trimethoprim--sulfamethoxazole-drug-combination and Spinal-Cord-Diseases

There were three objectives to the present study: (1) compare the bladder infection rate and extent of biofilm formation for seven untreated spinal cord injured (SCI) patients and seven given prophylactic co-trimoxazole, (2) identify a level of bacterial adhesion to bladder cells which could be used to help predict symptomatic infection, and (3) determine from in vivo and in vitro studies whether fluoroquinolones were effective at penetrating bacterial biofilms. The results showed that the infection rate had not changed with the introduction of prophylaxis. However, the uropathogenic population had altered subsequent to the introduction of prophylaxis with E. coli being replaced by E. faecalis as the most common cause of infection. In 63% of the specimens from asymptomatic patients, the bacterial counts per cell were < 20, while 81% of specimens from patients with at least one sign and one symptom of urinary tract infection (UTI) had > 20 adherent bacteria per bladder cell. Therefore, it is proposed that counts of > 20 bacteria adherent to sediment transitional epithelial bladder cells may be predictive of symptomatic UTI. Clinical data showed that fluoroquinolone therapy reduced the adhesion counts to < 20 per cell in 63% of cases, while trimethoprim-sulfamethoxazole only did so in 44%. Further in vitro testing showed that ciprofloxacin (0.1, 0.5 and 1.0 micrograms/ml) partially or completely eradicated adherent biofilms from 92% of spinal cord injured patients' bladder cells, while ofloxacin did so in 71% cases and norfloxacin in 56%. These findings have important implications for the detection and treatment of bacteriuria in spinal cord injured patients.

Topics: Adult; Aged; Anti-Infective Agents; Bacterial Adhesion; Biofilms; Epithelial Cells; Female; Fluoroquinolones; Humans; Male; Microscopy, Electron, Scanning; Middle Aged; Spinal Cord Diseases; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder Diseases; Urinary Tract Infections

The most common clinical presentation of Toxoplasma gondii in HIV patients is encephalitis; however, the intramedullary involvement has been reported in a few cases. We report a case of intramedullary toxoplasmosis in a female patient diagnosed with HIV/tuberculosis co-infection, and history of poor adherence to antiretroviral therapy. The patient developed subacute paraparesis with compromise of sensory function and urinary sphincter. The nuclear magnetic resonance evaluation showed a single intramedullary ring-enhanced lesion at the T-8 level which was solved after an anti-Toxoplasma therapy with trimethoprim/sulfamethoxazole.

Topics: Adult; AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Central Nervous System Protozoal Infections; Coinfection; Dexamethasone; Female; Humans; Magnetic Resonance Imaging; Spinal Cord Diseases; Toxoplasmosis; Trimethoprim, Sulfamethoxazole Drug Combination

Nocardiosis of the central nervous system is a challenging and difficult diagnosis for the clinician. The combination of infections of the brain and spinal cord is even more rare. The authors report on a patient with multiple lesions in the brainstem and cervical spinal cord. This 81-year-old immunocompetent woman presented with symptoms of progressive walking difficulty and ataxia. The results of an extensive workup with laboratory investigation, MRI, lumbar puncture, positron emission tomography (PET), and bone marrow biopsy remained inconclusive. Only after an open biopsy of a cervical lesion by an anterior approach through a partial central corpectomy of the cervical spine, was the diagnosis of nocardiosis made, allowing for specific antibiotic treatment.

Topics: Anti-Infective Agents; Brain Abscess; Brain Diseases; Brain Stem; Central Nervous System Bacterial Infections; Cervical Vertebrae; Female; Humans; Magnetic Resonance Imaging; Nocardia; Nocardia Infections; Spinal Cord Diseases; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Adult; Anti-Bacterial Agents; Drug Therapy, Combination; Female; Humans; Nocardia Infections; Spinal Cord Diseases; Trimethoprim, Sulfamethoxazole Drug Combination

Although there have been reports of Brucella granuloma or abscess in the literature, they were all localized extradurally except one, and most patients underwent surgery.. A 40-year-old female presented with urinary and fecal incontinence and a two-month history of progressive weakness of the right leg and numbness of the left leg. Four months previously, she had been diagnosed with systemic brucellosis with a period of radiculomeningoencephalitis; she was treated successfully with rifampicin, doxycycline, trimethoprim/sulfamethoxazole (TMP/SMZ), and streptomycin, and was discharged symptom-free on rifampicin and doxycycline. Neurological examination revealed spastic paraparesis, globally hyperactive deep tendon reflexes (DTRs) and sensory level at T6. Magnetic resonance imaging (MRI) of the spinal cord revealed a 10 x 30 mm intradural-intramedullary mass lesion at the T5 level with surrounding edema that enhanced with contrast. The cerebrospinal fluid (CSF) was xanthochromic with lymphocytic pleocytosis and elevated levels of albumin, immunoglobulins, and antibody titers for Brucella. The medications were modified to rifampicin 1200 mg, doxycycline 400 mg, and TMP/SMZ 480/2400 mg daily, and methylprednisolone 100 mg in decremental doses (for 6 weeks). After 2 months, the patient was almost symptom-free and her medication doses were decreased. After 5 months, the mass lesion resolved almost completely. The treatment was discontinued after 2 years.. The case is presented because of its uniqueness. In cases of Brucella granuloma, the authors recommend a trial of medical treatment with adequate dosages for a reasonable length of time before considering surgical intervention.

Topics: Adult; Brucellosis; Dose-Response Relationship, Drug; Doxycycline; Drug Administration Schedule; Drug Therapy, Combination; Female; Follow-Up Studies; Granuloma; Humans; Magnetic Resonance Imaging; Methylprednisolone; Neurologic Examination; Rifampin; Spinal Cord; Spinal Cord Diseases; Thoracic Vertebrae; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Drug Therapy, Combination; Gentamicins; Humans; Listeriosis; Magnetic Resonance Imaging; Male; Meningitis, Listeria; Middle Aged; Monitoring, Physiologic; Spinal Cord; Spinal Cord Compression; Spinal Cord Diseases; Trimethoprim, Sulfamethoxazole Drug Combination

We report a case of multiple cerebral and spinal abscesses due to Nocardia asteroides in a non-immunocompromised patient. The initial central nervous system manifestation was a sterile meningitis, with secondary development of multiple cerebral and spinal abscesses. Since the location of the abscesses did not allow neurosurgical exploration and the cultures remained negative, the diagnosis was finally established by raised antibody titres to Nocardia asteroides. After specific antibiotic therapy, resolution of the spinal and cerebral abscesses was documented on the basis of serial magnetic resonance tomography and computed tomography controls.

Topics: Abscess; Amikacin; Brain Abscess; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neurologic Examination; Nocardia asteroides; Nocardia Infections; Spinal Cord Diseases; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination