trimethoprim--sulfamethoxazole-drug-combination and Heart-Diseases

Whipple's disease is a systemic bacterial infection that once was uniformly fatal and now is treatable with several different antibiotics in most cases. The exact nature of the Whipple's bacillus is unknown, since the organism cannot consistently be cultured. There is also controversy concerning the role of immunologic dysfunction in patients with Whipple's disease. In addition to the small intestine, Whipple's disease can involve the remainder of the gastrointestinal tract, as well as the lymph nodes, joints, nervous system, heart, eyes, hematopoietic system, lungs, liver, and other organs. The clinical manifestations, diagnosis, and treatment of this rare but fascinating disease will be reviewed in this article.

Topics: Bacterial Infections; Diagnosis, Differential; Drug Combinations; Eye Diseases; Heart Diseases; Hematologic Diseases; Humans; Joint Diseases; Lung Diseases; Lymphatic Diseases; Muscular Diseases; Nervous System Diseases; Penicillins; Skin Diseases; Streptomycin; Sulfamethoxazole; Tetracycline; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Whipple Disease

Topics: Anti-Infective Agents; Ceftriaxone; Constriction, Pathologic; Diagnosis, Differential; Edema; Emotions; Heart; Heart Diseases; Humans; Male; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination; Whipple Disease; Wit and Humor as Topic

Coxiella burnetii is a category B bioterrorism agent. We numerically evaluated the risks and benefits from postexposure prophylaxis (PEP) after an intentional release of C. burnetii to the general population, pregnant women, and other high-risk populations. For each group, we constructed a decision tree to estimate illness and deaths averted by use of PEP/100,000 population. We calculated the threshold points at which the number of PEP-related adverse events was equal to the cases averted. PEP was defined as doxycycline (100 mg 2x/day for 5 days), except for pregnant women, where we assumed a PEP of trimethoprim-sulfamethoxazole (160 mg/800 mg 2x/day) for the duration of the pregnancy. PEP would begin 8-12 days postexposure. On the basis of upper-bound probability estimates of PEP-related adverse events for doxycycline, we concluded that the risk for Q fever illness outweighs the risk for antimicrobial drug-related adverse events when the probability of C. burnetii exposure is >or=7% (pregnant women using trimethoprim-sulfamethoxazole = 16%).

Topics: Adult; Anti-Bacterial Agents; Bioterrorism; Child; Coxiella burnetii; Decision Trees; Doxycycline; Female; Heart Diseases; Heart Valve Diseases; Humans; Immunocompromised Host; Infant, Newborn; Male; Models, Biological; Pregnancy; Pregnancy Complications, Infectious; Q Fever; Risk Assessment; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination