rifampin and Brain-Diseases

Intracranial tuberculomas are rare yet lethal forms of tuberculosis. Diagnosis is often difficult because of its nonspecific symptoms and radiological findings.. This study aims to perform a literature review of multiple tuberculomas to improve disease recognition and management in immunocompetent patients along with presenting a case report on the topic.. Scopus, LILACS, Ovid MEDLINE and EMBASE.. Case reports and case series up to December 2018 in English, Spanish, and Portuguese focusing on intracranial tuberculomas in adult and pediatric immunocompetent patients. Data on presentation, diagnostic workup, and treatment was analyzed.. Cochrane Collaboration/Cochrane Handbook and PRISMA guidelines.. Twenty reports involving 21 patients were included. Most patients were male (57.14%). The average age at diagnosis was 26.9 ± 14.9 years. Headache was the most common presenting symptom (52.4%; 11/21), followed by motor weakness (47.6%; 10/21) and vomiting (23.8%; 5/21). MRI was the most used image technique (17/21). Most lesions occurring in the cerebral hemispheres (16/21); we found five or more lesions in 66.6% (14/21) of the patients. The majority treated with anti-tuberculous drugs resulted in a favorable outcome.. Immunocompetent patients living in TB endemic areas whose clinical evaluation and neuroimaging findings are compatible with tuberculoma should undergo anti-tubercular treatment despite a lack of bacteriological confirmation.

Topics: Antitubercular Agents; Blindness; Brain; Brain Diseases; Cerebellar Ataxia; Dexamethasone; Drug Therapy, Combination; Endemic Diseases; Ethambutol; Female; Glucocorticoids; Humans; Immunocompetence; Isoniazid; Magnetic Resonance Imaging; Nausea; Nystagmus, Pathologic; Peru; Pyrazinamide; Quadriplegia; Rifampin; Tomography, X-Ray Computed; Tuberculoma, Intracranial; Tuberculosis, Pulmonary; Vomiting; Young Adult

A 14 year old girl presented with a 6-month history of headaches and visual blurring. CT showed a right tentorial enhancing lesion. Angiogram showed no enhancement. Histopathological examination of the excised material was consistent with tuberculoma. The presentation of such unusual intracranial tuberculoma is reported and the literature reviewed on the subject.

Topics: Adolescent; Antitubercular Agents; Brain Diseases; Drug Therapy, Combination; Female; Humans; Isoniazid; Pyrazinamide; Rifampin; Tomography, X-Ray Computed; Tuberculoma

The authors show a literary review on Mycoplasma pneumonia which represents a fifth of human pneumonia. M. pneumoniae is the major cause of illness in school-age children (5-9 years) and young adults and the peak incidence of illness occurs in this age. The infection appears mainly as an interstitial pneumonitis and the onset of illness is gradual, influence-like with few clinical symptoms and typical roentgenographic and bronchoscopic findings. Cold hemagglutinins appear in approximately 50% of patients. A severe prognosis can be associated with extrarespiratory symptoms; Erythromycin (as others macrolides) is the drug of choice.

Topics: Age Factors; Brain Diseases; Child; Child, Preschool; Erythromycin; Heart Diseases; Humans; Mycoplasma pneumoniae; Pneumonia, Mycoplasma; Prognosis; Rifampin; Seasons; Skin Diseases

35 children with suspected tuberculomas of the brain were given a therapeutic 4-drug trial of isoniazid, rifampicin, pyrazinamide and ethambutol. Their clinical and computed tomographic (CT) appearances were analysed retrospectively: 32 responded well to treatment with recognizable improvement on CT after 6 weeks. Three patients did not respond. One of these non-responders had a surgically removed temporal cystic astrocytoma. The majority presented with focal seizures and had a single hemispheral lesion. 14% had multiple lesions, 6% were in the cerebellum. Only 2 patients had raised intracranial pressure and required ventriculoperitoneal shunting.

Topics: Adolescent; Antitubercular Agents; Brain Diseases; Child; Child, Preschool; Combined Modality Therapy; Ethambutol; Female; Humans; Infant; Isoniazid; Male; Pyrazinamide; Retrospective Studies; Rifampin; Tomography, X-Ray Computed; Tuberculoma

We report the case of a 53-year-old healthy man, presenting with confusion. The patient had been clinically diagnosed with cat-scratch disease (CSD) and prescribed a 10-day course of doxycycline orally. Approximately a week after he had completed the treatment, he was admitted to our department with confusion. Neurological examination revealed expressive dysphasia with no motor or sensory deficits. Cerebrospinal fluid (CSF) examination showed only increased content. Imaging with CT and MRI of the brain did not reveal any abnormalities, and funduscopy was normal. Serology confirmed

Topics: Anti-Bacterial Agents; Aphasia; Bartonella henselae; Brain; Brain Diseases; Cat-Scratch Disease; Doxycycline; Drug Therapy, Combination; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Rifampin; Tomography, X-Ray Computed

To see the characteristics, course and outcome of patients suffering from intracranial tuberculoma.. Retrospective review of 102 patients diagnosed as intracranial tuberculoma at a tertiary care center over 10 years.. A total of 102 cases were seen with an age range of 1 to 75 years (mean, 30 years). Predisposing factors included Diabetes mellitus (8 patients) and pregnancy or puerperium (7 patients). Five pediatric patients had tuberculoma despite documented BCG vaccination. Fever (59%), headache (57%), meningeal irritation (36%) were the commonest presenting features; one-third of patients were drowsy or comatosed at presentation. Cerebrospinal fluid analysis was performed in 63 patients, of whom 88% had elevated protein, 83% had low glucose, and 84% had pleocytosis (one-third with neutrophilia). Forty-nine (50%) patients had clinical or laboratory evidence of concomitant tuberculous meningitis. Chest radiographs showed active or old tuberculous infection (25%), with a miliary pattern in 20%. Two-thirds of subjects had multiple tuberculomas (mean, 4.5 lesions per patient) on contrast CT or MRI scan. Hydrocephalus was present in 37 (37%) patients of which 21 required shunt surgery. Thirty-nine patients had > 9 months of follow up; 17 patients showed complete recovery, 20 patients had partial recovery, and 2 patients had no response. Coma at presentation and miliary pattern on chest X-ray were predictors of poor prognosis.. The study demonstrate that fever, headache, signs of meningeal irritation and cranial nerve palsies are common presenting features. Complete recovery was seen in 40% patients. Coma and military TB are predictors of poor prognosis.

Topics: Adolescent; Adult; Antibiotics, Antitubercular; Brain Diseases; Child; Child, Preschool; Drug Therapy, Combination; Female; Humans; Infant; Isoniazid; Logistic Models; Magnetic Resonance Imaging; Male; Middle Aged; Prognosis; Retrospective Studies; Rifampin; Treatment Outcome; Tuberculoma, Intracranial

Central nervous system involvement by brucellosis is infrequent and usually presents as acute meningoencephalitis. Neurobrucellosis presenting as a focal brain mass has rarely been demonstrated on imaging studies. We describe the imaging and pathologic findings in a child affected by neurobrucellosis with focal cortico-subcortical involvement.

Topics: Adolescent; Anti-Bacterial Agents; Brain; Brain Diseases; Brucellosis; Drug Therapy, Combination; Humans; Magnetic Resonance Imaging; Male; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Adult; Anti-Infective Agents; Brain Diseases; Brucellosis; Drug Therapy, Combination; Endoscopy; Female; Humans; Pituitary Diseases; Rifampin; Sulfamethoxazole; Trimethoprim

Topics: Antibiotics, Antitubercular; Antitubercular Agents; Brain Diseases; Child, Preschool; Drug Therapy, Combination; Ethambutol; Female; Follow-Up Studies; Hip Joint; Humans; Magnetic Resonance Imaging; Pyrazinamide; Rifampin; Time Factors; Tuberculosis, Multidrug-Resistant; Tuberculosis, Osteoarticular; Tuberculosis, Pulmonary

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Bone Marrow Transplantation; Brain Diseases; Female; Humans; Rifampin; Transplantation, Homologous

A consecutive series of six adult patients ranging in age from 29 to 53 years is presented. The clinical and radiological features in each patient are described. Attention is drawn to the features demonstrated on computed axial tomography. In only one patient, the first encountered, was surgical excision undertaken and histological verification obtained. One patient died before any form of treatment could be instituted. The remaining four patients were treated with antituberculous chemotherapy alone and their progress monitored by sequential computed tomography. The excellent response and good outcome in this conservatively treated group are documented.

Topics: Adult; Brain Diseases; Drug Therapy, Combination; Humans; Isoniazid; Male; Middle Aged; Pyrazinamide; Rifampin; Streptomycin; Tomography, X-Ray Computed; Tuberculoma

A personal series of 14 patients with tuberculomas of the brain were treated with anti-tuberculous drugs. There were eight patients with solitary and six with multiple lesions, the size of the lesions varying from 3 x 2 cm to 7.5 x 6 cm. The symptoms and signs of tuberculomas of the brain are non-specific. The initial diagnosis is therefore presumptive and based on their characteristic CT patterns on contrast enhancement. These patterns are usually solid enhancing lesions, ring enhancing lesions or mixed solid and ring forms. The final diagnosis is established by the patient's clinical improvement and the CT scan evidence of decrease in the extent of the oedema and the size of the lesion after a therapeutic test by means of triple anti-tuberculous drug therapy lasting for 12 weeks. All patients but one were treated successfully with triple anti-tuberculous drug therapy, for a continued total period of 18 months. A failure of medical treatment occurred in one patient due to non-compliance. In this patient, the residual cerebral lesion after the tuberculoma had healed required excision to control intractable epilepsy. Associated obstructive hydrocephalus in another patient needed a ventriculo-peritoneal shunt. The patients were followed for six months to five years. There were no recurrences. It is concluded that medical treatment with anti-tuberculous drugs is the treatment of choice for tuberculomas of the brain. With the use of steroids to control the brain oedema and its resultant mass effect and increased intracranial pressure, and a ventriculo-peritoneal shunt for hydrocephalus, almost all tuberculomas of the brain, irrespective of their size, can be cured by medical treatment.

Topics: Adult; Antitubercular Agents; Brain Diseases; Drug Combinations; Female; Humans; Isoniazid; Male; Middle Aged; Rifampin; Tomography, X-Ray Computed; Tuberculoma

Three children had staphylococcal infections of the CNS. In two cases the organisms were resistant to methicillin sodium. Each case was treated with a combination of vancomycin hydrochloride and rifampin; in one instance vancomycin alone had been unsuccessful. The addition of rifampin resulted in prompt clinical and bacteriologic resolution. Satisfactory levels of rifampin were achieved by administering the drug either orally or intravenously, and in one patient oral administration of rifampin produced assayed levels in subdural pus many times that required for minimal bactericidal activity. Combination therapy with vancomycin and rifampin is recommended for staphylococcal infections of the CNS.

Topics: Adolescent; Brain Diseases; Cellulitis; Central Nervous System Diseases; Drug Therapy, Combination; Empyema, Subdural; Female; Humans; Infant; Male; Meningitis; Orbital Diseases; Rifampin; Staphylococcal Infections; Vancomycin

Topics: Adult; Brain Diseases; Brain Stem; Drug Therapy, Combination; Ethambutol; Female; Humans; Isoniazid; Rifampin; Tomography, X-Ray Computed; Tuberculoma

Staphylococcus epidermidis ventriculitis developed in a patient undergoing treatment for meningeal lymphoblastic lymphoma via Ommaya subcutaneous reservoir. Treatment with a regimen of intravenous and intraventricular vancomycin and oral rifampin resulted in prompt cure of the infection without removal of the reservoir. The antibiotic therapy, guided by CSF bacteriocidal levels, was convenient to administer, nontoxic, and well tolerated. No interruption of lymphoma treatment was necessary.

Topics: Adult; Brain Diseases; Cerebral Ventricles; Drug Implants; Drug Therapy, Combination; Humans; Lymphoma; Male; Meningeal Neoplasms; Rifampin; Staphylococcal Infections; Vancomycin

A case of clinically unsuspected mesencephalic tuberculoma that was diagnosed at operation is presented. After intraoperative diagnosis, the surgical procedure was interrupted and specific treatment with tuberculostatic agents was started. The symptoms remitted totally in a few months. This conservative management is preferable to surgical removal when diagnosis of brain-stem tuberculoma has been established.

Topics: Adult; Brain Diseases; Ethambutol; Humans; Male; Mesencephalon; Rifampin; Tuberculoma

A case of multiple cerebral tuberculomata involving the pons and cerebellum was presented. The lesions were demonstrated by CT as isodense to slightly dense foci. All four intra-axial lesions showed homogeneous enhancement following an intravenous injection of the contrast medium, and one of them was surrounded by a small area of low density, probably representing the perifocal edema. The patient responded well to chemotherapy with streptomycin, hydrazid and rifampicin : cranial nerve signs and long tract signs clearing rapidly and the enhancing lesions and mass effect on CT disappearing concomitantly. Although cerebral tuberculoma is nowadays very rare in Japan, still a high index of suspicion should always be entertained during the investigation of patients showing solitary or multiple enhancing lesions with no or slight degree of perifocal edema on CT, and a trial of antituberculous drugs should be given before the incurable malignancy is presumed or the lesion is explored surgically.

Topics: Brain Diseases; Brain Stem; Cerebellar Diseases; Drug Therapy, Combination; Humans; Male; Middle Aged; Rifampin; Streptomycin; Tomography, X-Ray Computed; Tuberculoma

Five cases of intracranial tuberculoma in Asian adults are described, all of whom presented with epilepsy. The computerised tomographic (CAT) scanner displayed the lesions particularly well, and their characteristics are described. Only two cases were explored surgically, but triple antituberculous chemotherapy has the scan abnormalities in all of them to resolve completely. It is concluded that Asian patients with lesions likely to be tuberculous should be given a trail of antituberculous drugs, and only explored if they should deteriorate clinically, or if the lesion should fail to respond on serial scans.

Topics: Adult; Brain Diseases; Ethambutol; Female; Humans; Isoniazid; Male; Middle Aged; Rifampin; Tomography, X-Ray Computed; Tuberculoma

Topics: Adult; Brain Diseases; Cerebral Angiography; Dexamethasone; Diagnosis, Differential; Electroencephalography; Epilepsy, Tonic-Clonic; Female; Humans; Isoniazid; Mycobacterium tuberculosis; Phenytoin; Rifampin; Streptomycin; Tuberculoma

Topics: Adolescent; Adult; Brain Diseases; Electroencephalography; Ethambutol; Female; Humans; Male; Middle Aged; Rifampin; Time Factors; Tuberculosis, Pulmonary

Three patients with verified intracranial tuberculomas are reported. One patient presented with attacks of hydrocephalus initially diagnosed erroneously as migraine, another had multiple tuberculomas and a fourth tuberculoma became apparent during treatment with antituberculous therapy. The third patient presented with a frontal lobe syndrome and the postoperative recovery was complicated by the development of hyperosmolar non-ketotic, non-acidotic diabetic pre-coma. Although there are no pathognomonic symptoms, signs, or radiological appearances of intracranial tuberculomas, a high index of suspicion should always be entertained during the investigation of non-European immigrants.

Topics: Adolescent; Aminosalicylic Acids; Brain Diseases; Dexamethasone; Diabetic Coma; Electroencephalography; Emigration and Immigration; Ethambutol; Female; Headache; Humans; Hydrocephalus; India; Isoniazid; Male; Papilledema; Pyrazinamide; Radionuclide Imaging; Rifampin; Streptomycin; Technetium; Tuberculoma; United Kingdom