rifampin and Exanthema

Doxycycline is currently the most frequently used treatment in patients with scrub typhus. However, doxycycline-resistant strains have been found, necessitating the development of a new treatment. Rifampin is known to be effective even for such strains. Our aim in this study was to compare the effects of rifampin and doxycycline treatment in patients with scrub typhus in areas in which resistance to doxycycline has not been reported.. Patients admitted to Chosun University Hospital and regional network hospitals between 2007 and 2009 with a body temperature ≥37.5°C and suspected to have scrub typhus were randomly assigned to 1 of 2 treatment groups: a group administered doxycycline 100 mg twice daily for 5 days and a group administered rifampin 600 mg once daily for 5 days. For treatment outcomes, fever, headache, muscle ache, and rash clearance times were compared between the groups.. The rifampin and doxycycline groups showed equivalence in all treatment outcomes evaluated. The proportions of patients with fever clearance within 48 hours were similar between groups. Furthermore, there was no significant difference in the occurrence of side effects following drug administration between groups.. On the basis of the finding that equivalent treatment effects and safety were found in patient groups that received 600 mg of rifampin and 200 mg of doxycycline, respectively, for 5 days to treat scrub typhus, rifampin may be considered an alternative treatment to doxycycline.. NCT00568711.

Topics: Aged; Anti-Bacterial Agents; Doxycycline; Exanthema; Female; Fever; Humans; Male; Middle Aged; Rifampin; Scrub Typhus; Treatment Outcome

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 During the first year of treatment, the combined regimen was withdrawn because of lack of efficacy and the regimen was replaced with 900 mg rifampicin (n=37).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: Anti-Bacterial Agents; Chemical and Drug Induced Liver Injury; Clinical Trials as Topic; Ethambutol; Exanthema; Humans; Norway; Rifampin; Vestibule, Labyrinth; Vision Disorders

Maintenance dialysis patients are at an increased risk for active tuberculosis (TB). In 2012, British Columbia, Canada, began systematically screening maintenance dialysis patients for latent TB infection (LTBI) and treating people with evidence of LTBI when appropriate. We examined LTBI treatment outcomes and compared treatment outcomes before and after rollout of the systematic screening program.. Retrospective cohort study.. The study comprised 365 people in British Columbia, Canada, initiating at least 90 days of dialysis from January 1, 2001, to May 31, 2017, and starting LTBI therapy: 290 (79.5%) people in the recent cohort and 75 (20.5%) in the historical cohort. People starting LTBI therapy from January 1, 2012, onward were classified as the recent cohort, whereas people starting LTBI therapy before January 1, 2012, were classified as the historical cohort.. Systematic LTBI screening and therapy.. Proportion of people who experience grade 3 to 5 adverse events (AEs) or any grade rash and end-of-treatment outcomes.. Outcomes were reported using descriptive statistics. 2-sample test of proportions using χ. 298 (81.6%) people successfully completed LTBI therapy. The proportion of people experiencing a grade 3 to 4 AE or any grade rash was 21.1%. Most AEs were related to gastrointestinal events, general malaise, or pruritus that resulted in regimen changes. 2 (0.5%) people were hospitalized for AEs related to LTBI therapy. No significant difference was found between the recent and historical cohorts in all outcomes of interest. No grade 5 AEs (deaths) were attributed to LTBI therapy.. Retrospective data and generalizability outside low-TB-burden settings.. Our findings suggest that a high proportion of people receiving maintenance dialysis can complete LTBI therapy. The rate of grade 3 to 4 AEs was high and associated with frequent medication changes during therapy. LTBI therapy in maintenance dialysis may be safe but requires close monitoring.

Topics: Aged; Antitubercular Agents; Chemical and Drug Induced Liver Injury; Cohort Studies; Exanthema; Female; Gastrointestinal Diseases; Humans; Isoniazid; Kidney Failure, Chronic; Latent Tuberculosis; Male; Mass Screening; Middle Aged; Pruritus; Renal Dialysis; Retrospective Studies; Rifabutin; Rifampin; Treatment Outcome; Vitamin B 6

Topics: Adult; Dapsone; Exanthema; Female; Humans; Leprostatic Agents; Leprosy; Rifampin

Topics: Adult; Clofazimine; Dapsone; Diagnosis, Differential; Exanthema; Humans; Leprostatic Agents; Leprosy; Male; Mycobacterium leprae; Patient Care Management; Rifampin; Skin

A multidrug regimen including isoniazid, rifampicin, pyrazinamide and ethambutol is commonly used as first-line treatment for tuberculosis. However, this regimen can occasionally result in severe adverse drug reactions, such as drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome and drug-induced liver injury. The culprit drug and mechanistic basis for the hypersensitive reaction are unknown.. To investigate drug-specific T-cell responses in patients with antituberculosis drug (ATD)-induced cutaneous hypersensitivity and its underlying mechanism.. We enrolled eight patients with ATD-induced maculopapular exanthema and DRESS and performed a lymphocyte transformation test. Subsequently, drug-specific T-cell clones were generated from four of the patients who showed proliferation in response to ATDs. We measured the drug-specific proliferative responses and counted the drug-specific interferon (IFN)-γ/granzyme B-producing cells after drug stimulation. Antihuman leukocyte antigen (HLA) class I and class II blocking antibodies were used to analyse human leukocyte antigen-restricted T-cell responses.. Positive proliferative responses to ATDs were mostly found in patients with cutaneous hypersensitivity. Furthermore, we isolated isoniazid/rifampicin-specific T cells from patients, which consisted primarily of CD4+ T cells. Drug-specific CD4+ T cells proliferated and secreted IFN-γ/granzyme B when stimulated with isoniazid or rifampicin, respectively. Isoniazid-responsive T-cell clones did not proliferate in the presence of rifampicin and vice versa. Drug-specific T-cell responses were blocked in the presence of anti-HLA class II antibodies.. This study identifies the presence of isoniazid/rifampicin-specific T cells in patients with ATD-induced maculopapular exanthema and DRESS. Furthermore, it highlights the important role of drug-specific T-cell immune responses in the pathogenesis of these reactions.

Topics: Adult; Antitubercular Agents; CD4-Positive T-Lymphocytes; Drug Hypersensitivity Syndrome; Exanthema; Female; HLA Antigens; Humans; Immunity, Cellular; Isoniazid; Male; Middle Aged; Rifampin

Topics: Child; Clinical Protocols; Contraindications; Desensitization, Immunologic; Diphenhydramine; Drug Dosage Calculations; Drug Hypersensitivity; Exanthema; Glucosephosphate Dehydrogenase Deficiency; Humans; Immune Tolerance; Isoniazid; Latent Tuberculosis; Male; Rifabutin; Rifampin

Brucellosis is considered a known widespread zoonotic disease and is endemic in Mediterranean region, like Iran. This study reviewed the clinical manifestations, laboratory findings, and therapeutic regimen in childhood brucellosis in Iran. In this retrospective study, we reviewed hospital-records of 34 consecutive children with a confirmed diagnosis of brucellosis among a total number of 10,864 patients admitted to Children's Medical Center, Tehran, Iran, between 2002 and 2010. Among the patients diagnosed with brucellosis, 22 (65%) were admitted during spring and summer. Clinical findings of these patients at admission were arthritis, splenomegaly, hepatomegaly, lymphadenopathy, maculopapular skin rashes, and fever. Anaemia (53%) and leukopenia (33%) were the most common findings in the children. Only one patient had presented with leukocytosis. Four children (12%) were thrombocytopenic, and none of patients had pancytopenia. Blood cultures were positive in 5 patients (23%). Only one patient underwent bone-marrow aspiration and had positive culture for Brucella spp. Positive titres were found in 33 cases (97%) in Wright test, 23 cases (96%) in Coombs test, and 16 patients (72.7%) in 2ME (2-Mercaptoethanol) test. In one case, Wright and Coombs test titres were below 1:80 while Brucella spp. were isolated from blood at the same time. It is concluded, prolonged fever with joint involvement and organomegaly may increase possibility of infection with Brucella spp. Appropriate treatment regimen by more tolerable oral drugs, with a duration of at least 8 weeks, is recommended.

Topics: Adolescent; Anti-Infective Agents; Arthritis; Brucellosis; Child; Child, Hospitalized; Child, Preschool; Doxycycline; Drug Therapy, Combination; Exanthema; Female; Fever; Hepatomegaly; Humans; Iran; Laboratories; Lymphatic Diseases; Male; Referral and Consultation; Retrospective Studies; Rifampin; Splenomegaly; Sulfamethoxazole; Trimethoprim

A 58-year-old female with a history of dermatomyositis was receiving large oral doses of steroids. She had pulmonary tuberculosis and developed a fever, systemic exudative erythema, exanthema, and epidermolysis covering 30% of her body surface area while being treated with four agents, including isoniazid (INH) and rifampicin (RFP). Histopathologically, eosinophilic necrosis was observed in all layers of the epidermis and a diagnosis of Stevens-Johnson syndrome (SJS) progressive toxic epidermal necrolysis (TEN) was made. The drugs suspected in the drug-induced lymphocyte stimulation test (DLST) re-testing were INH and RFP, and the DLST was considered to be important during the recovery period as well as in the acute phase. Early treatment with plasma exchange therapy and large quantities of intravenous immunoglobulin (IVIG) was successful. Plasma exchange therapy and IVIG are extremely effective when SJS and TEN occur in a patient already on high-dose steroid therapy. Note that the incidence of SJS and TEN is believed to be higher in patients with collagen disease, such as in our case, as compared to the general population.

Topics: Dermatomyositis; Desensitization, Immunologic; Exanthema; Female; Humans; Immunoglobulins, Intravenous; Isoniazid; Middle Aged; Plasma Exchange; Rifampin; Stevens-Johnson Syndrome; Treatment Outcome; Tuberculosis, Pulmonary

Brucellosis is a significant health problem especially in developing countries as Turkey. Skeletal system involvement is relatively a common complication of human brucellosis, however genitourinary, cardiovascular, neurovascular and skin involvements are less frequent. In this case report, a 36-years-old female patient with fever, arthralgia, disseminated macular rash at the extremities and body and peripheral polineuropathy has been presented. The patient, living at a rural area, had a history of consumption of raw milk products. Polyneuropathy of the patient presenting as glove-sock type paresthesia was evaluated with electromyography and reported as mild demyelinated sensorial polyneuropathy and radiculopathy compatible with right L(4-5) involvement. Brucella agglutination test was found to be positive at a titer of 1/1280 in the serum sample. Other bacterial and viral agents presenting with maculopapular rash were ruled out by serological tests. Bacterial growth was detected in the blood culture by automated BacT/ALERT 3D system (bioMerieux, USA) and the bacteria was identified as Brucella melitensis by automated VITEK-2 system (bioMerieux, France). Microbiologic diagnosis was confirmed by detection of agglutination with polyvalent and monovalent anti-M Brucella sera. The patient was successfully treated with rifampicin and doxycycline combination for six weeks. The macular rash was recruited leaving a brown pigmentation in the first week of treatment, whereas the neurologic signs and symptoms disappeared at the end of the first month. Brucella infection should be considered in the differential diagnosis of skin rash and neurologic disorders especially in endemic areas such as Turkey.

Topics: Adult; Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Diagnosis, Differential; Doxycycline; Exanthema; Female; Humans; Peripheral Nervous System Diseases; Rifampin

Human brucellosis is a multisystemic infectious disease with a broad spectrum of clinical manifestations. Severe complications involving musculoskeletal, nervous, genitourinary, and cardiovascular systems may be encountered during the course of the disease; however, cutaneous complications have been reported rarely. We report a patient with brucellosis in whom the main presenting clinical feature was a maculopapular rash and fever. He was initially diagnosed as brucellosis based on the standard tube agglutination test and blood culture positivity. Histopathologic examination of these maculopapular lesions showed perivascular and periadnexal inflammation with loose granuloma formation including giant cells. We emphasize that brucellosis is an infectious disease that should always be kept in mind in the differential diagnosis of a patient with rash and fever, especially in endemic areas.

Topics: Agglutination Tests; Anti-Bacterial Agents; Antihypertensive Agents; Brucellosis; Diagnosis, Differential; Doxycycline; Drug Therapy, Combination; Duodenal Ulcer; Exanthema; Humans; Hypertension; Lymphoma, T-Cell, Cutaneous; Male; Middle Aged; Rifampin; Skin Neoplasms

Several forms of arthritis and rheumatism can sometimes complicate leprosy. However, its presentation as an acute onset arthritis is unusual. We report two adult male naïve patients who presented to our rheumatology outpatient clinic with acute onset inflammatory polyarthritis, skin rash and mild sensory neurodeficit. Borderline lepromatous leprosy (in type I lepra reaction) was diagnosed. We also refer to 19 case records of Hansen arthritis in the clinic database (1998-2007) from approximately 35,000 patients and a community study to highlight the missed diagnosis of Hansen's disease and its unusual association with rheumatoid arthritis. In countries like India where leprosy is endemic, this disease also merits attention in rheumatology clinics.

Topics: Acute Disease; Aged; Arthritis; Clofazimine; Dapsone; Diagnosis, Differential; Drug Therapy, Combination; Exanthema; Glucocorticoids; Humans; Leprostatic Agents; Leprosy; Male; Middle Aged; Mycobacterium leprae; Peripheral Nerves; Peripheral Nervous System Diseases; Rifampin; Treatment Outcome

Topics: Adult; Antibiotics, Antitubercular; Anticonvulsants; Antitubercular Agents; Erythema; Ethambutol; Exanthema; Female; Humans; Phenobarbital; Phenytoin; Pruritus; Rifampin

Topics: Age Factors; Aged, 80 and over; Clofazimine; Dapsone; Diagnosis, Differential; Exanthema; Humans; Leprostatic Agents; Leprosy; Male; Rifampin

Topics: Acute Disease; Aged; Drug Eruptions; Exanthema; Female; Humans; Prednisolone; Rifampin

Topics: Aged; Dapsone; Diagnosis, Differential; Endemic Diseases; Exanthema; Humans; Leprosy, Tuberculoid; Leukemia, Lymphoid; Male; Rifampin; Texas

Topics: Aged; Clofazimine; Dapsone; Exanthema; Humans; Hypesthesia; Leprostatic Agents; Leprosy; Male; Rifampin; Spain; Venezuela

Topics: Adult; Antitubercular Agents; Diagnosis, Differential; Drug Hypersensitivity; Ethambutol; Exanthema; Fever; Humans; Isoniazid; Liver; Liver Failure; Male; Pyrazinamide; Pyridoxine; Rifampin; Skin; Tuberculosis, Pulmonary

Topics: Adult; Blood Cell Count; Brucella melitensis; Brucellosis; Doxycycline; Drug Therapy, Combination; Exanthema; Fever; Humans; Male; Rifampin; Turkey

We report 3 cases of rash after the first dose of antituberculosis polytherapy, thus raising questions concerning the procedures to be followed.. Three patients developed a pruritic rash 1 hour after the first dose of isoniazide, rifampicine, pyrazinamide and ethambutol given simultaneously. The eruption did not recur after readministration of isoniazide and rifampicine successively. Pyrazinamide, which was readministered last (at the full dose in one case and at progressive doses in the two others), induced a recurrence in two of them. Pyrazinamide was definitively withdrawn in one patient with recurrence and slower pyrazinamide readministration allowed continuation of treatment in the other two patients.. Since pyrazinamide appeared to be responsible for rash following the first administration of antituberculosis polytherapy, a protocol for readministration of the 4 drugs is suggested. If the responsibility of pyrazinamide is confirmed it should be readministered very slowly.

Topics: Aged; Antitubercular Agents; Child; Drug Combinations; Drug Eruptions; Ethambutol; Exanthema; Female; Humans; Isoniazid; Male; Middle Aged; Pruritus; Pyrazinamide; Recurrence; Rifampin; Tuberculosis, Pulmonary

We report a rash after the first dose of antituberculosis polytherapy which raises questions concerning procedures to be followed.. An 8-year-old child presented with a pruritic rash 1.5 hours after the first dose of isoniazide, rifampicine, pyrazinamide and ethambutol was simultaneously administered, which did not recur after successive re-administration of isoniazide and rifampicine. Pyrazinamide, which was re-administered last, induced a recurrence. Slower pyrazinamide re-administration allowed continuation of treatment.. A protocol for re-administration of the four drugs is suggested.

Topics: Antibiotics, Antitubercular; Antitubercular Agents; Child; Drug Combinations; Drug Eruptions; Ethambutol; Exanthema; Humans; Isoniazid; Male; Pyrazinamide; Recurrence; Rifampin; Tuberculosis, Pulmonary

The aim of this study was to determine the current incidence of side-effects severe enough to cause intolerance of standard antituberculosis therapy with isoniazid, rifampin and pyrazinamide in patients hospitalized as a result of pulmonary tuberculosis. Five hundred and nineteen patients with proven pulmonary tuberculosis, who initially received standard antituberculosis therapy, were retrospectively studied in the department of infectious diseases in a teaching chest hospital. The incidence of severe side-effects related to the therapy, which led to the definitive termination of one of the three standard drugs, was measured and the risk factors for intolerance were analysed. Final termination of either isoniazid, rifampin or pyrazinamide because of severe side-effects was necessary in 121 of the 519 patients (23%). The most severe side-effects leading to final termination of one drug were hepatotoxicity (11%), exanthema (6%), and arthralgia (2%). Pyrazinamide showed more severe side-effects (15%) than isoniazid (7%) and rifampin (1.5%). Significant risk factors for intolerance of the standard therapy following a multivariate analysis were a history of hepatitis (odds ratio (OR) 3.4; 95% confidence interval (95% CI) 1.6-7.6; p = 0.0026) and an age > or = 60 yrs (OR 1.9; 95% CI 1.2-3.2; p = 0.017). Both of these risk factors were also significantly associated with the intolerance of pyrazinamide (history of hepatitis: OR 2.5; 95% CI 1.4-4.3; p = 0.0045; age > or = 60 yrs: OR 2.1, 95% CI 1.3-3.5; p = 0.0029) but not of isoniazid and rifampin. The side-effects of standard antituberculosis therapy are frequent in hospitalized patients aged > or = 60 yrs or with a history of previous hepatitis, and are probably due to pyrazinamide rather than to isoniazid or rifampin.

Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Antitubercular Agents; Arthralgia; Child; Child, Preschool; Exanthema; Female; Hepatitis; Hospitalization; Humans; Incidence; Infant; Isoniazid; Liver; Logistic Models; Male; Middle Aged; Multivariate Analysis; Pyrazinamide; Retrospective Studies; Rifampin; Risk Factors; Treatment Outcome; Tuberculosis, Pulmonary

Topics: Adult; Body Weight; Drug Therapy, Combination; Ethambutol; Exanthema; Female; Fever; Follow-Up Studies; Gastrointestinal Diseases; Hemorrhage; Humans; Male; Middle Aged; Pain; Pyrazinamide; Recurrence; Rifampin; Shock; Sputum; Time Factors; Tuberculosis, Pulmonary