trimethoprim--sulfamethoxazole-drug-combination and Pleural-Effusion

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 community-based prospective surveillance and case management study of acute respiratory infection (ARI) in children aged 2-60 months of age was carried out over a 12-month period in Pakata, a semi-urban community in Ilorin, Kwara State, Nigeria. A cohort of 481 children was followed by trained community health assistants with thrice weekly home visits to record all symptoms and signs of ARI, and institute treatment based on WHO recommendations. There were three episodes of mild, moderate, or severe ARI per child per year, including 1.3 pneumonia episodes per child per year. The peak of infection corresponded to the rainy season (July-November), and a smaller peak to the dry season (February-April). Most of the health worker decisions were considered appropriate, although there was a tendency toward over-treatment with antibiotic drugs. An effective referral system was established from the community to a tertiary centre. There were no ARI-related deaths during the study period. These data indicate that a system of case management using trained community health workers can improve case management of ARI and may prevent severe ARI-related disease and deaths.

Topics: Acute Disease; Child, Preschool; Cloxacillin; Cohort Studies; Community Health Services; Female; Gentamicins; Health Promotion; Home Care Services; Humans; Infant; Male; Managed Care Programs; Nigeria; Pleural Effusion; Pneumonia, Staphylococcal; Prospective Studies; Respiratory Tract Infections; Severity of Illness Index; Staphylococcus aureus; Surveys and Questionnaires; Trimethoprim, Sulfamethoxazole Drug Combination; Workforce; World Health Organization

We report a case of drug-induced lupus erythematosus (DILE) secondary to trimethoprim/sulfamethoxazole (TMP/SMX) in a patient with underlying inflammatory bowel disease (IBD). The initial presentation was with febrile pleural and pericardial effusions followed by cardiac tamponade. The patient was treated with a short course of corticosteroids with complete resolution of symptoms. To our knowledge this is the first reported case of TMP/SMX-induced DILE presenting with life-threatening serositis. When confronted with sterile exudative effusions, clinicians should strongly consider non-infectious etiologies.

Topics: Adrenal Cortex Hormones; Cardiac Tamponade; Female; Humans; Inflammatory Bowel Diseases; Lupus Erythematosus, Systemic; Middle Aged; Pleural Effusion; Serositis; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

Nocardia is a genus of gram-positive Actinomycetes that are ubiquitous in decaying organic material, soil, and water. Some Nocardia species can infect humans, mainly by airborne transmission. Several reports describe disseminated infections, which are rare and mostly affect strongly immunocompromised patients because intact T-cell-mediated immunity is the major protective mechanism.. We report a case of disseminated pulmonary, cerebral, and cutaneous infection with Nocardia farcinica in a 66-year-old kidney transplant recipient treated with low-dose triple immunosuppression. The patient was initially admitted because of severe hyponatremia and pneumonia with radiologic signs of pleural effusion. The infectious agent was isolated when cutaneous lesions developed. Oral trimethoprim/sulfamethoxazole treatment led to severe hyponatremia; therefore, long-term treatment with parenteral amikacin and minocycline was initiated. After 7 months of consistent intravenous treatment, the lesions completely resolved and treatment was stopped, against some expert suggestions. The patient had remained free of relapse at the time of writing.. Disseminated Nocardia infection in immunocompromised patients is a rare but life-threatening disease. Owing to its infrequency, the variety of clinical patterns, antimicrobial resistance, and often fatal complications of standardized therapy, the diagnosis and treatment of this infection remain challenging and protracted.

Topics: Administration, Intravenous; Aged; Brain Diseases; Female; Humans; Hyponatremia; Immunocompromised Host; Immunosuppressive Agents; Kidney Transplantation; Male; Nocardia; Nocardia Infections; Opportunistic Infections; Pleural Effusion; Pneumonia, Bacterial; Postoperative Complications; Skin Diseases, Bacterial; Trimethoprim, Sulfamethoxazole Drug Combination

Nocardiosis is a potentially life-threatening disease in renal transplant recipients. It is an uncommon infection with high lethality if left untreated. We report a case of a 67 year-old kidney transplant recipient who developed pulmonary nocardiosis and presented with pleural effusion along with an underlying lung mass, which was successfully treated with trimethoprim-sulphamethoxazole in conjunction with a reduction in immunosuppressive therapy. Five months later, graft function remains stable with complete regression of radiological abnormalities and absence of symptoms. Nocardiosis should be suspected in the presence of pulmonary symptoms in a transplant patient with unusual radiological presentation.

Topics: Aged; Anti-Bacterial Agents; Humans; Immunocompromised Host; Immunosuppressive Agents; Kidney Transplantation; Male; Nocardia Infections; Opportunistic Infections; Pleural Effusion; Respiratory Tract Infections; Solitary Pulmonary Nodule; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Pulmonary nocardiosis is a rare respiratory infection whose diagnosis can easily be missed because there are no suggestive symptoms. Nocardiosis is typically regarded as an opportunistic infection, but one-third of infected patients are immunocompetent. We present two situations of pulmonary lesions in immunocompetent people. A CT-guided percutaneous transthoracic needle biopsy was performed in both cases but was not informative. Suppurative inflammation had developed as a complication of the procedure in the biopsy site after 1-2 weeks. Pus was aspirated and culture showed Nocardia spp. Therefore we hypothesize that the pulmonary lesion was caused initially by Nocardia which had subsequently disseminated to the chest wall after the biopsy. Treatment with trimethoprim/sulfamethoxazole was undertaken. Resolution of the disease was evaluated according to the clinical symptoms and radiological resolution after 6 months therapy.

Topics: Aged; Anti-Bacterial Agents; Biopsy, Needle; Female; Humans; Lung; Male; Nocardia; Nocardia Infections; Pleural Effusion; Pneumonia; Pseudomonas Infections; Radiography, Interventional; Skin; Solitary Pulmonary Nodule; Thoracic Wall; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination; Wound Infection

Pneumocystis jivorecii (formerly known as carinii) pneumonia (PCP) is potentially a life-threatening opportunistic infection after organ transplantation, occurring most frequently in the first 12 months, where the incidence rate is several-fold higher than in later years. PCP typically presents with fever, cough, dyspnoea and hypoxia. In organ transplant recipients, the onset of symptoms is generally more fulminant compared to patients infected with the human immunodeficiency virus. We present a patient who developed PCP five years after a renal transplantation. His presentation was characterised by atypical symptoms and an indolent onset. Previous acute vascular rejection, ongoing maintenance prednisolone usage, cytomegalovirus seropositivity and past tuberculous infection may have predisposed this patient to PCP.

Topics: Anti-Infective Agents; Bronchoscopy; Cytomegalovirus Infections; Graft Rejection; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Pleural Effusion; Pneumonia, Pneumocystis; Prednisolone; Radiography, Thoracic; Risk Factors; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Tuberculosis, Pulmonary

Pneumocystis carinii pneumonia (PCP) is a life-threatening opportunistic infection that occurs in immunocompromised hosts, especially patients with the acquired immunodeficiency syndrome (AIDS). However, this infection is increasing in frequency in other immunosuppressed patients, including organ transplant recipients and those with malignancy who are treated with chemotherapeutic regimens. It carries a relatively high mortality in the non-human immunodeficiency virus (HIV) population. Pleural involvement is rare with PCP; all reported cases in the literature are associated with HIV disease and characterized as small effusions. We report a case of a renal transplant recipient with PCP and moderate-sized pleural effusion with pneumocystis cysts.

Topics: Adult; Anti-Infective Agents; Diagnosis, Differential; Female; Humans; Immunocompromised Host; Kidney Transplantation; Pleural Effusion; Pneumonia, Pneumocystis; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Anorexia; Anti-Bacterial Agents; Brain Abscess; Combined Modality Therapy; Diagnosis, Differential; Female; Fever; Headache; Humans; Immunocompromised Host; Liver Abscess; Lupus Erythematosus, Systemic; Nocardia asteroides; Nocardia Infections; Opportunistic Infections; Pleural Effusion; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Aged; Amikacin; Ciprofloxacin; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Nocardia asteroides; Nocardia Infections; Pleural Effusion; Pneumonia; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acinetobacter Infections; Blood; Drug Combinations; Humans; Male; Middle Aged; Pleural Effusion; Pneumonia; Sulfamethoxazole; Tobramycin; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Pneumocystis carinii pneumonia occurred in two patients with unusual clinical findings. In one case, P carinii infection was diagnosed for the first time in a patient with Crohn's disease. Due to the lack of typical features in both cases an empiric trial of antimicrobial therapy could have delayed diagnosis and initiation of specific treatment for P carinii. Contrariwise, without histologic confirmation, specific therapy for P carinii pneumonia might have been mistakenly discontinued in the second patient. Empiric therapy with trimethoprim-sulfamethoxazole may cause rapid disappearance of P carinii cysts from pulmonary tissues and cause subsequent biopsies to be falsely negative in patients who fail to respond to treatment.

Topics: Adult; Crohn Disease; Drug Combinations; Female; Humans; Lung; Middle Aged; Pleural Effusion; Pneumocystis; Pneumonia, Pneumocystis; Radiography; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination