trimethoprim hydrochloride (Primsol)

Case Report: Multiple brain abscess-like lesions with concurrent detection of Nocardia amamiensis and Leishmania infantum in cerebrospinal fluid.

Liang Jiahao J, Wang Gang G, Shen Ruile R

Central nervous system nocardiosis is rare and potentially life-threatening, and human infection due to Nocardia amamiensis has seldom been reported; central nervous system involvement in visceral leishmaniasis is likewise uncommon. We report a 69-year-old man who developed progressive impairment of consciousness and coma after recurrent fever. Brain magnetic resonance imaging revealed multiple abscess-like lesions in both cerebral hemispheres, the cerebellum, and the brainstem, accompanied by acute or subacute cerebral infarctions. The cerebrospinal fluid opening pressure was 300 mmH2O. The white blood cell count was 285 × 106/L, with 81.9% polymorphonuclear cells; protein was 1.977 g/L and glucose was 2.34 mmol/L. MetaCAP analysis of cerebrospinal fluid concurrently detected N. amamiensis and L. infantum, and bone marrow smear demonstrated Leishmania amastigotes within macrophages. The patient tested negative for human immunodeficiency virus, and abdominal ultrasonography showed no hepatosplenomegaly. On the available evidence, visceral leishmaniasis was established and central nervous system nocardiosis was strongly suspected. Detection of L. infantum in cerebrospinal fluid supported possible central nervous system involvement, but did not establish a direct contribution to the brain abscess-like lesions. The patient received trimethoprim-sulfamethoxazole, imipenem-cilastatin, amikacin, and liposomal amphotericin B, but his condition continued to deteriorate. He was discharged against medical advice, and follow-up revealed that he had died. This case illustrates that sequencing-based detection is an important clue but cannot replace culture, pathogen-specific polymerase chain reaction, or evidence from lesion tissue.

Correction to: In vitro comparative quality evaluation of different brands of metformin hydrochloride tablets available in Mekelle City, Tigray Regional State, Ethiopia.

Welegebrial Brhane Gebrehiwot BG, Gezae Zenawi Z, Gebrekidan Samrawit Kidanemariam SK, Gebrerufael Gebru Gebremeskel GG et al.

High Rate of Adverse Events in Patients Receiving Oral Antimicrobials Under a COpAT Monitoring Protocol.

Sawey Ciara C, Burgoyne Colleen C, Winbush Angelina A, Qualls Brandon W BW et al.

We conducted a retrospective review to characterize adverse events in patients receiving oral linezolid, trimethoprim-sulfamethoxazole, voriconazole, and itraconazole monitored under an outpatient parenteral antimicrobial therapy program. Among 118 patients, 61% incurred at least 1 adverse event during treatment, highlighting the need for evidence-based monitoring protocols for complex outpatient antimicrobial therapy.

A case report of ocular nocardiosis secondary to Nocardia asiatica in a patient with acquired immunodeficiency syndrome.

Chen Mike Y MY, Thomas Joanne J, Zhu Catherine C, Mehta Nihaal N et al.

To describe the clinical presentation, diagnosis, management, and outcome of endogenous ocular nocardiosis caused by Nocardia asiatica in a profoundly immunocompromised patient. A 27-year-old man with acquired immunodeficiency syndrome presented with encephalopathy, severe immunosuppression, and innumerable ring-enhancing brain lesions concerning for disseminated opportunistic infection. Ophthalmic examination revealed bilateral subretinal abscesses and deposits without vitreous inflammation, as well as a macula-involving exudative retinal detachment in the right eye. Extensive microbiologic evaluation, including anterior chamber polymerase chain reaction testing, was unrevealing. Progressive neurologic decline prompted craniotomy with brain biopsy, which demonstrated branching filamentous organisms on Grocott methenamine silver staining, with molecular sequencing confirming Nocardia asiatica. Targeted trimethoprim-sulfamethoxazole therapy resulted in systemic and neurologic improvement with consolidation of subretinal lesions. Final visual acuity remained severely limited in the macula-involved right eye but recovered to 20/20 in the left eye. This case represents a detailed report of endogenous ocular nocardiosis attributable to Nocardia asiatica presenting as bilateral subretinal abscesses with multifocal brain involvement. Subretinal abscess-like lesions with minimal intraocular inflammation in the setting of disseminated infection, particularly when accompanied by multifocal brain abscesses, should prompt early consideration of nocardiosis. Early recognition and empiric trimethoprim-sulfamethoxazole therapy may facilitate systemic recovery and preserve vision in less affected eyes.