trimethoprim--sulfamethoxazole-drug-combination and Liver-Abscess

We report the case of a melioidosis-like abscess of the liver caused by Stenotrophomonas (Xanthomonas) maltophilia infection in a Chinese man living in Hungary. Although this appears to be the first documentation of a liver abscess of this origin in a nonimmunocompromised patient, our case report demonstrates that this common facultative pathogen can also cause liver abscess and sepsis. After repeated negative blood cultures, histological examinations of liver biopsies suggested the possibility of chronic melioidosis, but the microbiological examination performed directly on the same specimen identified a Stenotrophomonas maltophilia infection. Surgical drainage was performed and sulphamethoxazole/trimethoprim therapy was commenced, after which the patient recovered fully. The facultative pathogen S. maltophilia, which most often causes nosocomial infections, may cause severe sepsis and liver abscess. We wish to draw attention to the fact that the antibiotic sensitivity of S. maltophilia is not necessarily the same in vivo and in vitro. This can create difficulties in both diagnosis and treatment.

Topics: Adult; Anti-Bacterial Agents; Drainage; Gram-Negative Bacterial Infections; Humans; Liver Abscess; Male; Stenotrophomonas maltophilia; Trimethoprim, Sulfamethoxazole Drug Combination

Melioidosis is endemic in Southeast Asia and tropical Australia with varying clinical features from benign skin lesions to fatal septicaemia. Imaging plays an important role in evaluation of the melioid liver abscesses. A 45-year-old man with underlying diabetes presented with fever and lethargy for 2 weeks and abdominal pain for 2 days. His liver was enlarged on examination. Blood investigations revealed mild leucocytosis and raised liver enzymes. Ultrasound showed multiple multiloculated hypoechoic lesions throughout the liver and spleen. CT of abdomen confirmed that some liver lesions were made up of asymmetric locules of varying sizes (honeycomb sign), while others had hypodense centre with small symmetric peripheral locules in radial fashion (necklace sign). Blood culture was positive for

Topics: Anti-Bacterial Agents; Burkholderia pseudomallei; Ceftazidime; Humans; Liver Abscess; Male; Melioidosis; Middle Aged; Splenic Diseases; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography

Nocardiosis is usually a disseminated disease seen in immunocompromised individuals. We herein present a rare case of isolated Nocardia liver abscess post liver transplantation. The patient responded well to treatment and is on long-term antibiotics for Nocardia infection.

Topics: Anti-Bacterial Agents; End Stage Liver Disease; Glucocorticoids; Humans; Immunocompromised Host; Immunosuppression Therapy; Immunosuppressive Agents; Liver Abscess; Liver Cirrhosis, Alcoholic; Liver Transplantation; Male; Middle Aged; Mycophenolic Acid; Nocardia; Nocardia Infections; Paracentesis; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; Tacrolimus; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography, Doppler; Ultrasonography, Interventional

Melioidosis caused by Burkholderia pseudomellei is an infection with protean clinical manifestations. Guillain-Barré syndrome [GBS] associated with melioidosis is very rare.. A 42-year-old woman with diabetes presented with abdominal pain, vomiting and intermittent fever for one month. Six months before presentation she had recurrent skin abscesses. Three months before presentation she had multiple liver abscesses which were aspirated in a local hospital. The aspirate grew "coliforms" resistant to gentamicin and sensitive to ceftazidime. On presentation she had high fever and tender hepatomegaly. Ultra Sound Scan of abdomen showed multiple liver and splenic abscesses. Based on the suggestive history and sensitivity pattern of the previous growth melioidosis was suspected and high dose meropenem was started. Antibodies to melioidin were raised at a titre of 1:10240. The growth from the aspirate of liver abscess was confirmed as Burkholderia pseudomellei by polymerase chain reaction [PCR]. After a week of treatment, patient developed bilateral lower limb weakness. Deep tendon reflexes were absent. There was no sensory loss or bladder/bowel involvement. Analysis of the cerebro-spinal fluid showed elevated proteins with no cells. There was severe peripheral neuropathy with axonal degeneration. A diagnosis of GBS was made and she was treated with plasmapharesis with marked improvement of neurological deficit. Continuation of intravenous antibiotics lead to further clinical improvement with normalization of inflammatory markers and resolution of liver and splenic abscess. Eradication therapy with oral co-trimoxazole and co-amoxyclav was started on the seventh week. Patient was discharged to outpatient clinic with a plan to continue combination of oral antibiotics for 12 weeks. At the end of 12 weeks she was well with complete neurological resolution and no evidence of a relapse.. Guillaine Barre syndrome is a rare complication of melioidosis and should be suspected in a patient with melioidosis who develop lower limb weakness. Plasmapharesis can be successfully used to treat GBS associated with active melioidosis.

Topics: Abdominal Pain; Administration, Oral; Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Burkholderia pseudomallei; Ceftazidime; Drug Resistance, Bacterial; Female; Gentamicins; Guillain-Barre Syndrome; Humans; Injections, Intravenous; Liver Abscess; Melioidosis; Meropenem; Peripheral Nervous System Diseases; Polymerase Chain Reaction; Splenic Diseases; Thienamycins; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Granulomatous Disease, Chronic; Humans; Liver Abscess; Male; Trimethoprim, Sulfamethoxazole Drug Combination

Hepatic abscess caused by brucellosis is extremely rare in children. We report the case of a 5-year-old girl in whom an abscess of the liver developed during an episode of acute brucellosis. To our knowledge, this is the second reported case of hepatic abscess caused by brucellosis in a child.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Brucella melitensis; Brucellosis; Child, Preschool; Female; Gentamicins; Humans; Liver Abscess; Magnetic Resonance Imaging; Rifampin; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography

Topics: Administration, Oral; Aged; Enterococcus faecium; Female; Gram-Positive Bacterial Infections; Humans; Liver Abscess; Trimethoprim, Sulfamethoxazole Drug Combination

Melioidosis is a suppurative chronic infection caused by a gramnegative bacterium, Burkholderia pseudomallei. We report two patients who presented with isolated liver abscesses caused by this pathogen. Both patients presented with high-grade fever and abdominal pain. On examination they were toxic and had tender hepatomegaly. Investigations showed leucocytosis and a shift to the left. Early diagnosis of melioidosis was made by culture and growth of Burkholderia pseudomallei from aspirated pus from the abscesses and the patients were treated with ceftazidime and co-trimoxazole. Despite institution of antibiotics both the patients succumbed to their illness. Melioidosis is an emerging infection in the Indian subcontinent and can cause isolated liver abscesses.

Topics: Anti-Bacterial Agents; Burkholderia pseudomallei; Ceftazidime; Diabetes Complications; Fatal Outcome; Humans; Liver Abscess; Male; Melioidosis; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Anorexia; Anti-Bacterial Agents; Brain Abscess; Combined Modality Therapy; Diagnosis, Differential; Female; Fever; Headache; Humans; Immunocompromised Host; Liver Abscess; Lupus Erythematosus, Systemic; Nocardia asteroides; Nocardia Infections; Opportunistic Infections; Pleural Effusion; Trimethoprim, Sulfamethoxazole Drug Combination

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

The first case of melioidosis diagnosed in New Zealand is described. The patient presented with an abscess overlying the liver, which resolved on oral cotrimoxazole therapy, without the need for surgical drainage.

Topics: Administration, Oral; Adult; Drug Combinations; Humans; Liver Abscess; Male; Melioidosis; New Zealand; Pseudomonas; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

We report two patients with chronic granulomatous disease (CGD) and life-threatening infections: a 10 10/12-year-old boy had Aspergillus fumigatus spondylitis with destruction of the 11th vertebral body and paravertebral abscess formation, and an 8 5/12-year-old boy had multiple Staphylococcus aureus hepatic abscesses with subphrenic abscess formation. Both patients failed to respond to intense antimicrobial therapy but showed a remarkable recovery following surgical drainage combined with granulocyte transfusions. These results suggest that antimicrobial therapy and surgical drainage followed by granulocyte transfusions may be the ideal mode of treatment for severe infections in patients with CGD.

Topics: Amphotericin B; Blood Transfusion; Child; Drug Combinations; Flucytosine; Granulocytes; Granulomatous Disease, Chronic; Humans; Liver Abscess; Male; Spondylitis; Staphylococcal Infections; Subphrenic Abscess; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Hepatic abscesses are rarely encountered in disseminated Nocardia infections. Sulfonamides alone or trimethoprim/sulfamethoxazole is often efficacious in treating infections caused by Nocardia asteroides. In vitro resistance of N. asteroides to trimethoprim/sulfamethoxazole is occasionally present. The patient described in this report had disseminated nocardiosis initially manifesting as multiple subcapsular hepatic abscesses. In vitro susceptibility studies demonstrated resistance to trimethoprim/sulfamethoxazole. Subsequent treatment with ampicillin and amikacin in conjunction with computed tomography-guided needle aspiration of several of the hepatic abscesses, surgical drainage of a right pleural empyema, and eventual discontinuation of use of corticosteroids resulted in cure of the infection.

Topics: Amikacin; Ampicillin; Combined Modality Therapy; Drug Combinations; Drug Therapy, Combination; Humans; Kanamycin; Liver Abscess; Male; Middle Aged; Nocardia asteroides; Nocardia Infections; Penicillin Resistance; Suction; Sulfamethoxazole; Tomography, X-Ray Computed; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

A Sudanese girl became desperately ill with liver and kidney abscesses due to Nocardia asteroides. She did not have pulmonary or cutaneous infection. She recovered after surgical drainage of the abscesses and prolonged treatment with intravenous amikacin and high dosage cotrimoxazole and sulphadimidine. After recovery normal neutrophil function, cell-mediated and humoral immunity were demonstrated.

Topics: Abscess; Amikacin; Child; Drainage; Drug Combinations; Female; Humans; Kidney Diseases; Liver Abscess; Nocardia Infections; Sulfamethazine; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

We have followed nine male patients with Chronic Granulomatous Disease at The Hospital for Sick Children, Toronto, since 1972. The diagnosis was established in each case by the failure of neutrophils to reduce nitroblue tetrazolium dye and to kill Staphylococcus aureus normally in vitro. Bacterial infections began between 6 months and 14 years of age. In five of the nine patients, infections began after 4 years of age. The first significant infection in five patients was a liver abscess(es), and one patient each had lymphadenitis, pulmonary aspergillosis, a parapharyngeal abscess, and a draining inguinal incision following surgery. Following diagnosis, all patients were started on Trimethoprim-Sulfamethoxazole at a dose of 2 mg/kg/day of Trimethoprim. The patients have been followed for 50 patient-years. Five of nine patients have been free of infection during 16 years of observation. For the remaining four patients, there have been six infections during 34 years of observation. A possible infection-related death occurred in one patient. The patients reported here appear to differ from those in previous reports. They present later in life, often with a liver abscess. They have a low incidence of subsequent bacterial infections which may, in part, be due to Trimethoprim-Sulfamethoxazole prophylaxis. The patients with chronic granulomatous disease reported here appear to have a better prognosis than previously thought.

Topics: Adolescent; Child; Child, Preschool; Drug Combinations; Granulomatous Disease, Chronic; Humans; Infant; Liver Abscess; Lung Diseases, Fungal; Lymphatic Diseases; Male; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination