trimethoprim--sulfamethoxazole-drug-combination and Depressive-Disorder

Neurological melioidosis, an extremely rare condition, is caused by the gram-negative bacterium Burkholderia pseudomallei. If treatment is suboptimal or delayed, this infection can produce diverse clinical symptoms and result in death.. A healthy 65-year-old female who had been treated with antipsychotic medication for neurotic depression for over 2 years presented with acute-onset fever, headache, lead-pipe rigidity of all limbs, and delirium.. Melioidosis meningitis was diagnosed by performing blood examinations and cerebrospinal fluid analysis and cultures.. Intravenous ceftazidime (2 g/8 h for 3 weeks) was administered in-hospital and 240 mg trimethoprim/1200 mg sulfamethoxazole and 100 mg minocycline twice daily administered out-hospital.. The patient fully recovered after antibiotic therapy without cognitive deficits and associated neurological complications.. Because melioidosis is endemic in Southern Taiwan and the use of antipsychotics might mask the symptoms, physicians dealing with patients from endemic areas with a medical history of antipsychotics should always consider the possibility of neurological melioidosis and provide prompt empirical management to suspicious cases.

Topics: Aged; Anti-Bacterial Agents; Antipsychotic Agents; Burkholderia pseudomallei; Ceftazidime; Cerebrospinal Fluid; Depressive Disorder; Diagnosis, Differential; Female; Humans; Melioidosis; Meningitis, Bacterial; Minocycline; Neuroleptic Malignant Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Aged; Arthritis, Rheumatoid; Bacteremia; Depressive Disorder; Female; Follow-Up Studies; Humans; Infusions, Intravenous; Magnetic Resonance Imaging; Memory Disorders; Nocardia; Nocardia Infections; Prednisone; Rare Diseases; Risk Assessment; Severity of Illness Index; Tomography, X-Ray Computed; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

HIV infections are a growing concern in the elderly as a result of improvements in therapeutics and monitoring, which have extended the life span for this HIV-infected population. Elderly patients potentially are more complicated to treat than younger HIV-infected individuals because of comorbidities and the physiological effects of aging on pharmacokinetics and pharmacodynamics. The patient, a 67-year-old African-American HIV-infected male, presents to the transitional care unit of university-affiliated hospital refusing to take medications and undergo laboratory testing, including blood draws. This patient's treatment is further complicated by poor renal function, medications with potential interactions, and a recent diagnosis of depression. This case demonstrates treatment and monitoring of an elderly patient with HIV and reveals the complications associated with this disease state. Specifically, it identifies nonadherence to medications and a lack of laboratory results, which affect the efficacy of treatment and monitoring, medication adjustments based on metabolism and renal excretion, monitoring of adverse effects of HIV and antiretroviral therapy, and comorbid conditions that may be linked to HIV and antiretroviral therapy such as depression and bone disease. Education on HIV medications, monitoring, and standards of care for pharmacists working with the geriatric population is warranted and should be emphasized as the HIV-infected elderly population continues to grow.

Topics: Aged; AIDS-Related Opportunistic Infections; Anti-HIV Agents; Antihypertensive Agents; Azithromycin; CD4 Lymphocyte Count; Depressive Disorder; Diltiazem; Drug Interactions; Drug Monitoring; HIV Infections; Humans; Hypertension; Lopinavir; Male; Patient Compliance; Pharmacists; Renal Insufficiency; Trimethoprim, Sulfamethoxazole Drug Combination; Zidovudine

Topics: Aged; Depressive Disorder; Drug Combinations; Female; Humans; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination