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1.
Infectio ; 25(2): 101-107, abr.-jun. 2021. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1250075

ABSTRACT

Resumen Objetivo: Estimar la resistencia del Staphylococcus aureus frente a diferentes antibióticos usados para el manejo ambulatorio de piodermias. Métodos: Se realizaron análisis descriptivos y de tendencias mediante modelos de regresión segmentada. Resultados: La mayor resistencia se presentó a la oxacilina, con mediana de 54,3% (RIQ: 43 - 58,8), seguido de eritromicina con el 20%, (RIQ: 15,4 - 26,5), clindami cina con el 14% (RIQ: 7,9 - 20), gentamicina con el 7,5% (RIQ: 0 -10), trimetoprima/sulfametoxazol (SXT) con el 5,5% (RIQ: 4 - 11), y ciprofloxacina con 2,1% (RIQ: 2 - 8.4). La tendencia de la resistencia del S. aureus a la oxacilina fue creciente con un cambio anual porcentual no significativo de (0,07) (IC 95%: -3,7; 3,9). Para eritromicina, clindamicina, ciprofloxacina, trimetoprima/sulfametoxazol, y gentamicina hubo decrecimiento. Conclusiones: La resistencia del S. aureus a oxacilina fue ligeramente creciente para el periodo 2010 al 2019 y francamente creciente en los últimos 3 años, superando en promedio a lo reportado a nivel país y Latinoamérica. Los antibióticos con menor resistencia fueron ciprofloxacina, SXT, clindamicina para uso sistémico, y ácido fusídico, mupirocina para manejo tópico y descolonización. Es pertinente articular la vigilancia del S. aureus en la atención ambulatoria a la red de vigilancia nacional.


Abstract Objective: To estimate the resistance trend of Staphylococcus aureus (S. aureus) against different antibiotics in a reference dermatology outpatient center in Colombia. Methods: Descriptive and trend analyzes were performed using segmented regression models for the period 2010 to 2019. Results: The greatest resistance was presented to oxacillin, with a median of 54.3% (RIQ: 43 - 58.8), followed by erythromycin with 20%, (RIQ: 15.4 - 26.5), then clindamycin with 14% (RIQ: 7.9 - 20), gentamicin with 7.5% (RIQ: 0 -10), trimethoprim / sulfamethoxazole (SXT) with 5.5% (RIQ: 4 - 11), and ciprofloxacin with 2.1% (RIQ: 2 - 8.4). The trend of S. aureus resistance to oxacillin from 2010 to 2019 was increasing with a non-significant Annual Percent Change (APC) of (0.07) (95% CI -3.7, 3.9). APC for erythromycin (-1.2) (95% CI: -11.3; 10), clindamycin (-1.7) (95% CI: 11; -12.9), ciprofloxacin (-25.4) (95% CI: -44.6; 0.5) and trimethoprim / sul famethoxazole (-20.7) (95% CI: -43.5; 11.2), were decreasing not significant. For gentamicin the trend was decreasing and significant (-44.2) (95% CI: -19.9; -61.1). Conclusions: The resistance of S. aureus to oxacillin exhibited a slightly increasing trend for the period 2010 to 2019 and increasing in the last 3 years, exceeding on average that reported at the country level and the world average. Antibiotics for outpatient management of skin and soft tissue pyoderma with less resistance were ciprofloxacin, SXT, clindamycin for systemic use, and fusidic acid, mupirocin for topical management and decolonization. It is important to articulate surveillance of S. aureus in outpatient care to the national surveillance network.


Subject(s)
Humans , Male , Adult , Middle Aged , Dermatology , Methicillin-Resistant Staphylococcus aureus , Staphylococcus aureus , Sulfamethoxazole , Gentamicins , Ciprofloxacin , Fusidic Acid , Anti-Bacterial Agents
2.
Rev. patol. trop ; 50(4)2021. ilus
Article in English | LILACS | ID: biblio-1353224

ABSTRACT

okenella regensburgei belongs to the family Enterobacteriaceae and is an opportunistic agent rarely associated with infections in humans. We report a case of osteoarticular knee infection caused by Y. regensburgei in a patient under treatment for rheumatoid arthritis, using corticosteroids, with complication in primary total arthroplasty of the knee. Y. regensburgei was identified using the VITEK2 system. Antimicrobial susceptibility testing was performed using the disk-diffusion method, according to the guidelines from the Clinical and Laboratory Standards Institute. The patient presented favorable clinical evolution after the second debridement, with complete removal of the prosthesis and antibiotic therapy with sulfamethoxazole/trimethoprim. This is the first case of Y. regensburgei infection described d in Brazil.


Subject(s)
Arthritis, Rheumatoid , Sulfamethoxazole , Trimethoprim , Osteoarthritis, Knee , Enterobacteriaceae , Knee
3.
Einstein (Säo Paulo) ; 18: eRC5002, 2020. tab, graf
Article in English | LILACS | ID: biblio-1056030

ABSTRACT

ABSTRACT The fixed drug eruption is a non-immediate hypersensitivity reaction to drug, characterized by recurrent erythematous or violaceous, rounded, well-defined border plaques, which always appear in the same location every time the culprit drug is administered. The usual practice is to avoid the drug involved and to use a structurally different drug. However, there are situations in which there is no safe and effective therapy. In such situations, desensitization is the only option. We describe the case of a patient who presented fixed eruption due to sulfamethoxazole-trimethoprim, who underwent successful desensitization, but required a repeat procedure twice due to relapse after inadvertent full-dose reintroduction. In non-immediate hypersensitivity reaction to drug, the indication is controversial and there is no technical standardization. Furthermore, the time at which such tolerance is lost after discontinuing the drug involved is unknown. In severe non-immediate reactions of types II and III, desensitization is contraindicated. The patient underwent desensitisation to sulfamethoxazole-trimethoprim three times − the first with recurrence of lesions and the second and third without manifestations, all concluded successfully and with no premedication.


RESUMO A erupção fixa por drogas é uma reação de hipersensibilidade a medicamento não imediata, caracterizada por placas eritematosas ou violáceas, arredondadas, recorrentes, de bordas bem definidas e que aparecem sempre na mesma localização cada vez que o medicamento culpado é administrado. A prática habitual é evitar a droga envolvida e utilizar um medicamento estruturalmente diferente. Contudo, há situações em que não há terapêutica segura e eficaz. Em tais situações, a dessensibilização é a única opção. Descrevemos o caso de um paciente que apresentou erupção fixa por drogas por sulfametoxazol-trimetoprim, tendo sido submetido à dessensibilização com sucesso, mas necessitou repetição do procedimento duas vezes, por recidiva da reação após reintrodução inadvertida em dose plena. Em reação de hipersensibilidade a medicamento não imediata, a indicação é controversa e não há padronização técnica. Além disso, não se conhece o tempo durante o qual essa tolerância é perdida após a suspensão da droga envolvida. Nas reações não imediatas graves e dos tipos II e III, a dessensibilização está contraindicada. O paciente foi submetido a dessensibilização ao sulfametoxazol-trimetoprim por três vezes − a primeira com recorrência de lesões, e a segunda e terceira sem manifestações, sendo todas concluídas com sucesso e sem uso de pré-medicação.


Subject(s)
Humans , Male , Aged , Trimethoprim, Sulfamethoxazole Drug Combination/adverse effects , Desensitization, Immunologic/methods , Drug Eruptions/etiology , Drug Eruptions/drug therapy , Sulfamethoxazole/adverse effects , Trimethoprim/adverse effects , Drug Hypersensitivity/etiology , Drug Hypersensitivity/drug therapy
4.
Infectio ; 23(1): 45-51, Jan.-Mar. 2019. tab
Article in Spanish | LILACS, COLNAL | ID: biblio-975562

ABSTRACT

Resumen Introducción: La infección de vías urinarias (IVU) es una de las enfermedades más prevalentes en la práctica clínica Objetivo: Identificar los principales agentes etiológicos y la frecuencia de resistencia a antibióticos por parte de microorganismos aislados por urocultivos en pa cientes con IVU en un hospital de primer nivel de atención. Materiales y Métodos: Estudio descriptivo de corte transversal, a partir de una muestra aleatoria de pacientes con IVU en La Virginia, Risaralda, entre el 1 de abril de 2014 a 31 de marzo de 2015. Se evaluaron las bacterias aisladas en la totalidad de urocultivos procesados y los resultados de los antibiogramas. Se establecieron frecuencias y proporciones. Para el análisis de datos, se utilizó SPSS Statistics 22. Se hizo análisis multivariado. Resultados: Se realizaron 1563 urocultivos en el periodo de estudio, de los cuales 329 (21,0%) mostraron crecimiento mayor a 100.000 UFC. Las frecuencias más altas de resistencia para E. coli se observaron para cefalotina (75,8%), ampicilina (72,6%) y trimetoprim/sulfametoxazol (55,3%). De 296 pacientes seleccionados aleatoriamente se halló que la cistitis era la IVU más frecuente (70,3%) y al 50,7% no se les prescribió ningún antimicrobiano. El uso de antiulcerosos se asoció con mayor probabilidad de uso inadecuado del antibiótico (OR:4,28; IC95%:1,070-17,153; p=0,04). Conclusiones: Existe una elevada resistencia bacteriana a los antibióticos de primera línea para el tratamiento de las IVUs, lo que sugiere la importancia de identi ficar los microorganismos y sus perfiles de sensibilidad a antimicrobianos para seleccionar con mejor criterio cual emplear.


Abstract Introduction: Urinary tract infection (UTI) is one of the most prevalent diseases in clinical practice. Objective: To identify the main etiologic agents and the frequency of antibiotic resistance by microorganisms isolated from urine culture and sensitivity in patients with IVU in a hospital primary care. Materials and Methods. Descriptive cross-sectional study, from a random sample of patients with UTI in La Virginia, Risaralda, from April 1, 2014 to March 31, 2015. Bacteria isolated from all processed urine cultures and the results of susceptibility were evaluated. Frequencies and proportions were established. For data analysis was used SPSS Statistics 22. Results: A total of 1563 urine cultures were performed in the study period, of which 329 (21.0%) showed further growth to 100,000 UFC. Higher frequencies of resis tance were observed for E. coli to cephalothin (75.8%), ampicillin (72.6%) and trimethoprim/sulfamethoxazole (55.3%). In the 296 randomized patients it was found that the most common UTI was cystitis (70.3%) and 50.7% were not prescribed any antimicrobial. The use of anti-ulcer is associated with increased probability of inappropriate use of antibiotics (OR:4.28; 95% CI:1.070-17.153; p=0.04). Conclusions: There is a high bacterial resistance to first-line antibiotics for treatment of UTIs, suggesting the importance of identifying microorganisms and their antimicrobial susceptibility profiles to select which use better approach.


Subject(s)
Humans , Female , Adult , Middle Aged , Urinary Tract , Urinary Tract Infections , Drug Resistance, Microbial , Cephalosporins , Cystitis , Anti-Bacterial Agents , Sulfamethoxazole , Bacteria , Trimethoprim , Cephalothin , Cross-Sectional Studies , Multivariate Analysis , Selectins , Escherichia coli , Ampicillin , Anti-Infective Agents , Anti-Ulcer Agents
5.
Health sci. dis ; 19(2)2018.
Article in French | AIM, AIM | ID: biblio-1262799

ABSTRACT

Introduction. Le marché parallèle de la vente des médicaments s'est développé au cours des dernières décennies dans les pays en voie d'émergence et il a été établi que la commercialisation de médicaments hors du circuit officiel est une source potentielle de risques pour la santé publique. Notre étude avait pour objectif d'étudier la stabilité du Cotrimoxazole 240 mg / 5 ml suspension stocké dans les circuits formel et informel. Méthodologie : De septembre 2015 à Mai 2016, une étude expérimentale a été conduite dans la ville de Douala. Un total de 81 échantillons de Cotrimoxazole 240 mg/5 mL suspension ont été prélevés dans neuf sites. Tous les échantillons ont subi un contrôle qualité sur la base des évaluations technico-règlementaire, organoleptique, physico-chimique et microbiologique. De plus, des analyses qualitative et quantitative des composés actifs du cotrimoxazole (sulfaméthoxazole et triméthoprime) ont été réalisées. Résultats. Le Ghana et l'Inde sont apparus comme les plus grands fournisseurs du Cotrimoxazole. Les numéros de lot, la notice, les dates de fabrication et de péremption, la présentation et la forme, la classe thérapeutique, les indications, et la posologie étaient présents sur tous les échantillons (100%). Par ailleurs, 41,99% et 55,55% des échantillons étaient de couleur ponceau et avaient un goût aromatisé à la fraise respectivement (p-value < 0,0001). Le pH moyen des suspensions de Cotrimoxazole dans le secteur informel s'est révélé significativement faible par rapport à celui des suspensions du secteur formel (p-value = 0,0054). Tous les échantillons étaient exempts de microorganismes pathogènes. L'analyse spectrophotométrique UV-Vis a montré que la teneur en substances actives était en moyenne significativement plus élevée dans le secteur formel (80,16% contre 73,16%; p-value = 0,001). Conclusion. Cette étude souligne le besoin urgent de lutter activement contre la vente illicite des médicaments ainsi que la nécessité de renforcer les systèmes de contrôle qualité des médicaments dans la ville de Douala


Subject(s)
Cameroon , Drug Stability , Drug Substitution , Nonprescription Drugs , Sulfamethoxazole , Trimethoprim
6.
Article in English | WPRIM | ID: wpr-717640

ABSTRACT

BACKGROUND: Pneumocystis is difficult to culture or detect in laboratory environments. Its ecology including the timing and method of transmission as well as environmental sources and communicability remain unclear. METHODS: We retrospectively evaluated the pattern and treatment outcome of Pneumocystis jirovecii pneumonia (PCP) in children with acute lymphoblastic leukemia (ALL) who received chemotherapy. RESULTS: A total of 56 patients with ALL were evaluated. While on chemotherapy, all patients received PCP prophylaxis. PCP were found in a total of 6 patients, including definite PCP in 2, probable PCP in 2, and possible PCP in 2 patients. There were no significant differences in sex, age group, National Cancer Institute risk group, or pneumocystis prophylaxis type between PCP and non-PCP groups. However, there was a significant statistical difference in the times of ALL diagnosis. Regarding recent chemotherapy at the time of PCP diagnosis, there were one induction, one consolidation, and four maintenance cases. All PCP patients were treated with high-dose sulfamethoxazole (100 mg/kg/day) and trimethoprim (20 mg/kg/day) intravenously. Five patients survived, while one patient with endotracheal mechanical ventilation therapy died due to respiratory failure in spite of aggressive treatment. CONCLUSION: Pediatric PCP became extremely rare due to routine prophylaxis in clinical practice of pediatric malignancy. Nevertheless, we analyzed patients with acute lymphoblastic leukemia who had received PCP prophylaxis for 14 years, and analyzed the clustered outbreaks of PCP. It is still important to emphasize the need for prophylaxis and to increase the level of attention and isolation under environmental and personal risk factors.


Subject(s)
Child , Compliance , Diagnosis , Disease Outbreaks , Drug Therapy , Ecology , Humans , Methods , Pneumocystis carinii , Pneumocystis , Pneumonia , Pneumonia, Pneumocystis , Precursor Cell Lymphoblastic Leukemia-Lymphoma , Respiration, Artificial , Respiratory Insufficiency , Retrospective Studies , Risk Factors , Sulfamethoxazole , Treatment Outcome , Trimethoprim
7.
IJB-Iranian Journal of Biotechnology. 2017; 15 (2): 135-142
in English | IMEMR | ID: emr-192452

ABSTRACT

Background: The presence of pharmaceuticals at low concentrations [ng to micro g] in the environment has become a hot spot for researchers in the past decades due to the unknown environmental impact and the possible damages they might have to the plantae and fauna present in the aquatic systems, as well as to the other living organisms


Objectives: The aim of the present investigation was to develop a bacterial consortium isolated from different origins to evaluate the ability of such a consortium to remove a mixture of pharmaceuticals in the batch system at lab scale, as well as assessment of its resistance to the other micropollutants present in the environment


Material and Methods: Using a closed bottle test, biodegradation of the mixed pharmaceuticals including Diclofenac [DCF], Ibuprofen [IBU], and Sulfamethoxazole [SMX] [at a concentration of 3 mg.L[-1] of each drug] by the bacterial consortium was investigated. The test was carried out under metabolic [pharmaceutical was used as the sole source of carbon] and co-metabolic condition [in the presence of glucose]. Finally, the ability of the bacterial consortium to resist other micropollutants like antibiotics and heavy metals was investigated


Results: Under the metabolic condition, the mixed bacteria [i.e., consortium] were able to metabolize 23.08% and 9.12% of IBU, and DCF at a concentration of 3 mg.L[-1] of each drug, respectively. Whereas, in co-metabolic conditions, IBU was eliminated totally, in addition, 56% of the total concentration of DCF was removed, as well. In both metabolic and cometabolic conditions, removal of SMX was not observed. The selected bacteria were able to resist to most of the applied antibiotics and the used heavy metals, except mercury, where only one strain [S4] was resistant to the later heavy metal


Conclusion: Results suggest that the developed consortium might be an excellent candidate for the application in the bioremediation process for treating ecosystems contaminated with the pharmaceutical


Subject(s)
Diclofenac , Ibuprofen , Sulfamethoxazole , Biodegradation, Environmental
8.
Infectio ; 19(3): 136-139, Sept.-Dec. 2015. tab
Article in Spanish | LILACS, COLNAL | ID: biblio-953960

ABSTRACT

Las infecciones por Oligella son muy raras. No existen cifras en la literatura con respecto a su prevalencia en población general. El objetivo de este documento es presentar las características de pacientes pediátricos en quienes se realizó aislamiento de los miembros del género Oligella . Se obtuvieron 8 cultivos positivos, dichos aislamientos provienen de muestras sanguíneas y de esputo, con mayor prevalencia en hombres en el 75% de los casos, con edades entre uno y 11 años, principalmente con enfermedad hematooncológica. Tres aislamientos fueron considerados contaminación y no tuvieron significado clínico; uno recibió tratamiento con trimetropim sulfametoxazol con adecuada respuesta clínica, los demás recibieron manejo antibiótico con meropenem. Solo un paciente falleció, por la severidad de su enfermedad de base. A pesar de su baja prevalencia, la infección por Oligella genera cuadros de respuesta inflamatoria importantes en pacientes con inmunosupresión que, de acuerdo con nuestra experiencia, responden al uso de carbapenémicos.


Oligella infections are rare. The prevalence in the general population is unknown. The objective of this paper is to present the characteristics of pediatric patients in whom isolation of members of the genus Oligella was performed. Eight positive cultures were obtained; 7 were from blood samples and one was from sputum. A high percentage of the patients were males (75%), aged between one and 11 years, most with hemato-oncological disease. Three isolates were considered contaminated and did not have clinical significance; one patient received trimethoprim-sulfamethoxazole treatment with an adequate clinical response and 4 received antibiotic treatment with meropenem. Only one of the patients died, due to the severity of his primary disease. Despite its low prevalence, Oligella infection generates high levels of inflammation in patients with immunosuppression. According to our experience, a good therapeutic response is obtained by using carbapenems.


Subject(s)
Humans , Male , Child , Gram-Negative Bacteria , Infections , Anti-Bacterial Agents , Sulfamethoxazole , Therapeutics , Carbapenems , Trimethoprim, Sulfamethoxazole Drug Combination , Immunosuppression , Gender Identity
9.
Article in Korean | WPRIM | ID: wpr-83892

ABSTRACT

Trimethoprim-sulfamethoxazole (TMP-SMX) is an antibiotic used for the treatment or prophylaxis of Pneumocystis pneumonia and other infectious conditions. Sulfonamide derivatives have been reported to cause delayed hypersensitivity reactions, resulting in switch to less effective second-line antibiotics. Although desensitization is traditionally known to be effective in patients with immediate hypersensitivity, it is also applied to the treatment of delayed hypersensitivity in recent years. A 66-year-old female who had a history of repeated TMP-SMX-induced delayed hypersensitivity presenting as whole body rashes needed to take prophylactic dose of TMP-SMX (80/400 mg daily) before initiation of chemotherapy for multiple myeloma. Intravenous rapid desensitization was performed by using a 11-step, 4-bottle protocol from 1:1,000 to 1:1 solution for 3 hours to reach the target dose for prophylaxis. After successful rapid desensitization of TMP-SMX, 1-month prophylaxis was completed without any complications until the patient recovered normal immunity. We herein reported a case of delayed hypersensitivity reaction to TMP-SMX in an about-to-be immunocompromised host with planned chemotherapy who successfully completed 1-month prophylaxis with the drug without any complications through rapid desensitization.


Subject(s)
Aged , Anti-Bacterial Agents , Desensitization, Immunologic , Drug Therapy , Exanthema , Female , Humans , Hypersensitivity, Delayed , Hypersensitivity, Immediate , Immunocompromised Host , Multiple Myeloma , Pneumonia, Pneumocystis , Sulfamethoxazole , Trimethoprim , Trimethoprim, Sulfamethoxazole Drug Combination
10.
Article in English | WPRIM | ID: wpr-83616

ABSTRACT

A 50-year-old male visited the outpatient clinic and complained of fever, poor oral intake, and weight loss. A chest X-ray demonstrated streaky and fibrotic lesions in both lungs, and chest CT revealed multifocal peribronchial patchy ground-glass opacities with septated cystic lesions in both lungs. Cell counts in the bronchoalveolar lavage fluid revealed lymphocyte-dominant leukocytosis, and further analysis of lymphocyte subsets showed a predominance of cytotoxic T cells and few T helper cells. Video-assisted wedge resection of the left upper lobe was performed, and the histologic examination was indicative of a Pneumocystis jirovecii infection. Trimethoprim-sulfamethoxazole (TMP-SMX) was orally administered for 3 weeks; however, the patient complained of cough, and the pneumonia was aggravated in the follow-up chest X-ray and chest CT. Molecular studies demonstrated mutations at codons 55 and 57 of the dihydropteroate synthase (DHPS) gene, which is associated with the resistance to TMP-SMX. Clindamycin-primaquine was subsequently administered for 3 weeks replacing the TMP-SMX. A follow-up chest X-ray showed that the pneumonia was resolving, and the cough was also alleviated. A positive result of HIV immunoassay and elevated titer of HCV RNA indicated HIV infection as an underlying condition. This case highlights the importance of careful monitoring of patients with P. jirovecii pneumonia (PCP) during the course of treatment, and the molecular study of DHPS mutations. Additionally, altering the anti-PCP drug utilized as treatment must be considered when infection with drug-resistant P. jirovecii is suspected. To the best of our knowledge, this is the first case of TMP-SMX-resistant PCP described in Korea.


Subject(s)
Anti-Bacterial Agents/administration & dosage , Drug Resistance, Bacterial , Humans , Lung/microbiology , Male , Middle Aged , Pneumocystis carinii/drug effects , Pneumonia/drug therapy , Sulfamethoxazole/administration & dosage , Trimethoprim/administration & dosage
11.
Journal of Infection and Public Health. 2014; 7 (6): 553-556
in English | IMEMR | ID: emr-149035

ABSTRACT

Brucellosis is a common zoonotic disease throughout the world. Brucella spp. transmit to humans through contact with fluids of infected animals, especially sheep, cattle, and goats. It is also transmitted by ingestion of fluid-derived products of infected animals, such as unpasteurized milk and cheese. Brucella spp. changes pH level of intracellular environment, so the first treatment approach is to administer antibiotics that have activity in acidic conditions. Anti-brucellosis treatment regimens include doxycycline for children older than eight years old and rifampicin and trimethoprim/sulfamethoxazole [TMP-SMX] combination therapy for children under eight years old, which may be able to act intracellularly under acidic conditions. A TMP-SMX allergy causing anaphylaxis has been reported previously. No alternative anti-brucellosis treatments have been reported in the literature for patients under eight years old with a TMP-SMX allergy. Here, we report a case of a child with brucellosis and a TMP-SMX allergy who was under eight years old at the time of diagnosis and was successfully treated with rifampicin, ciprofloxacin, and gentamicin


Subject(s)
Humans , Female , Brucellosis/therapy , Trimethoprim , Sulfamethoxazole , Anaphylaxis , Trimethoprim, Sulfamethoxazole Drug Combination
12.
Article in English | WPRIM | ID: wpr-103952

ABSTRACT

Chronic diarrhea with a 35 kg weight loss (75 kg to 40 kg) occurred during 2 years in an alcoholic patient was diagnosed with Isospora belli infection in the Republic of Korea. The patient, a 70-year old Korean male, had been a heavy drinker for more than 30 years. He was admitted to the Seoul National University Hospital because of long-standing diarrhea and severe weight loss. He had an increased white blood cell (WBC) count with high peripheral blood eosinophilia (36.8-39.9%) and lowered protein and albumin levels but without any evidence of immunosuppression. A parasitic infection was suspected and fecal examination was repeated 3 times with negative results. Peroral endoscopy with mural biopsy was performed in the upper jejunum. The biopsy specimens revealed villous atrophy with loss of villi together with various life cycle stages of I. belli, including trophozoites, schizonts, merozoites, macrogamonts, and microgamonts. The patient was treated successfully with oral doses of trimethoprim 160-320 mg and sulfamethoxazole 800-1,600 mg daily for 4 weeks. A follow-up evaluation at 2.5 years later revealed marked improvement of body weight (68 kg), increased protein and albumin levels, and normal WBC count with low eosinophils (3.1%). This is the first clinical case of isoporiasis with demonstration of various parasitic stages in the Republic of Korea.


Subject(s)
Aged , Alcoholism/complications , Antiparasitic Agents/administration & dosage , Diarrhea/drug therapy , Humans , Isospora/isolation & purification , Isosporiasis/diagnosis , Male , Republic of Korea , Sulfamethoxazole/administration & dosage , Treatment Outcome , Trimethoprim/administration & dosage
13.
Article in English | WPRIM | ID: wpr-47109

ABSTRACT

Autoimmune neutropenia of infancy (AIN) is caused by increased peripheral destruction of neutrophils as a result of antibodies in patients' blood that are directed against their own neutrophils. Due to non-specific symptoms, benign clinical courses, and cumbersome diagnostic tests, AIN are commonly undetected. Antineutrophil antibody test for diagnosis of AIN has recently become available. Compared to its relatively lower absolute neutrophil count (ANC), the clinical course of AIN is mostly benign. Therefore, although treatment is not usually necessary for AIN, it is applicable in order to rule out other significant diseases, such as severe congenital neutropenia (SCN), which can be transformed to myelodysplastic syndrome or acute myelocytic leukemia. For this reason, several treatments can be used for neutropenia: granulocyte-colony stimulating factor (G-CSF) for SCN, trimethoprim and sulfamethoxazole (TMP-SMX) for prophylaxis. Here we report on two cases of AIN confirmed by indirect immunofluorescence test using flow cytometry.


Subject(s)
Antibodies , Diagnostic Tests, Routine , Flow Cytometry , Fluorescent Antibody Technique, Indirect , Leukemia, Myeloid, Acute , Myelodysplastic Syndromes , Neutropenia , Neutrophils , Sulfamethoxazole , Trimethoprim
14.
Article in English | WPRIM | ID: wpr-788470

ABSTRACT

Autoimmune neutropenia of infancy (AIN) is caused by increased peripheral destruction of neutrophils as a result of antibodies in patients' blood that are directed against their own neutrophils. Due to non-specific symptoms, benign clinical courses, and cumbersome diagnostic tests, AIN are commonly undetected. Antineutrophil antibody test for diagnosis of AIN has recently become available. Compared to its relatively lower absolute neutrophil count (ANC), the clinical course of AIN is mostly benign. Therefore, although treatment is not usually necessary for AIN, it is applicable in order to rule out other significant diseases, such as severe congenital neutropenia (SCN), which can be transformed to myelodysplastic syndrome or acute myelocytic leukemia. For this reason, several treatments can be used for neutropenia: granulocyte-colony stimulating factor (G-CSF) for SCN, trimethoprim and sulfamethoxazole (TMP-SMX) for prophylaxis. Here we report on two cases of AIN confirmed by indirect immunofluorescence test using flow cytometry.


Subject(s)
Antibodies , Diagnostic Tests, Routine , Flow Cytometry , Fluorescent Antibody Technique, Indirect , Leukemia, Myeloid, Acute , Myelodysplastic Syndromes , Neutropenia , Neutrophils , Sulfamethoxazole , Trimethoprim
15.
Infectio ; 15(4): 289-292, oct.-dic. 2011. tab
Article in Spanish | LILACS, COLNAL | ID: lil-649985

ABSTRACT

Cupriavidus pauculus es un bacilo Gram negativo con metabolismo oxidativo, que se ha aislado de muestras de agua y suelo, pero raramente de personas como entidad clínica. En la literatura científica existen menos de veinte artículos de reportes de caso de este microorganismo. La mayoría han sido pacientes con algún tipo de inmunosupresión, sometidos a procedimientos invasivos, especialmente de tipo vascular, y que han requerido múltiple manejo antibiótico. Cupriavidus pauculus ha mostrado baja virulencia y sensibilidad antibiótica, principalmente a trimetoprim-sulfametoxazol, betalactámicos de amplio espectro y quinolonas. Se presenta el caso de una paciente de 55 años con antecedentes de trasplante renal, que ingresó con infección de tejidos blandos y a quien se le diagnosticó bacteriemia asociada a catéter por C. pauculus durante la hospitalización.


Cupriavidus pauculus it’s a gram-negative bacillus with an oxidative metabolism that has been isolated in water and soil samples, but rarely in people clinical entities. There are less than 20 articles case-reported about this microorganism. Most of which have been patients with some type of immune impairment, mostly subjects with invasive vascular procedures, who had required multiples antibiotic management. Cupriavidus pauculus has mainly shown a low virulence and antibiotic sensibility to trimethoprim-sulfametoxazol, broad spectrum betalactamics and quinolones. As presented in the case of a 55 year old patient with renal transplantation history admitted with a soft tissue infection and diagnosed with a catheter associated bacteremia by C. pauculus, during hospitalization.


Subject(s)
Humans , Female , Middle Aged , Bacteremia , Soft Tissue Infections , Cupriavidus , Catheter-Related Infections , Catheters , Sulfamethoxazole , Trimethoprim , Virulence , Immunosuppression , beta-Lactams , Anti-Bacterial Agents
16.
Infectio ; 15(3): 147-154, sep. 2011. graf, tab
Article in Spanish | LILACS, COLNAL | ID: lil-635687

ABSTRACT

Objetivo. Analizar la resistencia de Escherichia coli a los antibióticos de acuerdo con la presencia de beta-lactamasas de espectro extendido (BLEE). Materiales y métodos. Estudio descriptivo y de corte transversal, en el Hospital Departamental de Villavicencio, centro de atención de mediana y alta complejidad. La población de estudio fueron los pacientes con cultivos positivos para E. coli. La variable de estudio fue la resistencia a ceftazidima, cefotaxima y clavulanato. Se confirmó la presencia de BLEE y la resistencia a otros antibióticos. Resultados. Se tamizaron 29.451 estudios de microbiología, de los cuales 26,7 % fueron positivos. Se identificaron 77,6 % como Gram negativos y 2.551 (41,8 %) como E. coli. De los cultivos, 65,1 % se obtuvieron de orina; 9,5 % fueron resistentes a ceftazidima y 8,7 % a cefotaxime. En los aislamientos de orina, la resistencia de E. coli a ceftazidima fue de 6,5 %, mientras que, en aspirados traqueales, fue de 35,0 % (OR=7,98; p<0,05). Se hicieron 315 pruebas confirmatorias para BLEE con equipo Vitek® y 506 con AutoScan®. La mayor cantidad de muestras se obtuvieron de la consulta externa (34,0 %) y, aunque allí se encontró un número significativo de BLEE (6,9 %), hubo mayor resistencia en la unidad neonatal (16,9 %). La resistencia a ampicilina, cefalotina, ciprofloxacina, gentamicina y trimetoprim-sulfametoxazol, fue alta. El 7,1 % de las pruebas confirmatorias con clavulanato fueron positivas para BLEE. Conclusiones. El estudio demostró una frecuencia de 7,1 % de BLEE en esta institución. Hubo servicios con mayor riesgo, como el de neonatos, aunque el fenómeno no se limitaba al ambiente hospitalario. También, se encontró un pequeño porcentaje que fue resistente a carbapenem.


Objective: To analyze antimicrobial resistance of Escherichia coli according to the presence of extended spectrum beta-lactamase. Design: A cross sectional descriptive study. Setting: Hospital Departamental de Villavicencio, a State center of second and tertiary care. Study population: Positive cultures for E. coli were analyzed between September 2005 and November 2009. Interventions: None. Study variable: Ceftazidime and cefotaxime resistance with and without clavulanate. Outcomes: Confirmation of ESBL test and resistance to other antimicrobials. Results: From the 29,451 microbiological samples that were screened, 26.7% were positive. 77.6% were identified as Gram negative and 2,551 (41.8%) were typified as E. coli. 65.1% isolations were from urine samples and 9.5 and 8.7% of them were resistant to ceftazidime and cefotaxime, respectively. 6.5% of urine samples were resistant to ceftazidime, but it raised to 35% for tracheal aspirate (OR 7.98 p<0.05). Three hundred and fifteen confirmatory tests for ESBL were performed with Vitek® and 506 with AutoScan®. Most samples were ambulatory patients (34.0%) and a significant number of them were positive for ESBL (6.9%), but it was higher at the newborn ward (16.9%). Resistance was high for antimicrobials commonly used for infections by this microorganism such as ampicillin, cephalothin, ciprofloxacin, gentamycin and trimethoprim-sulfamethoxazole. Confirmatory ESBL test was 7.1%. Conclusions: The study demonstrates a 7.1% frequency of ESBL at this hospital but the samples from newborn ward showed a higher frequency of ESBL; nevertheless, the issue is not restricted to hospitalized patients. We also found a small number of isolations resistant to carbapenem.


Subject(s)
Humans , beta-Lactamases , Carbapenems , Escherichia coli , Microbiology , Anti-Bacterial Agents , Sulfamethoxazole , Tertiary Healthcare , Ciprofloxacin , Cefotaxime , Ceftazidime , Trimethoprim, Sulfamethoxazole Drug Combination , Cephalothin , Colombia , Clavulanic Acid , Action Spectrum , Ampicillin
17.
Infectio ; 15(1): 44-48, mar. 2011. ilus, tab
Article in Spanish | LILACS, COLNAL | ID: lil-635675

ABSTRACT

Las manifestaciones en el sistema nervioso central por Listeria monocytogenes son variadas, e incluyen desde la meningitis hasta las presentaciones más infrecuentes como los abscesos cerebrales. Éstos son clínicamente indistinguibles de otros tipos de abscesos y sugieren una alteración de la inmunidad celular. Se describe el caso de una mujer seropositiva para el virus de la inmunodeficiencia humana (VIH) que consultó al servicio de urgencias con un síndrome convulsivo tónico-clónico generalizado de un mes de evolución y deterioro progresivo de su estado de conciencia. En el estudio del líquido cefalorraquídeo se encontró pleocitosis linfocitaria, con elevación de las proteínas e hipoglucorraquia. En el estudio del sistema nervioso central por resonancia magnética se observaron múltiples lesiones hipodensas que se realzaban con el medio contraste. Se aisló L. monocytogenes en el cultivo del líquido cefalorraquídeo. Después de un esquema de tratamiento antibiótico específico asociado a esteroides, los síntomas neurológicos mejoraron y, concomitantemente, se observó una disminución progresiva hasta la desaparición de las lesiones en el seguimiento imaginológico del sistema nervioso central. L. monocytogenes es causa de abscesos cerebrales en pacientes inmunosuprimidos, en especial, con VIH sin terapia antirretroviral o sin profilaxis con trimetoprim-sulfametoxazol.


The manifestations of Listeria monocytogenes central nervous system infection are wide, ranging from meningitis to cerebral abscesses. Those are clinically indistinguishable from other forms of cerebral abscesses. We are describing a HIV positive woman who presented with generalized tonicclonic seizures, progressive alter mental status, evidence of lymphocytic pleocytosis and multiple hypodense lesions that enhanced with contrastae on imaging studies (CT and MRI) Listeria monocytogenes was isolated of cefaloraquid liquid cultures. After a specific antibiotic treatment regimen associated with steroids, improved neurological symptoms and concomitant documented a progressive decrease until disappearance of the lesions in the CNS imaging follow. Listeria monocytogenes is a cause of brain abscesses in immunosuppressed patients especially HIV patients without antiretroviral therapy and without prophylaxis with trimethoprim / sulfamethoxazole.


Subject(s)
Humans , Female , Pregnancy , Adolescent , Adult , Listeria monocytogenes , Sulfamethoxazole , Women , HIV , Colombia , Abscess , Meningitis
18.
São Paulo; s.n; 2011. 134 p. ilus, tab.
Thesis in Portuguese | LILACS | ID: lil-620084

ABSTRACT

Stenotrophomonas maltophilia é um bacilo Gram-negativo, não fermentador, considerado um microorganismo pouco virulento, relacionado principalmente a infecções associadas à assistência a saúde. A S. maltophilia apresenta um padrão de resistência intrínseca à maioria das classes de antibióticos. A droga de escolha para o tratamento das infecções por S. maltophilia é a sulfametoxazol/ trimetoprima (SMX/TMP). Entretanto, estudos atuais relatam o aumento da resistência a esse antibiótico, o que limita assim as opções para terapia efetiva. Outras opções de tratamento são o levofloxacino e a tigeciclina, porém, faltam estudos clínicos e in vitro dessas drogas. A proposta deste estudo foi avaliar os possíveis mecanismos de resistência a SMX/TMP e as quinolonas em isolados clínicos de pacientes internados no Instituto Central do Hospital das Clínicas e do Hospital A.C. Camargo. Foram avaliadas 106 amostras de S. maltophilia isoladas de pacientes adultos com infecção relacionada à assistência a saúde, internados no Instituto Central do Hospital das Clínicas da FMUSP e no Hospital de Câncer A.C Camargo durante o período de dezembro de 2008 a dezembro de 2010. A sensibilidade à SMX/TMP foi de 78,3%, para levofloxacino de 82% e 14,2% para cirpofloxacino, para minociclina de 100% e tigeciclina 91,6%. Foi realizado PCR para detecção dos genes sul1, sul2 e dfrA1 para avaliar a resistência à SMX/TMP, os genes int1 e iscr2 para avaliação da presença de elementos genéticos móveis e os genes gyrA, qnr, smeD, smeT e aac(6)-Ib-cr para avaliação da resistência as quinolonas. Quatorze amostras (13,2%) foram positivas para o gene sul1. Desses isolados, nove amostras apresentavam resistência ao SMX/TMP com CIM50 de 8 g/mL e CIM90 de 128 g/mL. Cinco amostras positivas para o gene sul1 foram sensíveis a SMX/TMP com CIM50 de 1 g/mL e CIM90 de 1 g/mL. A sequencia do integron1 da amostra com CIM >125 g/mL mostrou um tamanho aproximado de 4000 pb contendo os genes cassetes aac4 e aadA1 e...


Stenotrophomonas maltophilia is a gram-negative, non-fermenter, considered a low virulent organism, mainly related to healthcare associated infections. S. maltophilia shows a pattern of intrinsic resistance to many classes of antibiotics. The drug of choice for the treatment of infections caused by S. maltophilia is SMX/TMP, however, current studies have reported increased resistance to this antibiotic, thus limiting the options for effective therapy. Among the treatment options appear tigecycline and levofloxacin, but clinical trials and studies in vitro to such drugs are lacking. The purpose of this study was to evaluate the possible mechanisms of resistance to SMX/TMP and quinolones in clinical isolates from patients admitted to the Institute's Central Clinical Hospital and the Hospital A.C Camargo. We evaluated 106 strains of S. maltophilia isolated from adult patients with healthcare associated infections, at the Instituto Central do Hospital das Clínicas and the Cancer Hospital AC Camargo in the period of December 2008 to December 2010. The sensitivity to SMX/TMP was 78.3%, 82% for levofloxacin, 14,2% for ciprofloxacin, minocycline 100% and for tigecycline 91.6%. PCR was performed for detection of gene sul1, sul2 and dfrA1 to evaluate the resistance to SMX/TMP, genes iscr2 int1 was performed to evaluate the presence of mobile genetic elements and genes gyrA, qnr, smeD , smeT and aac (6 ')-Ib-cr for evaluation of resistance to quinolones. Fourteen samples (13.2%) were positive for the gene sul1. In these isolates, nine samples showed resistance to SMX/TMP with MIC50 of 8 g/ml and MIC90 of 128 g/mL. Five strains were positive for sul1 gene and were susceptible to SMX/TMP with MIC50 of 1 g/ml and MIC90 of 1 g/mL. The sequence of the integron class 1 strain with an MIC> 125 g/mL showed an approximate size of 4000 bp containing the gene cassettes aadA1, aac4 and qac/sul1. A strain resistant to SMX/TMP was positive for the gene sul2 located on ISCR2 a...


Subject(s)
Humans , Male , Female , Bacterial Infections , Quinolones , R Factors , Stenotrophomonas maltophilia , Sulfamethoxazole , Trimethoprim Resistance
19.
Korean Journal of Medicine ; : 365-369, 2011.
Article in Korean | WPRIM | ID: wpr-75336

ABSTRACT

Bactrim consists of the sulfonamides trimethoprim and sulfamethoxazole. These induce relatively frequent adverse drug reactions, including allergic reactions ranging from urticaria to anaphylaxis. Either component can be the causative allergen, so it is necessary to determine which has caused an allergic reaction to prevent further allergy. We report the case of a 46-year-old male with chronic renal failure who experienced anaphylactic shock twice after ingesting trimethoprim-sulfamethoxazole, as was proven by the medical history and skin prick testing. Enzyme-linked immunoassays and enzyme-linked allergen inhibition assays for allergen-specific IgE antibody for the five components of Bactrim showed that sulfamethoxazole was the causative allergen.


Subject(s)
Anaphylaxis , Drug-Related Side Effects and Adverse Reactions , Humans , Hypersensitivity , Immunoassay , Immunoglobulin E , Kidney Failure, Chronic , Male , Middle Aged , Skin , Sulfamethoxazole , Sulfonamides , Trimethoprim , Trimethoprim, Sulfamethoxazole Drug Combination , Urticaria
20.
Article in English | WPRIM | ID: wpr-306865

ABSTRACT

<p><b>OBJECTIVE</b>To investigate the kinetic rate constants ozone and hydroxyl radicals towards two groups of antimicrobials -sulfadiazine (SD) and sulfamethoxazole (SMX).</p><p><b>METHODS</b>The solute consumption method was used to detect the rate constants of ozone alone with sulfadiazine and sulfamethoxazole, and tertiary butanol was selected as a scavenging agent and pH was adjusted to 2.5 by adding orthophosphate buffers (OB); and the competition kinetics studying methodwith nitrobenzene as a reference was applied to measure the rate constants of hydroxyl radicals towards sulfadiazine and sulfamethoxazole, and pH was adjusted to 7.0 by adding OB.</p><p><b>RESULTS</b>The rate constants of SD and SMX with ozone alone were 261 mol(-1) · dm(3) · s(-1) and 303 mol(-1) · dm3 · s(-1) by calculating in low reaction system. The rate constants of hydroxyl radicals with SD and SMX were 2.2×1010 mol(-1) · dm(3) · s(-1) and 2.7×1010 mol(-1) · dm(3) · s(-1), respectively. Moreover, the rate constants of hydroxyl radicals with SMX were found to have increased from 3.6×109 mol(-1) · dm(3) · s(-1) to 2.8×1010 mol(-1) · dm(3) · s(-1) with pH value rising from 5.0 to 7.8.</p><p><b>CONCLUSION</b>SMX and SD are both refractory to ozone oxidation alone, and are liable to be degraded by hydroxyl radicals, and the rate constants of SMX with the hydroxyl radical slightly increases with pH rise.</p>


Subject(s)
Hydroxyl Radical , Chemistry , Kinetics , Ozone , Chemistry , Sulfamethoxazole , Chemistry , Sulfonamides , Chemistry , Water , Chemistry
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