rifampin and Esophageal-Fistula

A 57-year-old man with an HIV infection, diagnosed a year ago, complained of fever and cough. The haemoglobin level was 7.5 g/dl, white cell count 3800/microliters, T-helper cell count 60/microliters and the CD4-CD8 ratio 0.1. Erythrocyte sedimentation rate was raised to 21/39 mm. Bacteriological tests were at first negative. The chest radiograph showed slight widening of the upper mediastinum which further increased over the next 10 days, at which time it also revealed a shadow in the right upper lobe. Computed tomography suggested necrotizing mediastinal lymph-nodes. Treatment was begun with rifampicin (600 mg daily) ethambutol (1.2 g daily), pyrazinamide (1.5 g daily) and ciprofloxacin (500 mg twice daily). Oesophagoduodenoscopy, performed after 3 weeks, revealed several fistulae which, after ingestion of contrast medium, were demonstrated to communicate with the mediastinum, presumably as a result of lymph-node liquefaction. Mycobacterium tuberculosis was demonstrated in gastric juice, sputum and stool only after tuberculostatic drugs had been started.

Topics: AIDS-Related Opportunistic Infections; Ciprofloxacin; Drug Therapy, Combination; Esophageal Fistula; Ethambutol; Fistula; HIV-1; Humans; Male; Mediastinal Diseases; Middle Aged; Pyrazinamide; Rifampin; Tuberculosis, Lymph Node

Bronchoesophageal fistula is a rare complication of Mycobacterium tuberculosis in children. An adolescent girl who was diagnosed of tubercular mediastinal lymphadenopathy with associated bronchoesophageal fistula at presentation, is reported here. This 16-y-old girl presented with high-grade fever, cough, decreased appetite, weight loss for 3 mo, and breathlessness for 10 d. Chest radiograph revealed hilar lymphadenopathy with bilateral pleural effusion. GA GeneXpert was positive for mycobacterium and rifampicin sensitivity. Despite antitubercular therapy cough persisted and there was a history of dry cough with food intake, especially more on liquids. Bronchoscopy and CECT chest confirmed bronchoesophageal fistula in the right main bronchus just below the carina. Child continued on tube feeding and antitubercular therapy. After completion of intensive phase, child improved with resolution of clinical symptoms and scarring of tract on repeat bronchoscopy. It is concluded that in children with combination of mediastinal lymphadenopathy and persistent cough following intake of food needs careful evaluation for trachea/bronchoesophageal fistula.

Topics: Adolescent; Antitubercular Agents; Bronchial Fistula; Child; Cough; Esophageal Fistula; Female; Humans; Lymphadenopathy; Rifampin; Tuberculosis, Lymph Node

A 76-year-old woman was admitted to the hospital four times from November 2007 to June 2009. In this complex case, the patient had silicosis complicated by broncholithiasis, oesophagobronchial fistulas, and relapsed tuberculosis. She had worked as a stone crusher for 3 years and was exposed to a large amount of quartz dust. Barium oesophagography, gastroesophageal endoscopy, and biopsy suggested oesophageal-related chronic inflammation and ulceration, which may have caused the repeated oesophagobronchial fistulas. Bronchoscopy revealed a free broncholithiasis in the left mainstem bronchus. The patient was admitted a fourth time because of silicotuberculosis relapse. After 9 months of antituberculosis treatment, the patient recovered and was still clinically well at the time of this writing.

Topics: Aged; Antibiotics, Antitubercular; Bronchial Fistula; Esophageal Fistula; Esophagoscopy; Female; Humans; Isoniazid; Lithiasis; Pyrazinamide; Rifampin; Silicotuberculosis; Stents; Treatment Outcome

Aortoesophageal fistula secondary to thoracic aneurysm is rare, but is usually lethal, and few survivors have been reported. We report successful surgery for aortoesophageal fistula in a one-stage operation. Repair involved in situ replacement of the thoracic aneurysm using a rifampicin-soaked graft, primary repair of the esophagus, omental wrap and tube jejunostomy. This is the original report of the surgical repair of aortoesophageal fistula using a rifampicin-soaked graft.

Topics: Anti-Infective Agents; Aortic Aneurysm, Thoracic; Aortic Diseases; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Enteral Nutrition; Esophageal Fistula; Esophagoscopy; Esophagus; Humans; Jejunostomy; Omentum; Prosthesis Design; Prosthesis-Related Infections; Rifampin; Surgical Flaps; Tomography, X-Ray Computed; Treatment Outcome; Vascular Fistula

In a 44-year-old female esophagomediastinal fistula was found secondary to tuberculous mediastinal lymphadenitis. Chest computed tomography revealed amorphous air collection in the subcarinal region of the mediastinum with mediastinal lymphadenopathy. Esophagography with gastrografin confirmed esophagomediastinal fistula. The patient was treated with antituberculous therapy with rifampicin, isoniazid, pyrazinamide and ethambutol, resulting in resolution of the esophagomediastinal fistula and mediastinal lymphadenopathy.

Topics: Adult; Antibiotics, Antitubercular; Esophageal Fistula; Ethambutol; Female; Fistula; Humans; Isoniazid; Mediastinal Diseases; Pyrazinamide; Radiography, Thoracic; Rifampin; Tomography, X-Ray Computed; Tuberculosis, Lymph Node

A patient with tuberculous oesophagopulmonary communication diagnosed by oesophagography and confirmed by endoscopy was successfully treated by medical means: a tuberculous aetiology was suggested by the detection of tubercle bacilli in the gastric washings and on culture. On reviewing the medical literature, successful results were reported in 3 adults and 2 children.

Topics: Adult; Antitubercular Agents; Esophageal Fistula; Esophagoscopy; Fistula; Humans; Lung Diseases; Male; Mediastinal Diseases; Rifampin; Tuberculosis, Lymph Node