rifampin and Fever

Bartonella henselae commonly involves the mononuclear phagocyte system (MPS), and its most common presentation is lymphadenitis. Rarely, it can cause isolated osteomyelitis. We present a case of a 3 year old with constitutional symptoms and new onset of limp. Previously reported cases of osteomyelitis due to B. henselae are also reviewed here, keeping the index case in mind.. We conducted a Medline search using MeSH subject headings Bartonella and osteomyelitis, limited to humans.. The index case is a 3-year-old female who had a subacute presentation with new-onset leg pain and fever. Subsequent imaging demonstrated osteomyelitis of the acetabulum. Multiple diagnostic attempts were unsuccessful, and the patient did not respond to empiric therapy. Despite indeterminate serology, the diagnosis of Bartonella osteomyelitis was eventually confirmed by PCR on bone biopsy of the lesion. The literature search revealed 48 publications, which were reduced to 28 when limiting articles to the English language and the pediatric population. After a report of 36 pediatric cases in 2007, there have been an additional 12 pediatric cases since 1998. Generally, these patients had a subacute presentation with relatively mild constitutional symptoms. Most commonly, bone involvement occurred as osteolytic lesions of the axial skeleton. Of the total 48 cases reported, only four reported involvement of the axial skeleton.. We present the first case, to our knowledge, of pediatric osteomyelitis of the pelvis due to B. henselae with indeterminate serologic and positive PCR results. Bartonella osteomyelitis should be included in the differential diagnosis when typical pathogens are not identified or if the patient is slow to respond to standard therapies. The sensitivity of tissue PCR for Bartonella osteomyelitis is now better than the current gold standard of serology, and new management guidelines may need to reflect this.

Topics: Acetabulum; Animals; Anti-Bacterial Agents; Azithromycin; Bartonella henselae; Biopsy; Child, Preschool; Female; Fever; Humans; Lymphadenitis; Osteomyelitis; Polymerase Chain Reaction; Rifampin; Sensitivity and Specificity; Treatment Outcome

Daily rifampin therapy is associated with minimal adverse effects, but administration on an intermittent or interrupted basis has been associated with severe immunoallergic reactions such as hemolytic anemia, acute renal failure, and disseminated intravascular coagulation. We describe a patient with Mycobacterium leprae infection who experienced recurrent episodes of disseminated intravascular coagulation after intermittent exposures to rifampin, and review eight previously reported cases of rifampin-associated disseminated intravascular coagulation. In six (75%) cases, previous exposure to rifampin was reported and seven (87.5%) patients were receiving the medication on an intermittent or interrupted basis. Clinical features of rifampin-associated disseminated intravascular coagulation included fever, hypotension, abdominal pain, and vomiting within hours of ingestion. Average time to reaction was 3-6 doses if rifampin was being administered on a monthly schedule. Three (37.5%) of eight reported cases were fatal. A complete history of previous exposure to rifampin is recommended before intermittent therapy with this medication.

Topics: Abdominal Pain; Aged; Anemia, Hemolytic; Disseminated Intravascular Coagulation; Dose-Response Relationship, Drug; Female; Fever; Humans; Hypotension; Leprosy; Rifampin; Vomiting

To review the clinical and laboratory features and response to treatment of patients with acute brucellar epididymo-orchitis reporting to a tertiary care hospital in Riyadh, and to compare these with other cases reported previously.. In this retrospective study, records of all 26 adult patients with brucellosis, who presented with epididymitis or epididymo-orchitis at a tertiary hospital in Riyadh from 1983 to 2000, were reviewed. Positive blood culture or high agglutination titres of > or = 1 : 320 and positive clinical manifestations of brucellosis were the main criteria for diagnosing brucellosis. Among these cases, epididymitis or epididymo-orchitis was diagnosed on the basis of a typical history of gradual onset of scrotal pain and findings of enlarged tender testes and/or epididymis.. Epididymo-orchitis occurred in 1.6% of all patients with brucellosis. Most (58%) were 25--44 years old; approximately 77% of the patients presented with acute symptoms of < 2 weeks' duration. All patients complained of swollen painful testicles. Other presenting symptoms included undulant fever (96%), chills (54%) and arthralgia (23%). Four patients had dysuria and one haematuria. Ten patients gave a positive history of ingestion of raw milk and milk products; one patient had laboratory-acquired brucellosis. Six patients had unilateral epididymo-orchitis (two with features of florid presentation); the remaining 20 had only orchitis (bilateral in two, right in 10 and left in eight). Leucocytosis was present in six patients; 25 had initial agglutination titres of > 1 : 320 and the remaining patient had a positive blood culture. All patients received combined therapy with streptomycin for the first 2 weeks (or oral rifampicin for 6 weeks) with doxycycline or tetracycline for 6 weeks. All showed improvement, fever subsided in 2--5 days and the scrotal enlargement and tenderness regressed. Only one patient had a relapse within one year.. In brucellosis-endemic areas, clinicians encountering epididymo-orchitis should consider the likelihood of brucellosis. A careful history, a meticulous physical examination and a rapid laboratory evaluation help in diagnosis. Clinical and serological data are sufficient for diagnosis. Leucocytosis is not an atypical feature of brucellar epididymo-orchitis and so cannot be used for differentiating it from the nonspecific variety. Conservative management with combination antibiotic therapy is adequate for managing brucellar epididymo-orchitis.

Topics: Adolescent; Adult; Aged; Brucellosis; Doxycycline; Drug Therapy, Combination; Epididymitis; Fever; Humans; Length of Stay; Male; Middle Aged; Orchitis; Retrospective Studies; Rifampin; Saudi Arabia; Streptomycin; Tetracycline

Topics: Adolescent; Adult; Age Factors; Aged; Drug Administration Schedule; Drug Therapy, Combination; Female; Fever; Humans; Isoniazid; Leukocytosis; Lymphopenia; Male; Middle Aged; Purpura, Thrombocytopenic; Rifampin; Sex Factors; Tuberculosis, Pulmonary

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

To determine whether the addition of rifampin to a quinolone-based antibacterial prophylactic regimen in patients undergoing high-dose chemotherapy (HDC) with peripheral-blood stem-cell transplantation (PBSCT) decreases the incidence of neutropenia and fever, Gram-positive bacteremia, and infection-related morbidity.. Patients with solid tumors undergoing HDC with PBSCT were randomized to receive prophylactic antibiotics with either ciprofloxacin 500 mg orally every 8 hours or the same ciprofloxacin regimen with rifampin 300 mg orally every 12 hours. Prophylaxis was started 48 hours before stem-cell reinfusion. Patients were monitored to document the occurrence of neutropenia and fever, incidence and cause of bacterial infection, time to onset and duration of fever, requirement for intravenous antimicrobials, and length of hospital admission.. Sixty-five patients were randomized to receive ciprofloxacin and 65 to receive ciprofloxacin plus rifampin, and from these groups, 62 and 61 were assessable, respectively. The proportion of patients who developed neutropenia and fever was 87% in the group treated with ciprofloxacin and 78% in the group treated with ciprofloxacin and rifampin (P =.25). Although there was a trend toward a reduction in the overall incidence of bacteremia (12 v 4 patients), and Gram-positive bacteremia (8 v 2 patients) with the addition of rifampin, none of these comparisons was statistically significant (P =.05 and P =.09, respectively).. The results of this study, which demonstrate that rifampin does not improve ciprofloxacin antibacterial prophylaxis in cancer patients undergoing HDC with PBSCT support but that it does increase the occurrence of undesirable side effects, do not support the routine use of rifampin in this setting.

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents; Antibiotics, Antitubercular; Antineoplastic Agents; Ciprofloxacin; Drug Therapy, Combination; Female; Fever; Gram-Positive Bacterial Infections; Hematopoietic Stem Cell Transplantation; Humans; Male; Neoplasms; Neutropenia; Prospective Studies; Rifampin; Statistics, Nonparametric; 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

This open-label, randomized, three-way crossover study of 28 healthy premenopausal women was conducted to compare the impact of concomitant rifabutin and rifampicin on the safety, pharmacokinetics, and pharmacodynamics of the oral contraceptives ethinylestradiol and norethindrone (Ortho-Novum 1/35; Ortho Pharmaceutical, Raritan, NJ). Each participant received oral contraceptives daily for 21 days for the first control cycle, then was randomized to one of two sequences to receive oral contraceptives with concomitant rifampicin and rifabutin at equal doses of 300 mg/day for 10 days. Ethinylestradiol, norethindrone, follicle stimulating hormone (FSH), luteinizing hormone (LH), progesterone, rifampicin, and rifabutin (and metabolite) were measured in plasma over the same time frames in all three cycles. Safety was assessed from before the beginning to the end of each cycle. Twenty-two subjects completed all three cycles. Compared with the control cycle, rifabutin and rifampicin significantly altered the disposition of the oral contraceptive. Area under the concentration-time curve from 0 to 24 hours (AUC0-24) and maximum plasma concentration (Cmax) of ethinylestradiol decreased by 64% and 42%, respectively, after coadministration with rifampicin and by 35% and 20%, respectively, after coadministration with rifabutin. The AUC0-24 of norethindrone decreased by 60% and 20% after coadministration with rifampicin and rifabutin, respectively. Unlike progesterone levels, FSH and LH levels increased during coadministration with rifampicin and rifabutin. The incidence of spotting was significantly higher after coadministration with rifampicin (36.4%) and rifabutin (21.7%) than during the control cycle (3.7%). Although both rifampicin and rifabutin affected the pharmacokinetics of ethinylestradiol and norethindrone, the magnitude of this effect was more pronounced with rifampicin. Likewise, the fact that the highest incidence of spotting occurred with rifampicin was consistent with higher metabolic induction by rifampicin. Despite the fact that there was no change in progesterone levels, it is recommended that patients be advised to use additional contraceptive methods while receiving rifabutin or rifampicin with oral contraceptives to prevent inadvertent pregnancy.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Area Under Curve; Contraceptives, Oral, Synthetic; Cross-Over Studies; Ethinyl Estradiol; Female; Fever; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Middle Aged; Neutropenia; Norethindrone; Rifabutin; Rifampin

We compared ciprofloxacin alone with ciprofloxacin plus rifampin (C + R) as a prophylactic antibacterial regimen for 40 patients with solid tumors treated with high-dose chemotherapy and autologous stem cell transplantation support. No differences were found between groups in the time elapsed to the onset of fever, incidence of febrile episodes, amphotericin B use, and length of hospital stay. However, C + R combination prophylaxis significantly reduced the incidence of gram-positive bacteremia (five versus zero episodes) but was associated with a higher incidence of drug-related side effects.

