trimethoprim--sulfamethoxazole-drug-combination and Malacoplakia

We report a case of prostatic malacoplakia in a 68-year-old man complaining of fever, residual urinary sensation and small urinary stream. Culture of the urine showed E. coli and Enterococcus faecalis. Digital examination and transrectal ultrasound of the prostate were most compatible with carcinoma. However, transrectal needle biopsy revealed the histopathological features of malacoplakia. The patient had been treated with trimethoprim-sulfamethoxazole, bethanechol and ascorbic acid for 5 months. Twenty-seven cases of prostatic malacoplakia in the Japanese literature are reviewed.

Topics: Aged; Anti-Bacterial Agents; Ascorbic Acid; Bethanechol; Bethanechol Compounds; Drug Therapy, Combination; Humans; Malacoplakia; Male; Prostatic Diseases; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Bacterial Agents; Antioxidants; Ascorbic Acid; Bethanechol; Biopsy; Diagnosis, Differential; Female; Fluoroquinolones; Humans; Ill-Housed Persons; Kidney; Kidney Function Tests; Malacoplakia; Middle Aged; Muscarinic Agonists; Organ Size; Prognosis; Renal Dialysis; Renal Insufficiency; Substance-Related Disorders; Tomography, X-Ray Computed; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

A 4-month-old female kitten presented with chronic lower urinary tract signs and Escherichia coli cystitis, and was diagnosed with urinary bladder malakoplakia based upon histopathology. The kitten was treated with a prolonged antibiotic course and the malakoplakia resolved. Malakoplakia is a chronic granulomatous reaction characterized by the formation of Michaelis-Gutman bodies within von Hansemann macrophages. It is well described in humans, but has never been documented in a living veterinary patient. This case report describes the first successful treatment of malakoplakia in veterinary medicine.

Topics: Animals; Anti-Bacterial Agents; Cat Diseases; Cats; Escherichia coli; Escherichia coli Infections; Female; Malacoplakia; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder Diseases; Urinary Tract Infections

To describe the clinical findings, treatment and results of long-term follow-up of a case of malacoplakia of the bladder.. After diagnostic endoscopic evaluation, transurethral resection of the lesion was performed and antibiotic therapy was administered. The same treatment was repeated 4 years later. During the following 10 years, the patient had a yearly endoscopic evaluation that showed no recurrence of the lesion.. Transurethral resection combined with antibiotic therapy is effective in the treatment of malacoplakia of the bladder. The importance of long-term follow-up of the patient is emphasized.

Topics: Anti-Bacterial Agents; Chronic Disease; Cystoscopy; Electrocoagulation; Escherichia coli Infections; Female; Follow-Up Studies; Hematuria; Histiocytes; Humans; Malacoplakia; Middle Aged; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder Diseases; Urinary Tract Infections

We describe a four-week-old male infant with bilateral renal parenchymal malakoplakia who presented with low grade fever, convulsions and lethargy. The patient had profound anemia, hepatosplenomegaly and bilateral nephromegaly with reduced renal function. Both blood and urine cultures grew Escherichia coli, and antibiotic therapy was started. A kidney biopsy obtained on the 20th hospital day confirmed the diagnosis of renal parenchymal malakoplakia. Following treatment with an intravenous methylprednisolone pulse therapy, the infant made significant clinical improvement. He has grown and developed normally in the three years following this episode. We suggest that the steroid therapy was useful in ameliorating renal parenchymal malakoplakia in a patient without an underlying systemic disease. This report describes the youngest patient to have malakoplakia.

Topics: Anti-Infective Agents, Urinary; Anti-Inflammatory Agents; Drug Administration Schedule; Humans; Infant; Kidney Diseases; Malacoplakia; Male; Methylprednisolone; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Clofazimine; Female; Humans; Malacoplakia; Skin Diseases; Trimethoprim, Sulfamethoxazole Drug Combination

Urinary malakoplakia may pursue an aggressive clinical course with persistent infection, despite seemingly appropriate antibiotic therapy. The authors studied seven adult females with urinary malakoplakia. Specific immunocytochemical staining demonstrated intracellular Escherichia coli in malakoplakia tissue in four patients. In two of the four patients, the bacteria were present despite antibiotic-induced sterile urines at time of biopsy. Cessation of therapy consistently lead to recurrent bacteriuria in these patients. In one such patient, the intracellular bacilli were confirmed as E. coli by culture of crushed malakoplakia tissue and electron microscopic study; the organisms were a routine E. coli strain susceptible to multiple previously administered antibiotics. Only sequential treatment with bethanechol chloride and trimethoprim-sulfamethoxazole, however, eliminated the infection; all three drugs are thought to be capable of enhancing intracellular killing of bacteria. Conventional antibiotic therapy failed to halt progression of disease in other malakoplakia patients. The data indicate that intracellular bacteria may serve as a reservoir of persistent/recurrent infection in urinary malakoplakia. Optimal therapy should include therapeutic agents that may control intracellular organisms.

Topics: Adult; Aged; Bacteriological Techniques; Bacteriuria; Bethanechol; Bethanechol Compounds; Drug Combinations; Escherichia coli; Escherichia coli Infections; Female; Humans; Immunoenzyme Techniques; Malacoplakia; Male; Middle Aged; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urologic Diseases

A case of malacoplakia involving the lower urinary tract of a young black boy, with associated bilateral vesicoureteral reflux, hydronephrosis and selective immunoglobulin A deficiency is reported. Reflux was caused by the malacoplakia. Reflux and hydronephrosis persisted despite elimination of bacterial infection and malacoplakia by drug therapy. These abnormalities were corrected by a conventional antireflux operation. Malacoplakia appears to be related to immunologic incompetence and diminished levels of intracellular cyclic 3',5' guanine monophosphate. Cholinergic agonists reverse or prevent the pathological changes of malacoplakia.

Topics: Anti-Infective Agents, Urinary; Bethanechol; Bethanechol Compounds; Child, Preschool; Drug Combinations; Dysgammaglobulinemia; Humans; Hydronephrosis; IgA Deficiency; Malacoplakia; Male; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder; Urinary Bladder Diseases; Vesico-Ureteral Reflux

The management of genitourinary malacoplakia in renal transplant recipients has been unsatisfactory previously, as evidenced by an unacceptably high rate of graft loss and mortality. To optimize future management of this problem we studied 2 poorly recognized factors in the pathogenesis and prognosis of genitourinary malacoplakia in transplant recipients: 1) the probable role of azathioprine as the specific immunosuppressive agent responsible for the pathogenesis of malacoplakia, and 2) the importance of the localization of the disease and its impact on the ultimate prognosis. A new therapeutic regimen is suggested, which includes long-term antibiotics combined with an immediate modification of azathioprine therapy and early graft nephrectomy in selected cases with renal parenchymal involvement.

Topics: Adult; Anti-Infective Agents, Urinary; Azathioprine; Biopsy; Drug Combinations; Female; Humans; Immunosuppression Therapy; Kidney Transplantation; Malacoplakia; Prognosis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder; Urinary Bladder Diseases

Malacoplakia is a granulomatous disease that most frequently involves the urinary tract but also may involve the genital tract, gastrointestinal tract and retroperitoneum. It is believed to be infectious in origin, secondary to a deficiency of intracellular lysosomal digestion, and heretofore considered a chronic problem. We report a case of malacoplakia of the bladder, which was treated successfully with a combination of bethanechol, trimethoprim-sulfamethoxazole and ascorbic acid.

Topics: Anti-Infective Agents, Urinary; Ascorbic Acid; Bethanechol; Bethanechol Compounds; Drug Combinations; Drug Therapy, Combination; Female; Humans; Malacoplakia; Middle Aged; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder Diseases