trimethoprim--sulfamethoxazole-drug-combination and Autoimmune-Diseases

Pneumocystis jirovecii pneumonia plays an increasing role in patients with autoimmune disorders, due to more intensive immunosuppressive therapy. Humans seem to be the most important pathogen reservoir. Diseases are probably caused by airborne new infections. Cough, subfebrile temperature and dyspnea on exertion are the leading symptoms. In addition to imaging, in particular high-resolution computed tomography, pathogen detection by staining methods or molecular genetic methods plays the decisive role. Trimethoprim and sulfamethoxazole (TMP-SMX) is the most important medication for treatment. Adjuvant corticosteroid treatment is sometimes recommended, but evidence for benefits in patients with rheumatological disorders is not well documented. For patients on high-dose systemic corticosteroid treatment or intensive combined immunosuppression, primary prophylaxis is recommended by many experts. TMP-SMX remains the first-choice preventive treatment in these patients.

Topics: Adrenal Cortex Hormones; Autoimmune Diseases; Bacteriological Techniques; Drug Therapy, Combination; Humans; Immunosuppressive Agents; Opportunistic Infections; Pneumonia, Pneumocystis; Primary Prevention; Risk Factors; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

Antiinfective drugs may show the same mechanisms of nephrotoxicity as other drugs, and these can be subgrouped into vascular, tubulotoxic, tubulo-obstructive, and immunologic effects. While vascular effects of antiinfective drugs are rare, tubulotoxicity is a well known phenomenon, especially in connection with aminoglycosides and amphotericin B as well as cephalosporins, pentamidine, foscarnet, and cidovir. The tubulo-obstructive effect caused by precipitation of the drug and first observed after treatment with sulfonamides in the 1940s, has become a renascent problem now that high doses of sulfonamides are being given to immunocompromised patients (sulfadiazine, cotrimoxazole). Moreover, this effect has also been associated with newer antiviral drugs like acyclovir and indinavir. We describe a transplant patient who received high doses of cotrimoxazole for pneumocystis carinii pneumonia and lost transplant function mainly due to bioptically proven glomerular and tubular crystallization with tubular degeneration caused by sulfamethoxazole. Acute interstitial nephritis is the main immunologic effect of antiinfective drugs (especially rifampicin but also cephalosporins, quinolones, sulfonamides, and penicillins). Immune stimulation by cytokine treatment (mainly interferon-alpha) involves several kinds of autoimmune renal diseases like acute interstitial nephritis or glomerulonephritis as well as interstitial and vascular rejection of renal transplants.

Topics: Adult; Anti-Infective Agents; Autoimmune Diseases; Female; Glomerulonephritis; Humans; Kidney Diseases; Kidney Failure, Chronic; Kidney Glomerulus; Kidney Transplantation; Kidney Tubules; Nephritis, Interstitial; Pneumonia, Pneumocystis; Sulfamethoxazole; Trimethoprim, Sulfamethoxazole Drug Combination

Linear IgA bullous dermatosis (LABD) is an autoimmune subepidermal blistering disease that may be associated with drug exposure.. Our purpose was to compare the clinical, pathologic, and immunofluorescence findings in drug-induced LABD with those in the idiopathic type.. Six patients with an acute drug eruption were identified who had linear IgA deposition at the basement membrane zone (BMZ). Lesional tissue was examined by brightfield microscopy, and perilesional tissue was examined by direct immunofluorescence (DIF). The presence of circulating BMZ antibody was assayed by indirect immunofluorescence (IIF) on monkey esophagus (ME) and salt-split human skin (SS).. Histopathologic examination showed subepidermal bullae with varying numbers of inflammatory cells. DIF showed linear IgA at the BMZ; three of the patients also had weak deposition of C3 at the BMZ. Serum from five patients was studied by IIF. One patient had circulating IgA BMZ antibodies in a titer of 1:80 on ME, localized to the dermal side on SS. All patients were free of lesions within 5 weeks after discontinuation of the drug.. Drug-induced LABD is a self-limited eruption characterized by linear deposition of IgA without IgG at the BMZ. Most patients lack circulating antibodies. The distribution of lesions and the course of the disease differ from those of idiopathic LABD.

Topics: Aged; Autoimmune Diseases; Basement Membrane; Captopril; Drug Eruptions; Female; Humans; Immunoglobulin A; Male; Phenytoin; Rifampin; Skin; Skin Diseases, Vesiculobullous; Somatostatin; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

Topics: Adult; Autoimmune Diseases; Contraindications, Drug; Drug Therapy, Combination; Female; Humans; Leukopenia; Liver; Male; Methotrexate; Middle Aged; Pneumonia, Pneumocystis; Transaminases; Trimethoprim, Sulfamethoxazole Drug Combination

Trimethoprim-sulfamethoxazole (TMP/SMX) treatment for pneumocystis pneumonia (PCP) in patients with autoimmune diseases who developed PCP was conducted in a retrospective study of the following: dosage, frequency of side effects and persistence rate of TMP/SMX and prognosis of patients. Seven patients (two males and five females, mean age: 72 years) were hospitalized between April 1, 2013 and August 31, 2015, and their underlying diseases were rheumatoid arthritis (six patients) and microscopic polyangiitis (one patient). Moderate-dose TMP/SMX (TMP equivalent to TMP/SMX, average: 9.6 mg/kg/day, range: 5.1-12.5 mg/kg/day) was used for PCP treatment. As a result, patients experienced the following side effects: hyponatremia in five patients (71.4%), exanthema in four patients (57.1%), and thrombocytopenia in two patients (28.6%). Elevated creatinine level, increased blood pressure, malaise, and hyperkalemia were experienced by each patient. Six patients (85.7%) discontinued TMP/SMX treatment due to side effects, but once they had recovered, desensitization to TMP/SMX was used to treat them. Eventually, four patients were successfully treated with TMP/SMX (final persistence rate, 57.1%). Their prognoses were good, and no patients died for at least 60 days after admission. Moderate-dose TMP/SMX treatment for PCP in patients with autoimmune diseases who developed PCP may have therapeutic effects equal to high-dose TMP/SMX treatment, and therefore collecting more case studies is expected.

Topics: Aged; Aged, 80 and over; Arthritis, Rheumatoid; Autoimmune Diseases; Female; Humans; Immunocompromised Host; Male; Microscopic Polyangiitis; Middle Aged; Pneumonia, Pneumocystis; Prognosis; Retrospective Studies; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Indications for Pneumocystis jirovecii pneumonia (PCP) prophylaxis in patients with autoimmune disease remain unclear. We aimed to determine (1) the incidence of PCP in patients with autoimmune disease in general, in a clinical setting where prophylaxis is not routine, and (2) whether high-dose glucocorticoid (≥30 mg oral prednisolone or equivalent per day) is a risk factor for PCP infection.. A retrospective review of the medical records of patients with autoimmune diseases hospitalized to a tertiary center over a 5-year study period was carried out. Patient demographics, mean glucocorticoid dose (in the last 1 month), and the outcomes of patients who developed PCP were analyzed.. The incidence rate of PCP infection was 75 per 100,000 patients per year. The in-hospital mortality was 50%, and all those who died were on high-dose glucocorticoid at the time of PCP diagnosis. There was a significant difference between the occurrence of PCP in patients who were on high-dose vs non-high-dose glucocorticoid (df = 1, P = 0.009), with a relative risk of 19 (P = 0.010; 95% confidence interval, 2.0-182.8). The mean oral prednisolone dose of patients who developed PCP and those who did not were 55.5 versus 10.7 mg, respectively, P = 0.002.. High-dose glucocorticoid may be associated with an increased risk of PCP infection in patients with autoimmune diseases.

Topics: Adult; Aged; Anti-Infective Agents; Autoimmune Diseases; Female; Glucocorticoids; Humans; Incidence; Male; Middle Aged; Pneumocystis carinii; Pneumonia, Pneumocystis; Prednisolone; Retrospective Studies; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination

Autoimmune disorders occur with a higher incidence in common variable immunodeficiency (CVID) patients than in the general population. To describe the clinical features of the autoimmune phenotype in patients with CVID.. The hospital records of all diagnosed CVID patients referred to the Children's Medical Center Hospital in Tehran, Iran between 2000 and 2010 were reviewed. Patients were also classified according to the presence or absence of autoimmune disease.. Of 52 patients studied, 26.9% (n=14) had shown at least 1 autoimmune manifestation during the study period. Autoimmune cytopenias and juvenile rheumatoid arthritis were the most common form of autoimmunity in our series. Autoimmunity was significantly associated with polyclonal lymphocytic infiltrative disorders (P = .017), increased serum Immunoglobulin (Ig) M levels (P < .001), decreased IgE values (P = .04) and diminished switched memory B-cell count (P < .001).. Because autoimmunity is one of the first manifestations in CVID, humoral immune system tests should be considered in autoimmune patients with a history of recurrent infection. The presence of polyclonal lymphocytic infiltrative disorders and decreased switched memory B-cells may predispose CVID patients to autoimmunity.

Topics: Adolescent; Autoimmune Diseases; Child; Common Variable Immunodeficiency; Female; Humans; Immunoglobulins; Male; Phenotype; Trimethoprim, Sulfamethoxazole Drug Combination

Nocardia species is an uncommon pathogen that affects both immunosuppressed and immunocompetent patients. The clinical and microbiologic spectrum of nocardiosis has changed recently due to the widespread use of cotrimoxazole prophylaxis, the emergence of new types of immunosuppressed patients, and the improved identification of isolates using molecular techniques. Nocardia asteroides was traditionally considered the predominant organism, and prophylaxis with cotrimoxazole was considered almost universally protective. We conducted the current study to determine the incidence of nocardiosis and its microbiologic and clinical characteristics in a general hospital over the last 12 years. We reviewed the clinical records of all patients in whom Nocardia species was isolated from clinical specimens between 1995 and 2006. Nocardia isolates were identified by standard procedures and by 5' end 16S rRNA gene polymerase chain reaction (PCR) and sequencing. Susceptibility to cotrimoxazole, minocycline, imipenem, linezolid, and amikacin was determined by the broth microdilution method following the guidelines of the Clinical and Laboratory Standards Institute.The incidence of Nocardia infections did not increase significantly during the study period (0.39/100,000 inhabitants in 1995-1998 and 0.55/100,000 inhabitants in 2003-2006). Nocardia was recovered from 43 patients. Six were considered to be colonized. The colonizing species were N. farcinica, N. nova, and N. asteroides. All colonized patients had severe underlying pulmonary conditions and were treated with antimicrobials (6 patients) or corticosteroids (4 patients). Invasive nocardiosis was diagnosed in 37 patients (86.5% were men, and their mean age was 55.8 +/- 17.3 yr). The most common underlying condition in our institution was human immunodeficiency virus (HIV) infection (10 patients; 27%), followed by chronic obstructive pulmonary disease (8 patients; 21.6%), autoimmune diseases (8 patients; 21.6%), solid organ transplantation (7 patients; 18.9%), and cancer (4 patients; 10.8%). The most important risk factor for nocardiosis was corticosteroid administration (23 patients; 62.2%). Nocardiosis affected the lungs in 26 cases (70.3%), the skin in 3 cases (8.1%), and the central nervous system in 2 cases (5.4%). It was disseminated in 5 cases (13.5%) and caused otomastoiditis in 1 (2.7%). The species identified were N. cyriacigeorgica (32.4%), N. farcinica (24.3%), N. otitidiscaviarum (10.8%), N. veterana (8.1%

Topics: Adult; Aged; Anti-Infective Agents; Autoimmune Diseases; Drug Resistance, Bacterial; Female; HIV Infections; Humans; Incidence; Male; Middle Aged; Neoplasms; Nocardia; Nocardia Infections; Organ Transplantation; Pulmonary Disease, Chronic Obstructive; Retrospective Studies; Risk Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Infective Agents; Autoantibodies; Autoimmune Diseases; Humans; Male; Middle Aged; Paranasal Sinus Diseases; Peroxidase; Sweet Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Autoimmune Diseases; Drug Therapy, Combination; Humans; Immunoglobulin A; Immunosuppressive Agents; Male; Middle Aged; Mycophenolic Acid; Skin Diseases, Vesiculobullous; Trimethoprim, Sulfamethoxazole Drug Combination

Anterior scleritis is defined as an inflammation of the sclera, located anteriorly to the equator of the eye. Cotrimoxazole is an antibiotic with an immunomodulatory action.. In case of idiopathic anterior scleritis or scleritis associated with autoimmune diseases, immunosuppressive treatment is often required. We report on six patients with anterior idiopathic scleritis non sensitive to local treatment where cotrimoxazole improved or cured the symptoms.. Cotrimoxazole seems to be an interesting therapeutic treatment in non threatening anterior scleritis.

Topics: Aged; Anti-Infective Agents; Antibodies, Antineutrophil Cytoplasmic; Antibodies, Antinuclear; Autoimmune Diseases; Female; Humans; Immunologic Factors; Middle Aged; Recurrence; Scleritis; Trimethoprim, Sulfamethoxazole Drug Combination

Most children with autoimmune neutropenia (AIN) have a benign clinical course because of the spontaneous resolution of neutropenia. The authors observed the clinical course of AIN in infancy accompanied by the prophylactic use of trimethoprim-sulfamethoxazole (TMP-SMX) during neutropenia.. Eight infants with AIN were followed by serial tests for antineutrophil antibodies and management of infectious complications.. The spontaneous disappearance of antineutrophil antibodies that preceded the normalization of the neutrophil count was found in all patients. Until the resolution of neutropenia, TMP-SMX was administered in five patients, resulting in a reduction in the incidence of infection with no adverse effects.. These observations demonstrate the possibility of the safety and usefulness of TMP-SMX treatment in patients with AIN.

Topics: Anti-Infective Agents; Antibiotic Prophylaxis; Antibodies, Antineutrophil Cytoplasmic; Autoantibodies; Autoimmune Diseases; Communicable Disease Control; Female; Follow-Up Studies; Humans; Infant; Infections; Male; Neutropenia; Neutrophils; Trimethoprim, Sulfamethoxazole Drug Combination

A 13 year old girl presented with auricular chondritis and recurrent episodes of unexplained chest pain, arthritis, bronchitis, conjunctivitis, prolonged steroid resistant alopecia areata, and a history of recurrent tonsillitis. Both the mosaic of autoimmunity and relapsing polychondritis were considered in the differential diagnosis. The patient was successfully treated with co-trimoxazole. The significance of co-trimoxazole, which is an antibiotic and an immunomodulatory drug, in the treatment of autoimmune disease is discussed.

Topics: Adolescent; Alopecia Areata; Anti-Infective Agents; Autoimmune Diseases; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Polychondritis, Relapsing; Trimethoprim, Sulfamethoxazole Drug Combination

Autoimmune neutropenia in infancy (AIN) is caused by granulocyte-specific autoantibodies. Clinical presentation and diagnosis have not been well studied, resulting in cumbersome diagnostic investigations and unnecessary treatment such as granulocyte colony-stimulating factor (G-CSF) therapy.. Clinical, laboratory and immunological data of 18 infants with AIN were evaluated. Granulocyte-specific autoantibodies were detected by the direct granulocyte immunofluorescence test (D-GIFT), indirect granulocyte immunofluorescence test (I-GIFT) and immunoblotting.. The average age of onset and resolution of neutropenia in AIN was 7.4 +/- 3.4 mo (mean +/- SD) and 20.4 +/- 4.9 mo, respectively. Sixteen of the 18 patients presented with mild infectious symptoms; the other 2 patients were detected by chance and presented with no infectious symptoms. D-GIFT was positive in all patients, and I-GIFT was positive in 17 of these 18 patients. Most patients showed preferential binding to neutrophils from NA(1 + 2-)-phenotyped donors by 1-GIFT and immunoblotting. An antibiotic (sulfamethoxazole-trimethoprim) was given to 15 patients for prophylaxis. G-CSF was given to only one infectious patient.. A combination of diagnostic tests for the detection of granulocyte-specific autoantibodies was useful in diagnosing AIN, thus avoiding unnecessary investigations. Continuous treatment with G-CSF was not necessary for prophylaxis, even if neutrophil counts were extremely low.

Topics: Anti-Infective Agents; Autoimmune Diseases; Drug Therapy, Combination; Female; Fluorescent Antibody Technique, Direct; Fluorescent Antibody Technique, Indirect; Granulocytes; Humans; Immunoblotting; Infant; Infant, Newborn; Male; Neutropenia; Trimethoprim, Sulfamethoxazole Drug Combination

Trimethoprim-associated systemic reactions, including aseptic meningitis, have been reported to be very rare adverse drug reactions. Patients with Sjögren's syndrome have been overrepresented, but no epidemiological surveys of the reaction have been conducted. To study the overall frequency of adverse drug reactions, and especially trimethoprim-associated reactions, we interviewed 85 primary Sjögren's syndrome patients and compared the results with those of 45 similarly interviewed osteoarthritis patients. Antimicrobial allergy was more common among Sjögren's syndrome patients than in osteoarthritis patients (46% vs. 27%). Eleven Sjögren's syndrome patients (13%), but no osteoarthritis patient, had experienced at least a partial, non-allergic systemic reaction with trimethoprim. Of them five (6%) had had a full-blown systemic reaction including both chills/fever and headache/backache and at least one of the following: malaise, vomiting, dizziness, confusion or meningeal irritation. Our findings confirm that allergic reactions to antimicrobials are frequent in Sjögren's syndrome. In addition to allergic reactions Sjögren's syndrome patients are prone to a specific trimethoprim-associated systemic reaction. This should be remembered when prescribing antimicrobials.

Topics: Adult; Aged; Antimalarials; Autoimmune Diseases; Drug Hypersensitivity; Female; Health Surveys; Humans; Interviews as Topic; Male; Middle Aged; Sjogren's Syndrome; Surveys and Questionnaires; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

No information is available concerning the target antigen(s) in drug-induced linear IgA disease. The purpose of this study was to define better drug-induced linear IgA disease by studying its immunopathological, immunoultrastructural and immunochemical characteristics in three patients. In the first patient, IgA deposits were seen in the lamina lucida. In the second and the third patients, IgA deposits were seen on each side of the lamina densa. Immunoblotting of the first patient's serum showed that IgA reacted with a protein of 230 kDa similar to the bullous pemphigoid-associated antigen 1 (BPAG 1). The second patient's serum did not react with specific bands. In the third patient IgA antibodies reacted with a protein of 97 kDa on epidermal extracts. Our findings suggest that, as in idiopathic forms, the target antigen is not unique in drug-induced linear IgA disease. In some patients, drug-induced linear IgA disease may represent an IgA class response to the BPAG 1.

Topics: Adult; Aged; Anti-Infective Agents; Anti-Inflammatory Agents, Non-Steroidal; Anticonvulsants; Autoimmune Diseases; Basement Membrane; Blotting, Western; Diclofenac; Female; gamma-Aminobutyric Acid; Humans; Immunoglobulin A; Male; Microscopy, Immunoelectron; Skin; Skin Diseases, Vesiculobullous; Trimethoprim, Sulfamethoxazole Drug Combination; Vigabatrin

We treated a patient with an atypical presentation of Wegener's granulomatosis (WG) with dural involvement as the initial clinical manifestation. A 37-year-old man had a dural lesion without lower respiratory tract or renal manifestations in the initial clinical course. His only initial symptom was headache, and at disease onset computed tomography (CT) and magnetic resonance imaging (MRI) of the head revealed bilateral abnormal subdural masses. The diagnosis of WG was made based on the results of needle biopsy of the nasal polyps and the finding of positive circulating antineutrophil cytoplasmic antibodies (c-ANCA). He achieved remission on daily prednisone and cyclophosphamide with the later addition of sulfamethoxazole-trimethoprim.

Topics: Adult; Antibodies, Antineutrophil Cytoplasmic; Autoimmune Diseases; Biopsy; Cyclophosphamide; Dura Mater; Granulomatosis with Polyangiitis; Headache; Hematoma, Subdural; Humans; Immunosuppressive Agents; Magnetic Resonance Imaging; Male; Nasal Polyps; Prednisone; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

We report 5 patients with repeated episodes of meningitis related to intake of trimethoprim containing compounds. On at least one occasion the patients received pure trimethoprim prior to reaction. Autoimmune disease was established in 3 of the patients. A close temporal relationship between drug intake and reaction was noted: symptoms appeared often within minutes. No evidence of infections was found. Lumbar puncture after recovery revealed normal values in 2 patients. This aseptic meningitis is most likely an adverse drug reaction and associated with trimethoprim intake. The reaction is infrequently reported in relation to drug sales but its incidence has probably been underestimated.

Topics: Adolescent; Adult; Aged; Anti-Infective Agents, Urinary; Autoimmune Diseases; Drug Combinations; Female; Humans; Meningitis; Meningitis, Aseptic; Sulfamethoxazole; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Cotrimoxazole administration is occasionally associated with thrombocytopenia. Interference with folate metabolism has been postulated. The drug has also been postulated to induce an autoantibody by acting as a hapten, but proof has not been forthcoming. A case is reported in which the serum has been shown to contain an anti-platelet autoantibody requiring sulphamethoxazole or cotrimoxazole for activity.

Topics: Adult; Autoantibodies; Autoimmune Diseases; Blood Platelets; Drug Combinations; Female; Humans; Sulfamethoxazole; Thrombocytopenia; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination