trimethoprim--sulfamethoxazole-drug-combination and Mycobacterium-Infections

Topics: Aged, 80 and over; Anti-Infective Agents; Cefepime; Cephalosporins; Drug Therapy, Combination; Humans; Injections, Intravenous; Male; Mycobacterium Infections; Pacemaker, Artificial; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

Mycobacterium fortuitum is a rarely reported cause of otitis media and mastoiditis. We report such a case recently seen at our institution and review the four previously published cases of this disease entity. Amikacin is recommended in the current medical literature as empirical treatment of disease due to M. fortuitum, but the isolate from our patient showed high-level resistance to amikacin, which is rare in clinical isolates of this species; this resistance was probably related to prior treatment with topical aminoglycosides. Our patient's infection responded to a 12-month course of therapy with clarithromycin and trimethoprim-sulfamethoxazole.

Topics: Adolescent; Amikacin; Anti-Bacterial Agents; Cefoxitin; Clarithromycin; Drug Resistance, Microbial; Drug Therapy, Combination; Female; Humans; Mastoiditis; Mycobacterium Infections; Nontuberculous Mycobacteria; Otitis Media; Trimethoprim, Sulfamethoxazole Drug Combination

Tumor necrosis factor-alpha inhibitors are potent anti-rheumatic drugs, but there is evidence that the high level of immunosuppression they provide may also lead to a higher risk of infections. At our institution, 3 patients with inflammatory arthritis treated with tumor necrosis factor-alpha inhibitors developed mycobacterial soft tissue infections after routine hand surgery. All 3 patients required multiple surgical procedures, inpatient hospitalizations, and prolonged antibiotic multidrug therapy to clear the infections.

Topics: Aged; Antibodies, Monoclonal; Antirheumatic Agents; Arthritis, Psoriatic; Arthritis, Rheumatoid; Azithromycin; Etanercept; Female; Hand; Humans; Immunoglobulin G; Infliximab; Male; Methotrexate; Middle Aged; Mycobacterium Infections; Receptors, Tumor Necrosis Factor; Tenosynovitis; Trimethoprim, Sulfamethoxazole Drug Combination; Tumor Necrosis Factor-alpha

Mycobacterium branderi, a potential human pathogen first characterized in 1995, has been isolated from respiratory tract specimens. We report here a case in which M. branderi was the only organism isolated upon culture from a hand infection. This isolate, along with a second isolate from a bronchial specimen, was subjected to conventional identification tests for mycobacterial species. Further analysis by high-performance liquid chromatography (HPLC) of mycolic acids and 16S rRNA gene sequencing was performed, and the antibiotic susceptibility profile was determined for both strains. Biochemical tests and the HPLC pattern were consistent with that of M. branderi and M. celatum, which are very similar. The 16S rRNA gene sequence of both strains corresponded to that of M. branderi and enabled us to confidently differentiate this organism from other closely related species such as M. celatum. This contributes to a further understanding of the status of this species as a potential human pathogen as well as illustrating the need for molecular diagnostics as a complementary method for the identification of rare mycobacterial species.

Topics: Chromatography, High Pressure Liquid; Ciprofloxacin; Clarithromycin; DNA, Ribosomal; Drug Therapy, Combination; Female; Hand; Humans; Lung Diseases; Microbial Sensitivity Tests; Middle Aged; Mycobacterium; Mycobacterium Infections; Mycolic Acids; RNA, Ribosomal, 16S; Skin Diseases, Bacterial; Trimethoprim, Sulfamethoxazole Drug Combination

Mycobacterium vaccae is a rapidly growing mycobacterial species that was previously not considered a human pathogen. We report four cases of M. vaccae infection that occurred in the southern United States; one patient had cutaneous disease, and three patients had cavitary lung disease. Two of the three patients with pulmonary disease had a history of exposure to cattle. The conditions of all patients improved with therapy: the cutaneous infection responded to therapy with minocycline and trimethoprim-sulfamethoxazole, and the pulmonary infections responded to therapy with ciprofloxacin.

