trimethoprim--sulfamethoxazole-drug-combination and Syndrome

The granulomatous vasculitides frequently involve the lung. These syndromes include Wegener's granulomatosis, allergic angiitis and granulomatosis, and the polyangiitis overlap syndrome. Although not a true systemic vasculitis, necrotizing sarcoid granulomatosis also represents a type of pulmonary vasculitis. It is clear that many infectious agents can cause a picture in the lung that can be confused with granulomatous vasculitis and that an infectious process must be ruled out before a diagnosis of pulmonary vasculitis can be established. Pulmonary vasculitis can be associated with the hypersensitivity vasculitides, and pulmonary hemorrhage can be secondary to pulmonary capillaritis. Therapy of the hypersensitivity vasculitides consists of removing the offending antigen and instituting a limited course of corticosteroids. If the vasculitis is secondary to an underlying disease, such as lymphoma, therapy should be directed at the primary disease. Combination therapy with cyclophosphamide and corticosteroids is effective in the systemic vasculitides and the 5-yr survival rate is approximately 90%.

Topics: Adrenal Cortex Hormones; Azathioprine; Behcet Syndrome; Chlorambucil; Connective Tissue Diseases; Cyclophosphamide; Cyclosporins; Drug Combinations; Granuloma; Granulomatosis with Polyangiitis; Hemorrhage; Humans; Lung Diseases; Lymphomatoid Granulomatosis; Respiratory Tract Infections; Sulfamethoxazole; Syndrome; Takayasu Arteritis; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Vasculitis; Vasculitis, Leukocytoclastic, Cutaneous

Trimethoprim/sulfamethoxazole is well known to cause intra-hepatic cholestasis which in rare instances can be prolonged and lead to vanishing bile duct syndrome. The risk regarding the potential for cross-reactivity between structurally related molecules such as dapsone and trimethoprim/sulfamethoxazole in causing hepatotoxicity is scarce. Herein, we report a case of vanishing bile duct syndrome following dapsone use in a patient with HIV infection and a recent history of trimethoprim/sulfamethoxazole-induced cholestasis. The patient had severe and protracted cholestasis during 2 years of follow-up and eventually died of liver failure.

Topics: Anti-Infective Agents; Cholestasis, Intrahepatic; Dapsone; Drug Interactions; Drug Therapy, Combination; Fatal Outcome; HIV Infections; Humans; Male; Middle Aged; Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Biopsy, Needle; Drug Therapy, Combination; Follow-Up Studies; Humans; Immunocompromised Host; Immunologic Deficiency Syndromes; Lung Neoplasms; Magnetic Resonance Imaging; Male; Meropenem; Middle Aged; Myasthenia Gravis; Nocardia; Nocardia Infections; Opportunistic Infections; Radiography, Thoracic; Risk Assessment; Severity of Illness Index; Syndrome; Thienamycins; Thymoma; Thymus Neoplasms; Tomography, X-Ray Computed; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adolescent; Adult; Allopurinol; Anti-Infective Agents; Anti-Inflammatory Agents, Non-Steroidal; Anticonvulsants; Carbamazepine; Child; Drug Combinations; Drug Eruptions; Eosinophilia; Exanthema; Female; Glucosamine; Gout Suppressants; Humans; Male; Middle Aged; Pruritus; Retrospective Studies; Sulfasalazine; Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

In some patterns of cutaneous adverse drug reactions, and depending on the culprit drug, patch testing has been helpful in confirming its cause. Its value in Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) has not been established in a large cohort of patients.. The aim of the present study is to evaluate the safety and usefulness of patch testing in DRESS.. Between January 1998 and December 2008, we studied 56 patients with DRESS induced by antiepileptic agents in 33 patients (59%), allopurinol in 19 (34%) and sulfasalazine, cotrimoxazole, tenoxicam, and amoxicillin in 1 patient each (7%).. A positive patch test reaction was observed in 18 patients (32.1%), of which 17 were with antiepileptics and 1 with tenoxicam. In the antiepileptic group, carbamazepine alone was responsible for 13 of 17 positive reactions (76.5%). Patch tests with allopurinol and its metabolite were negative in all cases attributed to this drug.. In this study, patch testing was a safe and useful method in confirming the culprit drug in DRESS induced by antiepileptic drugs, whereas it had no value in DRESS induced by allopurinol. The pathogenesis of DRESS is not yet entirely clarified, but positive patch tests suggest a drug-dependent delayed hypersensitivity mechanism.

Topics: Allopurinol; Amoxicillin; Anticonvulsants; Drug Hypersensitivity; Eosinophilia; Exanthema; Female; Humans; Male; Middle Aged; Patch Tests; Sulfasalazine; Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination

We report on a 3-year-old Melanesian girl admitted for acute renal failure following subfulminant hepatitis A virus infection. While the child was slowly recovering from severe cytolytic hepatitis, she presented 8 weeks of protracted fever and major eosinophilia (30,000/microl); thereafter, acute renal failure (serum creatinine 295 micromol/l) occurred. Renal histology displayed diffuse eosinophilic infiltrate, with severe acute tubulointerstitial lesions associated with mild glomerular endocapillary proliferation and eosinophilic infiltrate, suggesting an immunoallergic mechanism. The child had received cefixime and cotrimoxazole 3 weeks prior to hospitalisation for the hepatitis A virus infection. The final diagnosis was of the syndrome drug reaction with eosinophilia and systemic symptoms or DRESS, induced by cefixime or cotrimoxazole and possibly triggered by the hepatitis A virus infection.

Topics: Acute Kidney Injury; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Cefixime; Child, Preschool; Drug Therapy, Combination; Eosinophilia; Female; Hepatitis A; Humans; Kidney; Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination

Human herpesvirus 6 (HHV-6), the causative agent of the common exanthem subitum, is a known cause of central nervous system infection in immunocompromised patients. It has been suggested that HHV-6 participate in the development of drug-induced hypersensitivity syndrome.. We reported a case of HHV-6 encephalitis associated with hypersensitivity syndrome induced by trimethoprim-sulfamethoxazole in a 72-year-old HIV-negative woman.. Our case confirmed that reactivation of HHV-6 infection may contribute to the development of the hypersensitivity syndrome.

Topics: Aged; Anti-Infective Agents; Antiviral Agents; Drug Hypersensitivity; Encephalitis, Viral; Female; Ganciclovir; Herpesvirus 6, Human; Humans; Roseolovirus Infections; Syndrome; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Agammaglobulinemia; Bone Marrow Transplantation; Bronchoalveolar Lavage Fluid; Drug Therapy, Combination; Dyspnea; Emergency Service, Hospital; Follow-Up Studies; Humans; Immunoglobulin M; Immunoglobulins, Intravenous; Infant; Male; Pneumonia, Pneumocystis; Pulmonary Eosinophilia; Risk Assessment; Syndrome; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Waiting Lists

Topics: Anti-Infective Agents; Antitubercular Agents; Child, Preschool; Female; Humans; Hypergammaglobulinemia; Immunoglobulin M; Osteomyelitis; Radiography; Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination; Tuberculosis, Cutaneous; Tuberculosis, Osteoarticular; Ulna

The World Health Organization has proposed the syndromic approach for management of sexually transmissible diseases (STD) in countries where diagnostic laboratory tests are not consistently available. The purpose of this study was to evaluate the effectiveness of this approach for treatment of ureteral discharge in Senegal. Twenty seven men presenting ureteral discharge underwent two-week treatment using a combination of cotrimoxazole plus tetracycline for suspected gonococcal and a chlamydial infections. Ureteral samples were collected before and after treatment to detect Neisseria gonorrhoeae by culture and Chlamydia trachomatis by direct immunofluorescence and ELISA. Results demonstrated successful treatment of all patients presenting gonococcal and chlamydial infections i.e. 84.6% of cases. Neither germ was detected in 15.4% of cases. Before treatment, Neisseria gonorrhoeae, Chlamydia trachomatis or both were found respectively in 53.9%, 5.1% and 25.6% of samples respectively. Based on these findings we conclude that the syndromic approach was effective in 84.6% of cases but treatment was in adequation with STD biologically documented only with 25.6% of cases.

Topics: Anti-Bacterial Agents; Chlamydia Infections; Chlamydia trachomatis; Drug Therapy, Combination; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Senegal; Syndrome; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination; Urethral Diseases

Trimethoprim-sulfamethoxazole is a commonly used medication. Side effects are numerous and include drug hypersensitivity syndrome. The case of a 24-year-old woman with severe liver failure is presented. Erythema multiforme and thrombocytopenia developed after the acute onset of hepatotoxicity and after all medications had been stopped. Clinical resolution of all features occurred over weeks but laboratory abnormalities persisted up to eight months later. A causal link with sulfamethoxazole was supported by timing, liver biopsy and lymphocyte toxicity test. This case illustrates one presentation and the possible severity of the drug hypersensitivity syndrome associated with trimethoprim-sulfamethoxazole.

Topics: Adult; Anti-Infective Agents; Diagnosis, Differential; Drug Hypersensitivity; Erythema Multiforme; Hepatitis A; Humans; Liver Failure; Male; Syndrome; Thrombocytopenia; Trimethoprim, Sulfamethoxazole Drug Combination

Caudal regression syndrome (CRS) is a rare anomaly of the lower body pole that represents a continuum of congenital malformations ranging from isolated sacral agenesis to absence of the lumbosacral spine and major visceral anomalies. While the exact etiology of this syndrome is unclear, maternal diabetes, genetic factors, teratogens and vascular anomalies altering blood flow have been hypothesized to play a role in its pathogenesis.. A fetus had extreme hypotrophy of the caudal body pole, aplasia of the lower spine and complete renal agenesis diagnosed in the second trimester by ultrasound. Maternal history revealed the use of minoxidil solution for preventing hair loss for four years prior to and during gestation. Also, the mother had taken trimethoprim-sulfamethoxazole during the first trimester for treatment of upper respiratory disease. No maternal diabetes or history of familial genetic diseases was evident.. In an extreme form of CRS consisting of complete aplasia of the lower body pole and viscera and additional malformations, a possible drug-related etiology was suggested but should be confirmed by more studies.

Topics: Abnormalities, Multiple; Administration, Oral; Administration, Topical; Adult; Anti-Infective Agents; Female; Humans; Kidney; Leg; Lumbosacral Region; Minoxidil; Pregnancy; Sacrum; Spine; Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination; Vasodilator Agents

To recommend a cost-effective approach for the management of acute male urethritis in the developing world, based on the findings of a theoretical study.. A model was developed to assess the cost-effectiveness of three urethritis management strategies in a theoretical cohort of 1000 men with urethral syndrome. (1) All patients were treated with cefixime and doxycycline for gonococcal urethritis (GU) and nongonococcal urethritis (NGU), respectively, as recommended by WHO. (2) All patients were treated with doxycycline for NGU; treatment with cefixime was based on the result of direct microscopy of a urethral smear. (3) All patients were treated with cotrimoxazole or kanamycin for GU and doxycycline for NGU. Cefixime was kept for patients not responding to the first GU treatment. Strategy costs included consultations, laboratory diagnosis (where applicable) and drugs. The outcome was the rate of patients cured of urethritis. Cost-effectiveness was measured in terms of cost per cured urethritis.. Strategy costs in our model depended largely on drug costs. The first strategy was confirmed as the most effective but also the most expensive approach. Cefixime should cost no more than US$ 1.5 for the strategy to be the most cost-effective. The second strategy saved money and drugs but proved a valuable alternative only when laboratory performance was optimal. The third strategy with cotrimoxazole was the least expensive but a low follow-up visit rate, poor treatment compliance or lower drug efficacy limited effectiveness. Maximizing compliance by replacing cotrimoxazole with single-dose kanamycin had the single greatest impact on the effectiveness of the third strategy.. Our model suggested that a cost-effective approach would be to treat gonorrhoea with a single-dose antibiotic selected from locally available products that cost no more than US$ 1.5.

Topics: Acute Disease; Anti-Bacterial Agents; Anti-Infective Agents; Cefixime; Cost-Benefit Analysis; Decision Trees; Developing Countries; Doxycycline; Drug Costs; Drug Therapy, Combination; Follow-Up Studies; Gonorrhea; Humans; Kanamycin; Male; Sensitivity and Specificity; Syndrome; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urethritis

Topics: Anti-Infective Agents; Bile Duct Diseases; Cholestasis, Intrahepatic; Humans; Liver Failure; Liver Transplantation; Male; Middle Aged; Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anaphylaxis; Anti-Infective Agents; Desensitization, Immunologic; Diagnosis, Differential; Drug Hypersensitivity; HIV Infections; Humans; Shock, Septic; Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination

A 24 year-old patient with a short-bowel syndrome receiving home parenteral nutrition in addition to oral feeding for 32 months was treated by oral trimethoprim-sulfamethoxazole for urinary tract infection. Three days later, he developed neurologic disorders associated with severe hyperchloremic acidosis and high plasma level of D-lactate. This is a rare complication of intestinal malabsorption due to small bowel by-pass or extensive resection due to transient alteration of intestinal microflora induced by the oral antibiotic treatment. Diagnosis requires a high indice of suspicion.

Topics: Acidosis, Lactic; Adult; Humans; Intestine, Small; Lactates; Malabsorption Syndromes; Male; Nervous System Diseases; Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Animals; Cattle; Drug Combinations; Endometritis; Female; Lactation Disorders; Mastitis, Bovine; Pregnancy; Puerperal Disorders; Sulfanilamides; Swine; Swine Diseases; Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination