Antibiotics versus no treatment for toxoplasma retinochoroiditis.

BACKGROUND: Acute toxoplasma retinochoroiditis causes transient symptoms of ocular discomfort and may lead to permanent visual loss. Antibiotic treatment aims primarily to reduce the risk of permanent visual loss, recurrent retinochoroiditis, and the severity and duration of acute symptoms. There is uncertainty about the effectiveness of antibiotic treatment. OBJECTIVES: To compare the effects of antibiotic treatment versus placebo or no treatment for toxoplasma retinochoroiditis. SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision group Trials Register) (2016, Issue 1), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to February 2016), EMBASE (January 1980 to February 2016), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to February 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 22 February 2016. We searched the reference lists of identified articles and contacted pharmaceutical companies for unpublished trials. SELECTION CRITERIA: We included randomised controlled trials that compared any antibiotic treatment against placebo or no treatment. We excluded trials that included immunocompromised participants. We considered any antibiotic treatment known to be active against Toxoplasma gondii. Antibiotic treatment could be given in any dose orally, by intramuscular injection, by intravenous infusion, or by intravitreal injection. DATA COLLECTION AND ANALYSIS: The primary outcomes for this review were visual acuity at least three months after treatment and risk of recurrent retinochoroiditis. Secondary outcomes were improvement in symptoms and signs of intraocular inflammation, size of lesion, and adverse events. We used standard methodological procedures expected by Cochrane. MAIN RESULTS: Four trials that randomised a total of 268 participants met the inclusion criteria. In all four studies antibiotic was administered orally.One study conducted in Brazil in both adults and children compared trimethoprim-sulfamexacocol over 20 months to no treatment and was judged to be at high risk of performance, detection, and attrition bias. The other three studies compared antibiotic treatment to placebo. We judged these three studies to be at a mixture of low or unclear risk of bias due to poor reporting. One study conducted in the US in adults studied pyrimethamine-trisulfapyrimidine for eight weeks; one study conducted in the UK in children and adults evaluated pyrimethamine for four weeks; and one study conducted in Brazil in adults investigated trimethoprim-sulfamethoxazole for 12 months. In the last study, all participants had active retinochoroiditis and were treated with antibiotics for 45 days prior to randomisation to trimethoprim-sulfamethoxazole versus placebo.Only the study in Brazil of trimethoprim-sulfamethoxazole over 12 months, in participants with healed lesions, reported the effect of treatment on visual acuity. People treated with antibiotics may have a similar change in visual acuity compared with people treated with placebo at one year (mean difference -1.00 letters, 95% confidence interval (CI) -7.93 to 5.93 letters; 93 participants; low-quality evidence).Treatment with antibiotics probably reduces the risk of recurrent retinochoroiditis compared with placebo (risk ratio (RR) 0.26, 95% CI 0.11 to 0.63; 227 participants; 3 studies; I(2) = 0%; moderate-quality evidence); similar results were seen for acute and chronic retinochoroiditis.The UK study of pyrimethamine for four weeks reported an improvement in intraocular inflammation in treated compared with control participants (RR 1.76, 95% CI 0.98 to 3.19; 29 participants; low-quality evidence). The study in Brazil of trimethoprim-sulfamethoxazole for 12 months stated that the severity of inflammation was higher in the comparator group when compared to the antibiotic-treated group but did not provide further details. In the US study of pyrimethamine-trisulfapyrimidine for eight weeks intraocular inflammation had almost completely resolved by eight weeks in all participants, however in this study all participants received steroid treatment.Two studies (UK and US studies) reported an increased risk of adverse events in treated participants. These were a fall in haemoglobin, leucocyte, and platelet count, nausea, loss of appetite, rash, and arthralgia. AUTHORS' CONCLUSIONS: Treatment with antibiotics probably reduces the risk of recurrent toxoplasma retinochoroiditis, but there is currently no good evidence that this leads to better visual outcomes. However, absence of evidence of effect is not the same as evidence of no effect. Further trials of people with acute and chronic toxoplasma retinochoroiditis affecting any part of the retina are required to determine the effects of antibiotic treatment on visual outcomes.

Sulfenamide and Sulfonamide Derivatives of Metformin - A New Option to Improve Endothelial Function and Plasma Haemostasis.

Type 2 diabetes mellitus (T2DM) is a multi-factorial disease which can cause multiple organ dysfunction, including that of the vascular endothelium. The aim of the present study was to evaluate the effects of metformin, and its sulfenamide and sulfonamide derivatives (compounds 1-8) on the selected markers of endothelial function and blood coagulation. The integrity of endothelial cells(ECs) was examined using the real-time cell electric impedance system. Tissue Factor(TF) production, the release of von Willebrand Factor (vWF) and tissue plasminogen activator(t-PA) from ECs were determined using immunoenzymatic assays, while the process of platelet thrombus formation using the Total Thrombus-Formation Analysis System. Sulfenamide with n-butyl alkyl chain(3) does not interfere with ECs integrity, and viability (nCI(24h) = 1.03 ± 0.03 vs. 1.06 ± 0.11 for control), but possesses anticoagulation properties manifested by prolonged platelet-dependent thrombus formation (Occlusion Time 370.3 ± 77.0 s vs. 286.7 ± 65.5 s for control) in semi-physiological conditions. Both p- and o-nitro-benzenesulfonamides (compounds7,8) exhibit anti-coagulant properties demonstrated by decreased vWF release and prolonged parameters of platelet thrombus formation and total blood thrombogenicity. In conclusion, chemical modification of metformin scaffold into sulfenamides or sulfonamides might be regarded as a good starting point for the design and synthesis of novel biguanide-based compounds with anticoagulant properties and valuable features regarding endothelial function.

Cutaneous nonpulmonary Mycobacterium chelonei infection. Successful treatment with sulfonamides in an immunosuppressed patient.

A 52-year-old man, who had received immunosuppressive therapy for four years after renal transplantation, had a deep-set skin infection in his thigh caused by Mycobacterium chelonei. In vitro studies indicated that the organism was resistant to antimycobacterial agents but potentially sensitive to high-dose sulfonamide therapy. Repeated surgical excisions failed to eradicate the infection, as documented by histopathologic examination. The combination of a reduced dose of immunosuppressive medication and the administration of high-dose sulfonamide therapy resulted in clinical recovery.

Quadruple therapy for ocular toxoplasmosis.

Between Dec. 1, 1973, and May 30, 1989, 36 patients (37 eyes) with ocular toxoplasmosis seen at a uveitis clinic received quadruple therapy (pyrimethamine, trisulfapyrimidines, clindamycin and prednisone). The criteria for quadruple therapy were active lesions involving or threatening the macula or the optic disc, or a visual acuity of 20/70 or worse due to vitreous opacification caused by active inflammation. All but four of the cases showed improved vision. A total of 54% of the cases responded favourably within 2 weeks after the start of treatment, and 81% responded within 3 weeks. Patients took pyrimethamine for 1 to 2 weeks and received trisulfapyrimidines and clindamycin for 3 weeks, with a tapering course of orally given prednisone. The only complication was skin rash secondary to trisulfapyrimidine therapy, in four cases. None of the patients manifested diarrhea, pseudomembranous colitis or bone marrow suppression. The length of follow-up ranged from 1 month to 15.5 years. There were seven recurrences in five patients, five of which responded to a second course of quadruple therapy.

[Hydra with seven heads: epidemic cerebrospinal meningitis or better meningococcal infection. Neisseria meningitis, Prévot 1933]. / Un'idar dalle sette teste: la meningite cerebro-spinale epidemica o, meglio, l'infezione da meningococco. Neisseria meningitidis, Prévot, 1933

A brief survey is presented of meningococcal meningitis, its history, its chemotherapy, the appearance of resistant bacterial strains, and its vaccine therapy. The epidemiology of the disease in various European and other countries is also described.

Managing ear infection in children.

Serous or suppurative middle ear effusion in children 2 years of age or older is common and is relatively easy to diagnose and treat. However, assessing and managing apparent ear infection in younger children--particularly infants--are more difficult tasks, and in many of these young patients the middle ear is found to be normal.

[African histoplasmosis]. / Afrikanische Histoplasmose.

This is a case report of two patients who suffered from African histoplasmosis. Clinical, histological, and mycological characteristics, and the treatment are described.

[Studies on the pharmacokinetics of Sulfaclomid, Mebacid, Nevigramon and Metindol in patients with reduced kidney function]. / Untersuchungen zur Pharmakokinetik von Sulfaklomid, Mebacid, Nevigramon und Metidol bei Patienten mit eingeschränkter Nierenfunktion.

In patients with restriction of the renal function the pharmacokinetics of Sulfaclomid, Mebacid, Nevigramon and Metindol was investigated. According to the different elimination mechanisms of the drugs investigated the kinetics was infleunced in different way by the restriction of the renal elimination of these drugs: The half-life periods for the elimination of Metindol, Nevigramon and Mebacid remained unchanged in patients with renal diseases; the half-value period for the elimination of Sulfaclomid was prolonged.

[Pharmacokinetic model studies of sulfamerazine in domestic mammals. 3. Acetylation, protein binding, and minimal inhibitory concentration of sulfamerazine]. / Pharmakokinetische Modelluntersuchungen an Sulfamerazin bei Haussäugetieren. 3. Mitteilung: Azetylierung, Eiweissbindung und minimale Hemmkonzentration von Sulfamerazin.

Acetylation and protein fixation were established for the purpose of elucidating the chemotherapeutically effective part of sulphamerazine when applied to cattle, swine, horse, sheep, dog, and cat. The highest degree of acetylation and lowest protein fixation in all species tested, were recorded from swine. A reciprocal correlation was found to exist between the two above parameters, and it was statistically secured, except for horse. A mathematical description of the functional relationship between sulphamerazine fixed to serum protein and free sulphamerazine was possible by means of the Freundlich isothermia which had been recommended by SCHOLTAN (1962) in the following form: cgeb = K+ . cfreim The problem of minimum inhibitory concentration is discussed and explained in greater detail by computational examples with Escherichia coli.

[Radionuclide and radiographic studies for the evaluation of results of short and long-term therapy in experimental dog pyelonephritis]. / Nuklearmedizinische und röntgenologische Verlaufsuntersuchungen zur Beurteilung des Erfolges einer Kurz- oder Langzeittherapie bei der experimentell erzeugten Pyelonephritis des Hundes.

In the animal experiment a pyelonephritis was produced in a dog. The results of a short-term therapy and of a long-term therapy are tested by means of the urine sediment, the urine culture, the excretion urography, radionephrography, angiography and histology.

Paracoccidioidomycosis case report: cure with amphotericin B and triple sulfa.

A man developed paracoccidioidomycosis with non-productive cough and changes on chest roentgenogram one year following agricultural work in Ecuador. Oropharyngeal and nasal lesions developed 2 years later. This chronic fungal infection is typically difficult to cure, and relapses are common. After treatment with 2.5 g of amphotericin B and a 3-year course of triple sulfa, our patient remained free of disease during 12 years of follow-up.

[Therapeutic study of the effect of selective decontamination on microbial overgrowth syndrome of the small intestine]. / Therapeutische Studie zum Einfluss der selektiven Dekontamination auf das mikrobielle Overgrowth-Syndrom des Dünndarms.

The microbial overgrowth syndrome of the small bowel (MOS) is characterized by clinically found symptoms of increased metabolic activities of microorganisms existing in a great number in the intestinal juice of these patients. We treated 15 patients who suffered from MOS following a modified scheme of selective intestinal decontamination (SID) with oral doses of BerlocombinR (trimethoprim/sulfamerazin) and polymyxin for three weeks. Comparative investigations of duodenal juices before and after treatment showed unchanged high germ-counts (total aerobes and total anaerobes up to 10(7) germs/ml juice). Only the increase of Clostridium (up to 10(6)/ml) was statistically significant which has to be disapproved. In most of the patients there was no subjective improvement. SID in the examined manner is not able to cure a microbial overgrowth in the upper gastrointestinal tract or to reduce facultatively pathogenic microorganisms.

[Screening for toxoplasmosis in pregnancy--a pilot program in Northeast Germany]. / Toxoplasmosescreening in der Schwangerschaft--ein Pilotprogramm im Nordosten Deutschlands.

A general serological screening of pregnant women for toxoplasmosis was carried out by means of an IgG-ELISA in Greifswald and its surroundings from October 1986 to the end of 1990. Anti-toxoplasma gondii antibodies were detected in 72.8% of 4355 pregnant women. Since 1987, the prevalence of antibodies has decreased from 76% to 68%. The incidence of acquired toxoplasmosis in pregnancy was 2.53 per 1000. Seroconversion occurred in 11 women, but only 8 of them were treated with combined pyrimethamine and sulphamerazine. Despite treatment we observed 3 connatal infections. No newborn infant had clinical symptoms. With regard to the epidemiological situation, a toxoplasmosis screening is recommendable, at least in our area, from an ethical, moral, medical and economical point of view. To ensure, that toxoplasmosis screening is adequately effective, treatment of the pregnant women and their infants must be guaranteed both organisationally and professionally. It must also comprise health education measures, especially for non-immunised women to avoid the well-known main sources of infection.

The relation between toxoplasmosis and pityriasis lichenoides chronica.

Pityriasis lichenoides chronica (PLC) is a rare skin disease of uncertain aetiology. Many infectious agents have been incriminated as the cause of the disease. One of these agents is toxoplasmosis. The aim of this work was to find out if there is a relationship between toxoplasmosis and PLC. Twenty two patients (17 males and 5 females) diagnosed clinically and histopathologically as PLC were chosen for this study. Also twenty apparently healthy individuals free from skin lesions were included as a control group. Patients and controls were examined clinically for signs of toxoplasmosis and submitted for indirect haemagglutination (IHA) and indirect immunofluorescent antibody (IFA) tests in our Parasitology laboratory for serodiagnosis of toxoplasmosis. Toxoplasmosis was diagnosed in 8 (36.36%) and 3 (15%) in PLC patients and controls respectively by both tests. Using pyrimethamine and trisulfapyrimidine in treating PLC patients, showed subsidence of skin lesions in five patients with toxoplasmosis within two months from the beginning of therapy. The remaining patients showed no response to treatment. On conclusion, toxoplasmosis appears to play a role in the aetiology of PLC and serological tests for diagnosing toxoplasmosis should be performed in all PLC patients.