zithromax and Ulcer

We conducted a randomized, unblinded, prospective study designed to determine the efficacy of single-dose azithromycin for the treatment of chancroid. Men and women 16 years of age and older who had darkfield-negative genital ulcers that were clinically suspected to be caused by Haemophilus ducreyi and who attended urban sexually transmitted disease clinics or presented to hospital emergency departments were enrolled in the study. Patients were randomized to receive 250 mg of ceftriaxone im or 1 g of azithromycin orally, both given as a single dose. They were followed for up to 23 days after treatment. For 65 patients, cultures were positive for H. ducreyi; there were 68 patients whose cultures were negative for both H. ducreyi and herpes simplex virus and who had no evidence of syphilis. All 133 patients returned for at least one follow-up visit. At the time of the last follow-up visit, all 32 patients whose cultures were positive for H. ducreyi and who were treated with azithromycin were clinically cured. In all 33 culture-positive cases in which ceftriaxone was used, there was either clinical improvement or cure at the time of the patient's last follow-up visit. In addition, azithromycin and ceftriaxone were equally effective in healing ulcers for which cultures were negative. We conclude that a single 1-g oral dose of azithromycin is as effective as a 250-mg im dose of ceftriaxone for the treatment of chancroid.

Topics: Administration, Oral; Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Cephalosporins; Chancroid; Female; Genital Diseases, Female; Genital Diseases, Male; Humans; Injections, Intramuscular; Male; Prospective Studies; Treatment Outcome; Ulcer

In yaws-endemic areas, two-thirds of exudative cutaneous ulcers (CU) are associated with Treponema pallidum subsp. pertenue (TP) and Haemophilus ducreyi (HD); one-third are classified as idiopathic ulcers (IU). A yaws eradication campaign on Lihir Island in Papua New Guinea utilizing mass drug administration (MDA) of azithromycin initially reduced but failed to eradicate yaws; IU rates remained constant throughout the study. Using 16S rRNA gene sequencing, we previously determined that Streptococcus pyogenes was associated with some cases of IU. Here, we applied shotgun metagenomics to the same samples we analyzed previously by 16S rRNA sequencing to verify this result, identify additional IU-associated microorganisms, and determine why S. pyogenes-associated IU might have persisted after MDA of azithromycin.. We sequenced DNA extracted from 244 CU specimens separated into four groups based upon microorganism-specific PCR results (HD+, TP+, TP+HD+, and TP-HD- or IU). S. pyogenes was enriched in IU (24.71% relative abundance [RA]) specimens compared to other ulcer sub-groups, confirming our prior results. We bioinformatically identified the emm (M protein gene) types found in the S. pyogenes IU specimens and found matches to emm156 and emm166. Only ~39% of IU specimens contained detectable S. pyogenes, suggesting that additional organisms could be associated with IU. In the sub-set of S. pyogenes-negative IU specimens, Criibacterium bergeronii, a member of the Peptostreptococcaceae, and Fusobacterium necrophorum (7.07% versus 0.00% RA and 2.18% versus 0.00% RA, respectively), were enriched compared to the S. pyogenes-positive sub-set. Although a broad range of viruses were detected in the CU specimens, none were specifically associated with IU.. Our observations confirm the association of S. pyogenes with IU in yaws-endemic areas, and suggest that additional anaerobic bacteria, but not other microorganisms, may be associated with this syndrome. Our results should aid in the design of diagnostic tests and selective therapies for CU.

Topics: Anaerobiosis; Azithromycin; Bacteria, Anaerobic; Child; Haemophilus ducreyi; Humans; RNA, Ribosomal, 16S; Skin Ulcer; Streptococcus pyogenes; Treponema pallidum; Ulcer; Yaws

We describe the first case of chancroid seen in the Czech Republic, diagnosed in a 40-year-old heterosexual HIV-positive man. Despite genital localization of the ulcer, the transmission of Haemophilus ducreyi infection in our patient remains unclear, as he denied having sexual intercourse and he did not travel outside the Czech Republic for several months before the ulcer appeared. The correct diagnosis has been revealed by a multiplex nucleic acid amplification test. Physicians in countries in the eastern and central Europe region should be aware that chancroid can occur in their patients.

Topics: Adult; Azithromycin; Chancroid; Haemophilus ducreyi; HIV Seropositivity; Humans; Lymphadenopathy; Male; Methicillin-Resistant Staphylococcus aureus; Multiplex Polymerase Chain Reaction; Staphylococcal Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Ulcer

The patient's history and the clinical appearance of the ulcer led to the diagnosis of this re-emerging condition.

Topics: Administration, Oral; Adult; Azithromycin; Humans; Male; Penis; Sexual and Gender Minorities; Syphilis; Treatment Outcome; Ulcer

In 2012 WHO declared a target to eradicate yaws by 2020. The cornerstone of this strategy is community mass treatment with azithromycin. Initial studies suggest this is a very effective tool that may be capable of interrupting transmission. Alongside this there has been progress in the development and validation of diagnostic tests for yaws. Several new challenges have also emerged, in particular, evidence that Haemophilus ducreyi can cause phenotypically similar ulcers in yaws endemic communities, and evidence for a possible non-human primate reservoir. The 2020 eradication target remains ambitious and more challenges should be expected on the journey.

Topics: Animals; Anti-Bacterial Agents; Azithromycin; Diagnostic Tests, Routine; Disease Eradication; Disease Reservoirs; Endemic Diseases; Haemophilus ducreyi; Humans; Primates; Treponema pallidum; Ulcer; World Health Organization; Yaws

Although detection of Treponema pallidum DNA in whole-blood specimens of syphilis patients has been reported, it is uncertain at what stage of the disease such specimens are most suitable for the molecular diagnosis of syphilis. Also, few studies have directly compared the different gene targets for routine laboratory diagnostic usage in PCR assays. We examined 87 specimens from 68 patients attending two urban sexually transmitted disease clinics in Alberta, Canada. PCR was used to amplify the T. pallidum tpp47, bmp, and polA genes as well as a specific region of the 23S rRNA gene linked to macrolide antibiotic susceptibility. In primary syphilis cases, PCR was positive exclusively (75% sensitivity rate) in ulcerative swabs but not in blood specimens, while in secondary syphilis cases, 50% of the blood specimens were positive by PCR. Four out of 14 (28.6%) of our PCR-positive syphilis cases were found to be caused by an azithromycin-resistant strain(s). Our results confirmed that swabs from primary ulcers are the specimens of choice for laboratory diagnostic purposes. However, further research is required to determine what specimen(s) would be most appropriate for molecular investigation of syphilis in secondary and latent syphilis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Alberta; Anti-Bacterial Agents; Azithromycin; Blood; Child; Child, Preschool; DNA, Bacterial; Drug Resistance, Bacterial; Female; Humans; Infant; Infant, Newborn; Male; Middle Aged; Polymerase Chain Reaction; Sensitivity and Specificity; Syphilis; Treponema pallidum; Ulcer; Young Adult

Thermal injury to the epiglottis as a result of ingestion of hot food should be considered in the differential diagnosis of earache, severe throat pain and odynophagia. We report a case of a 48-year-old physician, who developed acute, severe throat pain, odynophagia and earache after inadvertent ingestion of hot food. This case is unique, as the physician performed the endoscopy on himself and diagnosed thermal epiglottitis. The epiglottitis responded to a short course of steroids and antibiotics. The physician has remained symptom free since treatment.

Topics: Acute Disease; Anti-Bacterial Agents; Azithromycin; Burns; Endoscopy, Digestive System; Epiglottis; Epiglottitis; Glucocorticoids; Humans; Male; Methylprednisolone; Middle Aged; Ulcer

The incidence of lymphogranuloma venereum (LGV) is low in the western world. Early LGV is characterised by bubonic disease following a painless papule or small ulcer. We report a white bisexual male who presented with a painful perianal ulcer, inguinal lymphadenitis, and concomitant infection with human immunodeficiency virus 1 (HIV-1). Chlamydia trachomatis serovar L2 was identified as the cause after polymerase chain reaction and genotyping the major outer membrane protein by restricted fragment length polymorphism. Treatment with a single dose of 1 g azithromycin was effective. This case illustrates that early LGV may mimic other genital ulcer diseases, such as genital herpes or chancroid, especially in HIV infected patients. In the western world, LGV must still be included in the differential diagnosis of bubonic disease with or without sexually acquired ulcers.

Topics: Adult; AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Anus Diseases; Azithromycin; Chlamydia trachomatis; Groin; HIV Infections; HIV-1; Humans; Lymphadenitis; Lymphogranuloma Venereum; Male; Ulcer

Topics: Anti-Bacterial Agents; Azithromycin; Ciprofloxacin; Contraindications; Doxycycline; Female; Genital Diseases, Female; Genital Diseases, Male; Gentamicins; Granuloma Inguinale; Humans; Infectious Disease Transmission, Vertical; Male; Pregnancy; Pregnancy Complications, Infectious; Ulcer

Topics: Anti-Bacterial Agents; Azithromycin; Breast Feeding; Ceftriaxone; Chancroid; Ciprofloxacin; Contraindications; Erythromycin; Female; Genital Diseases, Female; Genital Diseases, Male; Haemophilus ducreyi; Humans; Male; Pregnancy; Pregnancy Complications, Infectious; Ulcer