rifampin and Fever-of-Unknown-Origin

Renal transplant recipients are prone to a variety of infections due a persistent immunodepleted state. Incidence of tuberculosis in this population is much higher compared with the general population. While pulmonary tuberculosis still remains the commonest form in this population, renal allograft tuberculosis is very rare. We report two cases of isolated allograft tuberculosis and one case of allograft tuberculosis with coexistent pleuro-pulmonary and bone marrow involvement. All three cases had presented with pyrexia of unknown origin, wherein despite extensive investigations the cause was not found. In two cases the diagnosis was confirmed on histology. Two cases responded to non-rifampicin-based modified antitubercular treatment and one to conventional four-drug Rifampicin-based regimen. Graft function improved in two cases while in one case the graft was lost. Tuberculosis involving the renal allograft is a potential cause for graft dysfunction/loss and requires a high index of suspicion for diagnosis. Timely detection and early institution of therapy can help save the renal allograft.

Topics: Adult; Antibiotics, Antitubercular; Biopsy; Bone Marrow; Drug Therapy, Combination; Female; Fever of Unknown Origin; Graft Rejection; Graft Survival; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Rifampin; Transplantation, Homologous; Treatment Outcome; Tuberculosis, Pleural; Tuberculosis, Pulmonary; Tuberculosis, Renal; Ultrasonography, Doppler, Color

Topics: Antitubercular Agents; Diagnosis, Differential; Echocardiography; Female; Fever of Unknown Origin; Humans; Middle Aged; Mycobacterium tuberculosis; Positron-Emission Tomography; Rifampin; Tomography, X-Ray Computed; Tuberculosis, Renal

A 37-year-old patient with cephalgia and fever after his return from Mexico is reported. Due to persistently elevated transaminases, a liver biopsy was performed. Histological examination revealed hepatic involvement of a granulomatous disease. Serologic analyses detected anti-Brucella IgM. The suspected diagnosis was thus brucellosis taking the typical anamnesis into account. Treatment with rifampicin and doxycycline led to a complete convalescence of the patient.. Brucellosis is an anthropozoonosis that exists worldwide. Potential sources of infection are uncooked or unpasteurized milk and milk products of infected animals. Complete cure of most brucellosis-infected patients can be achieved by an early and adequate antibiotic treatment.

Topics: Adult; Alanine Transaminase; Anti-Bacterial Agents; Antibodies, Bacterial; Aspartate Aminotransferases; Biopsy; Brucella; Brucellosis; Combined Modality Therapy; Doxycycline; Drug Therapy, Combination; Dyspnea; Fever of Unknown Origin; Hepatitis; Humans; Immunoglobulin M; Liver; Liver Function Tests; Male; Mexico; Rifampin; Travel; Ultrasonography, Interventional

Children who undergo treatment for malignancies are at high for infection with both typical and opportunistic pathogens. Fever in these children prompts extensive evaluation and empiric treatment with broad-spectrum antimicrobials. In the United States (US), tuberculosis is an infrequently reported cause of fever in the pediatric cancer patient and has not been well described. In this report we describe a case of primary pulmonary tuberculosis (TB) in a boy with precursor B-cell acute lymphoblastic leukemia (ALL) and review the pertinent literature.

Topics: Antineoplastic Combined Chemotherapy Protocols; Antitubercular Agents; Azithromycin; Child, Preschool; Combined Modality Therapy; Contact Tracing; Cyclophosphamide; Cytarabine; Dexamethasone; Doxorubicin; Drug Therapy, Combination; Ethambutol; Fever of Unknown Origin; Humans; Immunocompromised Host; Isoniazid; Lymphopenia; Male; Mycobacterium tuberculosis; Pneumonectomy; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Pyrazinamide; Rifampin; Tuberculosis, Pulmonary; Vincristine

Systemic cat scratch disease (CSD) is often associated with prolonged fever and microabscesses in the liver and/or spleen. We report a case of systemic CSD with hepatic, splenic and renal involvement in an aboriginal child in Taiwan. A previously healthy 9-year-old girl had an intermittent fever for about 17 days, and complained of abdominal pain, headache and weight loss. Abdominal computed tomography showed multiple tiny hypodense nodular lesions in the spleen and both kidneys. Laparotomy revealed multiple soft, whitish-tan lesions on the surface of the liver and spleen. Histopathologic examination of a biopsy specimen of the spleen showed necrotizing granulomatous inflammation with central necrosis surrounded by epithelioid cells and occasional Langhans' giant cells, strongly suggestive of Bartonella henselae infection. History revealed close contact with a cat. B. henselae DNA was detected by polymerase chain reaction in the tissue specimen, and the single antibody titer against B. henselae was greater than 1:2048. These results confirmed the diagnosis of visceral CSD caused by B. henselae. The patient's symptoms resolved after treatment with rifampin and tetracycline. This case illustrates the need for inclusion of systemic CSD in patients with fever of unknown origin and abdominal pain.

Topics: Animals; Bartonella henselae; Cat-Scratch Disease; Cats; Child; Female; Fever of Unknown Origin; Humans; Polymerase Chain Reaction; Rifampin; Tetracycline

Topics: Adolescent; Anti-Bacterial Agents; Antibiotics, Antitubercular; Antibodies, Bacterial; Brucella melitensis; Brucellosis; Child; Diagnosis, Differential; Doxycycline; Drug Therapy, Combination; Female; Fever of Unknown Origin; Humans; Male; Practice Guidelines as Topic; Rifampin

The reactivation of mycobacterium infection in renal transplant recipients in developing countries is a common therapeutic dilemma, especially in those patients receiving cyclosporin immunosuppression. The inclusion of rifampicin in the antituberculosis protocol increases the risk of precipitating acute allograft rejection due to its interaction with cyclosporin and also increases the financial burden. We successfully treated 16 patients who developed mycobacterial infection post renal transplant with a rifampicin sparing antituberculosis drug regimen. Pyrexia of unknown origin was the most common manifestation observed and a therapeutic trial with antituberculosis drugs is justified. De novo diabetes mellitus appears to be an added risk factor and increases the susceptibility to mycobacterial infection.

Topics: Adult; Antibiotics, Antitubercular; Antitubercular Agents; Cyclosporine; Developing Countries; Female; Fever of Unknown Origin; Humans; Immunosuppressive Agents; India; Kidney Transplantation; Male; Retrospective Studies; Rifampin; Tuberculosis

A 33-year-old Portugese worker presented with a one-week history of nonproductive cough and fever. A presumptive diagnosis "viral infection of the respiratory tract" was made. However, because of persisting cough and fever further investigations were necessary, and finally Brucella melitensis was isolated in blood cultures. Three months before admission to the hospital the man was dressing the carcasses of a goat in Portugal and consumpted fresh goats milk cheese. Antibiotic therapy with Rifampicin and Trimethoprim/Sulfamethoxazol over 6 weeks improved the signs and symptoms of the infection.

Topics: Adult; Animals; Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Cough; Drug Therapy, Combination; Fever of Unknown Origin; Germany; Goats; Humans; Male; Portugal; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination; Zoonoses

Topics: Antibiotics, Antitubercular; Cat-Scratch Disease; Child; Child, Preschool; Diagnosis, Differential; Fever of Unknown Origin; Humans; Liver Abscess; Male; Rifampin; Spleen; Splenic Diseases; Ultrasonography

Topics: Chemical and Drug Induced Liver Injury; Fever of Unknown Origin; Humans; Isoniazid; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Liver Function Tests; Male; Middle Aged; Rifampin; Time Factors

Topics: Child, Preschool; Fever; Fever of Unknown Origin; Humans; Hydrazines; Male; Pyrazinamide; Rifampin; Tuberculosis, Miliary; Tuberculosis, Pulmonary