trimethoprim--sulfamethoxazole-drug-combination and Central-Nervous-System-Diseases

Whipple's disease is a multisystemic infection caused by the ubiquitous bacterium Tropheryma whipplei. Immunological host factors enable classical Whipple's disease; however, T. whipplei can be found in three other clinical conditions: healthy colonization, self-limiting infections, and isolated endocarditis. The genetic predisposition of the host rather than the genotype of the bacterium influences the infection. Modern diagnostic methods elucidate the many facets of Whipple's disease. In particular, isolated T. whipplei-induced infective endocarditis can only be diagnosed after valve resection. The sole treatment of Whipple's disease evaluated prospectively comprises intravenous induction therapy with ceftriaxone or meropenem, followed by continuation therapy with oral TMP-SMX. In the case of Immune reconstitution inflammatory syndrome (IRIS) or inflammatory lesions of the CNS in the setting of Whipple's disease, additional treatment with corticosteroids should be considered to avoid severe tissue damage.

Topics: Adrenal Cortex Hormones; Adult; Algorithms; Anti-Bacterial Agents; Biopsy; Carrier State; Ceftriaxone; Central Nervous System Diseases; Child; Diagnosis, Differential; Drug Therapy, Combination; Duodenum; Endocarditis, Bacterial; Gastroscopy; Genetic Predisposition to Disease; Heart Valves; Humans; Immune Reconstitution Inflammatory Syndrome; Meropenem; Thienamycins; Trimethoprim, Sulfamethoxazole Drug Combination; Tropheryma; Whipple Disease

We report 12 cases of Whipple disease in patients with prominent neurologic symptoms, along with 122 cases of Whipple disease with nervous system involvement reported in the literature. We analyzed the clinical signs and results of additional examinations in 2 groups: the first group included patients with predominantly but not exclusively neurologic signs, and the second included patients with clinically isolated neurologic presentation of the disease. Whipple disease is a multisystemic infectious disease due to Tropheryma whippelii that may present with prominent or isolated symptoms of either the central or the peripheral nervous system. Recent reports stress the importance of polymerase chain reaction (PCR) analysis of cerebrospinal fluid, magnetic resonance imaging (MRI) during follow-up, and prolonged antibiotic therapy with drugs able to cross the blood-brain barrier. Cerebrospinal fluid should be analyzed repeatedly during follow-up, and treatment should be discontinued only when the results of PCR assay performed on cerebrospinal fluid are negative. Other examinations to be done include searching for gastrointestinal tract involvement with multiple duodenal biopsies and searching for systemic involvement with lymph node biopsies, which should be analyzed with light microscopy, electron microscopy, and PCR. When all examinations are negative, if Whipple disease is suspected and a lesion is found on brain MRI, a stereotactic cerebral biopsy should be performed. Treating Whipple disease with long-term trimethoprim-sulfamethoxazole is usually effective, but the use of third-generation cephalosporins in case of incomplete response deserves further attention.

Topics: Actinomycetales Infections; Adult; Aged; Anti-Bacterial Agents; Anti-Infective Agents; Biopsy; Blood-Brain Barrier; Central Nervous System Diseases; Cephalosporins; Female; Humans; Lymph Nodes; Magnetic Resonance Imaging; Male; Middle Aged; Peripheral Nervous System Diseases; Polymerase Chain Reaction; Stereotaxic Techniques; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Whipple Disease

Cerebral and cerebellar masses occurred in patients with paracoccidioidomycosis. Correct diagnosis was delayed due to overlooking the abnormal lung roentgenograms and the history of previous disease in a different localization. The fungus was identified through biopsy and direct examination of the samples. In two patients necropsy confirmed the diagnosis. None of the patients responded to amphotericin B or cotrimoxazole. A 10 year English and Latin American literature review on neuroparacoccidioidomycosis was performed through a MEDLINE and LILACS (Latin American Literature Search System) data base systems.

Topics: Amphotericin B; Central Nervous System Diseases; Humans; Male; Middle Aged; Paracoccidioides; Paracoccidioidomycosis; Trimethoprim, Sulfamethoxazole Drug Combination

The evaluation of adverse drug reactions (ADR) in clinical practice is difficult and imprecise. Establishing a causal relationship may not be possible, and data on incidence cannot be obtained because the number of patients treated is not known. This article describes the ADR reported during the clinical trial program of cinoxacin, a synthetic antibacterial drug used to treat urinary tract infections. Results from 2,801 patients who received cinoxacin showed that 5 per cent reported ADR that were probably or definitely drug induced, and 10 per cent reported ADR in which the relationship was uncertain. There was no relationship between number of reports and patient's age, drug dose, or duration of treatment. Adverse drug reactions affecting the gastrointestinal system were reported by 5.5 per cent of the patients, those involving the central nervous system by 4.3 per cent, and hypersensitivity reported by 2.4 per cent. In the comparative studies, patients treated with cinoxacin reported fewer ADR than those treated with nalidixic acid, furadantin, amoxicillin, or trimethoprim-sulfamethoxazole. Although problems in the assessment and evaluation of ADR still exist, it is hoped that the results from the formal trial program will be representative of those seen in clinical practice.

Topics: Adult; Aged; Amoxicillin; Anti-Infective Agents, Urinary; Central Nervous System Diseases; Cinoxacin; Clinical Trials as Topic; Drug Combinations; Drug Hypersensitivity; Gastrointestinal Diseases; Humans; Middle Aged; Nalidixic Acid; Nitrofurantoin; Pyridazines; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Bacterial Agents; Ceftriaxone; Central Nervous System Diseases; Chloroquine; Drug Resistance, Bacterial; Drug Therapy, Combination; Humans; Male; Meropenem; Microbial Sensitivity Tests; Minocycline; Thienamycins; Trimethoprim, Sulfamethoxazole Drug Combination; Whipple Disease

Nocardia concava was identified as a new species in 2005; however, the clinical manifestations of Nocardia concava infection have yet to be clarified. We herein present the case of an immunosuppressed patient who developed disseminated nocardiosis caused by N. concava with multiple abscesses in the lungs, cutis, subcutaneous tissue, skeletal muscles and kidneys accompanied by central nervous system involvement, including meningitis and ventriculitis. The patient was cured with appropriate treatment including linezolid after testing for susceptibility. Linezolid should be considered as an alternative agent for treating disseminated nocardiosis because of its effective distribution to multiple sites.

Topics: Acetamides; Acute Disease; Aged; Anti-Bacterial Agents; Central Nervous System Diseases; Humans; Immunocompromised Host; Linezolid; Male; Microbial Sensitivity Tests; Minocycline; Nocardia; Nocardia Infections; Oxazolidinones; Respiratory Insufficiency; Trimethoprim, Sulfamethoxazole Drug Combination

Nocardia species is a well-known pathogen in immunocompromised hosts, including renal transplant recipients. Primary pulmonary infection can disseminate to other organs and recommended first-line therapy is high-dose trimethoprim/sulfamethoxazole (TMP/SMX). We report two cases of primary pulmonary Nocardia sp. in immunosuppressed patients who were treated with minocycline, a second-line drug. During treatment with minocycline, both patients developed central nervous system (CNS) lesions of Nocardia sp. and were then treated with TMP/SMX with resolution of disease. The literature on Nocardia and treatment with minocycline is reviewed. Treatment of pulmonary Nocardia sp. with 200 mg minocycline daily is not adequate to prevent disseminated CNS disease.

Topics: Anti-Bacterial Agents; Brain; Central Nervous System Diseases; Female; Humans; Immunocompromised Host; Kidney Transplantation; Middle Aged; Minocycline; Nocardia; Nocardia Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Ceftriaxone; Central Nervous System Diseases; Humans; Recurrence; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination; Whipple Disease

The central nervous system (CNS) is frequently involved in patients with Whipple's disease and is the most common site of disease relapse. Antibiotics such as trimethoprim-sulfamethoxazole (TMP-SMX) that have reliable CNS penetration, are therefore recommended as first-line therapy. We report a patient with Whipple's disease who was treated with TMP-SMX and presented 14 months after initiation of therapy with visual decline and severe headaches. The patient was also treated concurrently with low-dose weekly methotrexate for severe psoriasis. Evaluation by magnetic resonance imaging revealed bilateral posterior white matter abnormalities that pathologically were consistent with Whipple's disease. He was ultimately treated with cefixime, an orally administered third-generation cephalosporin. Visual function improved on this regimen and follow-up magnetic resonance imaging showed regression of the lesions. This case represents the first report of both CNS relapse during therapy with TMP-SMX and successful treatment with cefixime. We also speculate that methotrexate, which impairs cell-mediated immunity, may have contributed to the relapse.

Topics: Cefixime; Cefotaxime; Central Nervous System Diseases; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Recurrence; Remission Induction; Trimethoprim, Sulfamethoxazole Drug Combination; Vision Disorders; Whipple Disease

Toxoplasmosis is the most frequent parasitic infection of the CNS in the immunocompromised host. When promptly treated with the sulfadiazine-pyrimethamine combination patients with cerebral toxoplasmosis characteristically respond with clear clinical and CT improvement within 1-2 weeks. We report the results achieved with the combination sulfamethoxazole-trimethoprim, and conclude that both combinations have similar effects in the treatment of CNS toxoplasmosis.

Topics: Acquired Immunodeficiency Syndrome; Adult; Central Nervous System Diseases; Female; Follow-Up Studies; Humans; Male; Opportunistic Infections; Prognosis; Toxoplasmosis; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adolescent; Anti-Bacterial Agents; Ceftazidime; Central Nervous System Diseases; Child; Child, Preschool; Drug Therapy, Combination; Female; Humans; Male; Melioidosis; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination