trimethoprim--sulfamethoxazole-drug-combination and Zoonoses

Q fever is a worldwide zoonosis caused by Coxiella burnetii. Q fever may be present as an acute or a chronic infection and can be reactivated during subsequent pregnancies. Although its exact prevalence remains unknown, it is likely that the number of cases of Q fever in pregnant women is underestimated. During pregnancy, the illness is likely to be asymptomatic, and diagnosis is based on serology. Acute infection results in appearance of IgM and IgG antibodies mainly directed against the avirulent form of C. burnetii (phase II). Chronic Q fever results in particularly high level of IgG and IgA antibodies directed against both virulent (phase I) and avirulent (phase II) forms of the bacterium. Q fever may result in adverse pregnancy outcome, including spontaneous abortion, intrauterine growth retardation, oligoamnios, intrauterine fetal death (IUFD), and premature delivery. Obstetric complications occur significantly more often as C. burnetii infects the patient at an early stage of her pregnancy. Occurrence of IUFD is correlated with the presence of placental infection by C. burnetii and might be the consequence of direct infection of the fetus. The mother is exposed to the risk of chronic Q fever and endocarditis with potential fatal evolution. Long-term cotrimoxazole therapy prevents from placental infection, IUFD, and maternal chronic Q fever. Such treatment should be used to treat pregnant women with Q fever. Women with previous history of Q fever should have a regular serological follow up. Obstetricians' knowledge about Q fever must be improved.

Topics: Animals; Antibodies, Bacterial; Chronic Disease; Coxiella burnetii; Delivery, Obstetric; Female; Fetus; Humans; Mass Screening; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Q Fever; Serologic Tests; Trimethoprim, Sulfamethoxazole Drug Combination; Zoonoses

Food- and waterborne coccidia including Cryptosporidium parvum, Cyclospora cayetanensis, Sarcocystis hominis and Sarcocystis suihominis, and Isospora belli are cyst-forming apicomplexan protozoa that cause intracellular infections, predominantly in the epithelial cells of the intestine. They are transmitted by oocysts from person-to-person by the fecal-oral route or via contaminated water or food. The most common symptom of infection is diarrhea, however, asymptomatic infections occur. Infections are associated with intestinal inflammation, with pathological lesions such as villus blunting, and abnormal function such as malabsorption. Mild-to-moderate, self-limiting diarrhea is common in healthy individuals ingesting infective stages of these organisms. However, patients with immune dysfunction can have severe intestinal injury and prolonged diarrhea. Diagnosis in many cases is made by a microscopic examination of the stool, and the use of appropriate staining techniques, but more recently molecular methods for detection are used increasingly. Effective antimicrobial treatment for prolonged infection in immunocompromised patients is available for most of these infections. These gastrointestinal coccidial pathogens have important similarities in epidemiology, disease pathogenesis, clinical manifestations, diagnosis, and treatment. Although there are many other cyst-forming coccidia of public health, veterinary and/or economic importance, discussion in this chapter will be limited to C. cayetanensis, as an important example of the group. Aspects of the biology, epidemiology, diagnosis, disease, treatment and control are considered. This parasite is considered to be an emerging pathogen. From 1990 to 2000, there were 11 foodborne outbreaks of cyclosporosis in North America that affected at least 3600 people. There are many outstanding questions regarding this parasite and under-reporting is common because general diagnostic methods for intestinal parasites are inadequate for detection of Cyclospora.

Topics: Animals; Anti-Infective Agents; Cyclospora; Cyclosporiasis; Disease Outbreaks; Food Parasitology; Humans; North America; Oocysts; Trimethoprim, Sulfamethoxazole Drug Combination; Water; Zoonoses

AIDS is a disorder that the pediatrician must consider when evaluating children with a variety of clinical conditions, including overwhelming infection with a number of parasites. This article discusses these opportunistic parasitic infections, focusing on their link with AIDS.

Topics: Acquired Immunodeficiency Syndrome; Adult; Age Factors; Animals; Anti-Bacterial Agents; Antiprotozoal Agents; Child; Child, Preschool; Cryptosporidiosis; Drug Combinations; Female; gamma-Globulins; Homosexuality; Humans; Infant; Male; Parasitic Diseases; Pentamidine; Pneumonia, Pneumocystis; Sulfamethoxazole; Transfusion Reaction; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Zoonoses

A primiparous white rhinoceros (

Topics: Animals; Animals, Newborn; Coxiella burnetii; Fatal Outcome; Female; Perissodactyla; Pregnancy; Pregnancy Complications, Infectious; Q Fever; Trimethoprim, Sulfamethoxazole Drug Combination; Zoonoses

Human Brucella canis infection incidence is unknown. Most identified cases are associated with pet dogs. Laboratory-acquired infections can occur following contact with Brucella spp. We identified a paediatric B. canis case, the source and other exposed persons. A 3-year-old New York City child with fever and dyspnoea was hospitalized for 48 h for bronchiolitis. After her admission, blood culture grew B. canis, she was prescribed anti-microbials and recovered. B. canis was also isolated from blood of the child's pet dog; these isolates were genetically similar. The dog originated from an Iowa breeding facility which was quarantined after identification of the dog's infection. Additionally, 31 laboratory workers were exposed and subsequently monitored for symptoms; 15 completed post-exposure prophylaxis. To our knowledge, this is the first report strongly suggesting B. canis zoonotic transmission to a child in the United States, and highlights the need for coordinated control policies to minimize human illness.

Topics: Animals; Anti-Bacterial Agents; Brucella canis; Brucellosis; Child, Preschool; Commerce; Dog Diseases; Dogs; Female; Humans; Iowa; New York City; Pennsylvania; Trimethoprim, Sulfamethoxazole Drug Combination; Zoonoses

A 62-year-old patient with peritoneal dialysis (PD)-associated peritonitis is described. Identical strains of Pasteurella multocida and Streptococcus minor were cultured from the dialysate, and from the saliva of her recently adopted stray cat. Pasteurella is not often encountered as pathogen in PD-associated peritonitis, Streptococcus minor has never been cultured in human infection before. We emphasise the importance of hygiene in peritoneal dialysis and the need for testing pets when zoonotic pathogens are cultured.

Topics: Animals; Anti-Bacterial Agents; Cat Diseases; Cats; Female; Humans; Middle Aged; Pasteurella Infections; Pasteurella multocida; Peritoneal Dialysis; Peritonitis; Saliva; Streptococcal Infections; Streptococcus; Trimethoprim, Sulfamethoxazole Drug Combination; Zoonoses

Brucellosis is one of the most common systemic zoonotic diseases transmitted by consumption of unpasteurized dairy products or by occupational contact with infected animals. Brucellosis is rare in renal transplant recipients. Only 3 cases have been reported in the literature. We report a case of brucellosis with hematologic and hepatobiliary complications in a patient 3 years after renal transplantation. The mean time from transplantation to the diagnosis of brucellosis in these 4 reported patients was 5.1 years (range 17 months to 13 years). All patients had fever and constitutional symptoms, and all attained clinical cure after combination antibiotic therapy. Given the small number of patients, further study is needed to identify the characteristics of brucellosis in renal transplant recipients. Drug interactions and acute renal failure developed in our patient during antibiotic treatment. Therefore, we should monitor the levels of immunosuppressive agents frequently. Several studies have shown in vitro susceptibilities of Brucella melitensis to tigecycline. In our patient, fever finally subsided after tigecycline administration. The minimum inhibitory concentration of tigecycline using Etest was 0.094 μg/mL. Tigecycline may be a potential option for treatment of brucellosis in the setting of transplantation.

Topics: Animals; Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Drug Therapy, Combination; Humans; Immunosuppressive Agents; Kidney; Kidney Transplantation; Male; Middle Aged; Minocycline; Tigecycline; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Zoonoses

The zoonotic risk of Brucella canis has been considered fairly high for persons who handle breeding dogs in kennels or are exposed to infected animals. Transmission to humans in other circumstances has been thought to be rare. We describe an uncommon outbreak of brucellosis caused by B. canis which, to the best of our knowledge, is the first reported in the literature. This outbreak involved six persons (three children and three adults), a bitch and three puppies which had close daily contact with the family. The clinical symptoms of the index case led to an erroneous diagnosis and the infection would have gone undiagnosed if culture had not been positive. This report aims to increase awareness of medical personnel of the need to order screening tests for children, immunodeficient persons or pregnant women presenting with fever of unknown origin, unexplained spleen or liver enlargement or other systemic signs. The emerging zoonotic potential of this disease in urban areas and the need to coordinate canine brucellosis surveillance systems should be evaluated.

Topics: Adult; Animals; Anti-Bacterial Agents; Antibodies, Bacterial; Brucella canis; Brucellosis; Child, Preschool; Dog Diseases; Dogs; Family; Female; Humans; Infant; Male; Trimethoprim, Sulfamethoxazole Drug Combination; Zoonoses

To present our 10-year clinical experience with brucellosis patients at the University Clinic for Infectious Diseases and Febrile Conditions in Skopje, Republic of Macedonia.. A total of 550 patients with brucellosis treated between 1998 and 2007 were retrospectively assessed for their demographic, epidemiological, and clinical characteristics and outcomes.. Of the 550 patients, 395 (72%) were male. The median age was 34.5 years (range, 1-82). Direct contact with infected animals was recorded in 333 (61%) patients and positive family history in 310 (56%). The most frequently seen symptoms were arthralgia (438, 80%), fever (419, 76%), and sweating (394, 72%). The most common signs were fever and hepatomegaly, which were verified in 357 (65%) and 273 (50%) patients, respectively. Focal brucellosis was found in 362 patients (66%) and osteoarticular in 299 (54%). Therapeutic failures were registered in 37 (6.7%) patients. Of the 453 (82%) patients who completed a follow-up period of at least 6 months, relapses occurred in 60 (13%).. Due to non-specific clinical manifestation and laboratory parameters, brucellosis should be considered one of the differential diagnoses of any patient suffering from obscure involvement of various organs in a brucellosis-endemic region. High percentage of relapses and therapeutic failures in spite of the use of currently recommended therapeutic regimens indicates the seriousness of this zoonosis and the need to control it.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Animals; Anti-Bacterial Agents; Arthralgia; Brucellosis; Child; Child, Preschool; Disease Outbreaks; Endemic Diseases; Female; Fever; Humans; Infant; Male; Middle Aged; Republic of North Macedonia; Retrospective Studies; Sweating; Time Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult; Zoonoses

The multistate occurrence of cases of urinary tract infection (UTI) caused by trimethoprim-sulfamethoxazole (TMP-SMZ)-resistant Escherichia coli strains belonging to a single clonal group (designated as clonal group A [CgA]) in the United States has raised an intriguing hypothesis that these infections may have been spread by contaminated food products. The present study attempted to determine if CgA strains could be traced to food animals.. A total of 495 animal and environmental E. coli isolates, which belonged to serogroups O11, O17, O73, and O77 and were collected between 1965 and 2002 by the Gastroenteric Disease Center at Pennsylvania State University (University Park, PA), were further subtyped by antimicrobial drug susceptibility, enterobacterial repetitive intergenic consensus (ERIC2) PCR, random amplified polymorphic DNA analysis, pulsed-field gel electrophoresis (PFGE), and virulence profile pattern.. Of 495 isolates, 128 (26%) had an ERIC2 PCR electrophoretic pattern indistinguishable from that of the human prototype CgA strain, and 14 CgA isolates were resistant to TMP-SMZ. Cluster analysis of PFGE patterns showed that 1 of these 14 isolates, obtained from a cow in 1988, was 94% similar to a CgA uropathogenic human-associated E. coli strain. The pattern for this isolate was included among a cluster of PFGE patterns for 5 human-associated UTI isolates that were >80% similar to each other.. These observations suggest that drug-resistant, uropathogenic human-associated E. coli strains potentially have an animal origin. The possibility that human drug-resistant UTI could be a foodborne illness has serious public health implications.

Topics: Animals; Anti-Bacterial Agents; Bacterial Typing Techniques; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Genotype; Humans; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Virulence Factors; Zoonoses

Topics: Acute Disease; Animals; Anti-Bacterial Agents; Bacterial Typing Techniques; Escherichia coli; Escherichia coli Infections; Female; Food Microbiology; Humans; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Zoonoses

A 33-year-old Portugese worker presented with a one-week history of nonproductive cough and fever. A presumptive diagnosis "viral infection of the respiratory tract" was made. However, because of persisting cough and fever further investigations were necessary, and finally Brucella melitensis was isolated in blood cultures. Three months before admission to the hospital the man was dressing the carcasses of a goat in Portugal and consumpted fresh goats milk cheese. Antibiotic therapy with Rifampicin and Trimethoprim/Sulfamethoxazol over 6 weeks improved the signs and symptoms of the infection.

Topics: Adult; Animals; Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Cough; Drug Therapy, Combination; Fever of Unknown Origin; Germany; Goats; Humans; Male; Portugal; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination; Zoonoses