trimethoprim--sulfamethoxazole-drug-combination and Tenosynovitis

Topics: Adult; Agricultural Workers' Diseases; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Clarithromycin; Contraindications, Drug; Drug Resistance, Bacterial; Drug Substitution; Finger Injuries; Humans; Male; Mycobacterium Infections, Nontuberculous; Occupational Injuries; Tenosynovitis; Trimethoprim, Sulfamethoxazole Drug Combination; Wound Infection

An 18-month-old Charolais steer was presented with lameness and fluctuant swelling of the right stifle joint, which yielded neutrophils on fine-needle aspiration. A diagnosis of bacterial proliferative tenosynovitis and arthritis was made on postmortem and histological examination. Culture and 16S rRNA sequencing identified a Nocardia sp. with 99% homology with the corresponding DNA fragment of N. mexicana DSM 44952. Antimicrobial susceptibility testing revealed the isolate was susceptible to co-trimoxazole and third-generation cephalosporins.. We report the first case, both in Australia and internationally, of proliferative tenosynovitis and arthritis caused by Nocardia spp. infection in a bovine and the first report of pathology attributed to N. mexicana in a veterinary patient. Given the limited susceptibility of the bacteria, the poor antimicrobial penetration that would be expected and the morphological changes that had taken place in the joint; the steer would have required protracted antimicrobial treatment in addition to invasive debridement of the lesion. This case emphasises the importance of routinely performing cytology and extended incubation of cultures in cases of arthritis in order to make ethical and economically viable treatment decisions.

Topics: Animals; Anti-Bacterial Agents; Arthritis, Infectious; Australia; Cattle; Cephalosporins; Male; Microbial Sensitivity Tests; Nocardia; Nocardia Infections; RNA, Ribosomal, 16S; Stifle; Tenosynovitis; Trimethoprim, Sulfamethoxazole Drug Combination

Tumor necrosis factor-alpha inhibitors are potent anti-rheumatic drugs, but there is evidence that the high level of immunosuppression they provide may also lead to a higher risk of infections. At our institution, 3 patients with inflammatory arthritis treated with tumor necrosis factor-alpha inhibitors developed mycobacterial soft tissue infections after routine hand surgery. All 3 patients required multiple surgical procedures, inpatient hospitalizations, and prolonged antibiotic multidrug therapy to clear the infections.

Topics: Aged; Antibodies, Monoclonal; Antirheumatic Agents; Arthritis, Psoriatic; Arthritis, Rheumatoid; Azithromycin; Etanercept; Female; Hand; Humans; Immunoglobulin G; Infliximab; Male; Methotrexate; Middle Aged; Mycobacterium Infections; Receptors, Tumor Necrosis Factor; Tenosynovitis; Trimethoprim, Sulfamethoxazole Drug Combination; Tumor Necrosis Factor-alpha

Topics: Animals; Anti-Bacterial Agents; Bacterial Infections; Calcaneus; Enterobacter; Escherichia coli; Gentamicins; Horse Diseases; Horses; Osteitis; Penicillins; Staphylococcus epidermidis; Streptococcus; Tenosynovitis; Trimethoprim, Sulfamethoxazole Drug Combination