rifampin and Fistula

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

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

We report a 52-year-old male presenting with a graft-appendiceal fistula four years after placement of an aorto-bifemoral Dacron prosthesis.. After appendectomy and total graft removal, the patient was treated with an in-situ repair using a rifampicin-silver graft. This kind of repair has only been reported in an animal study.. This infected aortic graft was treated successfully with a rifampicin-silver graft with a follow-up of 15 months without complications.. In-situ repair of a graft-appendiceal fistula with a rifampicin-silver graft seems a promising strategy. The long-term outcome needs to be studied.

Topics: Administration, Topical; Animals; Anti-Infective Agents; Appendicitis; Blood Vessel Prosthesis; Fistula; Humans; Male; Middle Aged; Prosthesis-Related Infections; Rifampin; Silver; Treatment Outcome

Topics: Antitubercular Agents; Coinfection; Drug Resistance, Bacterial; Drug Therapy, Combination; Female; Fistula; HIV Infections; Humans; Infant; Mycobacterium bovis; Rifampin; Treatment Outcome; Tuberculosis, Lymph Node; Vietnam

To study the etiology, clinical and pathologic characteristics of periductal mastitis with fistula and estimate the effect of anti-mycobacterial agents for periductal mastitis with fistula.. Totally 27 patients of periductal mastitis with fistula received anti-mycobacteria drugs therapy from December 2008 to September 2011 were analyzed retrospectively. All of the patients were female. The mean age at onset was 28 years (range 15 to 40 years old). The main clinical manifestation of the 27 patients was breast fistula, including 21 patients with single fistula and 6 patients with multiple fistula. Three patients manifested with pure fistula, 14 patients with both fistula and lump, 10 patients with fistula, lump and abscess. The samples including pus or tissues of all patients were underwent bacteria culture and all patients core needle biopsy. All patients were given primary anti-mycobacteria drugs therapy, parts of patients received surgery based on the evaluation of medical treatment.. The common bacteria culture of all patients failed to demonstrate any causative microorganism. Four cases were selected randomly to undergo PCR of mycobacteria, only one case was identified as Massiliense in bacteria culture of mycobacteria. Twenty-seven patients with periductal mastitis with fistula were treated with anti-mycobacterial agents (isoniazid, rifampicin and ethambutol or pyrazinamide of triple oral drugs) for 1 to 3 months, the fistula of all 27 patients were closed well. Sixteen patients were treated with the agents only and cured. Eleven patients received surgical treatment after treated with the medical agents. None of the patients were given mastectomy. All patients had no reccurence until now.. The periductal mastitis with fistula has a closely relationship with the infection of nontuberculosis mycobacteria. Those patients could be treated with triple anti-mycobacterial agents and could also avoided mastectomy.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Drug Therapy, Combination; Ethambutol; Female; Fistula; Humans; Isoniazid; Mastitis; Nontuberculous Mycobacteria; Pyrazinamide; Retrospective Studies; Rifampin; Young Adult

A case report of cervical osteomyelitis possibly associated with a Zenker's diverticulum perforation.. To present clinical, radiologic, and surgical findings of a cervical osteomyelitis due to a Zenker's diverticulum perforation.. A 56-year-old patient was in an intensive care unit for a severe head injury. He was fed via a nasogastric tube. Four months later he developed a pyogenic cervical vertebral infection.. Plain films and magnetic resonance imaging showed a diffuse cervical osteomyelitis. Investigation of his dysphagia revealed a Zenker's diverticulum.. After administration of antibiotics and surgical treatment of the diverticulum, the cervical infection resolved. Plain films and magnetic resonance imaging showed healing with vertebral fusion.. Cervical osteomyelitis is uncommon. Only one case of direct contamination leading to cervical vertebral osteomyelitis after esophageal perforation has been previously described. Direct contamination of the prevertebral soft tissues by bacteria traveling through the fistula may have occurred. The development of vertebral osteomyelitis in this case is consistent with the hypothesis of direct contamination. Management relies on appropriate antimicrobial therapy and surgical management of the diverticulum. The association of Zenker's diverticulum with vertebral osteomyelitis and discitis is a unique, previously undescribed situation.

Topics: Anti-Infective Agents; Antibiotics, Antitubercular; Cervical Vertebrae; Fistula; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Ofloxacin; Osteomyelitis; Rifampin; Spinal Diseases; Suppuration; Tomography, X-Ray Computed; Zenker Diverticulum

A patient with Hodgkin's disease (HD) underwent autologous bone marrow transplantation (ABMT). Six months later while receiving interleukin (IL)-2 and alpha-interferon immunotherapy, he developed a painful lesion in his oral cavity with a fistula in the buccal area. Excision biopsy disclosed necrotizing granulomatous inflammation with acid-fast bacillus. The patient received a 9-month course of isoniazide, rifampin and pyrazinamide, and recovered. The possible pathophysiological mechanism is discussed.

Topics: Adjuvants, Immunologic; Adult; Anti-Bacterial Agents; Antitubercular Agents; Bone Marrow Transplantation; Combined Modality Therapy; Disease Susceptibility; Drug Therapy, Combination; Fistula; Hodgkin Disease; Humans; Immunocompromised Host; Interferon-alpha; Interleukin-2; Isoniazid; Male; Opportunistic Infections; Oral Ulcer; Pyrazinamide; Recombinant Proteins; Rifampin; Risk Factors; Transplantation Conditioning; Transplantation, Autologous; Tuberculosis, Oral

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

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

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

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

Topics: Adolescent; Adult; Bone Diseases; Child; Child, Preschool; Evaluation Studies as Topic; Female; Fistula; Humans; Infant; Male; Rifampin; Tuberculosis, Osteoarticular