trimethoprim--sulfamethoxazole-drug-combination and Empyema

Empyema necessitatis is a rare complication of empyema in which the pleural infection spreads outside of the pleural space to involve the soft tissues of the chest wall. Most cases of empyema necessitatis are related to Mycobacterium tuberculosis and, less commonly, to Actinomyces spp. and Streptococcus spp. Staphylococcus aureus has rarely been reported as the causative agent of empyema necessitatis, with the majority of S. aureus isolates being methicillin sensitive. Only two cases of empyema necessitatis due to methicillin-resistant S. aureus (MRSA) have been reported in the medical literature. We report the case of a 59-year-old Caucasian male who presented to our institution with complaints of pain in and swelling of his left upper chest of 2-months duration. A computed tomography scan of the chest showed an 8.1- by 6.5-cm lesion which extended from the left upper lobe of the lung into the extrathoracic soft tissues beneath the left upper pectoralis muscle. A wedge resection of the left upper lung lobe revealed lung tissue with an organized pneumonia-like pattern associated with marked acute pleuritis. Blood and urine cultures and cultures of the left chest soft tissue mass grew MRSA. The patient was successfully treated with vancomycin followed by a 10-day outpatient course of ciprofloxacin and trimethoprim-sulfamethoxazole. This case represents an extremely rare manifestation of an increasingly dangerous bacterial pathogen.

Topics: Anti-Bacterial Agents; Blood; Ciprofloxacin; Empyema; Humans; Lung; Male; Methicillin Resistance; Middle Aged; Pneumonia; Radiography, Thoracic; Staphylococcal Infections; Staphylococcus aureus; Thorax; Trimethoprim, Sulfamethoxazole Drug Combination; Urine; Vancomycin; White People

Cotrimoxazole prophylaxis reduces morbidity and mortality in HIV-1-infected children, but mechanisms for these benefits are unclear.. CHAP was a randomized trial comparing cotrimoxazole prophylaxis with placebo in HIV-infected children in Zambia where background bacterial resistance to cotrimoxazole is high. We compared causes of mortality and hospital admissions, and antibiotic use between randomized groups.. Of 534 children (median age, 4.4 years; 32% 1-2 years), 186 died and 166 had one or more hospital admissions not ending in death. Cotrimoxazole prophylaxis was associated with lower mortality, both outside hospital (P = 0.01) and following hospital admission (P = 0.005). The largest excess of hospital deaths in the placebo group was from respiratory infections [22/56 (39%) placebo versus 10/35 (29%) cotrimoxazole]. By 2 years, the cumulative probability of dying in hospital from a serious bacterial infection (predominantly pneumonia) was 7% on cotrimoxazole and 12% on placebo (P = 0.08). There was a trend towards lower admission rates for serious bacterial infections in the cotrimoxazole group (19.1 per 100 child-years at risk versus 28.5 in the placebo group, P = 0.09). Despite less total follow-up due to higher mortality, more antibiotics (particularly penicillin) were prescribed in the placebo group in year one [6083 compared to 4972 days in the cotrimoxazole group (P = 0.05)].. Cotrimoxazole prophylaxis appears to mainly reduce death and hospital admissions from respiratory infections, supported further by lower rates of antibiotic prescribing. As such infections occur at high CD4 cell counts and are common in Africa, the role of continuing cotrimoxazole prophylaxis after starting antiretroviral therapy requires investigation.

