trimethoprim--sulfamethoxazole-drug-combination and Fever-of-Unknown-Origin

Fever of unknown origin (FUO) is a rare but important disease. The definition of FUO has not changed in the last 50 years. Classical FUO is defined by an illness of at least 3 weeks duration with fever greater than 38 masculine C, and no established diagnosis after 1 week of hospital investigation. The causes of FUO can be divided in four categories: infectious diseases, noninfectious inflammatory diseases, neoplasms, and others (miscellaneous). Recent studies have surprisingly shown that despite improved diagnostic procedures the percentage of patients with FUO, in which no diagnosis after intensive investigations in specialized centres can be found, has increased. However, finding the correct diagnosis in FUO is essential for these patients for psychological and vital reasons. Therefore and because of economic reasons patients with FUO should be investigated in specialized centres with a department for rheumatology and infectious diseases.

Topics: Aged; Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Diagnosis, Differential; Fever of Unknown Origin; Glucocorticoids; Humans; Male; Medical History Taking; Middle Aged; Mucocutaneous Lymph Node Syndrome; Mycoses; Parasitic Diseases; Q Fever; Sprue, Tropical; Time Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Virus Diseases; Whipple Disease

Periprostatic local anesthesia for prostate biopsy requires 2 or more extra needle punctures and injection of the local anesthetic through the highly colonized rectum. To our knowledge we report the first prospective randomized trial to assess the infectious or hemorrhagic complications associated with this method.. A total of 100 consecutive patients with sterile urine cultures underwent transrectal ultrasound guided prostate biopsy. They were randomized to receive a periprostatic nerve block or no anesthesia. Patients were evaluated for the amount of rectal and urethral bleeding, and symptoms and signs of infection after biopsy.. The amount of urethral bleeding was slight and similar in the 2 groups. Rectal bleeding was significantly less in the patients who received anesthesia. High fever (greater than 37.8C) was more frequent in the nerve block group and 2 patients in this group required rehospitalization. Bacteriuria in post-biopsy urine cultures was significantly more common in the anesthesia group.. Our results suggest that periprostatic local anesthesia for prostate biopsy does not increase the risk of urethral bleeding. It is associated with a decreased incidence of rectal bleeding, presumably due to decreased patient discomfort. The incidence of bacteriuria was significantly higher in the anesthesia group. High fever and hospitalization due to infectious complications were also more common in the local anesthesia group, although not statistically significant. Prospective randomized trials seem warranted to determine the optimum antibiotic prophylaxis regimen in patients undergoing biopsy with a periprostatic nerve block.

Topics: Aged; Anesthesia, Local; Antibiotic Prophylaxis; Bacteriuria; Biopsy, Needle; Endosonography; Fever of Unknown Origin; Gastrointestinal Hemorrhage; Hematuria; Humans; Lidocaine; Male; Middle Aged; Patient Readmission; Prostate; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination

To compare the efficacy and safety of ciprofloxacin (CIP) and trimethoprim/sulfamethoxazole (TMS) for the prevention of bacterial infections in patients who received bone marrow transplantation (BMT) for the treatment of solid and hematopoietic neoplasms.. Adult inpatients about to undergo BMT for lymphoma, leukemia, or solid tumors were enrolled onto a prospective, randomized, double-blinded, controlled trial that compared CIP (750 mg orally twice per day) with TMS (160 mg trimethoprim and 800 mg sulfamethoxazole orally twice per day). Subjects were stratified before randomization according to tumor and BMT type. Prophylaxis was begun within 96 hours of initiation of the BMT preparative regimen and continued until the onset of fever, signs or symptoms of infection, serious adverse effects, or recovery of the absolute granulocyte count (AGC) to > or = to 400/microL.. Seventy-five CIP recipients and 71 TMS recipients were assessable for efficacy. No difference was noted between the two groups in occurrence of fever during neutropenia, time to onset of first fever, or overall infection rates. Ten bacteremias occurred in CIP recipients versus six in TMS recipients (P = .43). Ten episodes of Clostridium difficile enterocolitis occurred in TMS recipients versus no episodes in CIP recipients (P = .001). Four infections caused by gram-negative bacilli, including one bacteremia, occurred in TMS recipients versus none in CIP recipients (P = .06). No differences were noted in the incidence of rash or organ toxicity. TMS recipients had longer durations of granulocytopenia at AGC levels < or = to 500/microL and < or = to 100/microL than did CIP recipients (P = .08 for both comparisons). Mean peak and trough serum levels of CIP decreased significantly between weeks 1 and 2 of prophylaxis.. CIP and TMS were equally safe and effective in the prevention of bacterial infections in BMT patients when the overall infection rate was used as the principal end point. TMS prophylaxis was associated with a higher incidence of C difficile enterocolitis and infections caused by gram-negative bacilli, as well as a trend toward prolongation of granulocytopenia.

Topics: Administration, Oral; Adult; Bacterial Infections; Bone Marrow Transplantation; Cause of Death; Ciprofloxacin; Double-Blind Method; Drug Administration Schedule; Drug Resistance, Microbial; Female; Fever of Unknown Origin; Humans; Incidence; Male; Middle Aged; Prospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Whole-Body Irradiation

We report a case of apparent malaria infection presented with a syndrome of painless, generalized lymphadenopathy without granulomas shortly after exposure to fresh water in rural West Africa. Residual infection with Massilia timonae was diagnosed and successfully treated with co-trimoxazole.

Topics: Anti-Infective Agents; Antimalarials; Bacterial Infections; Belgium; Fever of Unknown Origin; Humans; Lymphatic Diseases; Malaria; Male; Middle Aged; Nigeria; Oxalobacteraceae; Travel; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

We report on a patient with Pneumocystis jirovecii pneumonia who developed fever, rash, eosinophilia and hepatitis 10 days after initiation of a therapy with sulfamethoxazole and trimethoprim. A DRESS syndrome was diagnosed and the therapy was changed successfully to pyrimethamine and dapsone. We describe the clinical picture, causative drugs, pathogenesis, differential diagnoses and therapy of this life-threatening disease to acquaint the general practitioner with it.

Topics: Antibodies, Monoclonal; Antibodies, Monoclonal, Murine-Derived; Antineoplastic Combined Chemotherapy Protocols; Cyclophosphamide; Diagnosis, Differential; Doxorubicin; Drug Eruptions; Drug Hypersensitivity; Eosinophilia; Exanthema; Fever of Unknown Origin; Humans; Liver Function Tests; Lymphoma, T-Cell; Male; Middle Aged; Opportunistic Infections; Pneumocystis carinii; Pneumonia, Pneumocystis; Prednisone; Rituximab; Trimethoprim, Sulfamethoxazole Drug Combination; Vincristine

A 33-year-old Portugese worker presented with a one-week history of nonproductive cough and fever. A presumptive diagnosis "viral infection of the respiratory tract" was made. However, because of persisting cough and fever further investigations were necessary, and finally Brucella melitensis was isolated in blood cultures. Three months before admission to the hospital the man was dressing the carcasses of a goat in Portugal and consumpted fresh goats milk cheese. Antibiotic therapy with Rifampicin and Trimethoprim/Sulfamethoxazol over 6 weeks improved the signs and symptoms of the infection.

Topics: Adult; Animals; Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Cough; Drug Therapy, Combination; Fever of Unknown Origin; Germany; Goats; Humans; Male; Portugal; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination; Zoonoses

Topics: Abdominal Abscess; Adult; Cyclophosphamide; Diagnosis, Differential; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Fever of Unknown Origin; Humans; Imipenem; Immunosuppressive Agents; Liver Abscess; Nocardia asteroides; Nocardia Infections; Opportunistic Infections; Prednisolone; Recurrence; Splenic Diseases; Takayasu Arteritis; Trimethoprim, Sulfamethoxazole Drug Combination

We studied episodes of fever and neutropenia in children and adolescents without documented infections to determine the risk of recurrent fever after early discontinuation of empiric antibiotic therapy; 213 episodes occurred in 106 patients. All patients received empiric antibiotic therapy after cultures were obtained. Antibiotic therapy was discontinued if no infection was found, culture results were negative for 48 hours, and the patient was afebrile for 24 hours. In 83 episodes without documented infection, antibiotic therapy was stopped with absolute neutrophil counts < 0.5 x 10(9)/L (< 500/mm3); 50 episodes occurred in patients with solid tumors, leukemia in remission, and other hematologic conditions (group 1), and 33 in patients with active leukemia (group 2). Fever recurred before neutropenia resolved in 6% of group 1 and 45% of group 2 episodes; five patients in group 2 had documented infection. Recurrent fever risk correlated with absolute neutrophil count and monocyte count at the time antibiotic therapy was stopped, in both groups, as did increasing absolute neutrophil count and increasing leukocyte count in group 2. We conclude that discontinuing antibiotic therapy is safe in febrile episodes without documented infections before neutropenia resolves in patients with high potential for bone marrow recovery. The risk of recurrent fever and infection is significant for patients with neutropenia and poor marrow recovery potential.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Child; Child, Preschool; Drug Therapy, Combination; Female; Fever of Unknown Origin; Humans; Infant; Infusions, Intravenous; Leukemia; Male; Neoplasms; Neutropenia; Recurrence; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Aged; Anti-Infective Agents; Diagnosis, Differential; Drug Combinations; Female; Fever of Unknown Origin; Humans; Pyrimethamine; Sulfamethoxazole; Toxoplasmosis; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination