trimethoprim--sulfamethoxazole-drug-combination and Vasculitis

Pneumocystis jirovecii is an opportunistic pathogen causing life-threatening pneumonia in immunosuppressed patients. The number of non-HIV immunosuppressed patients at risk for Pneumocystis pneumonia is rapidly growing. In contrast to HIV patients, there are no guidelines for Pneumocystis prophylaxis in other immunocompromised hosts. A detailed analysis of current literature data allowed us hereby to define the type of immunocompromised patients for whom evidence suggests a benefit for PCP prophylaxis.

Topics: Anti-Infective Agents; Connective Tissue Diseases; Drug-Related Side Effects and Adverse Reactions; Evidence-Based Medicine; HIV Infections; Humans; Immunocompromised Host; Neoplasms; Pneumocystis carinii; Pneumonia, Pneumocystis; Practice Guidelines as Topic; Protein-Energy Malnutrition; Randomized Controlled Trials as Topic; Risk Factors; Transplantation; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Vasculitis

A diagnosis of Wegener granulomatosis requires granulomatous manifestations in the respiratory tract. With the increasing use of antineutrophil cytoplasmic autoantibodies as a diagnostic tool, Wegener granulomatosis is diagnosed earlier than in the past, and not infrequently when only ear, nose and throat manifestations are present, placing the otorhinolaryngologist in a central role in diagnosis and management. Diagnostic biopsies should be obtained from active lesions in the nose and paranasal sinuses and concomitant infection should be identified. Because of the apparent relation between infection and activation of disease, the management of infections-especially those due to Staphylococcus aureus-requires special attention. The increasing numbers of early cases identified warrants further investigations of whether less toxic treatment regimens will be of advantage in such cases. Medical and surgical treatment of the acute and chronic manifestations presents specific problems because of altered immune competence, prevalent superinfection, and tissue destruction, and is therefore best taken care of by specially dedicated otorhinolaryngologists.

Topics: Ear Diseases; Granulomatosis with Polyangiitis; Humans; Laryngeal Diseases; Mouth Diseases; Nasal Mucosa; Nose Diseases; Paranasal Sinus Diseases; Salivary Gland Diseases; Staphylococcal Infections; Tracheal Diseases; Trimethoprim, Sulfamethoxazole Drug Combination; Vasculitis

High-dose corticosteroids in combination with cytotoxic drugs are universally accepted as the initial approach in vasculitides that are associated with anti-neutrophil cytoplasmic antibodies. Cyclophosphamide is the most effective cytotoxic drug and is used in more severe cases. Because cyclophosphamide has more severe short- and long-term side-effects than methotrexate, methotrexate is used in less severe cases. New prospects for the treatment of vasculitis include novel immunosuppressive agents (e.g. mycophenolate, 15-deoxyspergualin, and leflunomide), sequential chemotherapy (e.g. cyclophosphamide followed by azathioprine or cyclophosphamide followed by methotrexate), intravenous immunoglobulin, tumour necrosis factor-alpha directed therapy, anti-lymphocyte directed therapy (e.g. antithymocyte globulin or anti CD52/anti CD4 antibodies), anti-adhesion molecule directed therapy (e.g. anti-CD18 or intercellular adhesion molecule-1 antisense) or immunoablation using high-dose cytotoxic medication with or without stem cell rescue.

Topics: Antibodies, Antineutrophil Cytoplasmic; Antilymphocyte Serum; Cyclophosphamide; Guanidines; Humans; Immunoglobulins, Intravenous; Immunosuppressive Agents; Intercellular Adhesion Molecule-1; Isoxazoles; Kidney Diseases; Leflunomide; Methotrexate; Mycophenolic Acid; Prednisone; Remission Induction; Trimethoprim, Sulfamethoxazole Drug Combination; Tumor Necrosis Factor-alpha; Vasculitis

Topics: Adrenal Cortex Hormones; Antibodies, Monoclonal; Azathioprine; Chlorambucil; Combined Modality Therapy; Cyclophosphamide; Humans; Immunoglobulins, Intravenous; Plasmapheresis; Trimethoprim, Sulfamethoxazole Drug Combination; Vasculitis

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

To investigate the clinical features and prognosis of nocardiosis complicated by connective tissue diseases (CTDs).. We examined patients with CTDs who were diagnosed with nocardiosis from October 2004 to 2019. We retrospectively investigated patient characteristics and therapeutic outcomes. We then performed a comparison between survivors and non-survivors.. Fourteen patients were examined. Underlying CTDs were systemic lupus erythematosus (28.6%), vasculitis syndrome (28.6%), rheumatoid arthritis (21.4%), adult Still disease (14.3%) and dermatomyositis (7.1%). Infected organs were lung (85.7%), brain (42.9%), skin/cutaneous lesions (28.6%) and muscle (7.1%). Disseminated infections were seen in nine patients (64.3%). At the onset of nocardiosis, all patients were given prednisolone (23.2 ± 11.9 mg/day). Only two patients (14.3%) were given TMP-SMX for prophylaxis of pneumocystis pneumonia. Relapse occurred in one patient (7.1%) and four patients (28.6%) died from nocardiosis for a cumulative survival rate at 52 weeks of 76.9%. In a comparison of survivors (71.4%) and non-survivors (28.6%), cutaneous lesions were significantly more frequent in the latter (10 vs 75%,. Cutaneous lesions as a result of dissemination might be a risk factor for nocardiosis mortality in patients with CTDs.

Topics: Adult; Anti-Bacterial Agents; Arthritis, Rheumatoid; Female; Humans; Lupus Erythematosus, Systemic; Male; Middle Aged; Nocardia Infections; Prognosis; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Vasculitis

Topics: Aged, 80 and over; Antibodies, Antineutrophil Cytoplasmic; Biomarkers; Humans; Immunocompromised Host; Nocardia Infections; Pneumonia, Bacterial; Prednisolone; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Vasculitis

There are no generally accepted diagnostic criteria for primary systemic vasculitis, and the application of classification as diagnostic criteria is not feasible and may even be misleading. We report a case of a 13-year-old boy with acute abdomen who was found to have isolated eosinophilic mesenteric vasculitis with extensive thrombosis and splenic infarction. All serological tests were negative, including antineutrophil cytoplasmic antibody. The vasculitis had been successfully controlled with surgical intervention, steroid, and cyclophosphamide therapy. This may be an atypical presentation of Churg-Strauss syndrome.

Topics: Adolescent; Anti-Infective Agents; Chemotherapy, Adjuvant; Cyclophosphamide; Eosinophilia; Humans; Immunosuppressive Agents; Jejunum; Male; Mesenteric Vascular Occlusion; Mesenteric Veins; Prednisone; Splenic Infarction; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Vasculitis; Venous Thrombosis

Topics: Adult; Anti-Infective Agents; Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Child, Preschool; Female; HIV Infections; Humans; Male; Mucocutaneous Lymph Node Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination; Vasculitis

6 cases with pathognomonic fundus pathologies are presented and discussed using multiple-choice questions.

Topics: Adult; Aged; Albinism, Oculocutaneous; Choroid; Choroid Hemorrhage; Clindamycin; Diagnosis, Differential; Drug Hypersensitivity; Eye Diseases; Female; Fluorescein Angiography; Fundus Oculi; Humans; Male; Pigment Epithelium of Eye; Retinal Necrosis Syndrome, Acute; Toxoplasmosis, Ocular; Trimethoprim, Sulfamethoxazole Drug Combination; Vasculitis

We describe a patient who sought treatment for acute renal allograft dysfunction 2 weeks after renal transplantation. Renal allograft biopsy (RAB) showed intimal arteritis, severe interstitial infiltration with a few eosinophils, and severe tubulitis. Pathologic diagnosis was acute rejection (grade 2b- Banff 93); however, another clinical diagnosis, drug-induced acute interstitial nephritis (AIN), was not excluded. Before the RAB, his trimethaprim-sulfamethoxazole (TMP-SMZ) treatment was discontinued. Renal function began to improve on biopsy day without antirejection therapy. Recovery of renal function without antirejection treatment and discontinuation of TMP-SMZ shows that renal pathology might be related to drug-induced dysfunction and drug-induced AIN and vasculitis. After 5 years, the patient and his renal allograft function are both well.

Topics: Adult; Biopsy; Diagnosis, Differential; Graft Rejection; Humans; Kidney; Kidney Transplantation; Male; Nephritis, Interstitial; Trimethoprim, Sulfamethoxazole Drug Combination; Vasculitis

Topics: Anti-Infective Agents; Drug Combinations; Female; Humans; Male; Middle Aged; Sulfadimethoxine; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Vasculitis