rifampin and Encephalitis

To evaluate the influence of the dose of co-trimoxazole prophylaxis on the risk of toxoplasmosis in human immunodeficiency virus (HIV)-infected patients, we performed a nested case-control study of 32 patients with toxoplasmosis (case patients) and 64 patients without toxoplasmosis (control patients) who were matched by CD4 cell count and Toxoplasma gondii serostatus; these patients were from a cohort of 521 HIV-infected patients who underwent a diagnostic neuroimaging study between March 1993 and January 1997. Twenty-seven (84.4%) of 32 case patients and 33 (51.6%) of 64 control patients received low doses of co-trimoxazole, a finding associated with an adjusted odds ratio (OR) of 9.36 (95% confidence interval [CI], 2.05-42.75) and indicating 89% protective efficacy for high doses. Fifteen (46.9%) of 32 case patients and 16 (25%) of 64 control patients were exposed to rifampin (adjusted OR, 3.38; 95% CI, 1.08-10.61). These results indicate that high doses of co-trimoxazole appear to be more effective than low doses for lowering the risk of toxoplasmosis in HIV-infected patients and that rifampin therapy may reduce the efficacy of co-trimoxazole.

Topics: Adult; AIDS-Related Opportunistic Infections; Animals; Anti-Infective Agents; Antibiotics, Antitubercular; Case-Control Studies; Dose-Response Relationship, Drug; Drug Therapy, Combination; Encephalitis; Female; HIV Infections; Humans; Male; Rifampin; Toxoplasma; Toxoplasmosis, Cerebral; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

We report a case of multifocal avascular osteonecrosis (AVN) following steroid administration in a case of tuberculous encephalitis in a young patient. The risk of joint-related AVN as a side effect of adjunctive steroid therapy should be taken into consideration when evaluating the dosage and treatment duration in tuberculous encephalitis.

Topics: Adolescent; Anti-Inflammatory Agents; Antitubercular Agents; Encephalitis; Female; Femur Head Necrosis; Humans; Humeral Head; Isoniazid; Joint Diseases; Prednisolone; Radiography; Rifampin; Tuberculosis, Central Nervous System

Neurobrucellosis is an uncommon complication of pediatric brucellosis. Acute meningitis and encephalitis are the most common clinical manifestations, however symptoms may be protean and diagnosis requires a high index of suspicion in patients from endemic areas. Diagnosis is often based on neurological symptoms, serology, and suggestive brain imaging because cerebrospinal fluid culture yields are low. Two cases of pediatric neurobrucellosis with unusual clinical and radiologic findings are presented.

Topics: Adolescent; Anti-Bacterial Agents; Brucellosis; Child; Doxycycline; Drug Therapy, Combination; Encephalitis; Female; Gentamicins; Humans; Incidence; Israel; Meningitis; Neuroimaging; Rifampin; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Streptococcus intermedius is increasingly being recognised as an aetiological agent in central nervous system infections. Primary ventriculitis caused by this organism has not been reported so far. We present a case of primary ventriculitis, which resulted in adhesions and multiloculated hydrocephalus, necessitating numerous surgical procedures to control it. No predisposing factor(s) could be identified. Although the organism could not be cultured from CSF, as he was already on antibiotic treatment, it could, however, be identified by 16S rDNA polymerase chain reaction on the CSF sample. It appears important to recognise this condition and to treat it aggressively to prevent complications such as adhesions and multiloculated hydrocephalus.

Topics: Anti-Infective Agents; Cefotaxime; Cerebral Ventricles; Encephalitis; Endoscopy; Glasgow Coma Scale; Humans; Hydrocephalus; Male; Metronidazole; Middle Aged; Rifampin; Streptococcal Infections; Streptococcus intermedius; Tomography, X-Ray Computed

Topics: Adult; Animals; Antibiotics, Antitubercular; Antibodies, Bacterial; Bartonella henselae; Cat-Scratch Disease; Cats; Ceftriaxone; Cephalosporins; Encephalitis; Eye Infections, Bacterial; Humans; Magnetic Resonance Imaging; Male; Optic Neuritis; Retinitis; Rifampin

Two cases of ventriculitis with Staphylococcus epidermidis that failed on therapy with an antistaphylococcal penicillin are presented. Both infections responded to a combination of intravenous and intraventricular vancomycin and rifampin. Vancomycin and rifampin represent an important antibiotic regimen for the management of resistant infections of the central nervous system, especially with those due to S. epidermidis or methicillin-resistant Staphylococcus aureus.

Topics: Anti-Bacterial Agents; Cerebral Ventricles; Cerebrospinal Fluid; Cerebrospinal Fluid Shunts; Child; Craniocerebral Trauma; Encephalitis; Female; Humans; Infant; Injections, Intraventricular; Male; Rifampin; Staphylococcal Infections; Staphylococcus epidermidis; Vancomycin

A case of Flavobacterium meningosepticum ventriculitis is described in which the failure of therapy with a combination of rifampicin and erythromycin is attributed to inadequate antibiotic levels in cerebrospinal fluid. The successful eradication of the organism was achieved with the use of mezlocillin and cefoxitin given by the intravenous and intraventricular route. In vitro sensitivity tests of recently isolated strains of Flavobacterium meningosepticum suggested that the combination mezlocillin and cefoxitin is more often synergistic than rifampicin and erythromycin.

Topics: Anti-Bacterial Agents; Bacterial Infections; Cefoxitin; Cerebral Ventricles; Drug Therapy, Combination; Encephalitis; Erythromycin; Female; Flavobacterium; Humans; Infant; Mezlocillin; Microbial Sensitivity Tests; Penicillins; Rifampin

Topics: Cerebral Ventricles; Encephalitis; Female; Humans; Infant, Newborn; Infant, Premature, Diseases; Rifampin; Staphylococcal Infections

Topics: Adult; Aphasia; Carotid Artery Diseases; Carotid Artery, Internal; Cerebral Infarction; Cerebral Ventricles; Cerebrospinal Fluid; Encephalitis; Female; Humans; Male; Middle Aged; Rifampin; Streptomycin; Tuberculosis, Meningeal; Tuberculosis, Miliary; Tuberculosis, Renal

Topics: Acute Kidney Injury; Amebiasis; Antimalarials; Cholera; Drug Resistance, Microbial; Encephalitis; Glomerulonephritis; Helminthiasis; Hepatitis B Antigens; Humans; Leprosy; Malaria; Neurologic Manifestations; Parasitic Diseases; Pyrimethamine; Rifampin; Sulfonamides; Thiabendazole; Tropical Medicine; Trypanosomiasis, African

Topics: Adult; Burkitt Lymphoma; Child; Cytarabine; Encephalitis; Female; Herpes Simplex; Herpesvirus 4, Human; Humans; Infectious Mononucleosis; Male; Rifampin; Virus Diseases

Topics: Amantadine; Animals; Antiviral Agents; Cytarabine; Encephalitis; Herpes Labialis; Herpes Simplex; Herpesvirus 3, Human; Humans; Idoxuridine; Indoles; Influenza, Human; Interferons; Keratitis, Dendritic; Rifampin; Thiosemicarbazones; Vaccinia