trimethoprim--sulfamethoxazole-drug-combination and Foot-Dermatoses

Botryomycosis is a rare chronic suppurative granulomatous infection caused by several genera of non-filamentous bacteria. The clinical and histopathological findings are similar to those of mycetoma caused by true fungi or aerobic actinomycetes. Botryomycosis is divided into cutaneous and visceral disease, with the cutaneous form being more common. Histopathology shows granules of etiologic bacteria called "sulfur granules". Botryomycosis occurs more commonly among immunocompromised patients, although some cases have also been reported in immunocompetent patients. We report the case of an 8-year-old immunocompetent boy who visited our hospital with a 4-mm diameter subcutaneous tumor with mild tenderness on his right heel for several months. We surgically removed the tumor with an initial diagnosis of epidermal cyst. Histopathology showed sulfur granules surrounded by an eosinophilic matrix, indicating the Splendore-Hoeppli phenomenon. The granules consisted of Gram-positive cocci, leading to a diagnosis of botryomycosis. The patient was successfully treated by excision and oral trimethoprim/sulfamethoxazole (240 mg b.i.d.) for 2 weeks as adjuvant therapy. No recurrence was noted following treatment. The subcutaneous tumor in this case was smaller than the typical in botryomycosis infections. We reviewed the infection duration and tumor size in reported cases of botryomycosis in immunocompetent patients. Small tumor size may suggest that the case is in an early stage; therefore, it is important to remove and investigate these lesions proactively.

Topics: Administration, Oral; Anti-Bacterial Agents; Child; Combined Modality Therapy; Dermatologic Surgical Procedures; Diagnosis, Differential; Epidermal Cyst; Epidermis; Foot Dermatoses; Gram-Positive Cocci; Humans; Male; Skin Diseases, Bacterial; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography

P. cepacia is reported to be an increasing cause of infection and colonization of patients in hospitals. Historically it is an important contaminant in the pharmaceutical industry. Its nutritional versatility, ability to survive and multiply in water, high intrinsic resistance to antibiotics, and ability to multiply in the majority of traditional disinfectants make it a superb agent for causing nosocomial infection. Recognition of its differences from P. aeruginosa and its ability to contaminate agents used in hospitals is important in proper treatment and infection control.

Topics: Anti-Bacterial Agents; Cross Infection; Disinfectants; Drug Combinations; Drug Contamination; Drug Resistance, Microbial; Endocarditis, Bacterial; Foot Dermatoses; Humans; Pigments, Biological; Pseudomonas; Pseudomonas Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Virulence

We present the case of an actinomycotic mycetoma of the foot due to Actinomycetes viscosus. It evolved for nine years on the foot of a 26-year-old patient from a rural environment: Douar Inezgane (city in southern Morocco). Bacteriological study of the skin and grains confirmed the diagnosis. It showed positive bacilli on direct examination and on Gram staining and in positive culture. Histological study showed a polymorphous granulomatous inflammation without signs of malignancy with actinomycotic grains. Then we retained the diagnosis of primary cutaneous actinomycosis without visceral locations. The treatment was based on antibiotics: penicillin G by intravenous infusion for five weeks, relayed orally by amoxicillin associated with trimethoprim-sulfamethoxazole for long periods. After six months of treatment, we observed a favorable outcome with reduction of the swelling, nodules, lymphadenopathy, fistula's number and extension of time of issue of grains. The current follow up is 15 months. The primary cutaneous actinomycosis is still relevant in Morocco.

Topics: Actinomyces viscosus; Actinomycosis; Adult; Anti-Bacterial Agents; Foot Dermatoses; Humans; Male; Morocco; Mycetoma; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Actinomycetales; Actinomycetales Infections; Actinomycosis; Anti-Bacterial Agents; Ciprofloxacin; Cutaneous Fistula; Diagnosis, Differential; Foot Dermatoses; Foot Ulcer; Guatemala; HIV Seronegativity; Humans; Immunocompetence; Male; Middle Aged; Mycetoma; Nocardia Infections; Osteitis; RNA, Ribosomal, 16S; Travel; Trimethoprim, Sulfamethoxazole Drug Combination

Mycetoma is a chronic, granulomatous, subcutaneous, inflammatory lesion caused by true fungi (eumycetoma) or filamentous bacteria (actinomycetoma). Mycetoma commonly affects young people between 20 and 40 years old. The most common affected site is the foot. The characteristic clinical triad is tumefaction, draining sinuses and discharging grains. We report a healthy 31-year-old male, with a 6-year history of a progressive inflammatory tumor associated with sinus tracts and granules on his left sole. Actinomycetoma was suspected. The clinical diagnosis was confirmed by microbiological and histopathological study. Polymerase chain reaction and DNA sequencing identified Actinomadura madurae. To our knowledge, this is the second case of mycetoma reported in Chile. Our report emphasizes the need to consider this diagnosis in patients with chronic granulomatous disease associated with sinus tracts, fistulas and grains.

Topics: Actinomycetales Infections; Adult; Anti-Bacterial Agents; Biopsy; Foot Dermatoses; Humans; Male; Mycetoma; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Actinomycetales; Actinomycetales Infections; Anti-Bacterial Agents; Anti-Infective Agents; Drug Therapy, Combination; Female; Foot Dermatoses; Humans; Middle Aged; Mycetoma; Streptomycin; Trimethoprim, Sulfamethoxazole Drug Combination

A 45-year-old male presented with history of multiple swellings over the foot with sinuses discharging seropurulent pus. Actinomadura madurae was demonstrated and identified by microbiological culture from the pus obtained directly of the lesion. This case is reported to emphasize the importance of laboratory diagnosis in the management and assessment of the prognosis of such cases.

Topics: Actinomycetales; Anti-Infective Agents; Dapsone; Drug Therapy, Combination; Foot Dermatoses; Gentian Violet; Humans; India; Male; Middle Aged; Mycetoma; Phenazines; Rifampin; Suppuration; Trimethoprim, Sulfamethoxazole Drug Combination

Mycetoma is a chronic infection that affects skin, subcutaneous tissue and bone. Its etiology can be mycotic or bacterial. It affects mainly the lower extremities of middle age men living in tropical climates. We report a 44-year-old male living in a template zone, consulting for swelling and pain in the left foot, lasting for 10 years. Physical examination showed a swollen left foot with hyperpigmented skin and a few crusted papules. Radiology showed an extensive bone involvement of the midfoot with several oval and radiolucid images. Magnetic resonance showed soft and bone tissue involvement, with multiple oval and low intensity images in T1 and T2. The biopsy was compatible with an unspecific chronic osteomyelitis. A bacterial identiFcation by polymerase chain reaction and sequencing in the biopsy determined the presence of an Actinomadumra madurae. Treatment with cotrimaxazol was started.

Topics: Actinomycetales; Adult; Anti-Infective Agents; Foot Dermatoses; Humans; Male; Mycetoma; Polymerase Chain Reaction; Trimethoprim, Sulfamethoxazole Drug Combination

A 29-year-old woman with swelling, multiple nodules and discharging sinuses of her right foot is presented. A single nodule on the sole was excised 15 years ago and since then she has had recurrent attacks of swelling and discharging sinuses that improved partially with antibiotics. Magnetic resonance images (MRI) revealed an ill-defined mass predominantly with low signal intensity on T2W images. Within the granulomata, multiple unenhancing foci, with low T1W and T2W signal most likely representing the fungal balls or grains were detected. Histopathological examination revealed large clusters of microorganisms resembling fungal hyphae and bacteria, which were surrounded by mixed inflammatory infiltrate cells and stained positively by PAS and Gomori's methenamine silver stain. As minimal regression was seen on MRI with 4 months' itraconazole (200 mg day(-1)) treatment, co-trimoxazole (160 TMP/800 SMX b.i.d.) was added to treatment. Complete remission was established by MRI examination after 10 months with this combination therapy.

Topics: Adult; Anti-Infective Agents; Antifungal Agents; Female; Foot Dermatoses; Fungi; Humans; Hyphae; Itraconazole; Magnetic Resonance Imaging; Microscopy; Mycetoma; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adolescent; AIDS-Related Opportunistic Infections; Anti-HIV Agents; Antifungal Agents; Blood Sedimentation; Female; Fluconazole; Foot Dermatoses; Hand Dermatoses; Hepatomegaly; Herpes Zoster; HIV Infections; Humans; Hypergammaglobulinemia; Immunocompromised Host; Onychomycosis; Tinea; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Antifungal Agents; Arthritis, Infectious; Foot Dermatoses; Humans; Itraconazole; Madurella; Magnetic Resonance Imaging; Male; Mycetoma; Osteitis; Staphylococcal Infections; Trimethoprim, Sulfamethoxazole Drug Combination

A total of 105 patients with established fixed drug eruption (FDE) by oral provocation were evaluated with regard to a drug-related site involvement. Cotrimoxazole was the leading causative agent (63.8%), followed by naproxen sodium (23.8%), dipyrone (5.7%), oxicams (4.8%) and other rare causes (1.9%). Cotrimoxazole most frequently induced lesions on genital mucosa; naproxen and oxicams on lips; and dipyrone on trunk and extremities. Isolated FDE on male genitalia (n = 16) was exclusively because of cotrimoxazole. A highly significant association could be established between naproxen and FDE on lips (chi-square = 28.3; corrected P =.000002). As this study represents the largest series of patients with naproxen-induced FDE, we would suggest that naproxen should be considered as an important potential cause of FDE on lips.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Dipyrone; Drug Eruptions; Facial Dermatoses; Female; Foot Dermatoses; Genital Diseases, Male; Hand Dermatoses; Humans; Lip Diseases; Male; Middle Aged; Naproxen; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Infective Agents; Dapsone; Drug Combinations; Foot Dermatoses; Humans; Japan; Mexico; Mycetoma; Nocardia Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Actinomycotic mycetoma is frequent in Senegal and the treatment has changed greatly over the last decades. We observed 27 cases due to Actinomadura pelletieri (n = 21), Actinomadura madurae (n = 5) and Streptomyces somaliensis (n = 1). The diagnosis was based on clinical and histological arguments. All the patients were treated with cotrimoxazole for several months. The mycetoma was situated on the foot in 15/27 patients. Extrapodal localizations were frequent for red grains due to A. pelletieri (11/21). These mycetomas, the most frequent in Senegal, are extremely severe lesions with rapid local and distance extension. We were able to obtain 8 clinical cures. One death occurred in patient with an abdominal localization and multiorgan invasion. Mid-term outcome could not be determined in the other cases since they were lost to follow-up after initial improvement with cotrimoxazole. As sole treatment, cotrimoxazole should lead to cure in most cases.

Topics: Actinomycetales; Buttocks; Female; Foot Dermatoses; Humans; Male; Mycetoma; Retrospective Studies; Senegal; Trimethoprim, Sulfamethoxazole Drug Combination