Trimethoprim-sulfamethoxazole—associated aseptic meningitis: Case reports and review of the literature

Joffe, Ari; Farley, John; Linden, Dennis; Goldsand, G.

doi:10.1016/0002-9343(89)90618-9

Cited by 15 publications

(28 citation statements)

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“…The diagnosis of co-trimoxazole induced aseptic meningitis was based on the close temporal association with ingestion of co-trimoxazole and rapid recovery after withdrawal. Unfortunately we could not obtain cerebrospinal fluid in the first episode of 'meningitis' but even normal findings in the cerebrospinal fluid would be compatible with a reaction to co-trimoxazole as a similar neurological illness has been reported after cotrimoxazole with normal findings.3 However, usually the cerebrospinal fluid picture is abnormal and consists of polymorphonuclear leucocytosis, raised protein concentration, and normal glucose concentrations, which is similar to our findings.1 3 Another feature of this condition, also observed by ourselves, is a trend towards increasing severity and rapidity of onset with each successive exposure to the drug.…”

Section: Discussionsupporting

confidence: 86%

See 1 more Smart Citation

Co-trimoxazole induced aseptic meningitis.

Pashankar¹,

McArdle²,

Robinson³

1995

Archives of Disease in Childhood

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Section: Discussionsupporting

confidence: 86%

“…The mechanism is unknown, most authors favouring an acute hypersensitivity reaction involving the meninges.1 3 Reports of meningitis after trimethoprim alone suggest that this drug could be the offending agent in co-trimoxazole.5…”

Section: Discussionmentioning

confidence: 99%

Co-trimoxazole induced aseptic meningitis.

Pashankar¹,

McArdle²,

Robinson³

1995

Archives of Disease in Childhood

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“…Unlike NSAIDs, immune complexes have been detected in the serum of 3 patients with meningitis induced by trimethroprim-sulfamethoxazoleinduced meningitis, but these were not found in their CSF. 48,62 In a case of cephalosporin-related DIAM, 72 immune complexes were present both in serum and CSF as well as an increased IgG value in the CSF. This may suggest either that transfer of immune complexes to the CSF is not involved in the pathogenesis of the illness or that they are not accesible for assay.…”

Section: Antibiotic-induced Meningitismentioning

confidence: 95%

“…We found 29 patients with recurrent DIAM, totaling 71 episodes, and analyzed their clinical and CSF characteristics ( Table 5 48 reported in a single patient was 5, but we have only analyzed the first 3 episodes due to the low number of patients with more episodes and to the lack of information on fourth and fifth episodes. Overall, there was a female predominance (81%) with a mean age of 40 ± 22 years (range, 2-82 years).…”

Section: Recurrent Diammentioning

confidence: 99%

The Challenge of Drug-Induced Aseptic Meningitis

Morís¹,

1999

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Several drugs can induce the development of aseptic meningitis. Drug-induced aseptic meningitis (DIAM) can mimic an infectious process as well as meningitides that are secondary to systemic disorders for which these drugs are used. Thus, DIAM constitutes a diagnostic and patient management challenge. Cases of DIAM were reviewed through a MEDLINE literature search (up to June 1998) to identify possible clinical and laboratory characteristics that would be helpful in distinguishing DIAM from other forms of meningitis or in identifying a specific drug as the culprit of DIAM. Our review showed that nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, intravenous immunoglobulins, and OKT3 antibodies (monoclonal antibodies against the T3 receptor) are the most frequent cause of DIAM. Resolution occurs several days after drug discontinuation and the clinical and cerebrospinal fluid profile (neutrophilic pleocytosis) do not allow DIAM to be distinguished from infectious meningitis. Nor are there any specific characteristics associated with a specific drug. Systemic lupus erythematosus seems to predispose to NSAID-related meningitis. We conclude that a thorough history on prior drug intake must be conducted in every case of meningitis, with special focus on those aforementioned drugs. If there is a suspicion of DIAM, a third-generation cephalosporin seems a reasonable treatment option until cerebrospinal fluid cultures are available.

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“…Najčešće prijavljivane bolesti koje su mogle da budu umešane u nastanak aseptičnog meningitisa (pored primenjenog leka) jesu sistemski lupus eritematozus, HIV infekcija, Sjogrenov sindrom, Kronova bolest, pozitivan test na antinuklearna antitela. Evidentna je povezanost aseptičnog meningitisa koji je indukovan antibiotikom sa autoimunom bolešću, mada nije tako snažna kao kod NSAIL (35). Bakterijski meningitis prijavljen u Sjedinjenim Američkim Državama javlja se u oko tri slučaja na 100.000 pacijenata godišnje, dok se virusni meningitis javlja u oko 10 slučajeva na 100.000 pacijenata godišnje (36,37).…”

Section: Diskusijaunclassified

10.5937/mckg48-4030 = Development of aseptic meningitis after administration of amoxicillin

Stojanović¹

2014

Medicinski casopis

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UVODAntibakterijska aktivnost amoksicilina veoma je slična dejstvu ampicilina, ali je njegova apsorpcija iz digestivnog trakta veća (1, 2). Kombinacija amoksicilina i klavulanske kiseline pokazala se efikasnom, bezbednom i dobro podnošljivom kod pacijenata svih starosnih doba (3, 4).Aseptični meningitis obično je benigni sindrom i obuhvata sve tipove zapaljenja moždanih meningea koji nisu uzrokovani stvaranjem gnoja pod uticajem mikroorganizama (5). Ima veoma širok spektar etioloških uzročnika infektivne i neinfektivne prirode. Javlja se kod svih starosnih doba, mada češće kod dece. Tri puta češće se javlja kod muškaraca nego kod žena, a interetničke razlike do sada nisu zabeležene (6, 7). Nekoliko grupa lekova češće izaziva aseptični meningitis od drugih: nesteroidni antiinflamatorni lekovi (NSAIL), antimikrobna sredstva, intravenski imunoglobulini, CD3 monoklonska antitela, vakcine, lekovi za intratekalnu primenu i drugi (8). Antibiotici koji su do sada indukovali aseptični meningitis jesu: trimetoprim-sulfametoksazol, ciprofloksacin, cefalosporini, metronidazol, amoksicilin, penicilin, izoniazid i pirazinamid (5,(8)(9)(10)(11)(12)(13)(14). Dosad su najčešće prijavljivana neželjena dejstva za amoksicilin i klavulansku kiselinu: dijareja, nauzeja i osip na koži (15). Hepatotoksičnost se češće javlja kod starijih ljudi koji su na produženom lečenju, dužem od 10 dana (16).Precizna dijagnoza aseptičnog meningitisa koji je indukovan amoksicilinom postavlja se metodom postepenog isključivanja drugih infektivnih i neinfektivnih uzročnika. Najučestalije stanje koje može biti povezano sa aseptičnim meningitisom koji je indukovan lekom jeste sistemski lupus eritematozus (8). Sve skorije vakcinacije treba ispitati jer i one mogu biti uključene u razvoj aseptičnog meningitisa koji je

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Trimethoprim-sulfamethoxazole—associated aseptic meningitis: Case reports and review of the literature

Cited by 15 publications

References 0 publications

Co-trimoxazole induced aseptic meningitis.

Co-trimoxazole induced aseptic meningitis.

The Challenge of Drug-Induced Aseptic Meningitis

10.5937/mckg48-4030 = Development of aseptic meningitis after administration of amoxicillin

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