rifampin and Cytomegalovirus-Infections

To summarize recent findings in the management of active tuberculosis (TB) in solid organ transplant (SOT) recipients.. Mycobacterium tuberculosis causes substantial morbidity and mortality in SOT recipients. According to the literature, transplantation might not be an absolute contraindication for patients with active TB. Although the use of rifampin, resulting in the decreased levels of calcineurin inhibitors, might lead to rejection, studies showed that rifampin-based regimens did not appear to be associated with post-TB rejection or mortality. Nevertheless, judicious adjustment and close monitoring of immunosuppressant levels during concurrent rifampin use for patients with active TB are needed. TB-associated immune reconstitution syndrome occurred in 14% of SOT recipients; liver transplantation, cytomegalovirus infection, and rifampin use are identified risk factors for the development of immune reconstitution syndrome.. Patients with active TB might be able to undergo transplantation if indicated. Rifampin-based regimen can be considered in the treatment of TB in SOT recipients. In addition to HIV-positive patients, immune reconstitution syndrome also occurs in SOT recipients, and deserves the recognition by primary care physicians to avoid unnecessary management.

Topics: Antitubercular Agents; Chemoprevention; Contraindications; Cytomegalovirus Infections; Graft Rejection; Humans; Immune Reconstitution Inflammatory Syndrome; Immunosuppressive Agents; Mycobacterium tuberculosis; Organ Transplantation; Rifampin; Risk Factors; Transplant Recipients; Treatment Outcome; Tuberculosis

Patients who undergo splenectomy and recipients of allogeneic marrow (alloBMT) or peripheral stem cell transplantation are at increased risk of overwhelming infection from encapsulated organisms such as Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis. As prophylaxis against these pathogens splenectomised patients are immunised and may also receive antibiotics for life. We report relapsing overwhelming sepsis caused by penicillin-resistant pneumococcus in a patient who was immunised and received prophylactic phenoxymethylpenicillin for 8 months following splenectomy and matched unrelated donor (MUD) marrow transplantation for refractory T cell lymphoma. No obvious focus of sepsis was found during any of the three episodes and S. pneumoniae serogroup 6, subtype 6B was isolated from blood cultures on each occasion. He was treated with i.v. cephalosporins, as the organisms were resistant to penicillin with a minimum inhibitory concentration (MIC) of 2.0, and there was complete resolution of symptoms each time. In the light of recurrent sepsis with this penicillin-resistant organism the decision was made to give prophylactic levofloxacin for the next 12 months. This case illustrates that the choice of prophylactic regimen and the treatment of sepsis in immunocompromised patients remain difficult and challenging issues.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Bacteremia; Bone Marrow Transplantation; Carmustine; Cefotaxime; Combined Modality Therapy; Cyclophosphamide; Cytarabine; Cytomegalovirus Infections; Doxorubicin; Drug Therapy, Combination; Etoposide; Humans; Idarubicin; Immunocompromised Host; Immunosuppressive Agents; Levofloxacin; Lymphoma, T-Cell; Male; Melphalan; Ofloxacin; Penicillin Resistance; Pneumococcal Infections; Prednisone; Recurrence; Rifampin; Splenectomy; Streptococcus pneumoniae; Transplantation Conditioning; Vincristine