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Twenty-two of 24 cases of Mycobacterium ulcerans infection in Ibadan are reviewed. The patients included Africans, Caucasians, and Indians. There were no differences between races in the manifestations of the disease. The average age of the patients was higher than that in other reports in the literature. The fact that most cases were originally wrongly diagnosed reemphasizes the need to search for M. ulcerans in cases of "tropical" ulcer that fail to respond to adequate therapy. Early recognition and surgery are the mainstay of treatment. Comexazole seems more effective than clofazimine in the treatment of these ulcers.
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Trimethoprim-sulfamethoxazole (TMP/SMX) prophylaxis and insecticide-treated bednets reduce malaria risk among HIV-infected adults. The efficacy of TMP/SMX may be diminished where antifolate resistance to malaria is high. We evaluated the efficacy of these interventions for malaria prevention among Ugandan children.
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Cotrimoxazole prophylaxis appears to mainly reduce death and hospital admissions from respiratory infections, supported further by lower rates of antibiotic prescribing. As such infections occur at high CD4 cell counts and are common in Africa, the role of continuing cotrimoxazole prophylaxis after starting antiretroviral therapy requires investigation.
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Of a total of 730 strains of S. typhi isolated in 1989-90, in the Medical College Hospital, Rohtak (India), 218 isolates showed resistance to chloramphenicol, ampicillin and cotrimoxazole. Minimum inhibitory concentration (MIC) for ampicillin and cotrimoxazole was up to 3200 micrograms/ml, intermediate for chloramphenicol (200-800 micrograms/ml) and low for tetracycline (50-400 micrograms/ml). A significant observation was prevalence of E1 as the predominant phage type amongst resistant strains accounting for 88.8 per cent of the resistant isolates, 95.8 per cent of these showed block resistance to ACCoT.
The role of enterotoxigenic Escherichia coli (ETEC) in childhood diarrhoea in New Caledonia was demonstrated in previous epidemiological works. This study was undertaken in order to characterize these strains and to determine whether bacterial components of current vaccine candidates (toxin, colonization factor antigens, O:H antigens) would be useful in our region. A total of 24 ETEC strains were studied: 5 strains produced heat-labile enterotoxin, 17 strains produced heat-stable enterotoxin (9 STp and 8 STh), and 2 strains produced both toxins (1 LT/STp/STh and 1 LT/STh). E. coli strains were screened for the presence of genes encoding for enterotoxins (DNA dot blot and Southern hybridization assays); results obtained with probes were closely correlated and were in agreement with biological assays. No two ETEC strains possessed similar plasmid profiles, and DNA sequences encoding for enterotoxins were located on plasmids ranging from 58 to 75 MDa. The O:H (O1:H-,O2:H7, O6:H16, O25:H-, O27:H7, O28ab:H9, O52:H10, O64:H5, O70:H-, O78:H12, O88:H25, O99:H6, O101:H-, O126:H12, O166:H30) serotypes are presented (all the strains were typable, but some ETEC serotypes were unusual). By using antisera against colonization factor antigens (CFA) I and II, results showed that 9 of the 24 ETEC strains expressed CFA (2 CFA/II and 7 CFA/I). These strains possessed high bacterial surface hydrophobicity. Fifteen ETEC did not possess CFA; among these, 11 did not exhibit high hydrophobicity or show haemagglutination activity. Four of the 15 CFA-negative strains exhibited high hydrophobicity (two O64:H45, one O70:H- and one O88:H25) but no haemagglutination in the presence or absence of mannose.(ABSTRACT TRUNCATED AT 250 WORDS)
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Infections due to methicillin-resistant Staphylococcus aureus (MRSA) have become more prevalent, in part because of the emergence and spread of community-acquired MRSA. This trend is particularly concerning because of the significant rates of morbidity and mortality associated with MRSA infections, and because MRSA strains are often resistant to many classes of antibiotics. Reports of infections of the head and neck, including wound infections, cellulitis, sinusitis, otitis media, and otitis externa, are well documented. However, to our knowledge, there have been no reports of bacterial laryngitis due to MRSA. We report the first published case of bacterial laryngitis caused by MRSA.
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In a double-blind multicentre study, 181 patients with fibrotic idiopathic interstitial pneumonia (89% diagnosed as definite/probable IPF) were randomised to receive co-trimoxazole 960 mg twice daily or placebo for 12 months in addition to usual care. Measurements were made of forced vital capacity (FVC) (primary endpoint), diffusing capacity of carbon monoxide (Dlco) and EuroQol (EQ5D)-based utility, 6-minute walk test (6MWT) and Medical Research Council (MRC) dyspnoea score (secondary endpoints). All-cause mortality and adverse events were recorded (tertiary endpoints).
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The hypothesis that defective cell wall synthesis seems to represent a final common pathway of drug-induced injury either within the bacterial cell or on its surface was supported by two different findings: (1) sulfamethoxazole and trimethoprim, either alone or in combination, induced morphological findings in various Escherichia coli and Proteus mirabilis strains identical to those found after incubation with so-called cell-wall-active antibiotics (e.g., penicillin) and (2) cell-wall-defective bacteria (L forms, spheroblasts) were resistant to sulfonamides and/or trimethoprim as compared to their normal bacterial cells.
Two hundred eighty-three participants, aged 15 to 84 years, were diagnosed with UTI and cultured. One hundred thirty-five (48%) of cultures were positive, with full susceptibilities reported (81% Escherichia coli). Only 2 isolates (1.5%) were fluoroquinolone resistant. Resistance to TMP/SMX was 18%, to nitrofurantoin 5%, and to cefazolin 4%. Seventy-four percent were sensitive to all 3 narrow-spectrum agents. Resistance to narrow-spectrum agents did not vary significantly by diagnosis, age, recent UTI, or any clinical or demographic factors; but overall, there was a trend toward lower resistance rates in our population than in our hospitals' published antibiograms.
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Co-trimoxazole was compared with nafcillin against Staphylococcus aureus in vitro and in the therapy of experimental Staph. aureus meningitis in rabbits. Co-trimoxazole (trimethoprim:sulphamethoxazole in a 1:20 ratio) was synergistic against 22/24 strains of Staph. aureus in vitro. The MBC90 of co-trimoxazole and nafcillin were 0.156-3.12 mg/l and 0.25 mg/l, respectively, concentrations below those achievable in purulent cerebrospinal fluid. The rate of bacterial killing (Staph. aureus) by co-trimoxazole and nafcillin were similar in both broth and pooled CSF in vitro. However, the MBC increased and the rate of bactericidal activity of both agents declined when tested in CSF at a higher inoculum (10(7) cfu/ml). During continuous intravenous infusion therapy of a reproducible, uniformly fatal (if untreated) model of experimental Staph. aureus meningitis, serum concentrations of all agents closely approximated those found in humans receiving standard parenteral regimens. The mean percent penetration into CSF ([CSF]/[serum] X 100) was 2.9, 35.6 and 27.1% for nafcillin, trimethoprim and sulphamethoxazole, respectively. Although both nafcillin and co-trimoxazole therapy reduced CSF Staph. aureus concentrations significantly more rapidly (P less than 0.001) when compared to untreated controls, the bactericidal rate was modest. The CSF was rendered sterile in 0/64 animals treated with either regimen for 8 h. Nafcillin was more rapidly bactericidal in vivo (P less than 0.03) than co-trimoxazole in this model. Caution is advised in the use of co-trimoxazole for infections of the central nervous system caused by Staph. aureus.
A patient who returned from a 3-year stay in Thailand and India one year ago, was admitted with fever of 38.5 degrees C and productive cough for the last four weeks. He remembered wounding his foot three years ago in India with contamination by soil. Subsequently, recurrent pustulae appeared on his feet. One such pustule was found on admittance. The clinical examination showed low body weight, without further abnormalities.