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Due to ongoing poor availability of organs, increasingly patients from developed countries are reported to be travelling abroad for renal transplants. We aimed to assess the extent and characteristics of this trend across the UK and Republic of Ireland.
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in 392 (86%) cases the urinary infection was caused by one of the isolated pathogens: Escherichia coli, Klebsiella spp. or Proteus mirabilis. Escherichia coli was the most frequently isolated pathogen (70-74%). We noted that the frequency of isolating of Klebsiella spp. grew from 6 to 10%, whereas that of Proteus mirabilis fell from 10 to 2% in the same years. Likewise, in the period from 2004-2006 we observed the same level of the susceptibility of Gram-negative bacteria to nitrofurantoin (84-88%) and trimethoprim-sulfamethoxazole (90-91%), whereas we observed a non-statistically significant lowering of susceptibility to aminopenicillins, and aminopenicillins combined with beta-lactamase inhibitors (from 92 to 74%; p=0.2). There was a statistically significant decrease in drug susceptibility to nitrofurantoin (from 86 to 60%; p<0.05). However, because the groups of children treated with nitrofurantoin were small (6-8-11 in successive years) further studies are needed.
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Two sources of rats free of latent Pneumocystis carinii are described. First, rats from a virus-free colony failed to develop infection after 8 weeks of immune suppression unless they were housed with previously infected rats. Second, pregnant rats (non-virus free) received trimethoprim-sulfamethoxazole from day 10 of gestation until the pups were weaned. Pups raised in filter-topped cages and immunosuppressed for 8 weeks were free of P. carinii infection.
A 39-year-old man presented with a 8-month history of proptosis of left eye. He had a history of recuring sinusitis and dyspnea. The diagnosis of Wegener's granulomotosis was confirmed by the nasal biopsy. A complete remission was achieved after treatment with corticosteroids, cyclophosphamide and trimethoprine sulfamethoxazole.
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The reasons for combining trimethoprim (TMP) with sulfonamides (SUL) are still mainly theoretical but are supported by results from experimental infections and treatment of specific pathogens in humans, such as Branhamella catarrhalis, Neisseria gonorrhoeae, Brucella, Nocardia asteroides and perhaps Bordetella pertussis and Chlamydia trachomatis. Addition of SUL to TMP confers a therapeutic advantage also in patients with complicated urinary tract infection but probably not in young women with acute cystitis. Conditions that may enable TMP-SUL synergy in vivo can be expected to occur only in occasional cases of infection due to staphylococci, streptococci, Haemophilus or enteric bacteria. This fact together with ethical problems and availability of alternative therapies make further evaluations of the clinical significance of the SUL component of TMP-SUL very difficult. Although the use of TMP alone has shown promise in exacerbations of chronic bronchitis the role of the SUL component in TMP-SUL treatment of infections outside the urinary tract remains to be defined in comparative clinical trials.
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A 62-year-old woman was admitted with fever and bloody sputum. A mass shadow in the left S3 and obstruction of the left B3 were seen on a chest radiograph and CT. Obstructive pneumonia was suspected, and cefotiam and imipenem/cilastatin were administered. However, this treatment did not show adequate efficacy. Bronchoscopy demonstrated a yellowish-white polypoid lesion in the left B3, but histopathological findings with HE staining yielded no definite diagnosis. Subsequently, Nocardia asteroides was detected in sputum test. A sulfamethoxazole-trimethoprim combination and minocycline were administered, and the clinical findings improved. Gram-positive microfilaments were confirmed retrospectively in the pathologic specimen, and a diagnosis of pulmonary nocardiosis was made.
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Lymphocyte transformation tests (LTT) to drugs remain widely used in drug reactions, despite controversies about their real usefulness. We tested the lymphocytes of 12 patients recovering from a drug-induced Toxic epidermal necrolysis (TEN). There was no difference between the amounts of thymidine incorporated when patients' lymphocytes were cultivated with culprit or innocent drugs. In both situations the lymphocytes from patients reacted like the lymphocytes from controls cultivated with the same panel of drugs. These negative results do not exclude that a hypersensitivity reaction may play a role in the physiopathology of TEN. Anyhow, they clearly indicate that testing lymphocyte transformation to drugs has no practical value in the diagnosis of TEN.
In previous studies, maternal exposure to folic acid antagonists was associated with increased risks of neural tube defects, cardiovascular defects, oral clefts and urinary tract defects. The objective of the current study was to assess the possible effects of using folic acid antagonists in pregnancy on placenta-mediated adverse outcomes of pregnancy.
University-affiliated infectious diseases outpatient clinic.
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At the M.D. Anderson Cancer Center (Houston), Listeria monocytogenes was cultured from 14 patients between 1980 and 1987. The case records of 11 of these patients were reviewed. Underlying malignancies included acute leukemia (three), lymphoma (two), myeloma (one), adenocarcinoma of colon (two), carcinoma of breast (one), carcinoma of lung (one), and Kaposi's sarcoma associated with the acquired immune deficiency syndrome (one). Listeria monocytogenes was cultured from blood (eight patients), cerebrospinal fluid (CSF) (two patients), and from both blood and CSF in one patient. All patients were receiving immunosuppressive therapy including corticosteroids in seven. An absolute neutrophil count of less than 1000/mm3 was noted in five. Bacteremia was the predominant type of infection and ten patients responded to antimicrobial therapy.
It is important to know the taxonomy, clinical features, diagnosis and precise species identification because of the multitude of pathogenic species involved and the different antibiotic susceptibility patterns. The authors review sulfonamides, aminoglycosides, penicillin derivatives, tetracyclines, glycylcyclines, oxazolidinones, carbapenems and the association of other potential drugs, the therapeutic effectiveness of traditional antimicrobials and new monotherapy and combined treatment alternatives. New oxazolidinones and the benzothiazinones are compounds that have been found effective in vitro and in experimental models.