trimethoprim--sulfamethoxazole-drug-combination and Splenic-Diseases

Melioidosis is endemic in the State of Sabah, Malaysia. We report a case of a 34-year-old man with one-week history of fever and cough, three days history of diarrhoea and vomiting, which was associated with a loss of appetite and loss of weight for one-month. Clinically, he had hepatosplenomegaly and crepitation over his right lower zone of lung. Chest radiograph showed right lower lobe consolidation. Ultrasound abdomen showed liver and splenic abscesses. Ultrasound guided drainage of splenic abscess yielded Burkholderia pseudomallei. Magnetic resonance imaging (MRI) lumbosacral confirmed right sacral intraosseous abscess after he developed back pain a week later. He received 6 weeks of intravenous antibiotics and oral co-trimoxazole, followed by 6 months oral co-trimoxazole and had full recovery.

Topics: Abscess; Adult; Anti-Bacterial Agents; Burkholderia pseudomallei; Humans; Male; Melioidosis; Splenic Diseases; Trimethoprim, Sulfamethoxazole Drug Combination

Melioidosis is endemic in Southeast Asia and tropical Australia with varying clinical features from benign skin lesions to fatal septicaemia. Imaging plays an important role in evaluation of the melioid liver abscesses. A 45-year-old man with underlying diabetes presented with fever and lethargy for 2 weeks and abdominal pain for 2 days. His liver was enlarged on examination. Blood investigations revealed mild leucocytosis and raised liver enzymes. Ultrasound showed multiple multiloculated hypoechoic lesions throughout the liver and spleen. CT of abdomen confirmed that some liver lesions were made up of asymmetric locules of varying sizes (honeycomb sign), while others had hypodense centre with small symmetric peripheral locules in radial fashion (necklace sign). Blood culture was positive for

Topics: Anti-Bacterial Agents; Burkholderia pseudomallei; Ceftazidime; Humans; Liver Abscess; Male; Melioidosis; Middle Aged; Splenic Diseases; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography

Melioidosis caused by Burkholderia pseudomellei is an infection with protean clinical manifestations. Guillain-Barré syndrome [GBS] associated with melioidosis is very rare.. A 42-year-old woman with diabetes presented with abdominal pain, vomiting and intermittent fever for one month. Six months before presentation she had recurrent skin abscesses. Three months before presentation she had multiple liver abscesses which were aspirated in a local hospital. The aspirate grew "coliforms" resistant to gentamicin and sensitive to ceftazidime. On presentation she had high fever and tender hepatomegaly. Ultra Sound Scan of abdomen showed multiple liver and splenic abscesses. Based on the suggestive history and sensitivity pattern of the previous growth melioidosis was suspected and high dose meropenem was started. Antibodies to melioidin were raised at a titre of 1:10240. The growth from the aspirate of liver abscess was confirmed as Burkholderia pseudomellei by polymerase chain reaction [PCR]. After a week of treatment, patient developed bilateral lower limb weakness. Deep tendon reflexes were absent. There was no sensory loss or bladder/bowel involvement. Analysis of the cerebro-spinal fluid showed elevated proteins with no cells. There was severe peripheral neuropathy with axonal degeneration. A diagnosis of GBS was made and she was treated with plasmapharesis with marked improvement of neurological deficit. Continuation of intravenous antibiotics lead to further clinical improvement with normalization of inflammatory markers and resolution of liver and splenic abscess. Eradication therapy with oral co-trimoxazole and co-amoxyclav was started on the seventh week. Patient was discharged to outpatient clinic with a plan to continue combination of oral antibiotics for 12 weeks. At the end of 12 weeks she was well with complete neurological resolution and no evidence of a relapse.. Guillaine Barre syndrome is a rare complication of melioidosis and should be suspected in a patient with melioidosis who develop lower limb weakness. Plasmapharesis can be successfully used to treat GBS associated with active melioidosis.

Topics: Abdominal Pain; Administration, Oral; Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Burkholderia pseudomallei; Ceftazidime; Drug Resistance, Bacterial; Female; Gentamicins; Guillain-Barre Syndrome; Humans; Injections, Intravenous; Liver Abscess; Melioidosis; Meropenem; Peripheral Nervous System Diseases; Polymerase Chain Reaction; Splenic Diseases; Thienamycins; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; AIDS-Related Opportunistic Infections; Anti-HIV Agents; Antifungal Agents; Atovaquone; Female; HIV; HIV Infections; Humans; Immunohistochemistry; Pentamidine; Pneumocystis carinii; Pneumocystis Infections; Polymerase Chain Reaction; Spleen; Splenic Diseases; Trimethoprim, Sulfamethoxazole Drug Combination

Splenic abscess due to Brucella spp. is extremely rare. We report a case of a splenic abscess due to Brucella spp. in a 61-year-old male patient. Brucella slide and tube agglutination tests (Wright) were positive while blood culture and culture from splenic tissue yielded negative results. The abdominal ultrasonography revealed a hypoechoic intrasplenic mass 15x12 mm in diameter at the middle portion of the spleen. The splenic lesions disappeared after prolonged treatment for 7 months with a combination of doxycycline, and rifampicin, followed by TMP-SXT. Brucella spp. should be considered in the differential diagnosis of splenic abscess in countries where brucellosis is endemic. The results of this case and literature review shows that a conservative approach using optimum antibiotics alone without surgical intervention can be successful in the treatment of patients with splenic brucellosis.

Topics: Abdominal Abscess; Agglutination Tests; Anti-Infective Agents; Brucellosis; Doxycycline; Drug Therapy, Combination; Enzyme Inhibitors; Humans; Male; Middle Aged; Rifampin; Spleen; Splenic Diseases; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography

Topics: Abdominal Abscess; Adult; Cyclophosphamide; Diagnosis, Differential; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Fever of Unknown Origin; Humans; Imipenem; Immunosuppressive Agents; Liver Abscess; Nocardia asteroides; Nocardia Infections; Opportunistic Infections; Prednisolone; Recurrence; Splenic Diseases; Takayasu Arteritis; Trimethoprim, Sulfamethoxazole Drug Combination

We report a case of 25 year old man who presented with a febrile illness and bilateral lower chest pain a pain in the left hypochondrium with fever and weight loss; investigations revealed a left sided empyema. The cause of the empyema was confirmed following the isolation in the pleural pus of Salmonella typhi. There was also a mass in the left hypochondrium which was shown on ultrasound to be a splenic abscess. After antibiotic therapy with Cotrimoxazole, repeated pleural aspirates and physiotherapy, there was a satisfactory outcome and the pleural effusion dried up and there was a significant reduction in the volume of the splenic abscess. In the light of their observations, the authors report the rare presentation of empyemas due to Salmonella typhi, the late presentation during the course of the third septenaire and the often favourable outcome under general antibiotic therapy associated with pleural aspirates to evacuate the pus and respiratory physiotherapy.

Topics: Abscess; Adult; Anti-Bacterial Agents; Empyema, Pleural; Humans; Male; Respiratory Therapy; Salmonella typhi; Splenic Diseases; Suction; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Topics: Adult; Aerosols; AIDS-Related Opportunistic Infections; Drug Resistance, Microbial; Homosexuality, Male; Humans; Liver Diseases; Male; Pentamidine; Pneumocystis; Pneumonia, Pneumocystis; Polymerase Chain Reaction; Splenic Diseases; Trimethoprim, Sulfamethoxazole Drug Combination