trimethoprim--sulfamethoxazole-drug-combination and Myositis

Melioidosis is considered endemic in certain areas of the world. Musculoskeletal and soft tissue involvement are relatively uncommon presentations in melioidosis. We present a case of infective myositis in a patient with melioidosis in Sri Lanka, which is not considered an endemic country. Even though multiple cases of melioidosis have been reported with an increasing number in Sri Lanka, infective myositis secondary to melioidosis was not reported previously.. A 60-year-old Sinhalese man with diabetes presented with fever of 4 months' duration and a limp with a painful lump on the right side of the upper thigh of 2 months' duration. He had been treated in a local hospital for community-acquired pneumonia 3 weeks prior to this admission, for which he had received intravenous meropenem and teicoplanin with intensive care unit admission. He had a 0.5-cm × 0.5-cm tender lump over the right vastus lateralis muscle, and contrast-enhanced computed tomography of the area showed an ill-defined, heterogeneously enhancing, hypodense area involving the vastus lateralis, vastus intermedius, and quadratus femoris, suggestive of infective myositis but without abscess formation. Histopathology of the muscle biopsied from the vastus lateralis showed suppurative inflammation of subcutaneous fat with connective tissue necrosis and muscle infiltrated by lymphocytes. These features are suggestive of infective myositis possibly due to melioidosis. Although the result of a culture taken from the muscle biopsy was negative, the patient's antibody titer was strongly positive for melioidosis. He did not show any other areas with infected foci. He was treated with intravenous meropenem for 2 weeks and responded well. He was discharged with trimethoprim-sulfamethoxazole for 6 months as a maintenance therapy.. Melioidosis is commonly an undiagnosed disease that has a wide variety of clinical presentations. Myositis in melioidosis is uncommon, and careful evaluation is mandatory to avoid misdiagnosis of this treatable but fatal disease. The clinician should have a high index of clinical suspicion, and further clinical and epidemiological studies are needed to determine the true burden of the disease.

Topics: Anti-Bacterial Agents; Burkholderia pseudomallei; Humans; Male; Melioidosis; Meropenem; Middle Aged; Myositis; Sri Lanka; Thigh; Tomography, X-Ray Computed; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

To present a case of cellulitis/myositis due to Stenotrophomonas maltophilia in the absence of trauma and to discuss a potentially novel treatment option.. A 57-year-old white man, having undergone an allogeneic bone marrow transplant, developed myositis with S. maltophilia of the left soleus muscle; there had been no trauma. Risk factors for infection included neutropenia, prolonged hospitalization and intensive care unit stay, and broad-spectrum antibiotic exposure. The affected area of muscle was resected and the patient successfully treated with trimethoprim/sulfamethoxazole (TMP/SMX), ticarcillin/clavulanate, and aztreonam.. In severe myositis/cellulitis caused by S. maltophilia, TMP/SMX is considered the drug of choice. However, bacteriostatic agents such as TMP/SMX are less than ideal in neutropenic patients. The combination of ticarcillin/clavulanate plus aztreonam has been shown to improve activity in vitro against this organism compared with TMP/SMX. This is likely due to inhibition of the 2 beta-lactamases this organism produces by clavulanate and aztreonam. In our study of clinical isolates of S. maltophilia, this combination reduced the minimum inhibitory concentration at 90% by 128-fold and was synergistic against 10 of 12 isolates tested in time-kill analysis.. S. maltophilia is emerging as an important pathogen in patients with compromised immunity, leading to severe infections that are difficult to treat. Based on in vitro synergy studied, we recommend considering ticarcillin/clavulanate plus aztreonam as a potential treatment option in immunocompromised patients with S. maltophilia infection.

Topics: Anti-Bacterial Agents; Aztreonam; Bone Marrow Transplantation; Cellulitis; Clavulanic Acid; Drug Therapy, Combination; Gram-Negative Bacterial Infections; Humans; Male; Middle Aged; Monobactams; Muscle, Skeletal; Myositis; Penicillins; Risk Factors; Stenotrophomonas maltophilia; Ticarcillin; Trimethoprim, Sulfamethoxazole Drug Combination

It is occasionally difficult to distinguish the features of spinal brucellosis from those of ankylosing spondylitis (AS), and the resultant delayed diagnosis may allow insidious progression of the complications of the brucella infection. The case of a 33-year-old male HLA-B27-positive patient with known diagnosis of AS for 7 years, who developed a paravertebral abscess in the left erector spinae muscle due to brucellosis, is presented in this paper. This case report illustrates two important points; first, co-occurrence of AS and brucellosis in the same patient, and second, posterior element involvement with abscess formation in erector spinae muscle, which has not been previously reported. Magnetic resonance imaging is a sensitive method for detecting spinal brucellosis and extent of infection throughout paravertebral structures. Clinicians serving patients from areas with endemic brucellosis should not overlook the possibility of this infection in the presence of axial musculoskeletal symptoms, even among patients with AS.

Topics: Abscess; Adult; Anti-Bacterial Agents; Brucella; Brucellosis; Diclofenac; Doxycycline; Drug Therapy, Combination; Humans; Lumbosacral Region; Magnetic Resonance Imaging; Male; Muscle, Skeletal; Myositis; Osteomyelitis; Spondylitis, Ankylosing; Streptomycin; Sulfasalazine; Trimethoprim, Sulfamethoxazole Drug Combination

Muscle sarcocystosis is a parasitic infection acquired by ingestion of sporocysts of Sarcocystis species. A case is described where symptoms of fever, chronic myositis and eosinophilia were present. Diagnosis was made via muscle biopsy. Improvement and cure coincided with treatment with cotrimoxazole. A limited review of human muscle sarcocystosis and an outline of the gaps in the knowledge of this infection is presented.

Topics: Adult; Eosinophilia; Humans; Male; Myositis; Sarcocystosis; Trimethoprim, Sulfamethoxazole Drug Combination

Coliform myositis was diagnosed in a young calf with signs of pain, swelling, and edema of the right hind limb. Diagnostic methods included bacteriologic culture and antimicrobial susceptibility testing. The organism isolated was a gas-producing Escherichia coli. The infection responded to administration of trimethoprim/sulfadiazine, to which the organism was susceptible in vitro.

Topics: Animals; Cattle; Cattle Diseases; Escherichia coli; Escherichia coli Infections; Male; Microbial Sensitivity Tests; Myositis; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Aged; Diagnosis, Differential; Heart Failure; Humans; Immunosuppression Therapy; Male; Myositis; Pneumocystis; Pneumonia, Pneumocystis; Respiratory Function Tests; Trimethoprim, Sulfamethoxazole Drug Combination

A case of tropical pyomyositis in a 24-year-old Greek is reported. The patient presented with high fever and swelling of the left thigh, generalized lymphadenopathy and multiple infiltrations in both lung fields on X-ray of the chest. Multifocal muscle abscesses were detected by CT scan of the left thigh and gluteal area. Staphylococcus aureus was identified in cultures of the purulent material which was surgically drained. The patient was subsequently treated with appropriate antibiotics. Lack of familiarity with this disease caused diagnostic confusion and delayed the initiation of treatment.

Topics: Adult; Diagnosis, Differential; Dicloxacillin; Drug Combinations; Greece; Humans; Male; Myositis; Phenylbutazone; Staphylococcal Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

A 29 year old woman with polymyositis treated with azathioprine presented with pneumonia. Rising serum antibody titres have confirmed a diagnosis of legionnaires' disease. Infection with Legionella pneumophila must now be considered in New Zealand when patients present with pneumonia and severe pyrexia, especially if they show known risk factors.

Topics: Adult; Antibodies, Bacterial; Azathioprine; Drug Combinations; Female; Humans; Legionnaires' Disease; Myositis; Pneumonia; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination