Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0021311 (Infection)
 38,178 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The case of a patient with a newly diagnosed HIV infection and Pneumocystis carinii pneumonia is presented. Despite treatment with high-dose trimethoprim/sulfamethoxazole (TMP/SMX) and prednisone with initial improvement, the patient acutely deteriorated with severe acidosis and died on the 4th day of hospitalization. Cryptococcus neoformans grew the next day in broncheoalveolar lavage (BAL) and blood culture. As simultaneous presence of more than one opportunistic infection can occur in these patients, systematic workup for other common opportunistic infections must be performed.
Infection 2002 Oct
PMID:Fatal sepsis in an AIDS patient during therapy for Pneumocystis carinii pneumonia. 1238 94

A case of disseminated infection with Nocardia asteroides in a 55-year-old immunocompetent woman after mild trauma to the arm is reported. Secondary dissemination was identified in the skin, right kidney, liver, peritoneal cavity, lungs and thigh. The patient was successfully treated with surgical drainage and a 9-week course of antibiotics including cefotaxime, amikacin, chloramphenicol, trimethoprim/sulfamethoxazole (TMP/SMX) and doxycycline. The administration of TMP/SMX in combination with doxycycline was clinically beneficial despite in vitro resistance.
Infection 2003 Mar
PMID:Disseminated Nocardia asteroides infection in an immunocompetent woman following an arm injury. 1268 17

Persons with acquired immunodeficiency syndrome (AIDS) have a higher incidence of invasive pneumococcal disease (IPD) than other adults, and many receive long-term trimethoprim-sulfamethoxazole (TMP-SMZ) prophylactic therapy. We used 1998-1999 data from the Active Bacterial Core surveillance of the Emerging Infections Program Network to compare IPD infections between adults aged 18-64 years with human immunodeficiency virus (HIV) infection and other adults. Of 2346 patients with IPD, 416 (18%) had HIV or AIDS (HIV/AIDS). Certain serotypes (serotypes 6A, 6B, 9N, 9V, 18C, 19A, 19F, and 23F) were more common among patients with HIV/AIDS than in adults with no underlying disease (P<.05, vs. serotype 4), even when TMP-SMZ-nonsusceptible isolates were excluded. HIV/AIDS (adjusted odds ratio [aOR], 1.93; 95% confidence interval [CI], 1.44-2.59), immunocompromising conditions other than HIV/AIDS (aOR, 1.56; 95% CI, 1.12-2.18), and black race (aOR, 1.50; 95% CI, 1.20-1.88) were independent risk factors for infection with these serotypes. HIV/AIDS was not an independent risk factor for TMP-SMZ nonsusceptibility. Vulnerability to certain serotypes among adults with HIV/AIDS may have implications in prevention strategies.
 ...
PMID:Multistate evaluation of invasive pneumococcal diseases in adults with human immunodeficiency virus infection: serotype and antimicrobial resistance patterns in the United States. 1293 79

We describe a 58-year-old patient with relapsing high-grade non-Hodgkin's lymphoma who exhibited exacerbation of posthypoxic action myoclonus during high-dose intravenous trimethoprim-sulfamethoxazole (TMP-SMX) treatment for highly suspicious Pneumocystis jiroveci pneumonia (PCP). Three months previously the patient had experienced a hypoxic insult caused by respiratory arrest due to an anaphylactic reaction to antibiotic therapy. He had developed posthypoxic action myoclonus (Lance-Adams syndrome), which was well controlled by oral treatment with piracetam. However, after TMP-SMX therapy (115 mg/kg daily) was started for suspicion of newly developed PCP, posthypoxic action myoclonus worsened dramatically resulting in complete disability. Anti-myoclonic therapy with increased doses of piracetam and valproic acid did not significantly improve his clinical condition. Only when TMPSMX doses were reduced (38 mg/kg daily) on day 12 did action myoclonus cease within 2 to 3 days. We suggest that TMP-SMX can exacerbate posthypoxic action myoclonus.
Infection 2004 Jun
PMID:Trimethoprim-sulfamethoxazole exacerbates posthypoxic action myoclonus in a patient with suspicion of Pneumocystis jiroveci infection. 1518 79

The use of oral prophylactic antibiotics in oncology patients is still a matter of debate. A systematic review was performed to assess the evidence for the effectiveness of oral prophylactic antibiotics to decrease bacteraemia and infection-related mortality in oncology patients during neutropenic episodes. Medline, Embase and the Cochrane register of controlled trials were searched from 1966 until 2002. The main outcome was the number of patients with documented bacteraemia (Gram-negative or Gram-positive bacteraemia) and infection related mortality. Data-extraction and quality assessment were performed independently by two reviewers. A total of 22 trials met the inclusion criteria. Seventeen trials compared prophylaxis (quinolones or Trimethoprim/sulfamethoxazole (TMP/SMZ)) to no prophylaxis. The incidence of Gram-negative bacteraemia decreased significantly (pooled OR 0.39, 95% CI 0.24-0.62) without an increase in Gram-positive bacteraemia. Quinolone-based regimens showed a stronger reduction in Gram-negative bacteraemia while TMP/SMZ based regimens were more effective in Gram-positive bacteraemia. Infection related mortality due to bacterial causes decreased with the use of prophylactic antibiotics (pooled OR 0.49, 95% CI 0.27-0.88). No increase in fungaemia or fungal related mortality was seen with the use of oral prophylaxis. In conclusion, this study has shown that oral prophylactic antibiotics decreased Gram-negative bacteraemia and infection related mortality due to bacterial causes during neutropenic episodes in oncology patients.
 ...
PMID:Efficacy of oral prophylactic antibiotics in neutropenic afebrile oncology patients: a systematic review of randomised controlled trials. 1591 83

Infection with Shigella sonnei that is resistant to antibiotics commonly used in pediatric practice has become more common during the past decade. In 2005, Kansas, Kentucky, and Missouri reported increases in shigellosis cases associated with day care centers caused predominantly by multidrug-resistant (MDR) (i.e., resistant to ampicillin and trimethoprim-sulfamethoxazole [TMP/SMX]) strains of S. sonnei. Pulsed-field gel electrophoresis (PFGE) patterns for isolates from Kansas and Missouri were similar, suggesting a common outbreak in the Kansas City area, whereas isolates from Kentucky had a different pattern. This report describes the investigation of two outbreaks of MDR shigellosis associated with day care centers and reviews measures for prevention and control of S. sonnei infection in these settings. Given the current rates of resistance to antibiotics available to treat children with shigellosis safely, public health measures initiated during shigellosis outbreaks should focus on promoting appropriate handwashing and diapering practices in day care centers.
 ...
PMID:Outbreaks of multidrug-resistant Shigella sonnei gastroenteritis associated with day care centers--Kansas, Kentucky, and Missouri, 2005. 1702 92

Pneumocystis jiroveci (formerly carinii) pneumonia (PCP) is a serious opportunistic infection in children and adolescents with cancer. It was the most common cause of death among children receiving chemotherapy prior to the inclusion of PCP prophylaxis as part of standard care for children with leukemia. The incidence of PCP has decreased significantly since initiation of prophylaxis; however, breakthrough cases continue to occur. Hematologic malignancies, brain tumors necessitating prolonged corticosteroid therapy, hematopoietic stem cell transplantation, prolonged neutropenia, and lymphopenia are the most important risk factors for PCP in children not infected with HIV. Of children with leukemia, 15-20% may develop PCP in the absence of prophylaxis. Infection with P. jiroveci occurs early in life in most individuals. However, clinically apparent disease occurs almost exclusively in immunocompromised persons. Dyspnea, cough, hypoxia, and fever are the most common presenting symptoms of PCP. Chest radiography and high-resolution CT scans of the chest demonstrate a characteristic ground-glass pattern. Induced sputum analysis and bronchoalveolar lavage are the diagnostic procedures of choice. Gomori's methenamine-silver stain, Geimsa or Wright's stain, and monoclonal immunofluorescent antibody stains are most commonly used to make a diagnosis. However, identification of P. jiroveci DNA using polymerase chain reaction assays in bronchoalveolar lavage fluid is more sensitive. Trimethoprim-sulfamethoxazole (TMP-SMZ; cotrimoxazole) is the recommended drug for the treatment of PCP. Patients who are intolerant of TMP-SMZ or who have not responded to treatment after 5-7 days of therapy with TMP-SMZ should be treated with pentamidine. A short course of corticosteroids is recommended for moderate to severe cases of PCP within the first 72 hours after diagnosis. Mutations in the dihydropteroate synthetase gene may confer resistance to TMP-SMZ; however, the clinical relevance of these mutations is not well established. TMP-SMZ is the most commonly used agent for prophylaxis. Myelosuppression is the most important adverse effect of TMP-SMZ and the most frequent cause for choosing alternative prophylactic agents in children undergoing chemotherapy. Alternative agents for chemoprophylaxis include dapsone, aerosolized pentamidine, and atovaquone. Alternative prophylactic agents must be used in patients developing myelosuppression secondary to TMP-SMZ or dapsone.
 ...
PMID:Management of Pneumocystis jiroveci pneumonia in children receiving chemotherapy. 1792 2

The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII) conducted a survey of the antimicrobial susceptibility patterns of uropathogens responsible for female acute uncomplicated cystitis in South Korea in 2006. KAUTII has already reported similar data in 2002, which are compared with the results of the present study. This study was carried out with the participation of 22 hospitals in South Korea. A total of 301 isolates were obtained from female outpatients with acute uncomplicated cystitis. The antimicrobial susceptibilities to commonly prescribed drugs were determined. The most prevalent causative organism was Escherichia coli (71.1%), followed by enterococci (13.0%), coagulase-negative staphylococci (5.3%) and other species of Enterobacteriaceae (10.6%). Among all Enterobacteriaceae isolates, 31.4% were susceptible to ampicillin, 52.3% to ampicillin/sulbactam, 97.6% to piperacillin/tazobactam, 78.9% to ciprofloxacin, 80.3% to gatifloxacin, 86.8% to cefazolin, 99.6% to amikacin, 80.5% to gentamicin, 81.1% to tobramycin and 73.9% to trimethoprim/sulfamethoxazole (TMP/SMX). The resistance rates of E. coli to ciprofloxacin and gatifloxacin were 23.4% and 21.8%, respectively, and 12 (11.8%) of 102 suspected strains were confirmed as producing extended-spectrum beta-lactamase (ESBL). All the ESBL-producing strains were also resistant to fluoroquinolones. Enterobacteriaceae were highly susceptible to piperacillin/tazobactam and amikacin (>97%). There was a small increase in susceptibility to TMP/SMX (73.9%) compared with the same study in 2002 (62.1%). Similar to 2002, the high prevalence of resistance to ampicillin, ampicillin/sulbactam and TMP/SMX still exists. The increasing number of ESBL-producing or fluoroquinolones-resistant strains remains a serious clinical problem in South Korea.
 ...
PMID:Prevalence of antimicrobial resistance among uropathogens causing acute uncomplicated cystitis in female outpatients in South Korea: a multicentre study in 2006. 1809 73

Infections caused by multidrug-resistant (MDR) Streptococcus pneumoniae remain a major concern when selecting an appropriate antimicrobial agent. In this analysis, 27 781 isolates of S pneumoniae collected from 2001 to 2005 in the United States were tested for MDR phenotypes. About 25% of all isolates were MDR, defined as resistant to 2 or more of the following agents: cefuroxime, a macrolide, penicillin, tetracycline (if available), and trimethoprim-sulfamethoxazole (TMP-SMX). There was a slight decreasing trend over time in multidrug resistance prevalence with erythromycin. Among MDR strains, the most common coresistance pair was erythromycin and TMP-SMX (74% of isolates, irrespective of resistance to other agents), although penicillin-erythromycin and penicillin-TMP-SMX coresistance patterns were also found in more than 56% of MDR strains. Resistance to 4 antimicrobial agents tested was observed in 33% of all antimicrobial-resistant isolates. Levofloxacin, which was used as a representative of the fluoroquinolone class, was active against at least 98% of all MDR isolates, and the minimum inhibitory concentration (90%) (MIC(90)) for this population was 1 microg/mL (identical to the total S pneumoniae, population). Multidrug-resistant isolates from 2003 to 2005 were found to be equally susceptible (98%) to other respiratory fluoroquinolones (gatifloxacin and moxifloxacin; data not shown), although only 88% of MDR isolates (from 2001-2005) were susceptible to ciprofloxacin. Careful monitoring of multidrug resistance patterns will help guide appropriate therapeutic selection and may provide early detection of changes in resistance to more potent agents.
 ...
PMID:Antimicrobial activity among multidrug-resistant Streptococcus pneumoniae isolated in the United States, 2001-2005. 1893 69

Cystoisospora belli (previously known as Isospora belli) is a tropical coccidian parasite sometimes leading to severe diarrhea in immunocompromised patients. Here we describe a fatal case of cystoisosporiasis in a non HIV-immunocompromised 71-year-old female with no recent travel history. Infection was either latent or potentially caused by the consumption of contaminated imported food from Asia. Diagnosis was made by microscopical detection of numerous C. belli oocysts in stools without specific staining. Treatment with TMP-SMZ slightly improved diarrhea within 3days, but dehydration subsequently led to acute decompensated heart failure and a fatal evolution. This report illustrates the possibility of severe cystoisosporiasis in non HIV-immunocompromised patients in a non-endemic country and highlights the risk of transmission through imported contaminated food consumption.
 ...
PMID:Uncommon and fatal case of cystoisosporiasis in a non HIV-immunosuppressed patient from a non-endemic country. 2962 63


<< Previous 1 2 3 4 Next >>