Topics: Aged; Animals; Anti-Bacterial Agents; Cattle; Ciprofloxacin; Humans; Male; Middle Aged; Minocycline; Mycobacterium; Mycobacterium Infections; Neoplasms; Pneumonia, Bacterial; Skin Diseases, Bacterial; 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

Topics: Child, Preschool; Clofazimine; Consanguinity; Drug Therapy, Combination; Ethambutol; Female; Hepatomegaly; Humans; Immunity, Cellular; Joint Diseases; Mycobacterium Infections; Rifampin; Skin Diseases; Trimethoprim, Sulfamethoxazole Drug Combination

Therapy of opportunistic infection in patients with the acquired immunodeficiency syndrome is frustrating, and there is no convincing evidence that aggressive treatment and/or prophylaxis other than for Pneumocystis infection can significantly prolong life. While much clinical effort is expended on treating sequential life-threatening infections, the overall course is usually progressively downhill. Thus, any real impact on the disease should be aimed at the causative viral agent, because it is destruction of a critical component of the immune system that predisposes to opportunistic infections.

Topics: Acquired Immunodeficiency Syndrome; Adult; Candidiasis; Cryptococcosis; Drug Combinations; Humans; Intestinal Diseases, Parasitic; Male; Mycobacterium Infections; Mycoses; Pneumonia, Pneumocystis; Sulfamethoxazole; Toxoplasmosis; Transfusion Reaction; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Virus Diseases

A 33-year-old fish fancier developed a protracted skin infection that ultimately was found to be caused by Mycobacterium marinum. The organism was isolated from the lesion as well as from infected fish taken from his home aquarium. The lesion resolved after a six-week course of oral sulfamethoxazole and trimethoprim. Forty-four additional cases of culture-proved M marinum skin infections acquired from aquariums and reported in the English-language literature are reviewed. Almost universally, the lesions remained circumscribed and were either single nodular (14 patients) or multiple sporotrichoid (31 patients). Diagnosis was supported by acid-fast smears (15 patients) and isolation of the organism from skin lesions (43 patients) or from fish (two cases). In vitro studies, as well as clinical outcomes, suggest sulfamethoxazole-trimethoprim or ethambutol hydrochloride plus rifampin to be the drugs of choice.

Topics: Adult; Animals; Anti-Bacterial Agents; Drug Combinations; Fish Diseases; Fishes; Hand Dermatoses; Hobbies; Humans; Male; Mycobacterium Infections; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Skin Diseases, Infectious; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acquired Immunodeficiency Syndrome; Drug Combinations; Humans; Lung; Lung Diseases; Lung Volume Measurements; Mycobacterium Infections; Pneumonia, Pneumocystis; Radiography; Sulfamethoxazole; Therapeutic Irrigation; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

One hundred twenty-three patients with nonpulmonary infections due to Mycobacterium fortuitum or Mycobacterium chelonei were treated by wound debridement and with chemotherapy on the basis of in vitro susceptibilities of the organism. Of 76 patients with infections caused by M. fortuitum, 13 required no therapy or were adequately treated with surgery alone. Patients with active localized disease received single drug therapy (usually with a sulfonamide) for a mean period of 10.6 weeks for cellulitis and seven months for osteomyelitis. Patients with extensive disease received amikacin or amikacin plus cefoxitin (mean, four weeks) followed by a sulfonamide (mean, six months). The 47 patients with infections caused by M. chelonei received no therapy or were treated with surgery alone (6); with amikacin (10), erythromycin (6), doxycycline (3), or cefoxitin (1); or with amikacin plus cefoxitin followed by cefoxitin alone for a total of 10-12 weeks (20); or other multiple-drug regimens (1). Surgery was performed on 74 (60%) patients. Schlichter tests or serum drug levels were determined for 81 (66%) patients. Response to therapy was excellent; 68 (90%) infections with M. fortuitum and 34 (72%) with M. chelonei were successfully treated. Cultures became negative within six weeks of chemotherapy, except for sternal osteomyelitis, for which cultures were not negative until up to 14 weeks. Follow-up for a mean period of 12 months following therapy was possible in 80% of cases. Relapses were rare except in patients with disseminated disease, and drug resistance developed in only one patient. These studies demonstrate the value of routine susceptibility testing of these mycobacterial species and the benefit of chemotherapy on the basis of in vitro susceptibilities.

Topics: Adult; Aged; Amikacin; Anti-Bacterial Agents; Cefoxitin; Drug Combinations; Erythromycin; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Mycobacterium; Mycobacterium Infections; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Sulfamethoxazole; Sulfisoxazole; Sulfonamides; Tetracyclines; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Animals; Dermatitis, Occupational; Drug Combinations; Drug Resistance, Microbial; Fishes; Humans; Male; Mycobacterium Infections; Mycobacterium Infections, Nontuberculous; Skin Diseases, Infectious; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Animals; Antitubercular Agents; Drug Combinations; Female; Fingers; Fishes; Forearm; Granuloma; Humans; Male; Mycobacterium Infections; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Skin Diseases, Infectious; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination