trimethoprim--sulfamethoxazole-drug-combination and Arthritis

Infections are associated with secondary forms of vasculitis. However, there is increasing evidence that microbial agents play a role also in primary systemic vasculitides. For a long time it has been noted that Hepatitis B virus (HBV) is involved in polyarteritis nodosa (PAN) although the incidence of HBV-associated PAN seems to decline. Cryoglobulinemic vasculitis has been shown to be strongly associated with Hepatitis C Virus (HCV) infection, but this is most striking in Southern Europe and less in Northern Europe. Different microbial agents have been suggested to influence disease expression in other primary vasculitides but no specific association has been established. In Wegener's Granulomatosis (WG) chronic carriage of Staphylococcus aureus (S. aureus) is associated with a strongly increased risk for relapsing disease. Various pathogenic pathways for this association have been suggested by clinical and experimental observations. Recent studies even suggest that S. aureus derived peptides, amongst others, may induce proteinase 3-ANCA via idiotypic-anti-idiotypic interactions. Treatment with co-trimoxazole in WG localized to the upper airways may result in (temporary) remission of the disease.

Topics: Anti-Infective Agents; Antibodies, Antineutrophil Cytoplasmic; Antigens, Bacterial; Arthritis; Cryoglobulinemia; Europe; Granulomatosis with Polyangiitis; Hepatitis B; Hepatitis B virus; Hepatitis C; Humans; Staphylococcal Infections; Staphylococcus aureus; Trimethoprim, Sulfamethoxazole Drug Combination

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

Although the frequency of bone and joint infections caused by Enterobacter spp. is increasing, studies regarding the optimal antibiotic therapy are scarce. The objective of this retrospective study was to assess the clinical outcomes and safety of a fluoroquinolone-cotrimoxazole combination for the treatment of bone and joint infections caused by Enterobacter cloacae. Between 2010 and 2017, 30 patients with bone and joint infections caused by E. cloacae were treated with a fluoroquinolone-cotrimoxazole combination for 8-12 weeks. There were 26 cases (87%) of infection of an internal fixation device, two cases (6.6%) of pseudarthrosis with chronic osteomyelitis, and two cases (6.6%) of infection of knee and ankle prosthetic devices. The cure rate of the fluoroquinolone-cotrimoxazole combination was 80% by intention-to-treat analysis, with a mean follow-up of 29.3 ± 19.1 months. The fluoroquinolone-cotrimoxazole combination for 8-12 weeks is effective for the treatment of bone and joint infections caused by E. cloacae.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Arthritis; Drug Therapy, Combination; Drug-Related Side Effects and Adverse Reactions; Enterobacter cloacae; Enterobacteriaceae Infections; Female; Fluoroquinolones; Humans; Male; Middle Aged; Osteomyelitis; Prosthesis-Related Infections; Retrospective Studies; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

A 5-year-old male castrated Lhasa Apso cross was evaluated for a 1-month history of inappetence, lethargy, gagging, and progressive right thoracic limb lameness. Synovial fluid analysis revealed nonseptic suppurative inflammation, and a diagnosis of immune-mediated polyarthritis (IMPA) was made. After 3 months of treatment with prednisone and later cyclosporine, the dog developed multiple firm cutaneous and subcutaneous masses and a focal mass within the jejunum. Cultures of blood, urine, skin lesions, and the jejunal mass identified Nocardia veterana by matrix-absorption laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS) and allowed for earlier identification of the organism compared to more traditional secA1 gene sequencing. Immunosuppressive drug treatment was discontinued, and the dog was treated for 3 months by administration of trimethoprim-sulfamethoxazole (TMS). No recurrence of clinical signs was reported 1 year later. This case report highlights the clinical utility of MALDI-TOF MS, particularly for the rapid identification of slow-growing, fastidious organisms.

Topics: Animals; Arthritis; Cyclosporine; Dog Diseases; Dogs; Immunosuppressive Agents; Male; Nocardia; Nocardia Infections; Prednisone; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; Trimethoprim, Sulfamethoxazole Drug Combination

A 50-year-old man was treated with trimethoprim-sulfamethoxazole (TMP-SMX) for acute arthritis of his right big toe. Within a few days, he developed dyspnoea, hypoxaemia and diffuse pulmonary infiltrates. Symptoms improved with discontinuation of the antibiotic but worsened again with its reintroduction. An open lung biopsy was performed. We describe the workup performed and the factors that pointed to a final diagnosis of TMP-SMX-related pulmonary toxicity in the form of acute fibrinous organising pneumonia.

Topics: Alveolar Epithelial Cells; Anti-Bacterial Agents; Arthritis; Biopsy; Fibrin; Humans; Lung; Male; Middle Aged; Pneumonia; Trimethoprim, Sulfamethoxazole Drug Combination

A 41-year-old lady was investigated by several hospital teams over a 5-year period. She initially presented with arthralgia but over time developed a myriad of signs and symptoms. Later, she was admitted for investigation of profound weight loss, anaemia and a rising C-reactive protein. Extensive gastrointestinal investigations were performed. Duodenal biopsy revealed microscopic evidence of villous blunting with prominent collections of macrophages within the lamina propria and submucosa. These changes were consistent with Whipple's disease and confirmed by polymerase chain reaction on the biopsy sample. Initiation of antibiotic therapy led to normalisation of inflammatory markers and marked clinical improvement. Even in younger female patients, this disease should always be considered.

Topics: Adult; Anti-Bacterial Agents; Arthritis; Biopsy; Ceftriaxone; Diagnosis, Differential; Diarrhea; Dose-Response Relationship, Drug; Drug Therapy, Combination; Duodenum; Female; Humans; Methotrexate; Prednisolone; Sulfasalazine; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Whipple Disease

We describe a septic loosening of a hip prosthesis in a 71-year-old woman caused by Gardnerella vaginalis. Infection was confirmed by culture and molecular identification of this bacterium. The patient was treated by a one-step exchange of prosthesis and antibiotic therapy combining trimethoprim-sulfamethoxazole and rifampin, with favorable evolution.

Topics: Aged; Anti-Bacterial Agents; Arthritis; Arthroplasty, Replacement, Hip; Bacterial Infections; Female; Gardnerella vaginalis; Humans; Molecular Sequence Data; Prosthesis-Related Infections; Rifampin; Sequence Analysis, DNA; Trimethoprim, Sulfamethoxazole Drug Combination

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

Topics: Anti-Infective Agents; Arthritis; Chronic Disease; Diarrhea; Duodenum; Gastrointestinal Transit; Humans; Intestinal Mucosa; Male; Middle Aged; Tomography, X-Ray Computed; Treatment Outcome; Tremor; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography; 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

Topics: Arthritis; Female; Humans; Ibuprofen; Meningitis, Aseptic; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

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

Topics: Aged; Anti-Infective Agents, Urinary; Arthritis; Drug Combinations; Humans; Male; Methotrexate; Psoriasis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Animals; Anti-Infective Agents; Arthritis; Dog Diseases; Dogs; Drug Combinations; Female; Pyoderma; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

The first reported case of Whipple's disease in a female who was HLA-B27 positive and had asymptomatic sacroiliitis is discussed. She presented great difficulty in diagnosis as she had multi-system involvement without diarrhea. This case supports the hypothesis that Whipple's disease is a disorder related to HLA-B27.

Topics: Anti-Infective Agents; Arthritis; Biopsy; Chloramphenicol; Drug Combinations; Female; HLA Antigens; HLA-B27 Antigen; Humans; Intestine, Small; Lymph Nodes; Lymphadenitis; Middle Aged; Radiography; Sacroiliac Joint; Sex Factors; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Whipple Disease