trimethoprim--sulfamethoxazole-drug-combination and Nephrotic-Syndrome

We evaluated the clinical manifestations and outcomes of nocardiosis, a rare opportunistic infection that occurs in patients with nephrotic syndrome.. The records of NS patients with nocardiosis in a single hospital during 2000-2019 were retrieved and studied in detail.. NS patients can develop immunodeficiency after treatment with glucocorticoid and immunosuppressants. In cases where patients develop systemic multiple abscesses, or lung images reveal isolated or scattered nodules and masses that are subpleural or close to the hilum, nocardial infection should be considered. Early diagnosis and specific treatment may improve patient outcomes.

Topics: Abscess; Adult; Aged; Anti-Bacterial Agents; C-Reactive Protein; Carbapenems; CD4 Lymphocyte Count; Drug Therapy, Combination; Female; Fever; Glucocorticoids; Humans; Lung Diseases; Male; Middle Aged; Nephrotic Syndrome; Nocardia; Nocardia Infections; Pleural Effusion; Procalcitonin; Retrospective Studies; Subcutaneous Tissue; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

A 70-year-old man treated for 6 months with prednisolone for nephrotic syndrome, was referred to our pulmonary division because of a nodule in the right lower lung field. Nocardia asteroides was isolated from the culture of the percutaneous lung aspiration, and the case was diagnosed as pulmonary nocardiosis. The lesion disappeared after 2 months of therapy with sulfamethoxazole/trimethoprim (1,600 mg/320 mg once a day). Though it had been given prophylactically (800 mg/160 mg twice a week) for the prevention of pneumocystis carinii pneumonitis.

Topics: Aged; Humans; Male; Nephrotic Syndrome; Nocardia asteroides; Nocardia Infections; Opportunistic Infections; Pneumonia, Bacterial; Pneumonia, Pneumocystis; Prednisolone; Trimethoprim, Sulfamethoxazole Drug Combination

Rituximab (RTX) effectively prevents relapses in patients with complicated steroid-sensitive nephrotic syndrome (SSNS). The 1-year relapse-free survival rate is approximately 30% in children after the first episode of SSNS treated with standardised corticosteroids. Whether the benefits of RTX extend to the first relapse are unknown. The efficacy and safety of RTX in the first episode of paediatric idiopathic nephrotic syndrome (RTXFIRPedINS) trial (NCT04783675) will assess its effect on the risk of subsequent relapse.. RTXFIRPedINS is an open-label, single-arm, multicentre trial targeting patients aged 1-18 years with a first episode of SSNS. All patients will receive standardised corticosteroid treatment for 12 weeks. A sample size of 44 patients provides 80% power to detect a 20% increase in the 1-year relapse-free rate, assuming a dropout rate of 10%. After obtaining informed consent and screening, eligible patients will be treated with a single intravenous infusion of 375 mg/m. This trial was approved by the Ethics Committee of the Children's Hospital of Fudan University and seven local ethics committees. We will publish our study results in peer-reviewed journals and present them at international scientific meetings.. NCT04783675.

Topics: Child; Humans; Immunologic Factors; Multicenter Studies as Topic; Neoplasm Recurrence, Local; Nephrotic Syndrome; Recurrence; Rituximab; Steroids; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Opportunistic infection with multiple pathogens currently has become less uncommon since the application of immunosuppressant or corticosteroid in non- Human immunodeficiency virus patients. However, the clinical diagnosis of the co-infection remains difficult since the uncertainty and deficiency of the microbiologic testing methods.. A 66-year-old male patient was admitted to our hospital with chest stuffiness, shortness of breath and elevated body temperature.. He was diagnosed with the co-infection of Pneumocystis jiroveci and cytomegalovirus by metagenomic next-generation sequencing of bronchoalveolar lavage fluid after bronchoscopy.. The patient was empirically treated with broad-spectrum antibiotics, trimethoprim/ sulfamethoxazole and ganciclovir in the beginning of the admission.. The condition of this patient was not improved even with the intervention at the early stage of the disease. His family requested discharge after 24 inpatient days.. This case highlights the application of metagenomic next-generation sequencing in the clinical diagnosis of pulmonary co-infection. Suitable prophylaxis, necessary clinical awareness and accurate diagnosis are indispensable for immunocompromised patients with pulmonary infection.

Topics: Aged; Anti-Infective Agents; Bronchoalveolar Lavage Fluid; Bronchoscopy; Coinfection; Cytomegalovirus; Cytomegalovirus Infections; Ganciclovir; High-Throughput Nucleotide Sequencing; Humans; Male; Metagenomics; Methylprednisolone; Nephrotic Syndrome; Pneumocystis carinii; Pneumonia, Pneumocystis; Trimethoprim, Sulfamethoxazole Drug Combination

Rituximab, an anti-CD20 antibody that targets B cells, is a promising agent against steroid-dependent and steroid-resistant nephrotic syndrome in children.. We report a 3-year-old boy who presented with atypical Pneumocystis jiroveci pneumonia (PCP) following administration of rituximab for refractory nephrotic syndrome. He had received cyclosporine and daily prednisolone for over 1 year. Following rituximab therapy, a hazy shadow was observed on his chest X-ray. Chest-computed tomography revealed multiple nodular lesions in bilateral lungs, although his clinical symptoms were subtle. PCR analysis demonstrated the presence of Pneumocystis DNA in his bronchoalveolar lavage. Lung wedge resection of the nodular lesion exhibited granulomas containing a few cysts of P. jiroveci that primarily consisted of T cells and histiocytes and lacked B cells. A deficiency of B cells following rituximab treatment suggests a dramatic effect on the immune response and, therefore, could result in granulomatous PCP. Nodular granulomatous lesions of PCP comprise an emerging concept previously reported in adults with hematological disease, bone marrow transplant, or treatment with rituximab. We report the first pediatric case of nodular PCP. Granulomatous PCP can be life-threatening. Moreover, bronchoalveolar lavage often fails to demonstrate the presence of P. jiroveci DNA. Wedge biopsy is warranted for definitive diagnosis. Our patient fully recovered with sulfamethoxazole/trimethoprim treatment because of early detection.. The indication of rituximab for refractory nephrotic syndrome has increased recently. Therefore, recognition of the risk of atypical PCP is important. Our findings suggest that PCP prophylaxis should be considered following rituximab therapy.

Topics: Anti-Infective Agents; Antibodies, Monoclonal, Murine-Derived; Child, Preschool; Granuloma; Humans; Immunocompromised Host; Immunosuppressive Agents; Male; Nephrotic Syndrome; Pneumocystis carinii; Pneumonia, Pneumocystis; Rituximab; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Albendazole; Humans; Ivermectin; Male; Nephrotic Syndrome; Strongyloidiasis; Trimethoprim, Sulfamethoxazole Drug Combination

Whipple's disease (WD) is a chronic infection caused by Thropheryma whipplei that usually manifests with intestinal, articular, pulmonary, neurological and cardiac abnormalities. Rarely, WD has been associated with renal AA amyloidosis.We report a 50 year-old male with nephrotic syndrome and renal failure whose renal biopsy revealed extensive AA amyloidosis. Amyloid was not found in other organs, namely in gastrointestinal tract and bone marrow. There was no evidence of chronic inflammatory disease, and despite detailed investigation, the diagnosis of the underlying disease remained obscure. Eight months after referral he started peritoneal dialysis. Three years later he developed anorexia, weight loss, anemia, and recurrent attacks of non-bloody diarrhea. A biopsy of the small intestine showed typical histological findings of WD and PCR was positive for T. whipplei. He was treated with ceftriaxone followed by co-trimoxazole, with remission of complaints and histological features. Three years later the patient underwent successful cadaveric kidney transplantation. In this case, AA amyloidosis preceded the manifestations of WD. To the best of our knowledge, this is the first report of kidney transplantation in a patient with amyloidosis due to WD. Recurrence of amyloidosis in renal graft is not expected.

Topics: Amyloidosis; Anti-Bacterial Agents; Ceftriaxone; Duodenum; Humans; Kidney; Kidney Transplantation; Male; Middle Aged; Nephrotic Syndrome; Serum Amyloid A Protein; Trimethoprim, Sulfamethoxazole Drug Combination; Tropheryma; Whipple Disease

Strongyloidiasis is caused by a small intestinal nematode with a complex life cycle. In Italy the infection is endemic in rural areas of the Po Valley. The clinical syndrome of S. stercoralis encompasses a broad spectrum of symptoms and signs and, in the immunocompromised host, larvae can migrate to different organs and tissues. Also immune response seems to play a role in the pathogenesis of the disease. We report a case of strongyloidiasis complicated by Gram-negative sepsis and nephrotic syndrome in an immigrant from South America with a normal immune response. Whereas sepsis cleared up quickly, parasitic clearance was obtained only after treatment with ivermectin and nephrotic syndrome was still present three months after the end of treatment.

Topics: Adult; Albendazole; Animals; Anthelmintics; Anti-Bacterial Agents; Bacteremia; Ecuador; Endemic Diseases; Escherichia coli Infections; Humans; Immunocompetence; Italy; Ivermectin; Larva; Male; Nephrosis, Lipoid; Nephrotic Syndrome; Prednisone; Strongyloides stercoralis; Strongyloidiasis; Trimethoprim, Sulfamethoxazole Drug Combination