rifampin and Eosinophilia

It were Liebow et al. (1965) who, for the first time, described the desquamative interstitial pneumonia (DIP) as one clinical and morphological unit. The etiopathology of this disease is still unknown and there exist many controversial opinions as to its role within the interstitial pneumonias. For the clinical-physician the DIP represents a difficult problem because there seems to be no uniform appearance to this disease. So a lung-biopsy is the unique way to make a definitive diagnosis. The following description represents a case of DIP observed at our hospital. At the same time we tried to give a review of our present knowledge concerning the morphology, course and therapy of this disease. We think it should be note that the DIP was accompanied by an extreme peripheral eosinophilia. To our knowledge this is the first time such a phenomenon is described. In the course of the treatment with steroids the eosinophilia disappeared parallel to the normalization of the radiographic findings.

Topics: Adrenal Cortex Hormones; Adult; Alveolitis, Extrinsic Allergic; Collagen Diseases; Diagnosis, Differential; Eosinophilia; Female; Histiocytosis, Langerhans-Cell; Humans; Isoniazid; Lung; Pneumonia; Pulmonary Eosinophilia; Radiography; Rifampin; Tetracycline

Some strains of scrub typhus in northern Thailand are poorly responsive to standard antirickettsial drugs. We therefore did a masked, randomised trial to compare rifampicin with standard doxycycline therapy for patients with scrub typhus.. Adult patients with strictly defined, mild scrub typhus were initially randomly assigned 1 week of daily oral treatment with 200 mg doxycycline (n=40), 600 mg rifampicin (n=38), or doxycycline with rifampicin (n=11). During the first year of treatment, the combined regimen was withdrawn because of lack of efficacy and the regimen was replaced with 900 mg rifampicin (n=37). Treatment outcome was assessed by fever clearance time (the time for oral temperature to fall below 37.3 degrees C).. About 12,800 fever patients were screened during the 3-year study to recruit 126 patients with confirmed scrub typhus and no other infection, of whom 86 completed therapy. Eight individuals received the combined regimen that was discontinued after 1 year. The median duration of pyrexia was significantly shorter (p=0.01) in the 24 patients treated with 900 mg daily rifampicin (fever clearance time 22.5 h) and in the 26 patients who received 600 mg rifampicin (fever clearance time 27.5 h) than in the 28 patients given doxycycline monotherapy (fever clearance time 52 h). Fever resolved in a significantly higher proportion of patients within 48 h of starting rifampicin (900 mg=79% [19 of 24], 600 mg=77% [20 of 26]) than in patients treated with doxycycline (46% [13 of 28]; p=0.02). Severe gastrointestinal events warranted exclusion of two patients on doxycyline. There were two relapses after doxycycline therapy, but none after rifampicin therapy.. Rifampicin is more effective than doxycycline against scrub-typhus infections acquired in northern Thailand, where strains with reduced susceptibility to antibiotics can occur.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Dose-Response Relationship, Drug; Doxycycline; Eosinophilia; Exanthema; Female; Fever; Follow-Up Studies; Gastrointestinal Diseases; Humans; Male; Middle Aged; Patient Dropouts; Rifampin; Scrub Typhus; Thailand; Time Factors; Treatment Outcome

Topics: Alkaline Phosphatase; Aspartate Aminotransferases; Bilirubin; Clinical Trials as Topic; Eosinophilia; Humans; In Vitro Techniques; Intestinal Absorption; Isoniazid; Jaundice; L-Lactate Dehydrogenase; Liver; Liver Function Tests; Mycobacterium; Mycobacterium tuberculosis; Rifampin; Thrombocytopenia; Transaminases; Tuberculosis, Pulmonary

Topics: Adult; Aged; Anti-Bacterial Agents; Chemical and Drug Induced Liver Injury; Clinical Trials as Topic; Drug Hypersensitivity; Eosinophilia; Ethambutol; Female; Gastrointestinal Diseases; Humans; Kidney Diseases; Male; Middle Aged; Rifampin; Tuberculosis, Pulmonary; Uric Acid; Vision Disorders

Drug reaction with eosinophilia and systemic symptom (DRESS) syndrome is a rare and severe side-effect, mainly described after intake of anticonvulsants, allopurinol, or antibiotics. It usually begins within 2 months after drug introduction. Symptoms include cutaneous rash, hematologic abnormalities, and internal organ involvement and the diagnosis might be challenging. This case report illustrates for the first time this life-threatening complication in a patient with cystic fibrosis (CF). In this case, withdrawal of the offending drug was sufficient for full recovery. Clinicians involved in CF care should be aware of DRESS syndrome, as they commonly prescribe several potentially culprit drugs. Pediatr Pulmonol. 2017;52:E18-E21. © 2016 Wiley Periodicals, Inc.

Topics: Anti-Bacterial Agents; Cystic Fibrosis; Diagnosis, Differential; Drug Hypersensitivity Syndrome; Eosinophilia; Humans; Male; Rifampin; Young Adult

Topics: Aged; Agranulocytosis; Anti-Bacterial Agents; Cephalosporins; Drug Eruptions; Drug Therapy, Combination; Eosinophilia; Female; Humans; Rifampin; Syndrome; Vancomycin

A 75-year-female with a history of Isoniazid (INH) therapy for latent tuberculosis, was admitted with a 4-week duration of dyspnea, cough, and pleuritic chest pain. She was treated with intravenous antibiotics for a diagnosis of pneumonia. Her stay was complicated by development of recurrent, exudative eosinophilic pleural effusions (EPEs). When symptoms continued to worsen and she developed joint pain and anasarca and did not respond to the antibiotics, a rheumatologic work-up was performed. She was found to have positive anti-double stranded-DNA antibodies and anti-histone antibodies; thus, a diagnosis of drug-induced lupus, secondary to INH, was made. INH was discontinued, and the patient was started on prednisone; within weeks her symptoms resolved. This case illustrates a unique side effect of INH that caused exudative EPEs and drug-induced lupus with positive anti-dsDNA.

Topics: Aged; Antibodies, Antinuclear; Antitubercular Agents; DNA; Drug Substitution; Eosinophilia; Exudates and Transudates; Female; Glucocorticoids; Humans; Isoniazid; Latent Tuberculosis; Lupus Erythematosus, Systemic; Pleural Effusion; Prednisone; Rifampin; Treatment Outcome

Functional adrenal insufficiency (FAI) is associated with increased mortality and is defined as subnormal cortisol production during acute severe illness.. After screening 200 adult patients admitted in the medical emergency unit of Mulago Hospital, Kampala, Uganda, 113 critically ill HIV-infected adults not receiving corticosteroids were enrolled after obtaining informed consent to determine the prevalence and factors associated with FAI.. Functional adrenal insufficiency, defined in this study as morning total serum cortisol level of 3%) occurred in 52% (11 of 21) patients with FAI compared to 24% (22 of 92) patients with normal adrenal function (p= 0.01). Factors predicting FAI on multivariate analysis were use of rifampicin and eosinophilia. The mortality rate among patients with FAI (19%) was not significantly different when compared to that among patients with a normal cortisol response (33%) (p=0.221). Hyponatremia, hypoglycemia, hyperkalemia, postural hypotension and the use of ketoconazole were not associated with FAI in this study.. The diagnosis of FAI should be considered in severely ill patients with stage IV HIV disease using rifampicin or those found to have unexplained eosinophilia. Further studies to determine benefits of corticosteroids in critically ill HIV patients are needed in this setting.

Topics: Adrenal Cortex Hormones; Adrenal Insufficiency; Critical Illness; Enzyme Inhibitors; Eosinophilia; Female; HIV Infections; Humans; Longitudinal Studies; Male; Prospective Studies; Rifampin; Risk Factors; Uganda

Eosinophilic meningitis has been defined as meningitis in which a total cerebrospinal fluid (CSF) sample is found to have more than 10 eosinophils per millimeter or is composed of greater than 10% eosinophils. The differential diagnosis is broad and the clinical presentation, lacking an internalized CSF diversion system, is often nonspecific. With respect to patients with shunt systems, a positive correlation exists between CSF eosinophilia and eventual shunt failure requiring revision. In this paper the authors present the highest reported level of CSF eosinophilia in conjunction with a rifampin and minocycline-impregnated ventriculostomy catheter recently approved by the Food and Drug Administration.

Topics: Adolescent; Anti-Bacterial Agents; Antibiotics, Antitubercular; Catheterization; Diagnosis, Differential; Eosinophilia; Humans; Male; Meningitis; Minocycline; Rifampin; Ventriculostomy

Rifampicin is a major drug used for the treatment of mycobacterial infections. It is usually well tolerated although cases of immunoallergic events have been reported in discontinuous regimens.. We report the case of a 55-year-old man who developed a severe drug reaction after taking rifampicin daily for two months with no interruption. The clinical course was favorable after drug withdrawal. Challenge with other antituberculous drugs did not induce any adverse reaction.. Despite the few cases reported, antituberculous regimens containing rifampicin can cause severe adverse reactions which subside progressively after drug withdrawal.

Topics: Antibiotics, Antitubercular; Antibodies; Diagnosis, Differential; Drug Eruptions; Drug Hypersensitivity; Drug Therapy, Combination; Eosinophilia; Humans; Long-Term Care; Male; Middle Aged; Rifampin; Tuberculosis, Pulmonary

Topics: Aged; Antitubercular Agents; Eosinophilia; Ethambutol; Humans; Isoniazid; Lymphocyte Activation; Male; Pneumonia; Rifampin

A 67 year old woman presented with miliary tuberculosis. She was treated with streptomycin, isoniazid, rifampicin, ethambutol and pyrazinamide. However, she developed rifampicin-induced thrombocytopenia after 6 weeks of treatment, and skin rash, blood eosinophilia and pulmonary infiltrates after 8 weeks of therapy. The latter was found to be ethambutol related. Additional evidence, including blood and sputum eosinophilia and the rapidity of its response to corticosteroid, suggested that the pulmonary infiltrates might also be eosinophilic in nature. To the best of our knowledge, this constitutes the first report of such adverse drug reaction, induced by ethambutol.

Topics: Aged; Drug Eruptions; Drug Therapy, Combination; Eosinophilia; Ethambutol; Female; Humans; Isoniazid; Pulmonary Eosinophilia; Pyrazinamide; Radiography; Rifampin; Streptomycin; Thrombocytopenia; Tuberculosis, Miliary

Topics: Colitis; Drug Eruptions; Eosinophilia; Fatal Outcome; Female; Humans; Middle Aged; Rifampin

A 42-year-old woman was admitted because of cough, sputum, and fever. A chest roentgenogram revealed a nodular density in the left upper lung field with satellite lesions compatible with tuberculoma. Mycobacterium tuberculosis was detected from sputum. Five weeks after starting the treatment with 0.4 g/day of isoniazid, 0.45 g/day of rifampicin, and 0.75 g/day of streptomycin, she showed itching erythema in the trunk. The white blood cell count was 4,500/mm3 with 14% eosinophils, and serum transaminases were slightly increased (GOT 101 U/L, GPT 74 U/L). Although isoniazid and rifampicin were stopped, the erythema with exfoliation spread to her extremities, suggesting exfoliative dermatitis. The white blood cell count reached 15,990/mm3 with 68% eosinophils (10,810/mm3). Stimulation indices measured with the lymphocyte stimulation test (LST) were 109% with rifampicin, 140% with isoniazid, and 275% with streptomycin, suggesting streptomycin-induced allergy. After cessation of streptomycin, the symptoms gradually improved. After the reaction had subsided, the treatment with isoniazid, rifampicin, and ethambutol was resumed, but she showed no further adverse reactions. LST seems to be very useful to identify the drug or drugs responsible for the reactions occurred during the treatment by antituberculosis drugs.

Topics: Adult; Chemical and Drug Induced Liver Injury; Drug Eruptions; Drug Therapy, Combination; Eosinophilia; Female; Humans; Isoniazid; Rifampin; Streptomycin; Tuberculosis, Pulmonary

Topics: Aged; Arteritis; Eosinophilia; Female; Humans; Rifampin

Topics: Adult; Eosinophilia; Female; Humans; Leprosy; Male; Rifampin; Tuberculosis, Pulmonary

Topics: Adult; Eosinophilia; Female; Humans; Rifampin; Tuberculosis, Pulmonary

Topics: Adult; Eosinophilia; Female; Humans; Leprosy; Male; Rifampin; Tuberculosis, Pulmonary

Topics: Eosinophilia; Humans; Male; Middle Aged; Rifampin

Topics: Adult; Aged; Alanine Transaminase; Aspartate Aminotransferases; Chronic Disease; Drug Therapy, Combination; Eosinophilia; Ethambutol; Female; Gastrointestinal Diseases; Humans; Kidney; Liver; Male; Mental Disorders; Middle Aged; Radiography; Rifampin; Sputum; Tuberculosis, Pulmonary; Vertigo; Vision Disorders

Topics: Adult; Agranulocytosis; Alkaline Phosphatase; Antitubercular Agents; Aspartate Aminotransferases; Bilirubin; Drug Resistance, Microbial; Eosinophilia; Female; Humans; Isoniazid; Leukopenia; Male; Middle Aged; Rifampin; Sputum; Streptomycin; Tuberculosis, Pulmonary; Uric Acid