Topics: Anti-Infective Agents; Antitubercular Agents; Cause of Death; CD4 Lymphocyte Count; Child; Child, Preschool; Disease Progression; Drug Resistance, Bacterial; Empyema; HIV; HIV Infections; Hospital Mortality; Hospitalization; Humans; Infant; Pneumonia; Trimethoprim, Sulfamethoxazole Drug Combination; Zambia

Nocardiosis is an uncommon and potentially life-threatening infection that usually affects immunocompromised hosts. No clinical guidelines have been established for managing this rare disease, and the optimal treatment modality remains unclear. Nocardia farcinica, a relatively infrequent pathogen of nocardiosis, causes a clinically aggressive infection. In addition to our patient data, our search of the literature for patients who presented with empyema caused by N. farcinica will provide fundamental information for optimal treatment modalities.. A 64-year-old man was diagnosed with empyema, 4 days following surgery for sigmoid colon cancer. Brain lesions were evaluated only after N. farcinica was isolated and identified as the causative pathogen through repeated culture tests.. N. farcinica was isolated from the pleural effusion and confirmed as the pathogen through 16S rRNA sequencing.. The patient was successfully treated with tube thoracotomy, neurosurgical evacuation, and a combination of trimethoprim/sulfamethoxazole plus imipenem. Long-term antibiotic therapy was required to prevent recurrence.. Pyothorax showed a good clinical response to antimicrobial therapy and drainage of pleural effusion, whereas brain abscess did not respond to medical therapy and required surgery. The patient eventually recovered and continued chemotherapy as treatment for sigmoid colon cancer.. Although extremely rare, this report demonstrates the importance of considering Nocardia infection as the differential diagnosis in immunocompromised patients who present with empyema. In particular, because of the N. farcinica infection's tendency to spread and the resistance of the organism to antibiotics, aggressive evaluation of metastatic lesions and standardized support from microbiological laboratories are important. Surgery may be required in some patients with brain abscesses to improve the chance of survival.

Topics: Adenocarcinoma; Anti-Infective Agents; Brain Abscess; Colonic Neoplasms; Diagnosis, Differential; Empyema; Humans; Immunocompromised Host; Male; Middle Aged; Nocardia; Nocardia Infections; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

Two horses with chronic empyema of the auditory tube diverticulum (guttural pouch) were refractory to medical treatment; empyema was bilateral in 1 horse and unilateral in the other. Both horses were treated by fistulation of the cartilage of the pharyngeal orifice by use of a neodymium:yttrium-aluminum-garnet laser in a noncontact manner. To maintain patency of the fistulae, indwelling catheters were placed into the openings created by the laser. For both horses, long-term follow-up did not reveal complications, and both owners were satisfied with results of the procedure. The authors recommend this procedure for horses that are unresponsive to medical treatment for chronic guttural pouch empyema.

Topics: Animals; Anti-Inflammatory Agents, Non-Steroidal; Chronic Disease; Dexamethasone; Ear Diseases; Empyema; Endoscopy; Eustachian Tube; Female; Horse Diseases; Horses; Laser Therapy; Male; Penicillin G Procaine; Phenylbutazone; Prednisone; Trimethoprim, Sulfamethoxazole Drug Combination

A case of pulmonary nocardiosis with empyema in a 55-year-old man with macroglobulinemic lymphoma is presented. Treatment with imipenem followed by oral trimethoprim-sulfamethoxazole (TMP-SMX) resolved his symptoms and cleared the roentgenographic abnormalities. This case illustrates the clinical potential of imipenem against Nocardia.

Topics: Drug Therapy, Combination; Empyema; Humans; Imipenem; Lung Diseases; Lung Neoplasms; Lymphoma; Male; Microbial Sensitivity Tests; Middle Aged; Nocardia asteroides; Nocardia Infections; Opportunistic Infections; Stomach Neoplasms; Trimethoprim, Sulfamethoxazole Drug Combination; Waldenstrom Macroglobulinemia

Branhamella catarrhalis, formerly regarded as an oropharyngeal commensal, has more recently been implicated as an opportunistic pathogen in the respiratory tract. This report describes the isolation of B. catarrhalis from two consecutive samples of empyema fluid and also from sputum in thirteen cases of lower respiratory tract disease, where the isolate was considered to be etiologically significant. The antibiotic therapy required to treat such infections is discussed.

Topics: Adult; Aged; Bronchitis; Drug Combinations; Empyema; Female; Humans; Infant; Male; Middle Aged; Neisseria; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination