rifampin and Cryptococcosis

Topics: Amphotericin B; Aspergillosis; Candidiasis; Cryptococcosis; Drug Synergism; Drug Therapy, Combination; Flucytosine; Humans; Mycoses; Prospective Studies; Rifampin

Topics: Amphotericin B; Antifungal Agents; Child; Clotrimazole; Cryptococcosis; Cryptococcus neoformans; Drug Therapy, Combination; Estrogens; Female; Flucytosine; Humans; Immunologic Techniques; Male; Meningoencephalitis; Miconazole; Middle Aged; Phagocytosis; Rifampin; Transfer Factor

Topics: Amphotericin B; Aspergillosis; Candidiasis; Cryptococcosis; Drug Synergism; Drug Therapy, Combination; Flucytosine; Humans; Mycoses; Prospective Studies; Rifampin

The incidences of infection with Mycobacterium tuberculosis and Cryptococcus neoformans in immunocompromised patients have increased, but there are few documented cases of their coexistence. We present the case of a 9-year-old female with systemic lupus erythematosus (SLE), treated with prednisone and cyclophosphamide, who was admitted to the emergency department with a 2-week history of fever, headache, malaise, fatigue, and diplopia 3 years after diagnosis. Physical examination showed limitation of abduction of the right eye, Kernig and Brudzinski signs, and hyporeflexia. Magnetic resonance imaging showed hyperdense lesions located in the caudate nucleus, and lumbar puncture showed pleocytosis, a low glucose level, and increased protein level. Cerebrospinal fluid culture identified C. neoformans and PCR detect M. tuberculosis. Treatment was started with isoniazid, rifampin, pyrazinamide, ethambutol, and amphotericin B. We found two similar reports in adults, but no data were found for either pediatric or SLE patients.

Topics: Amphotericin B; Antitubercular Agents; Child; Coinfection; Cryptococcosis; Cryptococcus neoformans; Ethambutol; Female; Humans; Immunocompromised Host; Isoniazid; Lupus Erythematosus, Systemic; Meningoencephalitis; Mycobacterium tuberculosis; Pyrazinamide; Rifampin

We report a rare combination of pulmonary cryptococcosis and pulmonary tuberculosis in a diabetic patient. A 63-year-old man was admitted to our hospital in January 2002 for evaluation of an abnormal chest radiograph. In 1999, the abnormality had first been detected by mass screening radiography. In 2000, an abnormality in a chest radiograph was again detected in a mass screening, and he visited another hospital. A chest CT scan revealed a cavitating lesion and several nodules in the left lower lobe. Fiberoptic bronchoscopy was performed, but was not diagnostic. The patient was referred to our hospital. He had a history of diabetes mellitus starting in 1984. The chest CT scan revealed solid nodules in the left lower lobe and several micronodules in both upper lobes. Video-assisted thoracoscopic surgery was performed and specimens were obtained from the left S8 and left S1 + 2. Histologically, cryptococci were detected in the resected left S8. In addition, mycobacterium tuberculosis was cultured from the resected left S1 + 2. A diagnosis of combined pulmonary cryptococcal and tuberculous infections was made and treatment with itraconazole, isoniazid sodium methansulfonate, rifampicin, and ethambutol hydrochloride was given.

Topics: Cryptococcosis; Diabetes Complications; Diagnosis, Differential; Drug Therapy, Combination; Ethambutol; Humans; Isoniazid; Itraconazole; Lung Diseases, Fungal; Male; Middle Aged; Rifampin; Thoracic Surgery, Video-Assisted; Tuberculosis, Pulmonary

The in vitro activities of three antifungal drugs alone and in combination were evaluated against five isolates of Cryptococcus neoformans using time-kill curves (TKC). The isolates were from AIDS patients who had either died or had failed to show a clinical response during amphotericin B (AMB) treatment. AMB, fluconazole (FCZ) and flucytosine (5FC), and combinations of the drugs (AMB plus 5FC, AMB plus rifampicin (RIF) and FCZ plus 5FC), were evaluated. With all five isolates AMB did not show fungicidal activity; instead, a persistent or tolerant effect was observed. Combinations of AMB plus 5FC and AMB plus RIF showed a clear synergic effect, except for one isolate tested with AMB plus RIF. In contrast, the FCZ plus 5FC combination did not inhibit growth of any isolate.

Topics: Acquired Immunodeficiency Syndrome; Amphotericin B; Antifungal Agents; Cryptococcosis; Cryptococcus neoformans; Drug Interactions; Drug Resistance, Microbial; Fluconazole; Flucytosine; Humans; Leprostatic Agents; Rifampin; Time Factors

Topics: Acquired Immunodeficiency Syndrome; Adult; Cryptococcosis; Drug Interactions; Fluconazole; Humans; Male; Meningitis; Rifampin