trimethoprim--sulfamethoxazole-drug-combination and Arthralgia

Brucellosis is transmitted from infected animals to humans mainly by unpasteurised dairy products. Typical symptoms include undulant fever and arthralgia, but the disease can affect all organ systems and cause chronic debilitating and disabling illness. The condition is likely severely underdiagnosed, especially in impoverished populations.. A young girl presented with a one-day history of ankle pain and low-grade fever. She was born in a refugee camp in the Middle East, but lived with a Norwegian foster family and was considered to be healthy before the symptoms emerged. Blood culture surprisingly revealed growth of Brucella melitensis. She was successfully treated with a combination of trimethoprim-sulfamethoxazole and rifampicin.. This girl was likely infected with Brucella through ingestion of goat's milk, which she was given in the refugee camp. The disease presented with arthritis nearly two years after exposure.

Topics: Animals; Arthralgia; Arthritis; Blood Culture; Brucella melitensis; Brucellosis; Female; Humans; Trimethoprim, Sulfamethoxazole Drug Combination

Whipple's disease is a chronic, rare, multisystemic, infectious entity, described for the first time in 1907. Its aetiological agent is the Gram-negative rod,

Topics: Abdominal Pain; Administration, Intravenous; Aged; Anti-Bacterial Agents; Arthralgia; Biopsy; Ceftriaxone; Diarrhea; Duodenum; Humans; Male; Trimethoprim, Sulfamethoxazole Drug Combination; Whipple Disease

Whipple disease (WD) is a rare disease caused by Tropheryma whipplei. The classic profile of the patient is that of a middle-aged man presenting with fever, chronic diarrhea, and arthralgias. Extragastrointestinal manifestations are not rare. A high degree of clinical suspicion for the disease is needed in atypical cases. Trimethoprim-sulfamethoxazole is the treatment of choice. We present two patients with WD. The first presented with melena and generalized hyperpigmentation. The second had depression for two years before the typical symptoms. Both hyperpigmentation and long-lasting depression without the typical manifestations of the disease are rare. Histologic examination of tissue biopsies was diagnostic for WD. Both patients were treated successfully with trimethoprim-sulfamethoxazole.

Topics: Adult; Anti-Bacterial Agents; Arthralgia; Biopsy; Depression; Diarrhea; Duodenoscopy; Fever; Humans; Hyperpigmentation; Male; Melena; Middle Aged; Tomography, X-Ray Computed; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Whipple Disease

Topics: Adolescent; Adrenal Cortex Hormones; Anti-Infective Agents; Arthralgia; Cyclophosphamide; Diagnosis, Differential; Fatigue; Female; Fever; Glomerulonephritis; Granulomatosis with Polyangiitis; Humans; Immunosuppressive Agents; Muscle Weakness; Pallor; Renal Dialysis; Stomatitis, Aphthous; Trimethoprim, Sulfamethoxazole Drug Combination

To present our 10-year clinical experience with brucellosis patients at the University Clinic for Infectious Diseases and Febrile Conditions in Skopje, Republic of Macedonia.. A total of 550 patients with brucellosis treated between 1998 and 2007 were retrospectively assessed for their demographic, epidemiological, and clinical characteristics and outcomes.. Of the 550 patients, 395 (72%) were male. The median age was 34.5 years (range, 1-82). Direct contact with infected animals was recorded in 333 (61%) patients and positive family history in 310 (56%). The most frequently seen symptoms were arthralgia (438, 80%), fever (419, 76%), and sweating (394, 72%). The most common signs were fever and hepatomegaly, which were verified in 357 (65%) and 273 (50%) patients, respectively. Focal brucellosis was found in 362 patients (66%) and osteoarticular in 299 (54%). Therapeutic failures were registered in 37 (6.7%) patients. Of the 453 (82%) patients who completed a follow-up period of at least 6 months, relapses occurred in 60 (13%).. Due to non-specific clinical manifestation and laboratory parameters, brucellosis should be considered one of the differential diagnoses of any patient suffering from obscure involvement of various organs in a brucellosis-endemic region. High percentage of relapses and therapeutic failures in spite of the use of currently recommended therapeutic regimens indicates the seriousness of this zoonosis and the need to control it.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Animals; Anti-Bacterial Agents; Arthralgia; Brucellosis; Child; Child, Preschool; Disease Outbreaks; Endemic Diseases; Female; Fever; Humans; Infant; Male; Middle Aged; Republic of North Macedonia; Retrospective Studies; Sweating; Time Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult; Zoonoses

Topics: Anti-Bacterial Agents; Arthralgia; Arthritis; Arthritis, Infectious; Arthroplasty, Replacement, Knee; Atorvastatin; Combined Modality Therapy; Debridement; Diagnosis, Differential; Doxycycline; Drug Interactions; Female; Heptanoic Acids; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hyperlipoproteinemia Type II; Levofloxacin; Middle Aged; Ofloxacin; Postoperative Complications; Prosthesis-Related Infections; Pyrroles; Recurrence; Reoperation; Rifampin; Thyroiditis, Autoimmune; Thyroxine; Trimethoprim, Sulfamethoxazole Drug Combination

Two patients, a woman aged 66 and a man aged 56 years, with an inflammatory syndrome, weight loss, joint pain and abdominal lymphadenopathy received long-term treatment with corticosteroids for alleged sarcoidosis. No long-term remission was induced and the patients were referred for a second opinion. Eventually the diagnosis of Whipple's disease was established 5 years after the appearance of the first symptoms in the case of the female patient and 4 years after in the case of the male patient. Both patients showed a marked clinical improvement after treatment with trimethoprim-sulfamethoxazole. An atypical presentation of alleged sarcoidosis should suggest the possibility of Whipple's disease, especially in the case of gastrointestinal symptoms and the failure to respond to corticosteroids, and warrants duodenal biopsy. The presence of granulomas with an elevated angiotensin-converting enzyme level is not pathognomonic for sarcoidosis. It is vitally important to distinguish the two disorders, as Whipple's disease is an infectious disorder that requires antibiotic therapy to prevent a fatal outcome.

Topics: Abdomen; Adrenal Cortex Hormones; Aged; Anti-Infective Agents; Arthralgia; Diagnosis, Differential; Female; Humans; Lymphatic Diseases; Male; Middle Aged; Sarcoidosis; Treatment Failure; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Weight Loss; Whipple Disease

Cardiac manifestations of Whipple disease are rarely diagnosed before death.. To describe four patients with endocarditis caused by Tropheryma whippelii who did not have overt gastrointestinal disease.. Case series.. Five hospitals in eastern Switzerland.. Three men and one woman undergoing replacement of insufficient heart valves.. Histologic characteristics of heart valves and intestinal biopsy; broad-range and specific polymerase chain reaction for T. whippelii.. Tropheryma whippelii was found in the heart valves (three aortic valves and one mitral valve) of four patients with culture-negative endocarditis necessitating valve replacement. All patients had arthralgia for different lengths of time. Only one patient had mild gastrointestinal symptoms. Histologic characteristics of intestinal mucosa were normal in all patients, and polymerase chain reaction on intestinal biopsy was positive for T. whippelii in only one patient, who did not have diarrhea. In all patients, arthralgia resolved promptly after institution of antibiotic therapy. Disease did not recur in any patient after prolonged antibiotic therapy with cotrimoxazole.. In patients with culture-negative endocarditis, the absence of clinical, microscopic, or microbiological evidence of gastrointestinal disease did not rule out T. whippelii.

Topics: Actinobacteria; Anti-Bacterial Agents; Aortic Valve; Arthralgia; Arthritis; Endocarditis, Bacterial; Female; Humans; Male; Middle Aged; Mitral Valve; Trimethoprim, Sulfamethoxazole Drug Combination; Whipple Disease