| We report the case of a 32-year-old woman who had pruritic urticarial skin lesions associated with episodes of arthralgia. The first site affected by the eruption was the inside surface of the thighs; the patient also reported the presence of leukorrhea. The woman had previously been treated with H1 antagonist with moderate and transitory results; skin lesions reappeared just after the interruption of the treatment. Her biochemical data showed increased levels of erythrocyte sedimentation rate, blood eosinophilia and hypocomplementemia. Antinuclear antibodies, rheumatoid factor, cryoglobulins and serological diagnosis for hepatitis or mononucleosis viruses resulted negative. Considering the initial site of the cutaneous features and the presence of leukorrhea, we requested a vaginal smear and a culture of the cervical secretion, which revealed the presence of a Trichomonas infection. Furthermore, the SDS-PAGE revealed the presence of a molecular mass of 230,000 Da (230-kDa) in the serum, which indicated a Trichomonas surface protein. The following treatment with oral metronidazole caused the eradication of the Trichomonas infection after 3 weeks and subsequently the resolution of the urticarial clinical features. We wish to underline that in the presence of a case of urticaria vasculitis syndrome which seems to be without cause, it is important to investigate every diagnostic suspicion scrupulously. ( info) |
| A patient with chronic vulvo-vaginitis due to trichomonas vaginalis, and obstructive uropathy associated with renal calculi, developed a perinephric abscess following trauma incurred in a motorcycle accident. T. vaginalis was seen on smear and cultured from the purulent drainage from the perinephric abscess. Although T. vaginalis is commonly pathogenic only to the lower genito-urinary system, the upper urinary tract may very rarely be involved by ascending infection. If this protozoan spreads to extraluminal sites the inflammatory potential is marked, as has been found in animals with experimental infection. Examination of a fresh smear of pus may be critically important in the diagnosis of closed-space infections of unknown etiology. ( info) |
3/34. Nitroimidazole-resistant vaginal trichomoniasis treated with paromomycin. A 33-year old woman with nitroimidazole-resistant vaginal trichomoniasis is described. She was treated with intravaginal paromomycin (500 mg daily for 2 days). This cured the trichomoniasis but resulted in severe local side effects. paromomycin may be useful for difficult cases of nitroimidazole-resistant trichomonas vaginalis vaginitis. The exact dosage still has to be determined. ( info) |
| trichomonas vaginalis is a vaginal pathogen associated with an increased incidence of adverse outcomes of pregnancy. Data are limited regarding the effects of trichomonas infections in the newborn. We report a symptomatic T. vaginalis infection in a 26-week premature infant and a review of the literature. ( info) |
5/34. metronidazole-induced pancreatitis in a patient with recurrent vaginal trichomoniasis. Recurrent acute pancreatitis associated with metronidazole developed in a 49-year-old woman who was taking the drug as treatment for vaginal trichomoniasis. The lack of alternative effective therapies for trichomoniasis governed the decision to rechallenge the patient with metronidazole despite a vague history of this reaction on a previous occasion. Six reports of this reaction are found in the literature. The patient was admitted to the hospital 12 hours after taking a single dose of metronidazole. Severe epigastric pain and elevated amylase and lipase concentrations led to the diagnosis of acute pancreatitis, although results of an abdominal ultrasound were unremarkable. The patient made a full recovery. Although this reaction occurs infrequently, this case report illustrates the need to develop additional therapies for treatment of trichomoniasis. ( info) |
| Distinguishing between re-infection and relapse of trichomonas infections is often a difficult task in the clinical setting. The chronicity of trichomonas infections and the ongoing sexual activity are two confounding factors. We present a patient with recurrent resistant vaginal trichomoniasis shortly following a sexual contact with an untreated partner after a complete response to treatment with tinidazole for nine months. We hypothesise that re-infection occurred from the asymptomatic partner who was an untreated chronic carrier of resistant trichomonas in the urogenital tract. ( info) |
| metronidazole and ornidazole, synthetic nitroimidazole derivatives, are used in the treatment of infections caused by anaerobic bacteria and protozoa. The drugs are well tolerated and serious side effects are very rarely encountered. Hepatotoxicity is a rare side effect and hitherto only six cases have been reported. We describe three patients who developed hepatitis after ornidazole use and review the previously reported cases. All three cases used ornidazole in conventional doses and developed hepatitis and associated cholestasis. They improved 1-2 months after discontinuation. We concluded that nitroimidazole derivatives may cause hepatotoxic damage resembling acute cholestatic hepatitis. Early recognition and withdrawal of the drug may prevent further damage. ( info) |
8/34. Successful response of metronidazole-resistant trichomonal vaginitis to tinidazole. A case report. Treatment of metronidazole-resistant trichomonas vaginalis infection is complicated by the lack of an effective alternative therapeutic regimen. Data on the susceptibility of the organism to metronidazole and other nitroimidazoles are important in managing intractable cases. A case of trichomonal vaginitis with true resistance to metronidazole that responded to treatment with tinidazole is reported. ( info) |
9/34. Symptomatic trichomoniasis, metronidazole allergic and pregnant--a management dilemma. A case of persistent trichomonas vaginalis (TV) in a pregnant, metronidazole-allergic woman is described. This case posed a management dilemma as untreated TV has been associated with adverse pregnancy outcomes but antibiotic desensitization is potentially dangerous during pregnancy. ( info) |
| metronidazole-resistant trichomonas vaginalis has been reported across the united states. Some reports have suggested that clinically resistant cases could be increasing. Currently, metronidazole is the only drug available to treat trichomoniasis, including resistant cases. In such cases, treatment usually consists of giving higher and more prolonged doses of metronidazole, which patients are often unable to tolerate. tinidazole, a second-generation nitroimidazole currently under development in the united states, has been shown to be an effective therapy in resistant T. vaginalis. tinidazole appears to have several advantages over metronidazole, including greater in vitro potency against both sensitive and resistant strains of T. vaginalis, a more prolonged duration of action, and improved patient tolerability. This report describes the successful use of tinidazole in 3 cases of clinically metronidazole-resistant trichomoniasis. ( info) |