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents; Antibiotics, Antitubercular; Antineoplastic Combined Chemotherapy Protocols; Ciprofloxacin; Drug Therapy, Combination; Female; Fever; Gram-Positive Bacterial Infections; Hematopoietic Stem Cell Transplantation; Humans; Male; Middle Aged; Neoplasms; Neutropenia; Rifampin

We studied the effectiveness of prophylactic oral ciprofloxacin and rifampin on fever prevention in patients undergoing autologous bone marrow transplantation (ABMT) for breast cancer. Furthermore, we evaluated the toxicity and efficacy of empiric once-daily vancomycin and tobramycin for febrile neutropenia.. Ninety-nine assessable women received prophylactic ciprofloxacin and rifampin after high-dose chemotherapy (HDC) for advanced or high-risk primary breast cancer supported with either bone marrow and peripheral-blood progenitor cells (PBPCs) or bone marrow purged with chemotherapy and monoclonal antibodies. Neutropenic fever was treated with empiric once-daily vancomycin and tobramycin. Patients were compared with historic controls treated with the identical HDC and bone marrow support regimen.. In patients treated with bone marrow and PBPCs, the incidence of fever during neutropenia was reduced by ciprofloxacin and rifampin from 98% to 57%. Documented infections were reduced from 42% to 13% (P < .01) and bacteremia from 18% to 0% (P < .001). In purged bone marrow recipients, the overall infection rate decreased from 74% to 17% (P < .001), and bacteremia from 29% to 7%. (P = .02). No patient developed breakthrough bacteremia or sepsis syndrome while on study. Serum creatinine level greater than 1.8 g/dL was noted in 7% of controls and 10% of study patients. Increased ototoxicity was not encountered with the higher peak concentrations of vancomycin and tobramycin.. The therapeutic strategy of ciprofloxacin and rifampin followed by once-daily vancomycin and tobramycin markedly reduced the incidence of infection and virtually eliminated bacteremia in both purged and nonpurged bone marrow recipients. Once-daily vancomycin and tobramycin was safe and effective and, because of the ease of use, facilitates outpatient management of ABMT patients.

Topics: Administration, Oral; Adult; Antineoplastic Combined Chemotherapy Protocols; Bacterial Infections; Bone Marrow Purging; Bone Marrow Transplantation; Breast Neoplasms; Ciprofloxacin; Drug Administration Schedule; Drug Therapy, Combination; Female; Fever; Humans; Injections, Intravenous; Middle Aged; Neutropenia; Rifampin; Stem Cell Transplantation; Tobramycin; Vancomycin

To determine the median response time to therapy with vancomycin alone or with vancomycin plus rifampin in patients with methicillin-resistant Staphylococcus aureus (MRSA) endocarditis.. Cohort analysis of a randomized study.. University medical center.. Forty-two consecutive patients with MRSA endocarditis were randomly assigned to receive either vancomycin (group I) or vancomycin plus rifampin (group II) for 28 days.. Clinical signs and symptoms were recorded, and blood cultures were obtained daily to determine the duration of bacteremia.. The median duration of bacteremia was 9 days (7 days for group I and 9 days for group II). The median duration of fever for all patients and for each treatment group was 7 days. Six patients failed therapy, including three patients who died 5, 6, and 9 days after therapy was started, respectively. The other three patients who failed therapy required valve surgery on days 2, 22, and 27, respectively. Although patients had sustained bacteremia, no unusual complications were seen in either treatment group, and most patients responded to continued antibiotic therapy.. Slow clinical response is common among patients with MRSA endocarditis who are treated with vancomycin or vancomycin plus rifampin. Nevertheless, few complications appear to be related solely to this sustained bacteremia.

Topics: Adult; Bacteremia; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Fever; Gentamicins; Humans; Male; Methicillin Resistance; Middle Aged; Prospective Studies; Rifampin; Staphylococcal Infections; Statistics as Topic; Time Factors; Vancomycin

Topics: Adult; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Fever; Humans; Rifampin; Time Factors

Topics: Adolescent; Adult; Age Factors; Aged; Antibody Formation; Body Weight; Clinical Trials as Topic; Drug Therapy, Combination; Female; Fever; Humans; Male; Middle Aged; Rifampin; Sex Factors; Tuberculosis, Pulmonary

In a controlled clinical trial in Hong Kong, 575 Chinese adults with smear-positive isoniazid-resistant pulmonary tuberculosis, who had previously been treated with first-line chemotherapy, were allocated at random to regimens of rifampicin plus ethambutol daily (ER7), twice-weekly (ER2), once-weekly (ER1), or daily for 2 months and then once-weekly (ER7ER1), or to a standard retreatment regimen of daily ethionamide plus pyrazinamide plus cycloserine (EtZC). The ER7 patients were allocated to 12 or 18 months of chemotherapy, and the remainder to 18 months. As assessed at 18 months, a favourable response was achieved in 87 per cent of 91 ER7 patients, 79 per cent of 84 ER2, 81 per cent of 53 ER1, 87 per cent of 62 ER7ER1, and in 88 per cent of 68 EtZC patients (93 per cent of 59 EtZC patients if those with ethionamide-resistant strains pretreatment are excluded). As assessed at 18 and 30 months the ER7 regime was as effective as the control EtZC regimen, and 18 months of chemotherapy on the ER7 regimen conferred no benefit over 12 months. No patient on either regimen relapsed after 18 months. Adverse reactions were uncommon on the daily rifampicin regimen but relatively common on the intermittent and control regimens. The commonest reaction to the intermittent regimens was the 'flu' syndrome, which was associated with the presence of circulating rifampicin-dependent antibodies (P less than 0-001).

Topics: Antibody Formation; Body Weight; Clinical Trials as Topic; Cycloserine; Drug Combinations; Drug Resistance; Ethambutol; Ethionamide; Fever; Follow-Up Studies; Humans; Pyrazinamide; Rifampin; Tuberculosis, Pulmonary

Topics: Clinical Trials as Topic; Drug Hypersensitivity; Drug Therapy, Combination; Ethambutol; Fever; Gastrointestinal Diseases; Humans; Jaundice; Purpura, Thrombocytopenic; Respiratory Insufficiency; Rifampin; Skin Manifestations; Time Factors; Tuberculosis, Pulmonary

Topics: Adult; Alanine Transaminase; Antibodies; Ethambutol; Female; Fever; Humans; Jaundice; Male; Middle Aged; Nausea; Pain; Placebos; Pyrazinamide; Respiratory Tract Diseases; Rifampin; Skin Manifestations; Tuberculosis, Pulmonary

Topics: Clinical Trials as Topic; Drug Therapy, Combination; Female; Fever; Gastrointestinal Diseases; Headache; Humans; Isoniazid; Male; Purpura, Thrombocytopenic; Rifampin; Time Factors; Tuberculosis, Pulmonary

Topics: Adult; Animals; Antibody Formation; Antigen-Antibody Reactions; Clinical Trials as Topic; Female; Fever; Headache; Humans; Immune Tolerance; Male; Mice; Middle Aged; Purpura, Thrombocytopenic; Rabbits; Rats; Rifampin; Tuberculosis, Pulmonary

This paper reports the nature, incidence, and severity of adverse reactions to regimens of rifampicin and ethambutol given once weekly, twice weekly, or daily and to a standard reserve regimen in a total of 330 Chinese failure patients who completed at least six months' chemotherapy in a therapeutic comparison in Hong Kong.The adverse reactions which occurred on the regimens of intermittent rifampicin were termed cutaneous, abdominal, "flu", and respiratory; in addition, purpura and abnormal liver function tests were encountered. There was an association of adverse reactions with the interval between doses and with the dose size of rifampicin, the highest incidence occurring with once-weekly rifampicin in high dosage. A procedure was developed for managing adverse reactions to intermittent rifampicin. Of 202 patients treated with intermittent rifampicin 60 developed adverse reactions, but in only 7 (3%) was it necessary to terminate the drug, though a further 10 (5%) were changed to daily rifampicin. On daily rifampicin, generalized hypersensitivity, cutaneous reactions, (one with purpura), and impaired liver function were encountered. Adverse reactions on the standard ethionamide, pyrazinamide, and cycloserine regimen were frequent and some were serious.

Topics: Alanine Transaminase; Antitubercular Agents; Bone Diseases; Chemical and Drug Induced Liver Injury; Colic; Drug Eruptions; Dyspnea; Ethambutol; Fever; Hong Kong; Humans; Jaundice; Purpura; Rifampin; Time Factors; Tuberculosis, Pulmonary

We report a case of brucellosis-induced severe neutropenia in a 2-year-old girl who presented with a 2-week history of fever. On clinical examination, the patient was febrile with mild aphthous stomatitis. However, her general condition was stable, and systemic examination did not show involvement of any other organ. Laboratory test results revealed severe neutropenia, mild anemia, and an elevated serum C-reactive protein level. Flow cytometry of peripheral blood leukocytes revealed no malignancy, and blood film morphology was unremarkable except for mild microcytosis and hypochromia. Antineutrophil antibody and Coombs test results were negative. We administered intravenous cefuroxime; however, therapy was switched to meropenem plus clarithromycin because fever persisted for 5 days, despite treatment. On the 10th day after admission, Brucella serology tests showed positive results, and trimethoprim-sulfamethoxazole plus rifampicin therapy was prescribed for 8 weeks. The fever defervesced, and the child was discharged in a good state of health. Neutropenia persisted for several months but gradually resolved. Neutropenia, defined as an absolute neutrophil count (ANC) < 1.5 cells × 10 9 /L beyond the first year of life, is a benign transient condition associated with an intercurrent infection (usually viral illnesses or infections) in immunocompetent children. However, severe neutropenia (ANC < 0.5 × 10 9 /L) associated with fever necessitates hospitalization and administration of broad-spectrum antibiotics to avoid the high risk of sepsis, particularly in children. Brucellosis is rarely associated with hematologic abnormalities such as neutropenia. Early diagnosis of hematologic complications of brucellosis is essential for prompt initiation of specific and aggressive treatment.

Topics: Anti-Bacterial Agents; Brucellosis; C-Reactive Protein; Cefuroxime; Child; Child, Preschool; Clarithromycin; Febrile Neutropenia; Female; Fever; Humans; Meropenem; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination

Brucellosis is a common Zoonosis affecting half a million people annually. The most common mode of infection is by consuming unpasteurized milk or milk products. The general manifestations are those of fever with generalized symptoms. The nervous system is affected in 4-7% of cases. The manifestations are protean and include meningo-encephalitis as well as peripheral nervous system involvement. The diagnosis relies on culture, which is cumbersome and can be falsely negative. Agglutination tests for the various species of the organism are the mainstay for diagnosis. Treatment is for 3-6 months with combination therapy including Doxycycline, Rifampicin and ceftriaxone. The main issue is prevention and better animal husbandry.

Topics: Agglutination Tests; Animals; Brucellosis; Doxycycline; Fever; Rifampin

Topics: Adolescent; Anti-Bacterial Agents; Antibiotics, Antitubercular; Back Pain; Brucellosis; Diagnosis, Differential; Doxycycline; Encephalitis, Herpes Simplex; Fever; Humans; Magnetic Resonance Imaging; Male; Rifampin

Tuberculosis (TB) is a chronic disease that mostly affects low-income countries. TB is transmitted through droplet aerosolization from a person with active pulmonary TB. Afghanistan is one of the 22 high TB burden countries where 39,445 people develop this disease and 7840 people die each year. Treatment outcome is one of the best measurements that explain how the current regimen works.. This was a retrospective cohort study, conducted in Kandahar Province, to find out the treatment outcome of anti-TB drugs regimens in TB patients. Data of pulmonary and extra-pulmonary TB patients, who fulfilled the eligible criteria of the study and were treated from 2005 to 2015, was retrieved from their medical record forms.. Among 1000 TB patients, 599 (59.9%) were females and 401 (40.1%) males; most of the patients (678/1000 [67.8%]) were from Kandahar city while 322/1000 (32.2%) were from the other districts of Kandahar. Mean age of the patients were 36.1 years with SD of 19.3 years. Main signs and symptoms of fever, cough, and weight loss were present in 949/1000 (94.9%), 880/1000 (88%), and 544/1000 (54.4%) of the patients, respectively. On first visit 459/1000 (45.9%) patients were sputum AFB (acid fast bacilli) positive. Majority (247/459 [53.8%]) of these patients were AFB 2+. After 2 months of intensive anti-TB treatment, 9/459 (1.9%) patients were still AFB positive (1+). Treatment outcome of these 1000 patients showed that 479 (47.9%) completed the treatment, 298 (29.8%) were cured, 35 (3.5%) failed the anti-TB treatment, while 5 (0.5%) patients died.. This clearly shows that TB is still one of the major threats to the people of Kandahar Province. There are cases of TB who do not respond to the first line regimens of anti-TB drugs advised by WHO and Afghan Ministry of Public Health (MoPH).

Topics: Adolescent; Adult; Afghanistan; Antitubercular Agents; Cohort Studies; Cough; Drug Therapy, Combination; Duration of Therapy; Ethambutol; Female; Fever; Humans; Isoniazid; Male; Middle Aged; Mortality; Prognosis; Pyrazinamide; Retreatment; Retrospective Studies; Rifampin; Sex Distribution; Sputum; Treatment Failure; Treatment Outcome; Tuberculosis, Pulmonary; Weight Loss; Young Adult

Topics: Aged; Antitubercular Agents; Deglutition Disorders; Delayed Diagnosis; Diagnosis, Differential; Directly Observed Therapy; Endoscopy, Digestive System; Esophageal Neoplasms; Esophagitis; Ethambutol; Fever; Humans; Isoniazid; Lymph Nodes; Lymphadenopathy; Male; Mexican Americans; Pyrazinamide; Rifampin; Substance-Related Disorders; Tomography, X-Ray Computed; Tuberculosis, Gastrointestinal; Ultrasonography

Tuberculosis (TB) can manifest prolonged fever or fever of unknown origin, especially when it is located extrapulmonary. We report a case of disseminated TB complicated by iliac bone osteolysis and a gluteal abscess in a 75-year-old female patient with fever and bone marrow dysplasia. Diagnosis of TB was made despite transient false-positive high-titer agglutination tests and ELISA antibodies to Brucella. The case presented shows that in a highly suggestive case of TB, positive agglutination tests or ELISA antibodies to Brucella should be interpreted with caution, and repeated testing should be performed to assess their persistence and fluctuation over time.

Topics: Aged; Anti-Bacterial Agents; Brucella; Brucellosis; Diagnosis, Differential; Doxycycline; Drug Therapy, Combination; Enzyme-Linked Immunosorbent Assay; Female; Fever; Humans; Rifampin; Tuberculosis, Pulmonary

Brucellosis is a zoonotic disease caused by brucella. It has been an increasing trend in recent years (Wang H, Xu WM, Zhu KJ, Zhu SJ, Zhang HF, Wang J, Yang Y, Shao FY, Jiang NM, Tao ZY, Jin HY, Tang Y, Huo LL, Dong F, Li ZJ, Ding H, Liu ZG, Emerg Microbes Infect 9:889-99, 2020). Brucellosis is capable to invade multiple systems throughout the body, lacking in typical clinical manifestations, and easily misdiagnosed and mistreated.. We report a case of a male, 5-year-and-11-month old child without relevant medical history, who was admitted to hospital for 20 days of fever. When admitted to the hospital, we found that he was enervated, irritable and sleepy, accompanied with red eyes phenomenon. After anti-infection treatment with meropenem, no improvement observed. Lumbar puncture revealed normal CSF protein, normal cells, and negative culture. Later, doppler echocardiography suggested coronary aneurysms, and incomplete Kawasaki Disease with coronary aneurysms was proposed. The next day, brucellosis agglutination test was positive. Metagenomic next-generation sequencing (mNGS) of cerebrospinal fluid suggested B.melitensis, which was confirmed again by blood culture. The child was finally diagnosed as brucellosis with meningocephalitis, coronary aneurysm and keratitis. According to our preliminary research and review, such case has never been reported in detail before. After diagnosis confirmation, the child was treated with rifampicin, compound sulfamethoxazole, and ceftriaxone for cocktail anti-infection therapy. Aspirin and dipyridamole were also applied for anticoagulant therapy. After medical treatment, body temperature of the child has reached normal level, eye symptoms alleviated, and mental condition gradually turned normal. Re-examination of the doppler echocardiographic indicated that the coronary aneurysm was aggravated, so warfarin was added for amplification of anticoagulation treatment. At present, 3 months of follow-up, the coronary artery dilatation gradually assuaged, and the condition is continued to alleviate.. Brucellosis can invade nervous system, coronary artery, and cornea. Brucellosis lacks specific signs for clinical diagnosis. The traditional agglutination test and the new mNGS are convenient and effective, which can provide the reference for clinical diagnosis.

Topics: Agglutination Tests; Animals; Anti-Infective Agents; Anticoagulants; Brucella melitensis; Brucellosis; Ceftriaxone; Child, Preschool; Coronary Aneurysm; Diagnostic Errors; Fever; Humans; Keratitis; Male; Meningoencephalitis; Rifampin; Sulfamethoxazole; Treatment Outcome; Zoonoses

Topics: Aged, 80 and over; Diabetes Mellitus, Type 2; Doxycycline; Echocardiography; Electroencephalography; Embolism; Endocarditis; Fever; Fluorodeoxyglucose F18; Heart Valve Prosthesis; Humans; Hypertension; Magnetic Resonance Imaging; Male; Myocardial Infarction; Positron Emission Tomography Computed Tomography; Rifampin; Treatment Outcome

The purpose of this study is to summarize the manifestations, diagnosis, differential diagnosis, and treatment of childhood brucellosis in non-epidemic areas of China. A retrospective review of 16 admitted children patients with brucella's disease who were diagnosed of brucellosis during the period from 2011 to 2016 was performed. Diagnostic criteria, clinical presentations, and outcomes were recorded. The most common symptom was fever. Osteoarticular involvement was found in 50% of the patients. They were infected by contacting with infected animals or consuming of unpasteurized milk or meat of sheep or goats, also. Standard agglutination test was positive in all patients and blood culture in 10 (62.5%) patients as well as medulloculture in 3 (18.8%) patients were positive. A combination of antibiotic treatment with rifampin plus cotrimoxazole showed good response and all clinical manifestations improved. Brucellosis is misdiagnosed frequently and should be considered in the differential diagnosis when patients do not respond to standard treatment. Blood culture, together with brucella serology test, is important and helpful in the diagnosis. MRI is a good method in differentiating those with symptoms of arthritis.

Topics: Adolescent; Agglutination Tests; Anti-Bacterial Agents; Brucellosis; Child; Child, Preschool; China; Diagnosis, Differential; Female; Fever; Humans; Infant; Male; Retrospective Studies; Rifampin; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Rifampicin has been widely used due to its broad antibacterial spectrum. Acute haemolysis is a rarely encountered complication of rifampicin. A 58-year-old woman was admitted to our department because of high-grade fever with rigors, accompanied by abdominal and lumbar pain and laboratory evidence of acute haemolysis. She had been treated for brucellosis initially with doxycycline and streptomycin. Due to subsequent appearance of myositis, ciprofloxacin and rifampicin were added for treatment of localised brucellosis. After intravenous administration of rifampicin, the patient deteriorated significantly. After exclusion of other causes of haemolysis, autoimmune haemolytic anaemia related to rifampicin was established by strongly positive direct Coombs test. Drug withdrawal in conjunction with intravenous immune globulin and prednisolone resulted in resolution of haemolysis and no relapse in the ensuing 1-year period. Our case highlights the importance of recognising commonly administrative drugs as cause of haemolytic anaemia, that can often be life threatening.

Topics: Abdominal Pain; Anemia, Hemolytic, Autoimmune; Anti-Bacterial Agents; Brucellosis; Chills; Female; Fever; Humans; Immunoglobulins, Intravenous; Middle Aged; Prednisolone; Rifampin; Treatment Outcome

This study aims to analyze the clinical characteristics and treatment outcomes of 590 patients with brucellosis in Xinjiang, China.. The clinical characteristics, laboratory findings, complications and prognosis of 590 patients infected with brucellosis were retrospectively analyzed. These patients had a mean age of 44.24 ± 15.83 years with 60.5% having a history of close contacting with cattle and sheep. Of them, 53.6% (316 /590) were in acute phase and 21.5% were in chronic phase. Agglutination test showed 98.5% positive with 34% blood culture positive of Brucella. The major symptoms were fatigue (91%), hyperhidrosis(88.1%), fever(86.9%), and joint pain(81%) with 29.8% having enlarged liver, 26.1% having enlarged spleen and 23.2% having osteoarticular complications. Combination of doxycycline plus rifampicin for 12 weeks was an effective regimen for patients without complications. The 3-drug regimen (doxycycline+rifampicin+levofloxacin) for 12 weeks was recommended for these with complications. There were 6 patients died (1.02%) with overall relapse rate of 5.98%.. Brucellosis is mostly associated with contacting with domestic animal production in Xinjiang, China. Clinical symptoms include fever, fatigue, hyperhidrosis, and joint pain with common complication of osteoarticular involvement. Three-drug-regimen of doxycycline+rifampicin+levofloxacin for 12 weeks was effective for these patients with complications.

Topics: Adolescent; Adult; Aged; Animals; Animals, Domestic; Anti-Bacterial Agents; Arthralgia; Brucella; Brucellosis; Child; Child, Preschool; China; Doxycycline; Drug Therapy, Combination; Female; Fever; Hepatomegaly; Humans; Levofloxacin; Male; Middle Aged; Retrospective Studies; Rifampin; Splenomegaly; Treatment Outcome; Young Adult

A 23-year-old indigenous Guatemalan man presented in 2016 to our clinic in Sololá, Guatemala, with 10 months of recurrent neck swelling, fevers, night sweats and weight loss. Previously, he had sought care in three different medical settings, including a private physician-run clinic, a tertiary private cancer treatment centre and, finally, a rural government health post. With assistance from our institution's accompaniment staff, the patient was admitted to a public tertiary care hospital for work-up. Rifampin-susceptible tuberculosis was diagnosed, and appropriate treatment was begun. The case illustrates how low tuberculosis recognition among community health workers and health system segmentation creates obstacles to appropriate care, especially for patients with limited means. As a result, significant diagnostic and treatment delays can occur, increasing the public health burden of tuberculosis.

Topics: Antibiotics, Antitubercular; Delayed Diagnosis; Fever; Guatemala; Humans; Male; Neck Pain; Rifampin; Tuberculosis; Young Adult

Topics: Adult; Anti-Bacterial Agents; Bartonella henselae; Cat-Scratch Disease; Doxycycline; Fever; Humans; Lymphadenopathy; Male; Retinitis; Rifampin

The rapid determination of pathogenic agent is very important to clinician for guiding their clinical medication. However, current diagnostic methods are of limitation in many aspects, such as detecting range, time-consuming, specificity and sensitivity. In this report, we apply our new-developing pathogen detection method to clarify that Propionibacterium acnes is the causative agent of a two-year-old boy with juvenile myelomonocytic leukemia presenting clinical symptoms including serious rash and hyperpyrexia while traditional clinical methods of diagnosis fail to detect the pathogenic agent and multiple antimicrobial drugs are almost ineffective Propionibacterium acnes is confirmed to be the infectious agent by quantitative real-time polymerase chain reaction.. After haploidentical hematopoietic stem cell transplantation, a two-year-old boy with juvenile myelomonocytic leukemia presented to a pediatrist in a medical facility with hyperpyrexia and red skin rash which later changed to black skin rash all over his body. Traditional diagnostic assays were unrevealing, and several routine antimicrobial treatments were ineffective, including the vancomycin, meropenem, tobramycin, cefepime and rifampin. In this case, pediatrist resorted to the next-generation sequencing technology for uncovering potential pathogens so as to direct their use of specific drugs against pathogenic bacteria. Therefore, based on the BGISEQ100 (Ion Proton System) which performed sequencing-by-synthesis, with electrochemical detection of synthesis, and each such reaction coupled to its own sensor, which are in turn organized into a massively parallel sensor array on a complementary metal-oxidesemiconductor chip, we detect and identify the potential pathogens. As a result, we detected a significantly higher abundance of skin bacteria Propionibacterium acnes in patient's blood than controls. It had been reported that patients infected by Propionibacterium acnes almost always had history of immunodeficiency, trauma or surgery. Considering this possible cause, antimicrobial treatment was adjusted to target this rare opportunistic pathogen. Fever and black skin rashes were rapidly reduced after administrating specific drugs against Propionibacterium acnes.. This case showed our new-developing pathogen detection method was a powerful tool in assisting clinical diagnosis and treatment. And it should be paid more attention to Propionibacterium acnes infection in clinical cases.

Topics: DNA, Bacterial; Fever; Gram-Positive Bacterial Infections; Hematopoietic Stem Cell Transplantation; Humans; Male; Postoperative Complications; Propionibacterium acnes; Real-Time Polymerase Chain Reaction; Rifampin; Sequence Analysis, DNA

An otherwise healthy 36-year-old man was hospitalised due to a traumatic tear of the meniscus in the left knee. An arthroscopy was performed and his meniscus was partially resected. Thirty days later, he was rehospitalised with arthritis in the left knee and cellulitis on the left tibia. Helicobacter cinaedi was isolated from the synovial fluid, which was incubated in a BACTEC Paediatric bottle. The patient was treated with oral rifampicin and moxifloxacin for 6 weeks with good clinical response without relapse. The source of the infection was not found. The case emphasises the importance of incubating the synovial fluid in a rich medium such as a BACTEC Peds Plus/F bottle. Physicians and microbiologists should be aware of H. cinaedi as a human pathogen causing a range of disease manifestations, including infective arthritis and cellulitis, particularly if symptoms evolve in the weeks following a surgical procedure.

Topics: Adult; Anti-Bacterial Agents; Arthroscopy; Fever; Fluoroquinolones; Helicobacter; Helicobacter Infections; Humans; Knee Injuries; Knee Joint; Male; Moxifloxacin; Rifampin; Species Specificity; Synovial Fluid; Treatment Outcome

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

Topics: Adult; Antibiotics, Antitubercular; Drug Therapy, Combination; Ethambutol; Fever; HIV Seropositivity; Humans; Isoniazid; Male; Pleural Effusion; Pyrazinamide; Radiography; Rifampin; Tuberculosis, Pulmonary; Young Adult

Tularemia is a rare zoonosis. The most common way is ingestion of contaminated meat or water, but the infection may also be acquired by insect bite. The clinical picture of the disease may be nonspecific. Due to polymorphisms of clinical picture, specific treatment is often delayed. In the last 50 years, in Poland, the most infections were acquired by handling hares. In our article, we present the case of a patient who was infected with Francisella tularensis due to arthropod bite. In the presented case, the diagnosis was difficult, because of the nonspecific clinical picture. Information of the epidemiology and the clinical picture changes of tularemia may have great clinical significance. Tularemia requires the special attention of physicians. All patients with lymphadenopathy and arthropod bite history should be screened for tularemia in the outpatient department and, if necessary, treated in hospital.

Topics: Adult; Animals; Anti-Bacterial Agents; Antibodies, Bacterial; Arthropod Vectors; Bites and Stings; Ceftriaxone; Fever; Francisella tularensis; Humans; Lymphatic Diseases; Male; Poland; Rifampin; Streptomycin; Treatment Outcome; Tularemia; Zoonoses

Extrapulmonary tuberculosis (TB) account for approximately 15-20% of TB cases in immunocompetent patients. The genitourinary system is the third most commonly affected site. We report the case of a 20-year-old man admitted with fever, chills, dry cough, right flank pain, and oliguria who developed renal function loss. The pyelogram evidenced silence of the right kidney, and the abdominal and pelvic magnetic resonance showed significant dilation of the right pyelocaliceal system and proximal ureter. Biopsies of renal cortex and retroperitoneal lymph nodes showed caseous granuloma consistent with TB. Treatment was started with rifampicin, isoniazid, pyrazinamide, and ethambutol, and the patient presented a favorable outcome but with non-dialytic chronic kidney disease. This case illustrates a case of chronic kidney disease secondary to TB in a young, otherwise healthy man.

Topics: Antitubercular Agents; Ethambutol; Fever; Humans; Isoniazid; Kidney Failure, Chronic; Male; Pyrazinamide; Renal Dialysis; Rifampin; Tuberculosis; Young Adult

Topics: Abdominal Pain; Adult; Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Diagnosis, Differential; Doxycycline; Female; Fever; Humans; Nausea; Rifampin; Vomiting

Leprosy is now considered in Western Europe as a strictly imported disease. A case of presumed locally acquired diffuse lepromatous leprosy was observed in a native-Portuguese woman living in France who developed an acute febrile presentation with extensive cutaneous signs.

Topics: Biopsy, Needle; Clofazimine; Dapsone; Diagnosis, Differential; Drug Therapy, Combination; Facial Dermatoses; Female; Fever; Follow-Up Studies; France; Humans; Immunohistochemistry; Leg Dermatoses; Leprosy, Lepromatous; Middle Aged; Rifampin; Risk Assessment; Severity of Illness Index; Treatment Outcome

Topics: Adult; Antitubercular Agents; Drug Therapy, Combination; Ethambutol; Fever; Humans; Isoniazid; Male; Mycobacterium Infections, Nontuberculous; Mycobacterium kansasii; Pyrazinamide; Radiography; Rifampin; Sputum; Tuberculosis, Pulmonary

Tuberculosis is an endemic disease responsible for death and morbidity in developing countries.. A 50-year-old man with no medical history was admitted to the emergency department for meningism associated with fever and confusion. The ophthalmic exam showed a decline in left visual acuity, reduced to light perception, VIth nerve left oculomotor paralysis, ocular fundus demonstrating a yellow tumor located on the posterior segment, measuring 1.5-2mm, papillomatous and prominent in the vitreous cavity. Fluorescein angiography showed a peritumoral choroiditis area, miliary tubercles of the choroid, and sectorial papillomatous edema. Color retinography unmasked inflamed posterior vitreous areas. Echography demonstrated a 4- to 5-mm oval hyperechogeneous and calcified tumor along with hyperechogeneous vitreous areas. Lumbar puncture showed lymphocytic meningitis associated with hyponatremia. The CT scan and MRI demonstrated optic neuritis. The antibiotic therapy was initiated and the outcome was favorable.. This case report shows the importance of systematic ocular fundus in the presence of systemic tuberculosis and outlines the assessment of color retinography to unmask vitreous lesions. It shows the importance of radiological imaging in the semiological study of orbital and cerebral lesions.

Topics: Adrenal Cortex Hormones; Anti-Inflammatory Agents; Antitubercular Agents; Calcinosis; Confusion; Diplopia; Drug Therapy, Combination; Fever; Humans; Isoniazid; Magnetic Resonance Imaging; Male; Meningoencephalitis; Middle Aged; Optic Neuritis; Papilledema; Pyrazinamide; Rifampin; Spinal Puncture; Streptomycin; Tuberculoma; Tuberculosis, Meningeal; Ultrasonography

Over six months, 129 consecutive brucellosis cases were diagnosed in females attending the outpatients' clinics the females in Al-Azhar and Ain Shams Universities Hospitals. Their ages ranged between 12-65 years old. 113 (87.6%) gave history of raw milk consumption, 13 (10%) gave history of home slaughtering of sheep, 2 (1.5%) gave history of animal contact, and one patient gave history of abortion, that partner had brucellosis. A total of 61.2% of patients gave serum agglutination test of 1: 640, who suffered acute or subacute infection. Titers of 1:320 (38.8%) were found in the majority of chronic cases. Causes of endemic parasitosis were excluded. Symptoms were fever (79.5%), headache (72.4%), generalized arthralgia (65.3%), sweating (65.3%), chills (63.8%), backache (34.6%), abdominal pain (27.5%), loss of appetite (25.5%), lassitude (17.2%), myalgia (14.2%), monoarthralgia (7.9%). Spinal involvement was in 15% patients, who had chronic brucellosis. 32/35 were successfully treated with a combination of streptomycin and tetracycline, 17/21 with streptomycin and septrin, 38/43 with tetracycline and septrin, and 26/26 (100%) with rifampicin and tetracycline or septrin, which treated all resistant patients.

Topics: Acute Disease; Adolescent; Adult; Age Factors; Aged; Anti-Bacterial Agents; Brucellosis; Child; Chronic Disease; Drug Therapy, Combination; Egypt; Female; Fever; Humans; Middle Aged; Rifampin; Risk Factors; Streptomycin; Tetracycline; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Antitubercular Agents; Drug Therapy, Combination; Female; Fever; Glucocorticoids; Humans; Immunocompromised Host; Isoniazid; Liver Cirrhosis, Biliary; Liver Transplantation; Middle Aged; Mycobacterium tuberculosis; Pericardiocentesis; Pericarditis, Tuberculous; Prednisolone; Pyrazinamide; Rifampin; Treatment Outcome

Topics: Adult; Antigens, Bacterial; Dapsone; Facial Dermatoses; Fever; Humans; Leprostatic Agents; Leprosy, Borderline; Male; Mycobacterium leprae; Peripheral Nervous System Diseases; Philippines; Prednisone; Rifampin; Uveitis

Topics: Abscess; Adult; Anti-Bacterial Agents; Cloxacillin; Endocarditis, Bacterial; Fever; Humans; Levofloxacin; Male; Methicillin Resistance; Ofloxacin; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Tricuspid Valve

Topics: Abdominal Pain; Adult; Animals; Brucella; Brucellosis; Calcinosis; Combined Modality Therapy; Doxycycline; Drug Therapy, Combination; Fever; Food Contamination; Food Microbiology; Hepatectomy; Humans; Liver Abscess; Male; Milk; Recurrence; Rifampin

Brucellosis remains a major zoonotic disease worldwide. It has never been reported at King Chulalongkorn Memorial Hospital (KCMH). The authors describe the first case of brucellosis in KCMH, and also review all previous reports in Thailand. The presented case was a 52-year-old Thai man, living in Phetchabun Province, who was diagnosed with idiopathic pulmonary fibrosis two years prior to admission. He presented with prolonged fever, dry cough, weight loss of eight kg over three months, hepatosplenomegaly, and pancytopenia. Blood and bone marrow cultures grew Brucella melitensis at 72 hours of incubation. A slide agglutination (Rose Bengal) test was also positive for Brucella antibody. He had been exposed to contaminated placenta of his goats that had spontaneous abortion in the past few months before his illness. The patient was successfully treated with gentamicin, doxycycline, and rifampicin. Clinicians should have a high index of suspicion when evaluating patients presenting with prolonged fever and having an exposure risk of brucellosis.

Topics: Animals; Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Doxycycline; Drug Therapy, Combination; Enzyme Inhibitors; Fever; Fluorescent Dyes; Gentamicins; Goats; Hospitals; Humans; Literature; Male; Middle Aged; Rifampin; Rose Bengal; Thailand

To present a case of successful emergency endovascular repair of a ruptured, probably mycotic, thoracoabdominal aortic aneurysm (TAAA) with a stent-graft deliberately covering the celiac axis.. A 79-year-old woman with significant pulmonary comorbidity presented with a ruptured mycotic TAAA extending to the celiac axis. The aneurysm was excluded with a stent-graft soaked in rifampicin and deployed to deliberately occlude the celiac axis for effective distal sealing and fixation. The patient recovered well and was prescribed antibiotic treatment for up to 6 months.. Endovascular repair of a ruptured TAAA may be a life-saving option. In emergency situations when poor distal anatomy is present, covering the celiac artery with the stent-graft should be considered.

Topics: Abdominal Pain; Aged; Aneurysm, Infected; Angiography; Angioplasty, Balloon; Anti-Bacterial Agents; Antibiotics, Antitubercular; Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Aortic Rupture; Blood Vessel Prosthesis Implantation; Celiac Artery; Diarrhea; Emergencies; Fatigue; Female; Fever; Humans; Patient Selection; Prosthesis Design; Rifampin; Stents; Tomography, X-Ray Computed; Treatment Outcome

Topics: Aged; Anti-Bacterial Agents; Bacteremia; Catheters, Indwelling; Diabetes Complications; Discitis; Endocarditis, Bacterial; Fever; Heart Valve Prosthesis; Humans; Hyperparathyroidism, Secondary; Incidence; Kidney Failure, Chronic; Lumbar Vertebrae; Methicillin Resistance; Prognosis; Renal Dialysis; Rifampin; Spain; Staphylococcal Infections; Staphylococcus aureus; Vancomycin

Neuromeningeal tuberculosis of deleterious, paradoxical, progression despite appropriate antibiotic therapy is rare.. An immunocompetent woman exhibited an immediately disseminated form of tuberculosis with progressive neurological involvement associating expanding intracranial tuberculomas and meningeal-radiculitis despite adapted anti-tuberculosis quadritherapy.. During anti-tuberculosis therapy clinical worsening is rare, particularly when 2 different manifestations are associated and the worsening occurs in an immunocompetent patient. This possibility should be systematically evoked in such cases. The explanation of this phenomenon is still unclear.

Topics: Aged; Anti-Inflammatory Agents; Antitubercular Agents; Confusion; Disease Progression; Drug Therapy, Combination; Female; Fever; Humans; Immunocompetence; Isoniazid; Magnetic Resonance Imaging; Ofloxacin; Prednisone; Radiculopathy; Rifampin; Spinal Puncture; Tomography, X-Ray Computed; Treatment Outcome; Tuberculoma; Tuberculoma, Intracranial; Tuberculosis, Meningeal

Brucellosis is a zoonosis that affects several organs and has a protean presentation. The authors report the case of a 61-year-old male patient with brucellar spondylodiscitis involving several vertebrae and a paravertebral abscess localized in the erector spinae muscle. Diagnosis was made by positive blood culture and MRI. No relapse was seen with a combined treatment (doxycycline/rifampin) for 3 months, followed by doxycycline alone for 6 months. Almost all radiologic findings disappeared at the end of a 1-year follow-up without any further treatment.

Topics: Abscess; Anti-Bacterial Agents; Brucella; Brucellosis; Discitis; Doxycycline; Drug Therapy, Combination; Fever; Humans; Low Back Pain; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Middle Aged; Rifampin; Thoracic Vertebrae; Treatment Outcome

Topics: Adult; Antitubercular Agents; Bone and Bones; Combined Modality Therapy; Drug Therapy, Combination; Ethambutol; Fever; Humans; Isoniazid; Knee; Male; Pain; Pyrazinamide; Radiography; Radius; Rifampin; Treatment Outcome; Tuberculosis, Osteoarticular; Weight Loss; Wrist

Topics: Antibiotics, Antitubercular; Drug Therapy, Combination; Female; Fever; Haemophilus Infections; Haemophilus influenzae; Humans; Infant, Newborn; Male; Pregnancy; Rifampin

Topics: Anti-Bacterial Agents; Antitubercular Agents; Biopsy, Fine-Needle; Child; Combined Modality Therapy; Drug Therapy, Combination; Ethambutol; Fever; Humans; Isoniazid; Laparotomy; Male; Mycobacterium tuberculosis; Pyrazinamide; Rifampin; Tomography, X-Ray Computed; Tuberculoma; Tuberculosis, Urogenital; Ultrasonography, Interventional; Urination Disorders

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

The incidence of acute rheumatic fever has seen a dramatic decline over the last 15 to 20 years in most developed countries and treatment of this disease has changed little since. The ease of travel and immigration and the cosmopolitan nature of many cities mean that occasionally the disease will come to the attention of clinicians not familiar with its presentation, resulting in delayed diagnosis and treatment. We present a case of recurrent acute rheumatic fever in a patient who was initially thought to be suffering from acute bacterial endocarditis on her previously diseased rheumatic aortic valve. This culminated in her undergoing urgent aortic valve replacement during a phase of the illness that should have been treated with high dose anti-inflammatory medication. Therefore, clinicians should be aware of this condition and include it in their differential diagnosis of the febrile patient with a previous history of rheumatic fever. We briefly discuss the diagnostic dilemma of patients suffering from this condition and in differentiating it from acute endocarditis.

Topics: Acute Disease; Adult; Amoxicillin; Anti-Inflammatory Agents; Aortic Valve; Aortic Valve Insufficiency; Arthralgia; Bangladesh; Clarithromycin; Diagnosis, Differential; Diagnostic Errors; Drug Therapy, Combination; Emigration and Immigration; Endocarditis, Bacterial; England; Female; Fever; Gentamicins; Heart Failure; Heart Valve Prosthesis Implantation; Humans; Penicillin G; Penicillin V; Pericarditis; Pharyngitis; Prednisone; Recurrence; Rheumatic Fever; Rheumatic Heart Disease; Rifampin; Unnecessary Procedures; Vancomycin

Topics: Antibiotics, Antitubercular; Biopsy; Cat-Scratch Disease; Fever; Granuloma; Humans; Infant; Male; Rifampin; Spleen; Splenomegaly

In spite of a decreasing incidence of tuberculosis in highly industrialized countries, an obvious increase of the disease is observed worldwide. In times of progressing international migration, the early detection of tuberculosis is also becoming important in Germany. The diagnosis, however, is often impaired by unspecific symptomatology and ambiguous imaging results.. A 27-year-old patient from Iraq presented with unclear recurring and antibiotic-resistant fever and inconspicuous thoracic X-ray. Only by thoracic computed tomography, markedly necrotizing mediastinal lymph nodes could be detected. Following lymph node biopsy and histologic investigation, the diagnosis of mediastinal lymph node tuberculosis could be ascertained. Test-adjusted antituberculotic combination treatment resulted in a normalization of body temperature and cessation of complaints. Starting from the case report presented, the importance of various investigative methods for the quick and secure diagnosis of tuberculosis and subsequent therapy are discussed.. Unclear febrile disease even in young patients with an inconspicuous conventional thoracic X-ray may be caused by tuberculosis. In this situation, early extension of imaging diagnostics appears to be advantageous.

Topics: Adult; Antibiotics, Antitubercular; Antitubercular Agents; Fever; Humans; Isoniazid; Lymph Nodes; Male; Mediastinoscopy; Mycobacterium tuberculosis; Radiography, Thoracic; Recurrence; Rifampin; Tomography, X-Ray Computed; Tuberculosis, Lymph Node

An 81-year-old man was admitted to hospital with pulmonary Mycobacterium tuberculosis infection and was treated with rifampicin (RFP), isoniazid (INH), and ethambutol (EB). On day 9 he developed fever and dyspnoea. Chest radiographs showed new infiltration shadows in the right lung. Bronchoalveolar lavage (BAL) was performed and increased numbers of lymphocytes were recovered. Drug induced pneumonitis was suspected so the antituberculous regimen was discontinued and methylprednisolone was administered. The symptoms and infiltration shadows improved. INH and EB were reintroduced without any recurrence of the abnormal shadows. T cell subsets in the BAL fluid and a positive lymphocyte stimulation test for RFP suggest that RFP induced pneumonitis may be related to a complex immunological response.

Topics: Aged; Aged, 80 and over; Antibiotics, Antitubercular; Cough; Fever; Humans; Male; Mycobacterium tuberculosis; Pneumonia; Rifampin; Tuberculosis, Pulmonary

Extrapulmonary tuberculosis is known to be the infection in an organ with or without pulmonary involvement. The infection in extrapulmonary tuberculosis is insidious and the symptoms and signs are generally nonspecific. We describe a 56-year-old male patient complaining of weight loss, fever, and night sweats. Although there were no signs and symptoms attributable to pulmonary tuberculosis, polymerase chain reaction (PCR), microscobical and cultural examination of bone marrow aspirate revealed isolated bone marrow tuberculosis. A treatment protocol of isoniazid, rifampicin, pyrazinamide, and streptomycin was administered. After 9 months of treatment, re-examination of the bone marrow revealed no signs of tuberculosis. Tuberculosis should be kept in mind especially in endemic areas and bone marrow should be examined in case of suspected tuberculosis infection.

Topics: Antitubercular Agents; Bone Marrow; Diagnosis, Differential; Fever; Humans; Isoniazid; Male; Middle Aged; Pyrazinamide; Rifampin; Streptomycin; Sweating; Tuberculosis, Miliary; Weight Loss

A 10-year-old girl with chronic myelogenous leukemia began receiving cyclosporine the day before bone marrow transplant surgery Three days after the transplant, she developed fever and neutropenia due to a Staphylococcus aureus bacteremia. Despite treatment with various antibiotics, the patient's fever persisted over the next 4 days. Intravenous rifampin was added to her antibiotic regimen of piperacillin, tobramycin, cloxacillin, and amphotericin. On day 12, the patient's blood cultures were negative and her fever had resolved; rifampin was discontinued. On day 16, the patient engrafted; she subsequently developed a grade II graft-versus-host disease of the skin and gastrointestinal tract, which responded to methylprednisolone. Her cyclosporine blood levels, which had been subtherapeutic since day 5 despite increasing intravenous dosages, were within the therapeutic range on day 21, and she was discharged 12 days later. To our knowledge, this is the first documented case of an intravenous cyclosporine-rifampin interaction that resulted in subtherapeutic cyclosporine concentrations in a child receiving a bone marrow transplant who subsequently developed acute graft-versus-host disease.

Topics: Antibiotics, Antitubercular; Bacteremia; Bone Marrow Transplantation; Child; Cyclosporine; Drug Interactions; Female; Fever; Graft vs Host Disease; Humans; Immunosuppressive Agents; Infusions, Intravenous; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Neutropenia; Rifampin; Staphylococcal Infections; Staphylococcus aureus

The psoas abscess is a rare complication in obstetric and gynaecology. Two types of psoas abscess are recognized. The primary psoas abscess is generally following haematogenous dissemination of an infectious agent and the source is usually occult. The most frequently isolated pathogen is Staphylococcus aureus. On the other hand, the secondary abscess is the result of local extension of an infectious process near the psoas muscle. We report the case of a patient who develops a bacteremia from an infected cesarean section wound. The complications were thigh and psoas abscesses with left sacroiliitis. Medical management with prolonged antibiotherapy permit clinical, biological and radiological improvement. Although it required a long hospital stay, medical treatment alone was effective. More experience is required to determine which therapeutic option: medical treatment and/or surgery, is the best choice for this type of complication.

Topics: Adult; Bacteremia; Cesarean Section; Female; Fever; Humans; Klebsiella Infections; Klebsiella pneumoniae; Magnetic Resonance Imaging; Oxacillin; Penicillins; Pregnancy; Psoas Abscess; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Tomography, X-Ray Computed

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

Short course regimens; 2HRZ (E)(S)/4HR (E), 6HRS (E)/3-6HR and 6-9HR have been accepted as a standard chemotherapy (SC) for initial treatment of pulmonary tuberculosis in Japan. We studied the frequency of the treatment completion, the causes of the treatment failure and the outcome of the patients in whom INH or RFP was discontinued within 6 months after starting SC. The subjects included 597 newly diagnosed culture positive pulmonary tuberculosis patients admitted to 16 national hospital in 1996. Results were as follows. 1. In 47 (7.9%) of the 597 patients, either INH (19; 3.2%) or RFP (33; 5.5%) was discontinued. These 47 cases were defined as a SC incompleted group and the other 550 as a SC completed group. 2. The patients in the SC incompleted group were seen more frequently in the ages of 20s (11.9%), 50s (10.9%), 60s (11.7%) or 70s (11.4%). 21 (13.6%) of 154 female patients and 26 (5.9%) of 443 male patients were in the SC incompleted group. 3. The causes of cessation of INH or RFP were drug side effects (33; 5.5%), drug resistance (10; 1.7%) and complications or underlying diseases (8; 1.3%). 4. Fever or eruption (19; 3.2%) and drug induced hepatitis (12; 2.0%) were frequently seen as drug related side effects causing the cessation of INH or RFP. 5. The rate of culture negative conversion of TB bacilli at 6 months after the start of the treatment was 98.9% in the SC completed and 88.9% in the SC incompleted group respectively. In the SC incompleted group, there were three cases continuously positive and two other patients who relapsed and became culture positive again. In these five patients, INH or RFP was discontinued because of drug resistance.

Topics: Adolescent; Adult; Aged; Antibiotics, Antitubercular; Antitubercular Agents; Chemical and Drug Induced Liver Injury; Drug Eruptions; Female; Fever; Humans; Isoniazid; Male; Middle Aged; Rifampin; Sex Factors; Tuberculosis, Multidrug-Resistant; Tuberculosis, Pulmonary

The use of anthrax as a weapon of biological terrorism has moved from theory to reality in recent weeks. Following processing of a letter containing anthrax spores that had been mailed to a US senator, 5 cases of inhalational anthrax have occurred among postal workers employed at a major postal facility in Washington, DC. This report details the clinical presentation, diagnostic workup, and initial therapy of 2 of these patients. The clinical course is in some ways different from what has been described as the classic pattern for inhalational anthrax. One patient developed low-grade fever, chills, cough, and malaise 3 days prior to admission, and then progressive dyspnea and cough productive of blood-tinged sputum on the day of admission. The other patient developed progressively worsening headache of 3 days' duration, along with nausea, chills, and night sweats, but no respiratory symptoms, on the day of admission. Both patients had abnormal findings on chest radiographs. Non-contrast-enhanced computed tomography of the chest showing mediastinal adenopathy led to a presumptive diagnosis of inhalational anthrax in both cases. The diagnoses were confirmed by blood cultures and polymerase chain reaction testing. Treatment with antibiotics, including intravenous ciprofloxacin, rifampin, and clindamycin, and supportive therapy appears to have slowed the progression of inhalational anthrax and has resulted to date in survival.

Topics: Anthrax; Anti-Bacterial Agents; Bacillus anthracis; Bioterrorism; Blood; Ciprofloxacin; Clindamycin; District of Columbia; Dyspnea; Fever; Humans; Lymphatic Diseases; Male; Mediastinal Diseases; Middle Aged; Occupational Exposure; Pleural Effusion; Polymerase Chain Reaction; Postal Service; Radiography, Thoracic; Respiratory Tract Infections; Rifampin; Spores, Bacterial; Survivors; Tomography, X-Ray Computed

To determine whether foals with pneumonia that were treated with erythromycin, alone or in combination with rifampin or gentamicin, had a higher risk of developing adverse effects, compared with foals treated with trimethoprim-sulfamethoxazole (TMS), penicillin G procaine (PGP), or a combination of TMS and PGP (control foals).. Retrospective study.. 143 foals < 240 days old.. Information on age, sex, breed, primary drug treatment, total days of treatment with the primary drug, and whether the foal developed diarrhea, hyperthermia, or respiratory distress was obtained from the medical records. Relative risk (RR) and attributable risk (AR) were calculated to compare risk of adverse reactions between foals treated with erythromycin and control foals.. Only 3 (4.3%) control foals developed diarrhea; none developed hyperthermia or respiratory distress. Foals treated with erythromycin had an 8-fold risk (RR, 8.3) of developing diarrhea, compared with control foals, and increased risks of hyperthermia (AR, 25%) and respiratory distress (AR, 15%).. Results suggest that use of erythromycin to treat foals with pneumonia was associated with an increased risk of diarrhea, hyperthermia, and respiratory distress, compared with use of TMS or PGP.

Topics: Animals; Animals, Newborn; Anti-Bacterial Agents; Anti-Infective Agents; Antibiotics, Antitubercular; Diarrhea; Drug Therapy, Combination; Erythromycin; Female; Fever; Gentamicins; Horse Diseases; Horses; Male; Penicillin G Procaine; Penicillins; Pneumonia; Respiratory Insufficiency; Retrospective Studies; Rifampin; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination

To analyse the impact of intensified prophylaxis with ofloxacin plus rifampin (O+R) in neutropenic patients we used this combination in 40 consecutive cycles of ifosfamide, cytarabine, prednisolone and etoposide (IAPVP-16). This salvage chemotherapy regimen for lymphoma usually produces four to six days of severe neutropenia without significant extrahematologic toxicities. We compared the infectious morbidity during neutropenia under O+R with 58 consecutives cycles using either norfloxacin or no prophylaxis (control group). Fifty-three percent of control group patients and 20% of the O+R group developed febrile neutropenia that required hospital admission (p<0.001, 95% CI for the difference between both proportions of 16% to 51%). Bacteremia was documented in two patients in the O+R group and six in the control group (p=0.08). Gram-positive cocci (GPC) accounted for all six bacteremias in the control group, while both cases in O+R group were due to a quinolone-resistant gram-negative bacteria (GNB) (p<0.01 for GPC). Five patients (13%) who received O+R and 23 (40%) in control group developed fever of unknown origin, p<0.001, while the total duration of hospitalization due to febril neutropenia was 42 days and 158 days, respectively (p<0.001). In conclusion, intensified prophylaxis with O+R appears to reduce the rate of febrile neutropenia and GPC bacteremia in patients with short and severe neutropenia, which translates into a reduction in the need for hospitalization.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Antineoplastic Combined Chemotherapy Protocols; Bacteremia; Carmustine; Cyclophosphamide; Etoposide; Female; Fever; Hodgkin Disease; Humans; Length of Stay; Lymphoma; Male; Middle Aged; Neutropenia; Ofloxacin; Opportunistic Infections; Rifampin; Salvage Therapy

Intravesical bacillus Calmette-Guerin (BCG) is widely used in the management of bladder cancer but because it is a living organism, local and disseminated infection may result.. A prospective assessment of complications of this therapy in 200 patients in Queensland was performed. A review of management of complications of intravesical BCG was also carried out.. Major side effects were rare. Cystitis was the most common side effect, being seen to some degree in all patients, although only forcing cessation of BCG therapy in two patients. Two patients developed persistent cystitis necessitating institution of isoniazid and rifampicin. Two patients had culture-proven bladder infection that presented several months after the BCG treatment. These patients also responded to two-drug antituberculous therapy. While low-grade fever is very common with this therapy, seven patients (3.5%) had fevers of > 39 degrees C within 48 h of receiving BCG. Fevers may be an indication of severe disseminated mycobacterial infection, which has a high mortality, so it needs to be treated aggressively. Alternatively bacterial sepsis with gram-negative bacterial pathogens or a hypersensitivity reaction to BCG may cause this degree of fever, and cannot be rapidly distinguished from fulminant mycobacterial infection. One patient in the present series developed pneumonia attributed to mycobacterial dissemination.. The key to appropriate management of complications of BCG therapy is awareness of their possibility, even months or years after the therapy has been given. Appropriate empirical therapy in acute situations and mycobacterial culture in chronic situations can then be performed.

Topics: Administration, Intravesical; Aged; Aged, 80 and over; Amoxicillin; Antitubercular Agents; BCG Vaccine; Carcinoma, Transitional Cell; Cystitis; Drug Therapy, Combination; Female; Fever; Gentamicins; Humans; Immunotherapy; Isoniazid; Male; Middle Aged; Prospective Studies; Rifampin; Urinary Bladder Neoplasms; Urinary Tract Infections

Topics: Antitubercular Agents; Fever; Humans; Isoniazid; Rifampin; Tuberculosis, Pulmonary

Infective endocarditis is an uncommon disease but retains a high mortality. Glycopeptides are used for patients with resistant pathogens, those allergic to penicillins or for those outside the hospital. The once daily administration of teicoplanin and its low toxicity suggest that it would be suitable for use in the long courses required for endocarditis. However, the dosage and combinations to be used require further study. A retrospective review has been made of 104 episodes of endocarditis treated with teicoplanin in 101 patients seen over 7 years. Most patients had been referred to major London hospitals following failure of medical treatment. After three loading doses of 400 mg, teicoplanin was given at a dose of 400 mg/day in combination with other antibiotics such as gentamicin. Follow up was for one year. The most common pathogens were Streptococcus sanguis (15 cases), Staphylococcus aureus (13 cases) and Staphylococcus epidermidis (10 cases). Of 80 patients febrile at the start of treatment with teicoplanin, 63 (79%) lost their fever within a median of 2 days (1-35 days). Cure without surgery was effected in 50 (48%) and 75% of patients survived. Other antibiotics, usually gentamicin or rifampicin, were used in 92 (90%) of patients. Two strains of Streptococcus spp. were said to be resistant but there was no relationship between MIC of teicoplanin and outcome. Pathogens with a high MBC tended to be more likely to resist treatment. Adverse effects resulted in the withdrawal of teicoplanin in 20 cases (19%) but most events were mild and renal deterioration occurred in only five patients. Teicoplanin was effective in the treatment of endocarditis and appeared to be safe given the severity of disease in the patients treated.

Topics: Adult; Aged; Anti-Bacterial Agents; Aortic Valve; Endocarditis; Female; Fever; Fusidic Acid; Gentamicins; Humans; London; Male; Microbial Sensitivity Tests; Middle Aged; Prostheses and Implants; Retrospective Studies; Rifampin; Staphylococcus aureus; Staphylococcus epidermidis; Streptococcus sanguis; Teicoplanin; Time Factors; Treatment Outcome

Topics: Antitubercular Agents; Chronic Disease; Drug Resistance; Fever; Humans; Intestinal Absorption; Isoniazid; Male; Middle Aged; Pyrazinamide; Rifampin; Tuberculosis, Pulmonary

Topics: Antibodies, Bacterial; Bartonella henselae; Cat-Scratch Disease; Child; Fever; Humans; Male; Polymerase Chain Reaction; Rifampin; RNA, Bacterial; RNA, Ribosomal, 16S

Topics: Adult; Antigen-Antibody Complex; Drug Hypersensitivity; Female; Fever; Headache; Humans; Leprosy; Male; Nausea; Rifampin; Syndrome; Vomiting

Tuberculosis may be diagnosed too late, especially in HIV-infected patients, with consequences on bacillus transmission and survival. Empiric antibuberculosis treatment (EATT) may be started before diagnosis of tuberculosis is confirmed. As rifampicin is a broad spectrum antibiotic, EATT including rifampicin may be effective in infections other than tuberculosis, leading to misdiagnosis.. To define the efficiency criteria of EATT with or without rifampicin.. Between 1988 and 1991, 20 febrile patients with suspected tuberculosis (including 15 who were HIV-positive) were started on EATT in the absence of bacteriological or histological proof of tuberculosis. 10 patients (50%) received a 4-drug non-specific EATT including rifampicin, isoniazid, pyrazinamide and ethambutol, and 10 (50%), received a 3-drug specific EATT without rifampicin.. In 10 patients (50%), the diagnosis of tuberculosis was confirmed by positive cultures within a mean of 32 days (15-57 days) after the beginning of EATT (group TB 1). Of the 10 patients whose cultures remained negative, 4 (20%) became afebrile and showed improvement under EATT (group TB 2), and 6 (30%) remained febrile and did not improve (group No TB). Patients from groups TB 1 and TB 2 became afebrile within a mean of 11 days (1-54 days). This delay was not different between patients receiving specific or non-specific EATT. In patients receiving specific EATT, rifampicin was added to the initial 3-drug treatment after resolution of fever.. EATT appears to be a useful method for rapid presumptive diagnosis and treatment of tuberculosis.

Topics: Adult; AIDS-Related Opportunistic Infections; Antitubercular Agents; Body Weight; Drug Administration Schedule; Drug Therapy, Combination; Ethambutol; Female; Fever; Follow-Up Studies; Humans; Isoniazid; Male; Middle Aged; Pyrazinamide; Rifampin; Time Factors; Treatment Outcome; Tuberculosis

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

Topics: Adult; Fever; Humans; Lupus Erythematosus, Systemic; Male; Rifampin

Two cases of 'flu' syndrome on once monthly rifampicin are reported. The symptoms were reproduced in one patient with the next supervised dose. In the second patient they did not recur probably because she was receiving systemic steroids for left ulnar neuritis.

Topics: Adult; Dizziness; Drug Administration Schedule; Female; Fever; Humans; Leprosy, Borderline; Rifampin; Shivering; Syndrome

Pharmacokinetics of rifampicin (20 mg/kg orally or i.v.) was determined in calves and rabbits. Seven days later a model pyrogen was administered i.v. to the same animals and 1 hr later the rifampicin administration was repeated. The pharmacokinetic analysis of oral rifampicin was performed using a one-compartment open model with absorption. Intravenously administered rifampicin was analysed by a two-compartment intravascular model. Injection of peptidoglycan in pyrogenic doses led to a significant increase of orally applied rifampicin serum levels in both animal species. The i.v. administration of rifampicin had the same parameters in the control and peptidoglycan experiments. Daily pretreatment of rabbits with small doses of peptidoglycan induced tolerance to the pyrogenic effect. In tolerant animals we did not observe any changes of rifampicin serum levels. Elevated temperature alone was not responsible for observed pharmacokinetic changes leading to the increase of bioavailability of oral rifampicin since another pyrogenic substance (endotoxin) had an opposite effect on pharmacokinetics of previously tested drugs.

Topics: Administration, Oral; Animals; Cattle; Chinchilla; Fever; Gram-Positive Bacteria; Injections, Intravenous; Male; Peptidoglycan; Pyrogens; Rabbits; Rifampin

Changes of pharmacokinetics of rifampicin (20 mg . kg-1 orally) were seen in rabbits pretreated with 0.02, 0.2 and 2.0 micrograms . kg-1 of endotoxin S. typhimurium given intravenously. The animals served as their own controls. The two higher endotoxin doses induced significantly lower plasma levels and changes in the absorption and elimination phase. After the lowest endotoxin dose the results were variable. Tolerance to pyrogenicity of endotoxin, produced by daily toxin administration abolished the otherwise induced changes in rifampicin pharmacokinetics.

Topics: Animals; Cattle; Diarrhea; Endotoxins; Fever; Intestinal Absorption; Kinetics; Male; Rabbits; Rifampin; Salmonella typhimurium; Species Specificity

Between January 1976 and June 1981, 814 patients with pulmonary tuberculosis were treated for 9 months with isoniazid (INH) and rifampin (RIF), daily for 1 month and twice weekly for the other 8 months. Overall success was achieved in 95% of the 586 patients who completed therapy: in 15 patients (2.9%), sputum cultures failed to convert to negative during therapy, and 10 patients (1.7%) have relapsed since stopping the chemotherapy. Major toxic effects occurred in 22 patients; in 14 during the daily phase and in 8 during the twice-weekly phase. Hepatic toxicity occurred in 13 patients during daily and in 5 during twice-weekly treatment, and it was caused by RIF in 5, INH in 10, and was undetermined in 3. Hematologic abnormalities developed in 4 patients: in 1 during the daily and in 3 during the twice-weekly phase. Minor side effects, which were not life threatening, were encountered in 62 patients: in 35 during the daily and in 27 during the twice-weekly therapy. These were gastrointestinal intolerance in 18, drug fever in 27 (including 11 with "flu-syndrome" during twice-weekly administration), cutaneous rashes in 14, and headache, general malaise, and weakness in 3. These side effects were produced by RIF in 43, by INH in 18, and the responsible drug was not identified in 1. Hypersensitivity reactions to twice-weekly administration of RIF were infrequent. Clinical surveillance for toxicity is preferred over routine and regular biochemical monitoring.

Topics: Adolescent; Adult; Aged; Chemical and Drug Induced Liver Injury; Drug Therapy, Combination; Female; Fever; Gastrointestinal Diseases; Hematologic Diseases; Humans; Isoniazid; Male; Middle Aged; Rifampin; Skin Diseases; Tuberculosis, Pulmonary

In a 48-year-old man, a consistent pattern of spiking fever occurred ten days after the initiation of therapy with isoniazid and rifampin. The fever recurred upon rechallenge with isoniazid, but not with rifampin. Isoniazid has the potential to induce fever, and this is thought to be a hypersensitivity reaction.

Topics: Drug Hypersensitivity; Fever; Humans; Isoniazid; Male; Middle Aged; Rifampin; Time Factors

Sixteen patients were given high-dose intermittent rifampicin treatment (900 mg twice weekly) in order to record side-effects of the flu-type. Three patients who experienced a febrile reaction were re-challenged under strict hospital supervision with a single dose (900 mg) of rifampicin. Two patients showed a distinct febrile response together with rapidly subsiding symptoms typical of the rifampicin-induced flu-syndrome, whereas the third patient's reaction was clinically different. During the challenge, the changes in a number of laboratory tests were indicative of a mild haemolytic reaction in the two patients with flu-syndrome. Plasma haemoglobin steeply increased within a few hours following the ingestion of the dose. This was associated with an acute increase in the total bilirubin and with a gradual decrease in the blood haemoglobin and haematocrit values. In further support of a drug-induced haemolysis was the findings that both patients showed a distinct reticulocyte response several days after the challenge. No such changes were seen in the third patient, whose reaction was later demonstrated to be related to isoniazid. The flu-syndrome thus may represent a first warning sign of intravasal haemolysis, which, if massive enough, eventually could lead to haemolytic crises and renal failure.

Topics: Anemia, Hemolytic; Bilirubin; Fever; Hematocrit; Hemoglobins; Hemolysis; Humans; Rifampin; Tuberculosis, Pulmonary

Topics: Female; Fever; Humans; Male; Rifampin

The course of fever was examined in 75 patients with pulmonary tuberculosis treated with modern chemotherapy. Sixteen patients (21%) were afebrile and differed from 59 febrile patients (79%) by having lower incidences of the following: symptoms (p < 0.02), alcoholism (p < 0.01), lung cavitation (p < 0.01), "far advanced disease" (p < 0.05), and sputum smears containing "numerous" acid-fast bacilli (p < 0.01). Resolution of fever was variable (mean, 16 days; median, 10 days; range, 1 to 109 days). Thirty-eight patients (64%) became afebrile within 2 wk (group 1); 21 (36%) had fever for longer than 2 wk (group 2). Far advanced disease and high temperature (> 38.8 degrees C) on admission were more frequent in group 2 (p < 0.05 and p < 0.01, respectively). However, the groups did not differ in demographic features or in the frequency of symptoms on admission, alcoholism, lung cavitation, numerous acid-fast bacilli on sputum smears, or coexisting bacterial respiratory infection. Antimicrobial drug treatment of presumed coexistent bacterial infection in 19 febrile patients did not influence the course of fever. Analysis of variance and covariance were used to compare the independent effects of various antituberculosis drug regimens on the course of fever; no significant differences were observed.

Topics: Alcoholism; Antitubercular Agents; Bacterial Infections; Drug Therapy, Combination; Ethambutol; Female; Fever; Humans; Isoniazid; Lung; Male; Middle Aged; Rifampin; Sputum; Streptomycin; Time Factors; Tuberculosis, Pulmonary

Topics: Antibodies; Chemical Precipitation; Cross Reactions; Fever; Humans; Immunodiffusion; Rifampin; Time Factors; Tuberculosis

Topics: Alcoholism; Ethambutol; Fever; Humans; Isoniazid; Rifampin; Tuberculin Test; Tuberculosis, Pulmonary

Two patients who developed reversible renal failure during intermittent rifampicin therapy are described. Both had febrile reactions to rifampicin. The first was also found to have uraemia associated with swelling of the glomerular endothelial cells. The second developed tubular necrosis unassociated with haemolysis or shock. The pathogenesis of the renal lesion in these two patients, as revealed by light microscopy, immunofluorescence studies and electron microscopy, is discussed.

Topics: Acute Kidney Injury; Adult; Antibodies; Endothelium; Ethambutol; Fever; Fibrin; Humans; Immune Complex Diseases; Ischemia; Kidney Glomerulus; Kidney Tubules; Male; Necrosis; Rifampin; Tuberculosis, Pulmonary; Uremia

Topics: Anemia, Hemolytic; Coombs Test; Fever; Humans; Jaundice; Pain; Rifampin; Thrombocytopenia

Topics: Adolescent; Adrenal Cortex Hormones; Anemia; Antibodies; BCG Vaccine; Biopsy; Bone Marrow Diseases; Ethambutol; Female; Fever; Hepatomegaly; Humans; Immunity, Cellular; Immunoglobulins; Immunologic Deficiency Syndromes; Iron; Isoniazid; Leukocyte Count; Lymph Nodes; Lymphocytes; Lymphopenia; Mycobacterium bovis; Mycobacterium Infections; Rifampin; Splenic Diseases; Splenomegaly; Tuberculin Test

Topics: Antibody Formation; Drug Therapy, Combination; Ethambutol; Fever; Humans; In Vitro Techniques; Lymphocytes; Rifampin; Thrombocytopenia

Topics: Adult; Female; Fever; Humans; Isoniazid; Radiography; Rifampin; Sacroiliac Joint; Streptomycin; Tuberculosis, Miliary; Tuberculosis, Osteoarticular

Topics: Aminosalicylic Acids; Biopsy, Needle; Chemical and Drug Induced Liver Injury; Child; Drug Eruptions; Ethambutol; Fever; Humans; Isoniazid; Liver; Male; Pain; Rifampin; Streptomycin; Tuberculosis, Pulmonary

Topics: Acute Kidney Injury; Adolescent; Cycloserine; Drug Therapy, Combination; Dyspnea; Ethambutol; Ethionamide; Fever; Follow-Up Studies; Headache; Humans; Purpura, Thrombocytopenic; Pyrazinamide; Rifampin; Time Factors; Tuberculosis, Pulmonary

Topics: Antibody Formation; Antigen-Antibody Reactions; Drug Therapy, Combination; Fever; Headache; Humans; Isoniazid; Nausea; Purpura, Thrombocytopenic; Pyridoxine; Rifampin; Streptomycin; Tuberculosis, Pulmonary

Topics: Drug Therapy, Combination; Ethambutol; Fever; Headache; Humans; Isoniazid; Kidney Diseases; Rifampin; Streptomycin; Time Factors; 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

Topics: Body Weight; Drug Therapy, Combination; Ethambutol; Female; Fever; Headache; Humans; Male; Nausea; Pain; Purpura, Thrombocytopenic; Rifampin; Time Factors; Tuberculosis, Pulmonary; Vomiting

Topics: Acute Kidney Injury; Antibodies; Drug Therapy, Combination; Ethambutol; Fever; Headache; Hemorrhage; Humans; Liver Function Tests; Nausea; Purpura, Thrombocytopenic; Rifampin; Time Factors; Tuberculosis, Pulmonary

Topics: Adult; Chemical and Drug Induced Liver Injury; Diarrhea; Drug Resistance, Microbial; Female; Fever; Humans; Male; Middle Aged; Mycobacterium tuberculosis; Rifampin; Sweating; Temperature; Tuberculosis, Pulmonary

Topics: Aminocaproates; Asthenia; Drug Hypersensitivity; Female; Fever; Gastrointestinal Diseases; Headache; Humans; Middle Aged; Rifampin; Thrombocytopenia; Tuberculosis, Pulmonary; Vertigo

Topics: Acute Kidney Injury; Adolescent; Adult; Antibodies; Child; Complement Fixation Tests; Epistaxis; Female; Fever; Humans; Isoniazid; Male; Middle Aged; Rifampin; Streptomycin; Thrombocytopenia; Tuberculosis

Daily rifampicin in a single dose of 600 mg, combined with other drugs, usually streptomycin and isoniazid, was given to 49 patients for three months. It was planned to continue for another 15 months with twice-weekly rifampicin 1,200 mg plus isoniazid 900 mg, but the high incidence of side effects led to cessation of the intermittent regimen when only two patients had completed 18 months.Though there was no serious problem with daily treatment 11 patients (22%) were unable to continue rifampicin on the intermittent regimen. In 8 (16%) a pyrexial syndrome occurred. In one of these patients there was also temporary renal failure, and in another precipitous thrombocytopenia led to epistaxis and bleeding into the tongue and lips. Symptomless thrombocytopenia developed in two other patients, making three cases (6%) of thrombocytopenia in all.In 16 (33%) of the 49 patients antibodies to rifampicin were detected in the blood. Side effects occurred in 9 (56%) of these, including the three developing thrombocytopenia, but in only 2 (6%) of the 33 patients with no antibodies detected. This association of toxic reactions with antibodies is highly significant (P<0.001).

Topics: Acute Kidney Injury; Adolescent; Adult; Aged; Antibodies; Child; Coombs Test; Epistaxis; Female; Fever; Humans; Isoniazid; Lip; Male; Middle Aged; Oral Hemorrhage; Rifampin; Streptomycin; Thrombocytopenia; Tongue Diseases; Tuberculosis, Pulmonary

Topics: Chronic Disease; Coma; Dactinomycin; Daunorubicin; Dexamethasone; Encephalomyelitis; Fever; Headache; Humans; Idoxuridine; Leukopenia; Meningitis, Viral; Mental Disorders; Pain; Paralysis; Respiratory Insufficiency; Rifampin; Vomiting