trimethoprim--sulfamethoxazole-drug-combination and Diabetic-Nephropathies

Emphysematous pyelonephritis is a rare and life-threatening suppurative infection of renal parenchymal and perirenal tissues, characterized by spontaneous gas production. Although uncommon (76 cases in the literature), it occurs almost exclusively in diabetic patients (87% of the cases). We describe a recent case of a diabetic woman with emphysematous pyelonephritis due to E. coli, successfully managed with unilateral nephrectomy. Symptoms, diagnostic approach and management are discussed and related to the previously reported series.

Topics: Aged; Diabetes Mellitus, Type 1; Diabetic Nephropathies; Female; Humans; Nephrectomy; Pyelonephritis; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination; Urography

Sphingomonas paucimobilis is an aerobic, oxidase-positive, yellow-pigmented, non-fermentative, Gram-negative opportunistic pathogen that rarely causes infections in humans. It is commonly found in nosocomial environments and, despite its low clinical virulence, it can be responsible for several different infections especially among patients with underlying disease. Here we describe a clinical case of a 46-year-old male paraplegic patient with a history of neurogenic bladder due to insulin-dependent diabetes mellitus and renal failure who was admitted to the urology clinic of a university hospital in Kirsehir, Turkey, with the complaints of urinary tract infection (UTI) including fever, chills, dysuria, abdominal and back pain. The urine culture was positive for Sphingomonas paucimobilis identified by the Vitek-2 system and the patient was successfully treated with oral co-trimoxazole 800/160 mg twice a day for ten days associated to cefixime and fosfomycin. A literature review of UTIs associated to Sphingomonas paucimobilis is reported as well.

Topics: Anti-Bacterial Agents; Cefixime; Community-Acquired Infections; Diabetes Mellitus, Type 1; Diabetic Nephropathies; Disease Susceptibility; Drug Therapy, Combination; Fosfomycin; Gram-Negative Bacterial Infections; Humans; Kidney Failure, Chronic; Male; Middle Aged; Opportunistic Infections; Paraplegia; Recurrence; Sphingomonas; Trimethoprim, Sulfamethoxazole Drug Combination; Turkey; Urinary Bladder, Neurogenic; Urinary Tract Infections

A 51-year-old man with diabetes mellitus and mild hypertension developed acute interstitial nephritis 4 days after starting a course of co-trimoxazole for bronchopneumonia. Following initial symptoms of overt hypersensitivity, he developed azotemia and renal tubular dysfunction with malaise and anorexia requiring hospitalization. Renal pathology demonstrated an acute granulomatous interstitial nephritis superimposed on chronic diabetic renal disease.

Topics: Anti-Infective Agents; Bronchopneumonia; Diabetic Nephropathies; Drug Combinations; Humans; Kidney; Male; Middle Aged; Nephritis, Interstitial; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Corynebacterium aquaticum was the cause of peritonitis in a 33-year-old diabetic woman on continuous ambulatory peritoneal dialysis (CAPD). This case represents the first reported instance of CAPD peritonitis due to this organism. Moreover, the organism was recovered from fibrin clots removed from dialysate bags when the patient was on antibiotic therapy. Routine cultural methods failed to reveal the organism at that time. The organism is described and key points differentiating it from similar organisms are emphasised. The world literature on C. aquaticum infections is reviewed.

Topics: Adult; Anti-Bacterial Agents; Corynebacterium; Corynebacterium Infections; Diabetic Nephropathies; Drug Combinations; Female; Humans; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Recurrence; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination