INTRODUCTION: Actinomycetoma is a neglected infectious disease that presents with a triad of subcutaneous mass, with sinus formation and seropurulent discharge containing grains. This causes severe functional disability to patients if not treated early and properly. CASE REPORT: We report a case of a 62-year-old adult Filipino farmer diagnosed with actinomycetoma of the left foot. For 8 years, the patient medicated with several antibiotic therapies affording minimal improvement of symptoms. Hence, surgical intervention with combination antimicrobial therapy was done which provided resolution of symptoms, improving the quality of life of the patient. CONCLUSION Treatment of actinomycetoma must be individualized among patients. Although oral antibiotics became the standard of treatment, combining surgical treatment with oral medications may be considered to ensure effective management of the disease.
actinomycetoma ; cotrimoxazole ; dapsone ; surgery ; case report

A 32-year-old man presented with epigastric pain. He had a previous episode of acute pancreatitis of undetermined cause 2 years earlier. The patient had taken trimethoprim (80 mg) and sulfamethoxazole (400 mg) twice daily because of acute urethritis 3 days prior to admission. No definite cause of acute pancreatitis could be identified on baseline studies. A thorough history-taking revealed that the patient had an episode of acute pancreatitis while taking trimethoprim (80 mg) and sulfamethoxazole (400 mg) twice daily for 2 weeks for prostatitis prior to the previous admission. Therefore, a cause-and-effect relationship between trimethoprim-sulfamethoxazole (TMP-SMX) and repeated episodes of pancreatitis was highly suggested. The patient was presumably diagnosed as TMP-SMX-induced pancreatitis. The final diagnosis was TMP-SMX-induced pancreatitis. Since drugs are rare causes of acute pancreatitis and the diagnosis of drug-induced pancreatitis is difficult to establish, we report this interesting case along with a review of medical literature.
Adult ; Humans ; Pancreatitis ; Prostatitis ; Sulfamethoxazole ; Trimethoprim ; Urethritis ; Trimethoprim, Sulfamethoxazole Drug Combination

In spite of highly developed antibiotics and chemotherapeutics, genitourinary tract infection still remains as troublesome subjects for urologists. New bactericidal agent, Bactrim (trimethoprim-sulfamethoxazole) was administered in 18 cases of genitourinary tact infection, which were resistant to most antibiotics and following results were obtained. 1) Among 9 cases of non-gonococcal urethritis. 5 cases were cured completely, 4 cases were improved. 2) Among 7 cases of chronic prostatitis, one case was cured but only mild improvement were noted in remaining 6 cases. 3) 2 cases of pyelonephritis showed improvement in both clinically and bacteriologically.
Anti-Bacterial Agents ; Prostatitis ; Pyelonephritis ; Trimethoprim, Sulfamethoxazole Drug Combination* ; Urethritis

A large outbreak of Shigella sonnei gastrointestinal infections occurred at Cheju Island in Korea from May to August 2000. We selected 54 strains which were isolated from the primary treatment failure cases in the outbreak, and characterized the resistance-determining region of the R-plasmid. The 54 strains showed same antimicrobial resistance patterns; resistance against ampicillin, streptomycin, tetracycline, and trimethoprim-sulfamethoxazole. The resistance to ampicillin, streptomycin, and tetracycline were mediated by a conjugable plasmid of about 80 kb size, but the trimethoprim- sulfamethoxazole resistance was not transferred by this plasmid. The R-determining region of the plasmid was cloned and characterized. The 8,384 bp sequences contained resistance genes in the following order:strA, strB, tetR, tetA, and sul1. Fifty four isolates harbored the same sized plasmid and showed same ribotyping patterns, which suggested the clonal spread of S. sonnei in the outbreak.
Ampicillin ; Clone Cells ; Jeju-do* ; Korea ; Plasmids* ; Ribotyping ; Shigella sonnei* ; Shigella* ; Streptomycin ; Sulfamethoxazole ; Tetracycline ; Treatment Failure ; Trimethoprim, Sulfamethoxazole Drug Combination

A large outbreak of Shigella sonnei gastrointestinal infections occurred at Cheju Island in Korea from May to August 2000. We selected 54 strains which were isolated from the primary treatment failure cases in the outbreak, and characterized the resistance-determining region of the R-plasmid. The 54 strains showed same antimicrobial resistance patterns; resistance against ampicillin, streptomycin, tetracycline, and trimethoprim-sulfamethoxazole. The resistance to ampicillin, streptomycin, and tetracycline were mediated by a conjugable plasmid of about 80 kb size, but the trimethoprim- sulfamethoxazole resistance was not transferred by this plasmid. The R-determining region of the plasmid was cloned and characterized. The 8,384 bp sequences contained resistance genes in the following order:strA, strB, tetR, tetA, and sul1. Fifty four isolates harbored the same sized plasmid and showed same ribotyping patterns, which suggested the clonal spread of S. sonnei in the outbreak.
Ampicillin ; Clone Cells ; Jeju-do* ; Korea ; Plasmids* ; Ribotyping ; Shigella sonnei* ; Shigella* ; Streptomycin ; Sulfamethoxazole ; Tetracycline ; Treatment Failure ; Trimethoprim, Sulfamethoxazole Drug Combination

Forty-Five cases of Shigellosis were treated with Ampicillin, TMP/SMX and Rifampin from April 1980. to November 1980. Of the 18 strains of shigellae, in-vitro sensitivity test was performed against twelve antimicrobial agents. The percentage of resistant strains was 77.8% in Ampicillin and 100% in TMP/SMX. Inhibition zone diameter by Rifampin disc was 8~10mm in all cases and clinical improvement with treatment was noted in nearly all cases, therefore we regarded inhibition zone diameter above 8mm sensitive to Rifampin. In clinical evaluation, the percentage of effectiveness by antibiotics was as follows; Ampicillin-60%, TMP/SMX-70% and Rifampin-93.3%. Rifampin appears to be the best, available drug bacteriologically and clinically for the treatment of Shilgellosis.
Ampicillin* ; Anti-Bacterial Agents ; Anti-Infective Agents ; Dysentery, Bacillary* ; Humans ; Rifampin* ; Shigella ; Trimethoprim, Sulfamethoxazole Drug Combination*

Adverse reactions to drugs are more common in HIV infected patients. Hypersensitivity to trimethoprim-sulfamethoxazole (TMP/SMZ) during treatment or prophylaxis of Pneumocystis carinii pneumonia (PCP) is the most frequent drug reaction of HIV infection. Although less extensively documented than sulphonamides, other drugs also seem to induce drug reactions in HIV-seropositive patients more than in other groups. Rifampin is an essential anti-tuberculosis medication; thus, desensitization of rifampin is especially necessary in our country in which mycobacterial infection is common. We report two cases of AIDS patients with pulmonary tuberculosis who have rifampin hypersensitivity whose rifampin treatment will end successfully through rifampin desensitization.
HIV ; HIV Infections ; Humans ; Hypersensitivity* ; Pneumonia, Pneumocystis ; Rifampin* ; Trimethoprim, Sulfamethoxazole Drug Combination ; Tuberculosis, Pulmonary

From August to November 1985 244 bacteriologically proven male uncomplirated goncicoccal urethritis patients at the VD clinic of Choong-Ku Public Health Center form August to November 1985 were divided into group A and group B according to a random number sheet. In group A, treated with kanamycin 2.Ogm, im plus benzyl penicillin-G 5 mega units, im plus probenecid, 1.Ogm, PO; 112 of 121 patients were followed and 10 patients (8.9%) failed to be recovered. In group B, treated with kanamycin, 2,Ogm, im plus trimethoprim-sulfamethoxazole, 9 tahlets, PO; 112 of l23 patients were followed and 7(6.3%) failed. There is no sign.ificant difference between the two groups (p>0. 05) The failure rates in PPNG urethritis were 14.3% and 8.0% in group A and group B respectively. There is a signficant difference in failure rate between the two groups (P<0.05). It is suggested that, because of high rate of PPNG among circulating N.gonorrhoeae, the combinatioin regimen of kanamycin and trime.thoprim-sulfamethoxazole may be used as a first line treatrnent regimen for uncomplicated gonococcal urethritis.
Gonorrhea* ; Humans ; Kanamycin* ; Male ; Penicillin G* ; Penicillins* ; Probenecid* ; Public Health ; Trimethoprim, Sulfamethoxazole Drug Combination* ; Urethritis

Nocardia brain abscess is rare. We report on a unique case of N. farcinica brain abscess in a liver transplant recipient, following Aspergillus fumigatus pneumonia. A 43-year-old liver transplant recipient presented with altered mentality at 2 months after A. fumigates pneumonia. He was successfully treated with surgical removal and antibiotic therapy with trimethoprim-sulfamethoxazole and ceftriaxone.
Adult ; Aspergillus fumigatus ; Brain ; Brain Abscess ; Ceftriaxone ; Humans ; Liver ; Nocardia ; Pneumonia ; Transplants ; Trimethoprim, Sulfamethoxazole Drug Combination

BACKGROUND: The purpose of this study is to recommend the initial therapeutic regimen for adult patients with acute pyelonephritis (APN) according to the changes of antimicrobial susceptibility patterns of causative microorganisms isolated from patients with APN. METHODS: We reviewed medical charts of 229 APN patients, who had been treated at Korea University Guro Hospital from 1st of January, 1999 to 31st of December, 2001. We investigated the demographic data, clinical findings, durations of hospital treatment, antimicrobial susceptibility patterns of the causative microorganisms and initial antibiotic regimens in patients with APN. RESULTS: In this study, 229 adult patients with APN were classified into simple APN patients (118 patients, 51.5%) and complicated APN patients (111 patients, 48.4%). Mean age of patients with simple APN was 38.2+/-14.1 years old and that of patients with complicated APN was 56.1+/-14.9 years old. Mean age of patients with complicated APN was significantly higher than that of simple APN patients (P<0.0001). Escherichia coli was the most common microorganism both in simple APN (96.7%) group and in complicated APN (90.6%) group. Antimicrobial susceptibility of E. coli was at the low level of ampicillin (31%/20%) and trimethoprim-sulfamethoxazole (42.6%/34.2%) in each group. In contrast, ciprofloxacin (11.5%/22.7%), gentamicin (16.4%/22%) and cefotaxime (0%/8.2%) resistance remained at relatively lower level. In comparison of simple APN with complicated APN, ciprofloxacin and gentamicin resistances were higher in complicted APN group. Average duration of hospitalization (5.9+/-2.3 days/8.2+/-4.6 days) and duration of antibiotic use (12.1+/-3.9 days/15.3+/-10.0 days) were significantly longer in complicated APN. CONCLUSIONS: The results of this study suggests that 3rd cephalosporin, aminoglycoside or quinolone antibiotic would considered as one of the initial therapeutic regimen for patients with simple APN in southwestern Seoul.
Adult* ; Ampicillin ; Cefotaxime ; Ciprofloxacin ; Escherichia coli ; Gentamicins ; Hospitalization ; Humans ; Korea ; Pyelonephritis* ; Seoul* ; Trimethoprim, Sulfamethoxazole Drug Combination