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

The best treatment for Tropheryma whipplei infections is controversial. We report a patient who suffered from T. whipplei aortic native valve endocarditis that relapsed despite surgery and four weeks of intravenous ceftriaxone followed by several months of oral trimethoprim/sulfamethoxazole. Cure was achieved after replacement of the prosthesis with a homograft and 18 months of oral doxycycline-hydroxychloroquine. We discuss the need for a change in treatment guidelines for T. whipplei infections.

Topics: Anti-Bacterial Agents; Aortic Valve; Ceftriaxone; Doxycycline; Drug Therapy, Combination; Endocarditis, Bacterial; Heart Valve Diseases; Humans; Hydroxychloroquine; Male; Middle Aged; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination; Tropheryma; Whipple Disease

Topics: Actinomycetales Infections; Anti-Bacterial Agents; Anticoagulants; Doxycycline; Drug Therapy, Combination; Edema, Cardiac; Endocarditis, Bacterial; Fever; Heart Valve Diseases; Humans; Hydroxychloroquine; Male; Middle Aged; Polymerase Chain Reaction; Shock, Cardiogenic; Stroke; Trimethoprim, Sulfamethoxazole Drug Combination; Tropheryma

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

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