trimethoprim--sulfamethoxazole-drug-combination and Stroke

Large cardiac vegetation carries a poor prognosis and high mortality risk, especially if associated with methicillin-resistant Staphylococcus aureus (MRSA) infection. We share our experience of a rare and complicated large cardiac vegetation which had a favourable outcome with combination antibiotic treatment alone. A 35-year-old HIV-negative, HCV-positive male patient with a previous history of methicillin-susceptible S. aureus endocarditis showed MRSA mitral valve endocarditis with large vegetation, complicated by embolic stroke. The strain was soon identified by PCR but only after culture did the patient receive efficacious antibiotics. A combination of daptomycin plus trimethoprim/sulfamethoxazole (TMP/SMX) was administered for six weeks, followed by a high dosage of TMP/SMX for a further six weeks. Effectiveness of the treatment was demonstrated by the patient's clinical improvement and instrumental evidence of cardiac mitral vegetation clearance. Innovative antibiotic strategies in patient management are needed to fight Staphylococcus aureus endocarditis because strains show varying antimicrobial susceptibility patterns in different geographic areas. Timely initiation of targeted antimicrobial therapy remains a crucial step to reduce morbidity and mortality but culture is crucial for appropriate fine-tuning of antibiotic therapy.

Topics: Adult; Anti-Bacterial Agents; Daptomycin; Drug Therapy, Combination; Endocarditis, Bacterial; Hepatitis C; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Staphylococcal Infections; Stroke; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Kidney transplant recipients are at a high risk of both stroke and infection. We report this case to inform readers of the possibility of the occurrence of Listeria monocytogenes brain abscess despite treatment with low dose trimethoprim-sulfamethoxazole.. Physicians should monitor unusual stroke symptoms and consider Listeria brain abscess as a differential diagnosis. This case suggests that listeria brain abscesses can potentially cause temporary neurological deficits akin to a stroke, despite trimethoprim-sulfamethoxazole prophylaxis, but these symptoms resolve without necessitating surgical intervention.

Topics: Brain Abscess; Humans; Listeria monocytogenes; Listeriosis; Stroke; Trimethoprim, Sulfamethoxazole Drug Combination

As the incidence of HIV infection has increased its neurological complications are being encountered in our clinical practice. Toxoplasmosis is a common cerebral opportunistic infection seen in HIV-infected patients, even though the incidence has declined with the use of antiretroviral therapy. Establishing a definitive diagnosis of cerebral toxoplasmosis is difficult in resource limited settings.. A 20 year old gentleman was referred to our institute as a case of stroke. Magnetic resonance imaging (MRI) of his brain showed multiple ill-defined and nodular enhancing lesions in bilateral supratentorial and infratentorial neuroparenchyma. Test for HIV-1 was reactive. Toxoplasma serology revealed raised IgG antibody levels. Based on the MRI features and positive toxoplasma serology a diagnosis of cerebral toxoplasmosis was made. He was treated with trimethoprim/sulfamethoxazole and pyrimethamine/ Sulfadoxine for 3 weeks. After 2 weeks of treatment, repeat MRI of brain was done which showed significant resolution of the lesions.. We are presenting this case to highlight the fact that cerebral toxoplasmosis should be considered in the differential diagnosis of multiple neuroparenchymal lesions in young individuals who present with neurological deficits.

Topics: AIDS-Related Opportunistic Infections; Antibodies, Protozoan; Brain; Drug Combinations; Humans; Immunoglobulin G; Magnetic Resonance Imaging; Male; Pyrimethamine; Serologic Tests; Stroke; Sulfadoxine; Toxoplasma; Toxoplasmosis, Cerebral; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

Topics: Actinomycetales Infections; Anti-Bacterial Agents; Anticoagulants; Doxycycline; Drug Therapy, Combination; Edema, Cardiac; Endocarditis, Bacterial; Fever; Heart Valve Diseases; Humans; Hydroxychloroquine; Male; Middle Aged; Polymerase Chain Reaction; Shock, Cardiogenic; Stroke; Trimethoprim, Sulfamethoxazole Drug Combination; Tropheryma

The central nervous system (CNS) may be affected in up to 50% of patients with Whipple's disease and this can occur even with little or no gastrointestinal involvement. We describe a 63-year-old patient in whom CNS involvement with Whipple's disease had the clinical and imaging features of a brain infarction. Treatment with aspirin and ceftriaxone followed by trimethoprim-sulfamethoxazole resulted in a good neurological recovery and complete remission of the malabsorption syndrome. Cerebral Whipple's disease resembling a stroke syndrome has so far been reported in only two other patients and in both cases it represented the first presentation of the disease. Arterial or arteriolar fibrosis, thrombosis and thickening associated with the inflammation of adjacent brain parenchyma and leptomeninges, and cerebral vasculitis caused by the hematogenous spread of Tropheryma whippelii to the brain may all be important triggers of brain infarction in patients with Whipple's disease. Our case report highlights the important point that cerebral Whipple's disease with the features of a stroke syndrome, if recognized early and treated aggressively with antibiotics, could have a favorable course with no long-term disability sequelae.

Topics: Anti-Infective Agents; Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Brain Diseases; Ceftriaxone; Cerebral Infarction; Drug Therapy, Combination; Humans; Male; Middle Aged; Stroke; Trimethoprim, Sulfamethoxazole Drug Combination; Whipple Disease