trimethoprim--sulfamethoxazole-drug-combination and Lung-Abscess

A 29-year-old man was admitted with fevers, cough, left-sided chest pain and lethargy for 1 week. He had a cardiac transplant 10 years prior and was on immunosuppressive drugs. He was found to have a pulmonary lesion and went on to develop a lung abscess. Propionibacterium acnes was identified on matrix-assisted laser desorption ionisation mass spectrometry-time of flight and 16s rRNA gene sequencing after drainage. He was curatively treated with co-trimoxazole and co-amoxiclav. He divulged a longstanding history of seborrhoeic dermatitis with frequent flares leading to large volumes of squames collecting on his bed sheets. We hypothesise this was a possible route of entry: inhalation of the Propionibacterium. This case highlights how a common commensal bacterium, P. acnes, was able to cause pathology in an immunosuppressed patient. This is the only case of a patient with transplantation developing a P. acnes pulmonary infection and the only case of P. acnes causing these clinical features to be reported in the literature.

Topics: Adult; Anti-Bacterial Agents; Diagnosis, Differential; Gram-Positive Bacterial Infections; Heart Transplantation; Humans; Immunocompromised Host; Lung Abscess; Male; Propionibacterium acnes; RNA, Ribosomal, 16S; RNA, Viral; Sequence Analysis, RNA; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acquired Immunodeficiency Syndrome; Amikacin; Anti-Bacterial Agents; Antiretroviral Therapy, Highly Active; Bronchoscopy; Clindamycin; Comorbidity; Fever; Hemoptysis; Humans; Imipenem; Immunocompromised Host; Lung Abscess; Male; Middle Aged; Neuroimaging; Nocardia Infections; Pneumonia, Bacterial; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination; Weight Loss

A 26-year-old pregnant woman who was an intravenous drug user (IDU) was admitted to our hospital for the treatment of tricuspid valve infective endocarditis (IE) and lung abscesses due to methicillin-resistant Staphylococcus aureus (MRSA). We started to treat her with vancomycin (VCM) alone and then in combination with rifampicin (RFP), but her condition did not improve. Then we added sulfamethoxazole/trimethoprim (SMZ/TMP) to VCM and RFP. After that, she improved rapidly. In Japan, there are very few reports about tricuspid valve IE caused by MRSA in IDUs. This case suggests that the combination of VCM, RFP, and SMZ/TMP may be effective for the treatment of severe MRSA infections.

Topics: Adult; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Humans; Lung Abscess; Methicillin-Resistant Staphylococcus aureus; Pregnancy; Pregnancy Complications, Infectious; Pulmonary Embolism; Rifampin; Staphylococcal Infections; Substance Abuse, Intravenous; Tricuspid Valve; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

A 71-year-old woman presented with suspected tuberculosis. She reported having productive coughs, unwanted weight loss and subfebrile temperature in the preceding 3 months. She was known to have chronic obstructive pulmonary disease treated with corticoids given systemically and by inhalation. She was a heavy smoker.. Computed tomography revealed a left apical lung abscess. In the further course of the disease magnetic resonance imaging of the head demonstrated multiple abscesses in both cerebral hemispheres and an abscess, 3.4 cm in diameter, in the right side of the cerebellum, as well as a intra-orbital tumor on the right. Needle aspirate of the eyeball grew Nocardia farcinica.. Over 3 weeks antimicrobial treatment was given with imipenem and amikacin, followed by oral cotrimoxazole for 12 months. The abscesses completely regressed and after 12 months no recurrence was demonstrated either radiologically or clinically.. Although nocardiasis is rare in Germany it must be included in the differential diagnosis of pneumonia with abscesses. This is especially so if acid-fast bacilli are found. As the resistance pattern of N. farcinica to antibiotics varies, early treatment is essential with antibiotics to which it is sensitive.

Topics: Aged; Amikacin; Anti-Bacterial Agents; Biopsy, Needle; Brain Abscess; Cerebellar Diseases; Diagnosis, Differential; Drug Therapy, Combination; Female; Humans; Imipenem; Lung Abscess; Magnetic Resonance Imaging; Nocardia Infections; Orbital Diseases; Pneumonia, Bacterial; Tomography, X-Ray Computed; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Anti-Bacterial Agents; Erythromycin; Humans; Kidney Transplantation; Lung Abscess; Male; Nocardia asteroides; Nocardia Infections; Postoperative Complications; Radiography, Thoracic; Sputum; Trimethoprim, Sulfamethoxazole Drug Combination

Mycobacterium fortuitum rarely causes lung disease despite its sporadic isolation as a saprophytic colonizer from sputum or saliva. If pulmonary disease occurs, it is usually indolent in nature. The case presented appears to be the first reported case of a M. fortuitum lung abscess that was successfully treated with a prolonged course of trimethoprim/sulfamethoxazole. The patient remains well without evidence of recurrence nearly 2 yr after the cessation of therapy.

Topics: Adult; Humans; Lung Abscess; Male; Mycobacterium Infections; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Tuberculosis, Pulmonary