; Lymph Nodes; Male; Medication Adherence; Middle Aged; Pericarditis, Constrictive; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination; Tropheryma; Whipple Disease

A 53-year-old patient had a prosthetic valve (St. Jude Medical 25) 9 years ago because of a Staphylococcus aureus endocarditis with severe aortic regurgitation. An initially mild, progressively more severe, aortic regurgitation then developed as a result of an empty paravalvular abscess cavity, requiring another valve replacement. Fever started on the 3rd postoperative day and persisted despite combined treatment with beta-lactam antibiotics and aminoglycoside.. At first no infectious focus could be identified radiologically or by echocardiography. But transoesophageal echocardiography revealed vegetations in the old abscess cavity. Several blood cultures were negative, while serological tests gave markedly raised antibody titers against Coxiella burnetii.. Assuming Coxiella burnetii endocarditis the patient was given doxycycline, 2 x 100 mg daily and cotrimoxazole, 1 x 960 mg daily. The fever subsided and the vegetations had disappeared after four weeks. Because of the high risk of recurrence the antibiotic treatment was to be continued for two years.. Coxiella burnetii should be considered as a possible cause of fever of unknown origin, especially in patients with existing or operated cardiac valvar defects, when endocarditic vegetations have been demonstrated and several blood cultures have been negative.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antibodies, Bacterial; Aortic Valve; Aortic Valve Insufficiency; Coxiella burnetii; Doxycycline; Drug Therapy, Combination; Echocardiography, Transesophageal; Endocarditis, Bacterial; Gentamicins; Heart Valve Prosthesis Implantation; Humans; Male; Middle Aged; Postoperative Complications; Q Fever; Recurrence; Reoperation; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination

From 1973 to 1983 nine cases of Brucella melitensis infection were hospitalised at the Centre hospitalier universitaire vaudois (CHUV), Lausanne. In each case, the infection was acquired in a Mediterranean country (4 cases in Italy, 2 in Spain, 2 in Portugal and 1 in Greece). In 6 of the cases the disease was acquired by ingestion of dairy products and in 2 cases by direct animal contact. Despite classical initial symptomatology (fever, rigors, weakness), the time from first symptoms to diagnosis varied between 10 days and 5 months. This delay probably explains why 6 of 9 patients were admitted because of septic complications: orchi-epididymitis, arthritis, meningitis and endocarditis. With prolonged antibiotherapy, the evolution was favourable in all cases. The patient who presented with endocarditis required emergency aortic valve replacement. Culture of the valve showed the presence of 10(9) B. melitensis/g of tissue. Cure was achieved by the administration of streptomycin and tetracycline for 6 weeks, followed by cotrimoxazole for one year. These cases show that the diagnosis of Brucella infection is becoming rare in Switzerland. It is often not suspected, and prompt diagnosis is delayed until further complications occur. Serology and blood cultures should be done in every patient presenting with fever after a stay in endemic countries.

Topics: Adult; Aortic Valve Insufficiency; Arthritis, Infectious; Blood; Brucella; Brucellosis; Cerebrospinal Fluid; Child; Drug Combinations; Endocarditis, Bacterial; Female; Heart Valve Prosthesis; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Sepsis; Streptomycin; Sulfamethoxazole; Synovial Fluid; Tetracyclines; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination