rifampin and Brain-Infarction

Tuberculomas optoquiasmaticos como reaccion paradojica al tratamiento de tuberculosis meningea.

Topics: Adult; Antitubercular Agents; Brain Infarction; Diagnostic Errors; Disease Progression; Drug Resistance, Microbial; Drug Substitution; Ethambutol; Female; Host-Pathogen Interactions; Humans; Isoniazid; Magnetic Resonance Imaging; Meningitis, Viral; Moxifloxacin; Mycobacterium tuberculosis; Neuroimaging; Optic Chiasm; Paresis; Prednisone; Pyrazinamide; Rifampin; Thalamus; Tuberculoma; Tuberculosis, Meningeal; Vision Disorders

Brucellosis is prevalent in North and East Africa, the Middle East, South and Central Asia, South and Central America and the Mediterranean countries of Europe. In 5% of cases it may lead to central nervous system manifestation presenting most often as a meningitis or meningoencephalitis. Here we report and discuss a case of neurobrucellosis with meningitis with cranial nerves neuritis. A 56-year-old German male was admitted with bilateral abducens nerve palsy, amblyacousia and intractable headaches. An enzyme-linked immunosorbent assay (ELISA) revealed antibodies against Brucella in serum and cerebrospinal fluid (CSF). Additionally, our patient suffered from an infarction of the left thalamus. In conclusion, in cases of unresponsive meningitis or meningoencephalitis and history of travel in endemic regions, neurobrucellosis should be considered. If initial microbiological tests fail, complementary investigations such as ELISA are indicated to detect Brucella species in serum and/or CSF.

Topics: Abducens Nerve Diseases; Anti-Bacterial Agents; Anti-Inflammatory Agents; Brain Infarction; Brucella; Brucellosis; Cranial Nerve Diseases; Doxycycline; Headache; Humans; Magnetic Resonance Imaging; Male; Meningitis, Bacterial; Methylprednisolone; Middle Aged; Rifampin; Thalamic Diseases; Treatment Outcome

Rifampicin is an antibacterial agent that is widely used in tuberculosis and leprosy therapy. Interestingly, some experimental studies indicate that rifampicin acts as a hydroxyl radical scavenger and a glucocorticoid receptor activator. In this study, the neuroprotective effect of rifampicin was evaluated after transient and permanent focal cerebral ischemia. Anaesthetized male C57BL/6j mice were submitted to permanent or transient thread occlusion of the middle cerebral artery (MCA). Reperfusion in transient ischemia was initiated 30 min later by thread retraction. Rifampicin or vehicle were applied intraperitoneally before permanent or immediately after 30 min of transient ischemia. Later, 24 h after permanent or transient ischemia, animals were re-anesthetized and decapitated. Brain injury was evaluated by triphenyltetrazolium chloride staining (TTC), terminal transferase biotinylated-dUTP nick end labeling (TUNEL) and cresyl violet staining. A 20-mg/kg sample of rifampicin showed a significant neuroprotection after cerebral ischemia. The number of TUNEL-positive cells in the striatum, where disseminated tissue injury was observed, was also reduced by application of rifampicin as compared with vehicle-treated animals. The present report shows that administration of rifampicin efficiently reduces brain injury after permanent and transient focal cerebral ischemia in mice.

Topics: Animals; Brain Infarction; Brain Ischemia; Cell Count; Cell Survival; Dose-Response Relationship, Drug; Enzyme Inhibitors; In Situ Nick-End Labeling; Infarction, Middle Cerebral Artery; Laser-Doppler Flowmetry; Male; Mice; Mice, Inbred C57BL; Reperfusion; Reperfusion Injury; Rifampin; Tetrazolium Salts