rifampin and Granulomatous-Disease--Chronic

In recent years, tuberculosis has re-emerged as a serious public health problem, raising the possibility that tuberculous eye disease may also have become more prevalent. Ocular tuberculosis usually occurs in apparently healthy individuals. It is rarely observed in patients with active pulmonary disease. An eight-year-old boy was admitted to our department because of chronic granulomatous anterior uveitis on his left eye. His medical history was unremarkable. There were no systemic symptoms of tuberculosis. He had a positive purified protein derivative test reaction. In our case, the diagnosis of ocular tuberculosis was presumptive and depended upon indirect evidence. The patient was started on anti-tuberculosis therapy with three drugs, which were continued for 12 months, with complete healing of the ocular lesions, including a marked improvement in the gait of the patient. Tuberculosis remains one of the most important causes of morbidity and mortality in developing countries.

Topics: Antibiotics, Antitubercular; Antitubercular Agents; Child; Granulomatous Disease, Chronic; Humans; Isoniazid; Male; Pyrazinamide; Rifampin; Tuberculosis, Ocular; Uveitis, Anterior

The histopathologic diagnosis of cutaneous tuberculosis (CTB) is often troublesome, because there are several other entities (tuberculids, demodicidosis, granulomatous rosacea, and acne agminata) that may display granulomatous inflammation with caseation necrosis. The current study describes four cases of granulomatous disease of the face. The final diagnosis (assessed on the basis of the clinical response to therapy) was CTB in three cases and granulomatous rosacea in one case. Histologically, epithelioid granulomas were a constant feature; in one case of CTB, they displayed a palisading (granuloma annulare-like) arrangement. Caseation necrosis was a prominent feature only in the case of granulomatous rosacea. Routinely processed biopsy specimens were evaluated with nested polymerase chain reaction (nPCR) for Mycobacterium tuberculosis (MBT) DNA. The correlation between nPCR results and clinical outcome was less than optimal; in fact, one case showed an excellent clinical response to the antituberculous drug therapy despite the absence of MBT DNA amplification. In granulomatous diseases of the face, the importance of evaluating not only nPCR but the overall clinicopathologic picture so as to avoid diagnostic misinterpretations is emphasized.

Topics: Adult; Antitubercular Agents; Diagnosis, Differential; DNA, Bacterial; Drug Therapy, Combination; Ethambutol; Face; Female; Granulomatous Disease, Chronic; Humans; Isoniazid; Male; Middle Aged; Mycobacterium tuberculosis; Polymerase Chain Reaction; Rifampin; Rosacea; Tuberculosis, Cutaneous

Granulocytes and monocytes/macrophages from patients suffering from chronic granulomatous disease (CGD) are ineffective in killing specific kinds of phagocytized bacteria, e.g., Staphylococcus aureus, due to decreased or lacking ability to produce reactive oxygen intermediates. Commonly used antibiotics like flucloxacillin are of limited therapeutic value, because the staphylococci are protected against their action in the interior of phagocytes. However, encapsulation of flucloxacillin into liposomes could enable its entrance into the interior of neutrophils from two CGD patients to kill phagocytized bacteria there. The effect of rifampicin against intracellular staphylococci could be similarly enhanced by liposome encapsulation. Dose-response relations and kinetics of killing of intracellular bacteria by antibiotics in the free and encapsulated form were studied under different conditions using J 774 mouse macrophages, because phagocytes from CGD patients are not available in great amounts. Preincubation of phagocytes with either antibiotic in liposomes subsequently endowed the cells with a strongly enhanced ability to kill phagocytized bacteria. Our data show that a drug which normally will not reach a phagosome can be delivered to this intracellular compartment by a liposome. A possible clinical use is discussed.

Topics: Anti-Bacterial Agents; Drug Carriers; Floxacillin; Granulomatous Disease, Chronic; Humans; Liposomes; Neutrophils; Phagocytes; Phagocytosis; Rifampin; Staphylococcus

Topics: Child; Colic; Granulomatous Disease, Chronic; Humans; Hydronephrosis; Male; Nephrostomy, Percutaneous; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination; Ureteral Obstruction

In chronic granulomatous disease (CGD) polymorphonuclear leukocytes (PMN) are unable to kill phagocytized catalase-positive bacteria. Therefore, patients with CGD are prone to infections and dependent on antimicrobial agents able to penetrate PMN membranes and to act intracellularly. Owing to their good lipid solubility, trimethoprim/sulfamethoxazole and rifampicin passively diffuse the membrane. In contrast, fosfomycin is transported actively into the cell. In normal PMN, it reaches cellular-to-extracellular ratios of 1.83 after 15 min, in CGD-PMN 2.18 after 30 min. At concentrations between 16 and 200 mg/liter, fosfomycin was able to kill staphylococci surviving within CGD-PMN, thus compensating for the bactericidal deficiency in CGD. A combination of low concentrations of fosfomycin (8 mg/liter) plus rifampicin (0.06 mg/liter) was more effective at the intracellular level than either agent alone. Apart from a stimulation of PMN-chemiluminescence of yet unknown significance, the agent did not interfere with other neutrophil functions. Clinical investigations are indicated to study whether fosfomycin can be added to the small number of antibiotics useful in CGD.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Bacterial Infections; Biological Transport, Active; Chemotaxis, Leukocyte; Child; Child, Preschool; Female; Fosfomycin; Granulocytes; Granulomatous Disease, Chronic; Humans; Intracellular Fluid; Male; Middle Aged; Neutrophils; Penicillins; Phagocytosis; Rifampin; Staphylococcus aureus; Sulfamethoxazole; Trimethoprim

Topics: Bacterial Infections; Child; Erythromycin; Female; Granulomatous Disease, Chronic; Humans; Isoniazid; Legionella; Rifampin; Sulfamethoxazole

Patients with chronic granulomatous disease (CGD) have recurrent infections with catalase-producing organisms, particularly staphylococci, that survive within their leukocytes. To be most effective, antibiotics used to treat infections in CGD patients may need to kill both intracellular and extracellular organisms. We studied the ability of certain antibiotics to penetrate normal and CGD neutrophils and to kill intracellular staphylococci. Trimethoprim and clindamycin were concentrated in normal and in CGD neutrophils; maximum cellular-to-extracellular concentration ratios of clindamycin and of trimethoprim were approximately 30 and approximately 4, respectively. In contrast, penicillin was excluded from normal neutrophils. Clindamycin, trimethoprim/sulfamethoxazole, rifampin, and trimethoprim/rifampin significantly reduced the number of viable intracellular staphylococci in normal and CGD neutrophils. After 24 h of incubation in the presence of these antibiotics, the number of viable intracellular staphylococci in normal and CGD neutrophils was similar. In contrast, dicloxacillin, gentamicin, and cephalothin had no significant effect on the number of intracellular staphylococci in normal or CGD neutrophils.

Topics: Anti-Bacterial Agents; Clindamycin; Granulomatous Disease, Chronic; Humans; Kinetics; Leukocytes; Neutrophils; Rifampin; Staphylococcus aureus; Sulfamethoxazole; Trimethoprim

Topics: Adolescent; Amphotericin B; Aspergillosis; Drug Therapy, Combination; Granulomatous Disease, Chronic; Humans; Male; Rifampin

Topics: Adult; Granulomatous Disease, Chronic; Humans; Male; Rifampin

Topics: Amphotericin B; Aspergillosis; Child, Preschool; Drug Therapy, Combination; Granulomatous Disease, Chronic; Humans; Male; Osteomyelitis; Rifampin

Topics: Agranulocytosis; Blood Bactericidal Activity; Candida; Chediak-Higashi Syndrome; Chromosome Aberrations; Chromosome Disorders; Female; Glucosephosphate Dehydrogenase Deficiency; Glutathione Peroxidase; Granulomatous Disease, Chronic; Heterozygote; Humans; Infant, Newborn; Leukocytes; Lupus Erythematosus, Discoid; Male; Neoplasms; Neutropenia; Neutrophils; Peroxidases; Phagocytosis; Pregnancy; Rifampin; Sulfonamides; Vitamin B 6 Deficiency