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A case of bilateral, symmetric, sporothricoid granulomas involving the dorsa of fingers and wrists is reported. The culture-proved Mycobacterium marinum skin infection was acquired by a fish-fancier while clearing his aquarium with bare hands. The patient suffered from chronic hand eczema. Treatment with co-trimoxazole was successful.
We investigated a retrospective case series of renal transplant and immunosuppressed patients with PCP within an ongoing outbreak in the northwest of England since 2009. Four patients with PCP developed psychosis following treatment with trimethoprim/sulfamethoxazole.
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Nocardia farcinica is a gram-positive, partially acid-fast, methenamine silver-positive aerobic actinomycete. Nocardia spp. are opportunistic pathogens, and N. farcinica is the least common species of clinical importance.
Transfer of resistance genes from bacteria from food producing animals to human pathogens is a potential risk to human health. The aim of this study was to determine in vivo transfer of a plasmid harbouring a class 1 integron containing gene cassettes dfrA1-aadA1 from Salmonella to Escherichia coli and the influence of the use of antimicrobials on this transfer. Thirty four-day-old SPF chickens colonized with E. coli K12 were divided into 3 groups of 10 animals each, and placed in separate isolators. Eleven days after inoculation with E. coli K12 the chickens were inoculated orally with 10(4)CFU of S. enterica spp. enterica serovar Typhimurium containing a plasmid harbouring a class 1 integron with gene cassettes dfrA1-aadA1. Two days after the administration of S. Typhimurium 1 group was treated orally with doxycycline, 1 group orally with trimethoprim/sulphamethoxazole and 1 group remained untreated (control group). E. coli K12, S. Typhimurium and the transconjugants were isolated from cloacal samples on selective MacConkey agar plates. Transfer of the plasmid was confirmed by plasmid characterization, PCR, PFGE and hybridization. Plasmid mediated transfer of a class 1 integron was observed almost immediately after inoculation with S. Typhimurium. Treatment of the chickens with antibiotics had neither a positive nor a negative effect on the transfer rates. In addition to the resistance genes located on the integron, resistance genes encoding for tetracycline and amoxicillin resistance transferred from the donor strain as well. The resistance genes and the integron were located on a 130 kb sized IncFIB plasmid. Our data demonstrate in vivo transfer of an IncFIB plasmid harbouring a class 1 integron containing gene cassettes dfrA1-aadA1 from Salmonella to E. coli, with or without selective pressure of antibiotics in chickens.
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Of 5457 TB suspects who received PITC, 89% underwent HIV testing. Although not statistically significant, TB suspects with TB disease had an HIV prevalence of 61% compared to 63% for those without. Of the 614 suspects who declined HIV testing, 402 (65%) had TB disease. Of 2283 patients referred for cotrimoxazole prophylaxis, 1951 (86%) were enrolled, and of 1727 patients assessed for antiretroviral treatment (ART), 1618 (94%) were eligible and 1441 (83%) started treatment.
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A case of primary lymphocutaneous nocardiosis caused by Nocardia otitidiscaviarum in a 69-year-old previously healthy woman is described. The organism was identified in cultures of pus specimens. The patient was treated with a six-month course of oral trimethoprim-sulfamethoxazole chemotherapy following incision and drainage, and the infection completely resolved.
6 cases with pathognomonic fundus pathologies are presented and discussed using multiple-choice questions.
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CTX prophylaxis together with ART reduced mortality of adult HIV patients during the first 12 months of ART in Henan Province, China. The effect was highest in the first 3 months of ART. CTX should be prescribed to all HIV-infected adults who initiate ART.
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In a multicentric study comparing oral single-dose therapy of fosfomycin trometamol (3 g as fosfomycin) versus co-trimoxazole (1.92 g) or ofloxacin (200 mg) as many as possible of the pathogens were sent to and analysed in a central laboratory. The pathogens were identified and minimal inhibitory concentrations (MIC) of fosfomycin, trimethoprim alone and in combination with sulfamethoxazole, ofloxacin, ampicillin, amoxicillin combined with clavulanic acid, and cephadroxil were determined. The eradication of pathogens (cfu < 10(3)/ml at one week after single-dose therapy) was analysed according to species and MIC of the antibiotic used. Urine cultures of 349 patients were analysed. Escherichia coli was the predominating species followed by staphylococci and Proteus mirabilis. Enterococci were mostly found in mixed culture. Baseline pathogens of monoinfections were eradicated in 87.1%, in 88.9% and in 86.4% of 284 patients treated with fosfomycin trometamol, co-trimoxazole and ofloxacin, respectively. The MICs of the five antibacterial agents and the two antibiotic combinations for 253 baseline pathogens showed that of the E. coli strains none was resistant to ofloxacin, three (MIC = 128 mg/l) were resistant to fosfomycin, 3.6% to co-trimoxazole, 6.2% to trimethoprim, 8.8% to ampicillin, and 5.7% to amoxicillin/clavulanic acid. The eradication rates according to the MICs of the corresponding drugs showed equally good eradication rates for fosfomycin up to an MIC of 64 mg/l. Above this level two out of three strains were also eradicated by fosfomycin trometamol. For co-trimoxazole and ofloxacin no intermediately sensitive or resistant strains were found. Within the range of MICs found there were equally good eradication rates for both antibacterial agents.(ABSTRACT TRUNCATED AT 250 WORDS)
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Pneumonia remains a concern for persons with long-standing HIV infection. We present a case of a 43-year-old HIV-infected woman with bilateral pneumonia whose presentation suggested the cause was a bacterial pathogen. A chest of radiograph and CT scan of the chest revealed infiltrates and adenopathies, but this did not help in the differential diagnosis. A Gram stain of a sputum specimen revealed gram-positive filamentous rods, and infection with Nocardia asteroides was diagnosed. The patient was started on a regimen of ceftriaxone and trimethoprim/sulfamethoxazole and experienced significant improvement within a few days.
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To compare the outcome of Legionnaires disease (LD) in patients with and without HIV infection.
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• Of the 1000 patients, 25 (2.5%) had post-biopsy complications requiring hospital admission or an ED visit. • Indications included twelve patients (1.2%) with urosepsis, eight (0.8%) with acute urinary retention requiring urethral catheterization, four (0.4%) with gross haematuria requiring bladder irrigation for <24 h, and one (0.1%) with a transient ischaemia attack 1 day after biopsy. • Patients with urosepsis had an average hospitalization of 5 days, and 75% carried quinolone-resistant Escherichia coli organisms. • All patients with urinary retention had catheters removed within 10 days. No patients with haematuria required a blood transfusion. • No demographic or biopsy variables were particularly associated with development of a post-procedure complication.
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We aimed to determine nasopharyngeal colonization rates and antibiotic resistance patterns of Streptococcus pneumoniae isolated from Guatemalan children, and to determine risk factors for colonization and antibiotic nonsusceptibility.
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Nocardia is a gram positive, aerobic branched actinomycete; it is an ubiquitous soil saprophyte. As an infecting agent it has been increasingly identified in humans, especially in immuno-suppressed hosts. Nocardia as a cause of septic arthritis is very unusual. The described genus was Nocardia asteroides in nearly all previously reported cases. We report an unusual case of spontaneous Nocardia farcinica septic arthritis of the left knee in a 68-year-old man, who was under systemic corticosteroids for chronic obstructive pulmonary disease. The diagnosis was rapidly made by Gram and acid-fast stains and later confirmed by culture. PCR was used to identify the subtype. The patient was treated successfully with sulphametaxazole-trimethoprim for six months. Our case re-emphasises, especially in the immuno-compromised patient, the importance of performing fungal and acid-fast bacilli cultures, besides the most common bacterial cultures for aerobic and anaerobic organisms, in order to identify less common organisms and to initiate early and adequate treatment.
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The ancient method of larval therapy for treatment of acute and chronic infections has become a revival and a new dimension with introduction of the Biobag (Vitapad). With use of this therapy trauma patients suffering infectious complications can be treated very effective, which can reduce the overall time needed for treatment and can result in diminished invalidity.
A prospective dose-escalation study was undertaken of serum TMP levels attained following oral doses of TMP of 5 mg/kg, 10 mg/kg or 20 mg/kg in stable HIV-infected children. Children who received a 20 mg/kg dose were randomised to get a second dose (5 or 10 mg/kg TMP) at 6 hours. TMP levels were measured at baseline, peak (3 hours), and trough (6 hours) using liquid chromatography. An additional TMP level was taken at 9 hours in those who received a second TMP dose.
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12 healthy, mature pony stallions.
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Medicinal leeches (Hirudo medicinalis) are indicated for salvage of tissue flaps, grafts, or replants when venous congestion threatens tissue viability. The purpose of this study was to evaluate the efficacy of prophylactic antimicrobial agents in patients who received medicinal leech therapy.
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A cross-sectional study was carried out by the bacteriology laboratory of the Lome-Tokoin University Hospital, to determine the frequency of gonorrhea in patients providing vaginal or urethral samples, and to investigate the susceptibility of N. gonorrhoeae to antibiotics. The samples were treated according to classic bacteriological methods and the disk diffusion tests were used to investigate antibiotic susceptibility. The samples were taken from 420 patients, 246 of whom were male (26.86% ¿NdT: d'où vient ce chiffre??, 58.33% si 420 patients, 61.19% si 402 patients¿) and 156 of whom were female (37.14% ¿NdT: plutôt 38.8% si 402 patients¿) ¿NdT: et le reste?? Il me semble que c'est plutôt 402 patients en total (= 246 + 156). Sinon il y a 18 patients qui ne sont ni male ni femelle?!¿. N. gonorrhoeae was isolated from 88 patients, giving a prevalence of 20.95% ¿NdT: ou 21.89% si 402 patients¿. We isolated strains of the bacterium from 76 men (25.78% ¿NdT: incorrect, 30. 89%¿ and 12 women (7.69%). Ciprofloxacin, ofloxacin and netilmicin were the most effective antibiotics. The cyclins, cotrimoxazole and penicillin were less effective.
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Ambulatory children younger than 18 years from whose ears P aeruginosa was isolated.