rifampin and Brain-Abscess

Acanthamoeba-related cerebral abscess and encephalitis are rare but usually fatal, being caused by free-living amoebic infections usually occurring in immunocompromised patients. In patients receiving transplants, a literature review showed that the infection is universally fatal. The diagnosis is often missed despite appropriate investigations including lumbar puncture, computerized tomography, and brain biopsy. We present the first reported liver transplant patient with Acanthamoeba cerebral abscess. The diagnosis was made in brain tissue removed at decompressive frontal lobectomy. He was successfully treated with a 3-month course of co-trimoxazole and rifampicin. There was no recurrence of the disease after 11 years of follow-up.

Topics: Acanthamoeba; Adult; Amebiasis; Animals; Antimalarials; Brain Abscess; Combined Modality Therapy; Drug Therapy, Combination; Frontal Lobe; Humans; Immunocompromised Host; Immunosuppressive Agents; Liver Transplantation; Male; Opportunistic Infections; Rifampin; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Mycobacterium avium complex (MAC) is a ubiquitous pathogen, widely distributed in the environment including water, soil and animals. It is an uncommonly encountered clinical pathogen; primarily causing pulmonary infections in patients with underlying lung disease or disseminated disease in immunocompromised hosts. Sporadically, extra-pulmonary infections have been documented including involvement of the liver, spleen, skin, soft tissue and lymph nodes. Central nervous system (CNS) infections due to MAC are exceedingly rare and carry a poor prognosis. Additionally, such infections are largely reported in patients infected with HIV. Herein we report the first case of intracranial abscess due to MAC in an immunocompetent man with a normal CD4 count and negative HIV status.. A previously healthy 40-year-old male presented to us with progressively worsening CNS symptoms. The patient's presentation was uncharacteristic of MAC infection in immunocompetent hosts, as he developed subacute, progressive symptoms that included severe frontal headaches, left eyelid swelling, blurry vision, and diplopia, without any pulmonary or systemic manifestations. Neuroimaging revealed multiple ring-enhancing lesions, which required neurosurgical intervention. MAC was the only pathogen that grew from intraoperative tissue cultures. The patient was subsequently treated with a 12-month regimen consisting of Clarithromycin, Ethambutol, and Rifampin, with successful clinical resolution.. Our findings indicate that it is important to consider rare infections such as MAC in immunocompetent patients, regardless of atypical symptoms. Despite the severity of this infection, with timely diagnosis effective treatment is available.

Topics: Adult; Anti-Bacterial Agents; Brain Abscess; Clarithromycin; Diagnosis, Differential; Drug Therapy, Combination; Ethambutol; Humans; Male; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Rifampin

Tubercular brain abscess is a rare manifestation of neurotuberculosis. Large brain absceses are usually surgically treated. We report a case of tubercular brain abscesses in left cerebellar hemisphere and right parietal lobe in a child who was treated surgically for the cerebellar abscess and conservatively with antitubercular drug for parietal abscess. The patient showed significant clinical improvement and healing of brain abscess on follow up imaging. The resolution of relatively large abscess by conservative management with antitubercular treatment is very rare.

Topics: Antitubercular Agents; Brain Abscess; Child, Preschool; Drug Therapy, Combination; Humans; Isoniazid; Magnetic Resonance Imaging; Male; Mycobacterium tuberculosis; Pyrazinamide; Rifampin; Tuberculosis, Central Nervous System

Cerebritis y abscesos cerebrales por Streptococcus pneumoniae en un recien nacido.

Topics: Anti-Bacterial Agents; Anticonvulsants; Bacteremia; Brain Abscess; Bronchiolitis; Cardiotonic Agents; Cerebral Hemorrhage; Drug Therapy, Combination; Fatal Outcome; Humans; Immunocompromised Host; Infant, Newborn; Magnetic Resonance Imaging; Male; Meningitis, Pneumococcal; Pneumococcal Infections; Respiratory Syncytial Virus Infections; Rifampin; Spleen; Streptococcus pneumoniae; Vancomycin

Brain abscesses are a rare but potentially lethal neurological lesions, generally occurring after septic episodes in immunodeficient patients or complicating neurosurgical procedures. Even though they are known complications of surgically treated intracerebral haemorrhages (ICH), the presence of a brain abscess at the site of an untreated ICH is a rare event. Such cases may result from haematogenous spread from distant foci or contiguous sites and are often preceded by episodes of sepsis and local infection. Immunodeficiency, AIDS, age, diabetes mellitus and vitamin-K deficiency are predisposing factors. Abscess formation should be considered in case of clinical deterioration, headache, and any neurological deficit after febrile episodes. Early diagnosis with neuroradiological imaging, infection blood markers and microbiological identification of the causative pathogen is crucial for treatment with surgical drainage or excision and specific antibiotic therapy, which guarantee good outcome and long-term survival. In fact, while prompt diagnosis and treatment guarantee good outcome and long-term survival, morbidity and mortality are very high in case of misdiagnosis. We report a case of a 49-year old man presenting with a brain abscess 13 weeks after a spontaneous ICH, without previous episodes of sepsis and with a suspected septic arthritis 2 weeks after abscess drainage.

Topics: Anti-Bacterial Agents; Brain Abscess; Cerebral Hemorrhage; Chemoradiotherapy; Drainage; Dysarthria; Headache; Hodgkin Disease; Humans; Hypertension; Levofloxacin; Magnetic Resonance Imaging; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Nervous System Diseases; Oxacillin; Rifampin; Spine; Tomography, X-Ray Computed; Treatment Outcome

Staphylococcus lugdunensis is a coagulase-negative staphylococcus with aggressive and rapidly progressive infectious behavior. This organism has emerged as an important pathogen implicated in both community-acquired and nosocomial infections, including meningitis, brain abscess, catheter-related bacteremia, and ventriculoperitoneal shunt infection.. We report the first known case of Staphylococcus lugdunensis intracranial abscess in a pediatric hydranencephalic patient, caused by a ventriculoperitoneal shunt-related infection. Further magnetic resonance imaging (MRI) confirmed a large abscess within the cranium that demonstrated multiple loculations. The patient received externalization of the right occipital ventricular catheter with evacuation of the brain abscess. Medical management included one week of intrathecal antibiotic treatment, and she was discharged on long-term intravenous rifampin and vancomycin, leading to cure of the infection.. This case suggests that if Staphylococcus lugdunensis is identified, a virulent and prolonged clinical course with the production of destructive lesions, similar to those with S. aureus, should be expected. A course of antibiotic therapy and aggressive management that may include surgical treatment will be needed.

Topics: Anti-Bacterial Agents; Brain Abscess; Ceftriaxone; Child, Preschool; Female; Humans; Hydranencephaly; Injections, Spinal; Neurosurgical Procedures; Rifampin; Staphylococcal Infections; Staphylococcus lugdunensis; Vancomycin; Ventriculoperitoneal Shunt

Methicillin-resistant Staphylococcus aureus (MRSA) is a rare cause of cerebral abscesses, however it is a relatively more common etiologic agent in post-neurosurgical abscesses and the main antibacterial therapy option is vancomycin. In this report, a case of brain abscess due to MRSA which did not respond neither to moxifloxacin + vancomycin nor vancomycin + rifampin combination therapies, and merely treated by linezolid + rifampin combination, has been presented. Fifty-one years old female patient who was operated 40 days ago for subarachnoid bleeding and aneurysm in middle cerebral artery bifurcation, was hospitalized due to purulent leakage from the operation area. She did not have fever and her physical examination, including the neurologic system, was normal. Computerized tomography revealed an approximately 1 cm lesion compatible with subdural empyema and cerebral abscess in the right frontoparietal area in supratentorial sections. The patient was operated for wound revision and moxifloxacin was initiated. Since the operation materials revealed MRSA growth, vancomycin (4 x 500 mg, IV) was added to the treatment. The isolate was identified by conventional methods, and antibiotic susceptibility test performed by disk diffusion method showed that it was susceptible to levofloxacin, linezolid, rifampin, vancomycin and teicoplanin. Since no clinical response was obtained in two weeks, moxifloxacin was switched to rifampin (300 mg 1 x 2). On the 10th day of vancomycin + rifampin therapy, radiological findings showed development of cerebritis and therefore vancomycin was changed with linezolid (2 x 600 mg, IV). The control CT of the patient revealed regression of the brain lesion and linezolid + rifampin treatment continued for six weeks. The patient did not develop any hematological, liver or renal toxicity during the therapy and the radiological findings regressed. No relapse were detected in the one year follow-up period. This case suggested that linezolid might be a treatment alternative in the therapy of vancomycin-refractory MRSA brain abscess.

Topics: Acetamides; Anti-Infective Agents; Brain Abscess; Drug Therapy, Combination; Female; Humans; Linezolid; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Middle Aged; Oxazolidinones; Postoperative Complications; Rifampin; Staphylococcal Infections; Tomography, X-Ray Computed; Treatment Failure

Topics: Adult; Antitubercular Agents; Brain Abscess; Cerebellar Diseases; Combined Modality Therapy; Craniotomy; Ethambutol; Female; Humans; Isoniazid; Magnetic Resonance Imaging; Mediastinum; Pyrazinamide; Rifampin; Tuberculosis, Central Nervous System; Tuberculosis, Lymph Node

We evaluated the efficacy of cefotaxime in the management of brain abscesses caused by Streptococcus milleri. Twenty two patients with a S. milleri brain abscess were treated with metronidazole and cefotaxime, in accordance with recent recommendations by the British Society Of Antimicrobial Chemotherapy (BSAC). Seven patients who had Glasgow Coma Scales < or =11 also received rifampicin and high dose cefotaxime. The clinical response of the patients was determined.. A retrospective study at the Queen Elizabeth Hospital, Birmingham covering the period April 1996-March 2004 was carried out. Neurosurgical and anti-microbial therapeutic approaches were reviewed. Any evidence of improvement of clinical features and radiological disappearance of brain abscesses were determined.. Outcome was assessed using the Glasgow Outcome Score (GOS) at 3 and 6 months from the time of surgical intervention. Eighteen patients (82%) had a good outcome by 6 months, with an outcome score of 4-5. Thirteen patients resumed normal life despite minor deficits (GOS 5), while a further five patients had moderate disability though remained independent (GOS 4). One patient had a GOS of 3 and there were three deaths (14). The minimum time to radiological resolution of the abscess was within 1 month in six cases (27) These all represented solitary lesions that required a single drainage procedure in conjunction with 4 weeks of intravenous cefotaxime and metronidazole. Ten cases (45%) had resolution within 4 months and a further three cases took at least 6 months from the time of surgery to show radiological clearance.. This cohort of patients responded favourably to the guidelines recommended by the BSAC. This was confirmed by the Glasgow Outcome Score (GOS 4-5) at 6 months review. Cefotaxime at a higher dose with rifampicin was prescribed for patients presenting with a decreased conscious level (GCS 8-11), subsequent failure of anticipated clinical improvement or clinical deterioration. There was no clinically significant difference in GOS between the two treatment groups. An algorithm for management of brain abscess is presented, based on our clinical experience and review of the literature.

Topics: Adolescent; Adult; Aged; Algorithms; Anti-Infective Agents; Brain Abscess; Causality; Cefotaxime; Cohort Studies; Drainage; Female; Glasgow Outcome Scale; Humans; Male; Metronidazole; Middle Aged; Retrospective Studies; Rifampin; Risk Factors; Streptococcal Infections; Streptococcus milleri Group; Time Factors; Treatment Outcome

Topics: Anti-Bacterial Agents; Aortic Valve; Brain Abscess; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Floxacillin; Gentamicins; Heart Valve Diseases; Humans; Middle Aged; Mitral Valve; Rifampin; Staphylococcal Infections; Tomography, X-Ray Computed; Treatment Outcome

Topics: Acetamides; Ampicillin; Anti-Bacterial Agents; Brain Abscess; Drug Hypersensitivity; Drug Therapy, Combination; Humans; Linezolid; Listeriosis; Male; Middle Aged; Oxazolidinones; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination

Delayed complications associated with sublaminar and interspinous wiring in the pediatric cervical spine are rare. The authors present a case of delayed complication in which a cervical fusion wire migrated into the cerebellum, causing subsequent cerebellar abscess 2 years after posterior cervical arthrodesis. A craniotomy was required to remove the wire and drain the abscess. Despite their history of safety and successful fusion, procedures involving sublaminar and interspinous wiring carry a risk of neurological injury secondary to wire migration. A thorough neuroimaging evaluation is required in patients who have undergone fusion and who have neurological complaints to detect late instrumentation-related sequelae.

Topics: Adolescent; Anti-Bacterial Agents; Bone Wires; Brain Abscess; Cerebellar Diseases; Cervical Vertebrae; Foreign-Body Migration; Humans; Magnetic Resonance Imaging; Male; Nafcillin; Penicillins; Reoperation; Rifampin; Spinal Fusion; Staphylococcal Infections; Tomography, X-Ray Computed

We describe an immunocompetent patient with a solitary brainstem abscess that responded to antituberculous therapy. Although prompt surgical therapy has been advocated, the possibility of medical resolution of brainstem tuberculous abscesses should be considered.

Topics: Adult; Antitubercular Agents; Brain Abscess; Brain Stem; Humans; Isoniazid; Magnetic Resonance Imaging; Male; Pyrazinamide; Rifampin

Primary amoebic meningoencephalitis due to Naegleria fowleri was found in a 38-year-old Chinese man living in Hong Kong who presumably acquired the infection from swimming in a hot spring in neighbouring China. Amoebic cysts were identified in tissue taken from a brain abscess. The patient responded to surgical drainage and a 6-week course of amphotericin B, rifampicin and chloramphenicol. This is one of 6 cases of successful treatment of primary amoebic meningoencephalitis documented in the medical literature.

Topics: Adult; Amebiasis; Amphotericin B; Animals; Brain Abscess; Chloramphenicol; Combined Modality Therapy; Craniotomy; Drainage; Drug Therapy, Combination; Hong Kong; Humans; Male; Meningoencephalitis; Naegleria fowleri; Rifampin

A young goat was presented with a left spastic hemiparesis and general proprioceptive ataxia with postural reaction deficits, a right head tilt and positional nystagmus. Seizure-like activity was elicited by rapid changes in the position of the animal's head. The neurological signs and quality of the seizure activity suggested a lesion involving the medulla and possibly the cerebellum. A focal lesion at the level of the left cerebellar peduncles could explain the left hemiparesis and right paradoxical vestibular signs. A large encapsulated abscess was found at the confluence of the left cerebellar peduncles. The morphology and staining characteristics of the organisms within the abscess were consistent with Corynebacterium pseudotuberculosis.

Topics: Animals; Ataxia; Brain; Brain Abscess; Cerebellar Diseases; Corynebacterium Infections; Corynebacterium pseudotuberculosis; Diagnosis, Differential; Diazepam; Goat Diseases; Goats; Hemiplegia; Male; Neurologic Examination; Penicillin G Procaine; Rifampin; Seizures

Ventricular obstruction and hydrocephalus are recognized complications of neurosurgical procedures and meningitis that has been previously treated. The confinement of bacterial meningitis solely to a lateral ventricle in an otherwise healthy individual, however, is rare. I describe a case in which a ventricular abscess occurred as the presenting manifestation of staphylococcal meningitis in a man who had no history of head trauma or neurosurgery.

Topics: Adult; Brain Abscess; Cerebral Ventricles; Humans; Magnetic Resonance Imaging; Male; Meningitis, Bacterial; Nafcillin; Rifampin; Staphylococcal Infections; Tomography, X-Ray Computed; Vancomycin

A case of tuberculous brain infection following tuberculous meningitis in a 67-year-old man is presented. It was located in an old cerebral infarct associated with left internal carotid artery occlusion. CT demonstrated capsule enhancement in the left temporal area after iodinated contrast medium. Chemotherapy with INH, RFP and SM diminished the lesion and the capsule disappeared thirteen months later. It is suggested that a relatively long clinical history together with the appearance of a thick-walled abscess-like lesion on the CT scan is consistent with the diagnosis of tuberculous brain infection, perhaps an abscess.

Topics: Aged; Brain Abscess; Cerebral Infarction; Humans; Isonicotinic Acids; Male; Rifampin; Streptomycin; Tomography, X-Ray Computed; Tuberculosis; Tuberculosis, Meningeal

A 55-year-old diabetic aboriginal woman presented with a two-week history of fever, altered mental state and convulsions. On the basis of computed tomographic scanning a diagnosis of cerebral abscess was made. The pus that was drained produced no bacterial growth but, on microscopy, amoebic cysts were observed. Special cultures produced a growth of Acanthamoeba. The patient appeared to respond to drainage of the abscess and antiprotozoal therapy. Unfortunately, she developed necrotizing enteritis which led ultimately to her death. Antibiotic sensitivity and pathogenicity testing suggest that the Acanthamoeba were unusually virulent. The problems of diagnosis and management are discussed.

Topics: Acanthamoeba; Amebiasis; Animals; Animals, Suckling; Brain Abscess; Chloramphenicol; Drug Therapy, Combination; Female; Humans; Mice; Middle Aged; Rifampin; Time Factors

The effect of 10% carbon dioxide on the sensitivity to four antibiotics of 10 strains of Bacteroides fragilis was studied. The minimum inhibitory concentrations of erythromycin and lincomycin hydrochloride for these strains were four to 32 times higher, when grown in hydrogen plus 10% carbon dioxide, than the values obtained when the strains were grown in pure hydrogen. A similar effect was obtained by growing the strains in hydrogen on an acid medium. Except for Haemophilus influenzae and Clostridium tertium the sensitivity to erythromycin and lincomycin hydrochloride of other species of bacteria examined was not affected by the atmosphere in which the tests were carried out. 7-Chlorolincomycin and rifamycin B diethylamide, to which the strains of B. fragilis were uniformly sensitive, were not significantly affected by additional carbon dioxide. The possible mechanisms underlying this phenomenon and its clinical implications are discussed, and a case report describing the successful use of erythromycin in the treatment of a cerebral abscess due to B. fragilis is presented. In a recent study in this laboratory of the sensitivity to antibiotics of B. fragilis the majority of strains were found to be inhibited by 0.15 mug/ml of erythromycin and by 0.55 mug/ml of lincomycin hydrochloride (Ingham, Selkon, Codd, and Hale, 1968). After this work had been completed hydrogen plus 10% carbon dioxide was substituted for pure hydrogen in the anaerobic technique. Strains of B. fragilis isolated on routine culture now appeared to be relatively resistant to erythromycin and lincomycin hydrochloride when their sensitivity was examined by the disc diffusion method. A more detailed investigation of this phenomenon was carried out, the results of which are reported here. The opportunity was also taken to examine the susceptibility of B. fragilis to two new antibiotics, namely, 7-chlorolincomycin and rifamycin B diethylamide.

Topics: Anti-Bacterial Agents; Bacteroides; Bacteroides Infections; Brain Abscess; Carbon Dioxide; Clostridium; Culture Media; Erythromycin; Haemophilus influenzae; Humans; Hydrogen; Lincomycin; Male; Microbial Sensitivity Tests; Middle Aged; Rifampin