trimethoprim--sulfamethoxazole-drug-combination and Duodenal-Diseases

We present a case of pyeloduodenal fistula in an 89-year-old woman with history of nephrolithiasis and recurrent urinary tract infection (UTI) who presented to the emergency department with back pain. CT revealed a malrotated right kidney with a large renal stone and possible fistulous connection between the second portion of the duodenum and the right renal collecting system. Technetium-99m scintigraphy confirmed presence of the fistula. The patient declined intervention and was discharged from the hospital with oral antibiotic suppressive therapy. The patient remained clinically stable at time of follow-up 3 months later. Spontaneous pyeloduodenal fistula is an aetiology of recurrent upper or lower UTIs or persistent bacteriuria though uncommonly recognised. Diagnosis may be achieved using several modalities, including technetium-99m scintigraphy. Nephrectomy and primary fistula closure has traditionally been the treatment of choice for this condition; however, conservative management is an option for patients with intact renal function.

Topics: Aged, 80 and over; Anti-Infective Agents, Urinary; Conservative Treatment; Duodenal Diseases; Duodenum; Female; Humans; Intestinal Fistula; Kidney; Kidney Calculi; Radionuclide Imaging; Technetium; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Anti-HIV Agents; Bone Marrow Diseases; Diarrhea; Duodenal Diseases; Edema; Enteral Nutrition; Humans; Hypotension; Leg; Male; Middle Aged; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Trimethoprim, Sulfamethoxazole Drug Combination

Whipple's disease is a rare systemic infectious disease caused by the bacterium Tropheryma whippelii. Early diagnosis is essential. Whipple's disease is potentially fatal but responds dramatically to antibiotic treatment. The diagnosis is confirmed by means of polymerase chain reaction (PCR) technology. This analysis may be useful for monitoring the efficacy of therapy. The recommended treatment al present is administration of cotrimoxazole twice daily for one year. When CNS involvement occurs, it is recommended initial treatment with daily parenteral administration of streptomycin 1 g and 1.2 million units of benzyl penicillin (Penicillin G) over a period of 14 days.

Topics: Aged; Anemia; Arthritis, Infectious; Biopsy; Diarrhea; DNA, Bacterial; Duodenal Diseases; Female; Folic Acid; Gastrointestinal Hemorrhage; Gram-Positive Bacteria; Heart Failure; Heart Valve Diseases; Humans; Laparotomy; Male; Penicillin G; Polymerase Chain Reaction; Streptomycin; Trimethoprim, Sulfamethoxazole Drug Combination; Weight Loss; Whipple Disease

Culture of Tropheryma whippelii has been established only once, in human fibroblast cell lines from a heart valve inoculum. Molecular-based diagnostic techniques, although highly sensitive, may be less specific. New diagnostic tools involving isolation of bacteria from contaminated intestinal biopsies and immunohistological detection need to be developed.. To describe a novel method for detection and culture of T whippelii strains.. Laboratory analysis of duodenal biopsy specimens from a patient with typical relapsing Whipple disease with intestinal involvement, performed Marseille, France, in March 2000. Biopsy specimens were decontaminated with antimicrobial agents and inoculated onto cell cultures. Mouse anti-T whippelii polyclonal antibodies were used to detect T whippelii in fixed specimens taken from the patient before and after relapse, compared with specimens from 10 controls. The genotype of the isolate was determined by amplification and sequencing of 2 DNA fragments (ITS and 23S rRNA).. Isolation and genotyping of a new strain(s) of T whippelii from the case patient's biopsy specimens.. A strain was grown from the case patient's intestinal specimen that has a genotype different from the first strain isolated. During 2 episodes of Whipple disease, T whippelii bacteria were detected by immunochemistry in the patient's duodenal biopsy specimens, but not in controls.. A second strain of T whippelii has been isolated and a protocol for isolation from the intestine has been proven to be efficient. Immunodetection of T whippelii in intestinal biopsy specimens may provide a useful tool for the diagnosis and follow-up of patients with Whipple disease. Both techniques need further evaluation and confirmation.

Topics: Actinobacteria; Actinomycetales Infections; Adult; Anti-Bacterial Agents; Antibodies, Bacterial; Biopsy; DNA, Bacterial; Duodenal Diseases; Female; Genotype; Humans; Immunohistochemistry; Microscopy, Confocal; Microscopy, Fluorescence; Polymerase Chain Reaction; Recurrence; RNA, Ribosomal, 16S; Trimethoprim, Sulfamethoxazole Drug Combination; Whipple Disease