trimethoprim--sulfamethoxazole-drug-combination and Mucositis

Clostridium difficile infection (CDI) is a significant complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Our primary objective was to determine risk factors for the development of CDI during the first year following allo-HSCT.. A matched case-control study nested in a cohort of allo-HSCT at a single hospital in Montréal, Québec, Canada, was conducted from 2002 through 2011.. Sixty-five of 760 patients who underwent allo-HSCT between 2002 and 2011 developed CDI, representing an incidence of 8.6%. We selected 123 controls matched for year of transplant for risk factor analyses. In the multivariable analysis, receipt of trimethoprim-sulfamethoxazole (TMP-SMX) prior to transplantation (adjusted odds ratio [aOR] 0.07, 95% confidence interval [CI] 0.02-0.27), mucositis (aOR 5.90, 95% CI 2.08-16.72), and reactivation of cytomegalovirus (CMV) (aOR 6.17, 95% CI 2.17-17.57) and of other Herpesviridae viruses (aOR 3.04, 95% CI 1.13-8.16) were the variables that remained statistically associated with CDI. High-risk antibiotic use in the late post-transplant period (aOR 7.63, 95% CI 2.14-27.22) was associated with development of late CDI.. This study revealed reactivation of CMV and other Herpesviridae viruses as novel risk factors for CDI. Administration of TMP-SMX prior to transplantation was independently associated with a decreased risk of CDI. Early and late CDI after HSCT may have distinct risk factors.

Topics: Adult; Anti-Bacterial Agents; Case-Control Studies; Clostridioides difficile; Clostridium Infections; Cytomegalovirus; Cytomegalovirus Infections; Female; Hematopoietic Stem Cell Transplantation; Humans; Incidence; Male; Middle Aged; Mucositis; Quebec; Retrospective Studies; Risk Factors; Transplantation Conditioning; Transplantation, Homologous; Trimethoprim, Sulfamethoxazole Drug Combination; Virus Activation

Topics: Aged; Anti-Infective Agents; Crohn Disease; Diarrhea; Drug Interactions; Female; Humans; Immunosuppressive Agents; Leucovorin; Methotrexate; Mucositis; Pneumonia, Pneumocystis; Prednisone; Stomatitis; Trimethoprim, Sulfamethoxazole Drug Combination

In addition to the well-known signs of methotrexate toxicity, rare cutaneous side effects have been described. These cutaneous signs may provide a diagnostic clue into the diagnosis of toxicity as well as facilitate early and aggressive therapy. We describe the case of a 37-year-old male, with a diagnosis of psoriasis, who developed characteristic signs and symptoms of acute methotrexate toxicity after receiving an unknown amount of intravenous methotrexate. The patient experienced a distinct change in the morphology of his existing psoriatic plaques, which became ulcerated and necrotic in the week following the methotrexate injection. Shortly after the development of cutaneous erosions, the patient developed pancytopenia, which ultimately led to his death. Ulceration and necrosis of cutaneous psoriasis plaques may serve as a herald for the impending development of life-threatening pancytopenia in patients with acute methotrexate toxicity.

Topics: Acute Kidney Injury; Adult; Azithromycin; Biopsy; Fatal Outcome; Filgrastim; Granulocyte Colony-Stimulating Factor; Humans; Immunosuppressive Agents; Leucovorin; Male; Methotrexate; Mucositis; Necrosis; Pancytopenia; Plasma; Psoriasis; Recombinant Proteins; Self Medication; Skin Ulcer; Trimethoprim, Sulfamethoxazole Drug Combination

Toxic epidermal necrolysis (TEN) is a rare, potentially life-threatening bullous drug reaction. Rapid diagnosis of TEN can lower the mortality rate when the offending drug is withdrawn immediately. Simple diagnostic tools such as cytology of skin blisters may be useful if rapid diagnosis is needed, in particular if standard histopathology service fails. An even faster bedside test for TEN in patients with black skin is color evaluation of skin blister fluid.

Topics: Adult; Anti-Bacterial Agents; Black or African American; Body Fluids; Bronchitis; Color; Early Diagnosis; Female; Humans; Keratinocytes; Melanins; Mucositis; Point-of-Care Systems; Stevens-Johnson Syndrome; Stomatitis; Trimethoprim, Sulfamethoxazole Drug Combination