rifampin and Hepatitis

A 71-year-old male patient with a superficial transitional cell carcinoma of the urinary bladder developed high fever and jaundice, accompanied by progressively increasing serum aminotransferase activities, 2 weeks after the fourth local instillation with an attenuated live strain of Mycobacterium bovis [bacillus Calmette-Guérin (BCG)]. A liver biopsy showed non-caseating granulomatous hepatitis. Cultures for mycobacteria were negative. Mycobacterial DNA was not detected in liver tissue using the polymerase chain reaction. Empirical treatment with rifampicin and isoniazid was started, resulting in partial recovery. After 6 months of therapy, however, serum aminotransferase activities were still twice the upper limit of normal. A second liver biopsy still demonstrated several granulomas. Only after addition of prednisolone, liver tests completely normalized. Also histologically the lesions improved dramatically. This suggests that the BCG hepatitis was at least partially caused by a hypersensitivity reaction. Our patient is the first reported case of BCG hepatitis with histological follow-up under therapy.

Topics: Adjuvants, Immunologic; Administration, Intravesical; Aged; Antitubercular Agents; BCG Vaccine; Biopsy; Carcinoma, Transitional Cell; Drug Hypersensitivity; Drug Therapy, Combination; Hepatitis; Humans; Immunosuppressive Agents; Isoniazid; Liver; Male; Prednisolone; Rifampin; Transaminases; Treatment Outcome; Urinary Bladder Neoplasms

Topics: Clinical Trials as Topic; Ethambutol; Female; Hepatitis; Humans; Isoniazid; Liver Function Tests; Male; Pyrazinamide; Rifampin; Streptomycin; Time Factors; Tuberculosis, Pulmonary; United Kingdom

Topics: Anti-Bacterial Agents; Bosnia and Herzegovina; Brucellosis; Cheese; Doxycycline; France; Gentamicins; Hepatitis; Humans; Raw Foods; Rifampin; Travel-Related Illness; Treatment Outcome

To compare the incidence of anti tuberculosis drug-induced hepatotoxicity (ATDH) with those on old vs. revised WHO doses in human immunodeficiency virus (HIV) negative children. The secondary objective was to determine the overall incidence of hepatitis in children on Anti tubercular treatment (ATT) and isoniazid prophylactic therapy (IPT).. Children attending pediatric outpatient / admitted in wards, on ATT/ IPT between January 2007 and December 2017 (11 y) were included. Children were divided into Group 1 (treated based on old doses, from January 2007 to December 2011) and Group 2 (treated based on revised doses from January 2012 to December 2017). Children with multi drug resistant tuberculosis (MDRTB) and pre-existing liver disease were excluded.. A total of 515 children were enrolled. Twelve children developed ATDH with an overall incidence of 2.3%. Five out of 260 (1.9%) developed hepatitis with old doses vs. 7 of the 255 (2.7%) with revised doses; this difference was not statistically significant. When calculated only for active TB (excluding children on IPT), overall incidence of hepatitis was 2.7%. Comparison between group 1 (2.04%) and group 2 (3.5%) was again not statistically significant. Ten out of 12 children who developed hepatitis were restarted on ATT without recurrence. No child on IPT developed hepatitis. There was no mortality.. Revised WHO dosing does not increase incidence of hepatitis compared to old dosing in HIV negative children. Overall incidence was 2.3%. Hepatitis did not occur with IPT.

Topics: Adolescent; Antitubercular Agents; Chemical and Drug Induced Liver Injury; Child; Child, Preschool; Coinfection; Drug-Related Side Effects and Adverse Reactions; Female; Hepatitis; HIV; HIV Infections; Humans; Incidence; India; Infant; Isoniazid; Liver; Liver Function Tests; Male; Prospective Studies; Retrospective Studies; Rifampin; Tuberculosis; Tuberculosis, Multidrug-Resistant

To investigate the clinical characteristics, adverse drug reactions, and outcomes of the oldest old patients (aged ≥80 years) with tuberculosis (TB) treated with rifampicin, isoniazid, and pyrazinamide (RIP)-containing regimens.. A retrospective chart review study.. A 1,200-bed tertiary teaching hospital in southwest Taiwan.. We conducted a retrospective observational study between January 1, 2005 and December 31, 2011. Seven hundred adult patients (aged ≥18 years) with TB treated with RIP-containing anti-TB regimens were reviewed, including 161 oldest old patients.. Clinical outcomes included clinical responsiveness and microbiological eradication. Adverse outcomes included drug-induced hepatitis, and other symptoms included gastrointestinal upset (eg, abdominal pain, vomiting, diarrhea, or dyspepsia), skin rash, joint pain, and hyperuricemia.. Compared with the non-oldest old adult patients, the oldest old patients more frequently had hepatitis (P=0.014), gastrointestinal upset (P=0.029), and unfavorable outcomes (P<0.001). In a multivariate analysis, hepatitis during treatment (adjusted odds ratio: 3.482, 95% confidence interval: 1.537-7.885; P<0.003) and oldest old age (adjusted odds ratio: 5.161, 95% confidence interval: 2.294-11.613; P<0.010) were independent risk factors for unfavorable outcomes. In the oldest old patients with hepatitis, rifampicin use was more common in the favorable outcome group than in the unfavorable outcome group (100% vs 37.5%; P=0.001).. The oldest old age and hepatitis during RIP treatment were associated with unfavorable outcomes. For the oldest old patients with TB having hepatitis during treatment, rifampicin rechallenge and use might benefit the treatment outcome.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antitubercular Agents; Chemical and Drug Induced Liver Injury; Comorbidity; Drug Therapy, Combination; Female; Hepatitis; Hospitals, Teaching; Humans; Isoniazid; Male; Middle Aged; Multivariate Analysis; Pyrazinamide; Retrospective Studies; Rifampin; Risk Factors; Taiwan; Treatment Outcome; Tuberculosis; Young Adult

Drug-induced hepatitis is known to occur in a proportion of patients on treatment for active tuberculosis (TB).. We prospectively examined the incidence of drug-induced hepatitis in 2070 patients treated for TB with the standard regimen based on 6 months of rifampicin (R, RMP) and isoniazid (H, INH), with 2 months of initial pyrazinamide (Z, PZA) and ethambutol (E, EMB), over a 30-year period from 1981 to 2010, in Blackburn, UK.. Of the 1031 (49.8%) males and 1039 (50.2%) females studied, 451 (21.8%) were White and 1585 (76.6%) were of South Asian origin. Only 34 (1.6%) were of African or other origins. Of the total number of patients treated, 63 (3.0%) had drug-related hepatitis, 26 (5.8%) of whom were White, 37 (2.33%) Asians and 0 other. Incidence was significantly higher in Whites than Asians (OR 2.13, P = 0.008). Incidence increased with increasing age (OR 1.16, P = 0.02). The presumed causative drug was PZA 57%, RMP 32%, INH 11%, EMB 0%. There was no trend of increased hepatitis rates over time.. Rates of drug-induced hepatitis where change of treatment is required are low in patients treated with standard RHZE-based therapy (3%). Caucasians and older patients were more likely to develop hepatitis than their counterparts.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antitubercular Agents; Chemical and Drug Induced Liver Injury; Child; Child, Preschool; Ethambutol; Female; Follow-Up Studies; Hepatitis; Humans; Incidence; Infant; Infant, Newborn; Isoniazid; Longitudinal Studies; Male; Middle Aged; Prospective Studies; Pyrazinamide; Rifampin; Tuberculosis; Young Adult

Q fever is a zoonotic infection caused by Coxiella burnetti, which has been previously regarded as an uncommon infectious disease in Korea but is sporadically reported recently. Common manifestations of acute Q fever usually present as influenza-like illness, pneumonia and occasionally hepatitis. Herein, we report 4 cases of acute Q fever as a cause of acute hepatitis and fever. All patients had fever and non-specific symptoms, and laboratory test showed acute hepatitis. Antibody surveys for many virus infections and bacterial cultures were negative. Finally, they were diagnosed acute Q fever by an indirect microimmunofluorescence test. Liver biopsy in 3 patients revealed granuloma including one with typical fibrin-ring. All patients had complete resolution of symptoms and signs with doxycycline treatment. Q fever should be considered in the differential diagnosis of patients with fever of unknown origin with acute hepatitis in Korea.

Topics: Acute Disease; Adult; Anti-Bacterial Agents; Coxiella burnetii; Doxycycline; Fluorescent Antibody Technique, Indirect; Hepatitis; Humans; Male; Middle Aged; Q Fever; Rifampin

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

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

Long-term treatment of patients with the macrolide antibiotic and prototypical activator of pregnane X receptor (PXR) rifampicin (Rif) inhibits the inflammatory response in liver. We show here that activation of the inflammatory response in hepatocytes strongly modulates SUMOylation of ligand-bound PXR. We provide evidence that the SUMOylated PXR contains SUMO3 chains, and feedback represses the immune response in hepatocytes. This information represents the first step in developing novel pharmaceutical strategies to treat inflammatory liver disease and prevent adverse drug reactions in patients experiencing acute or systemic inflammation. These studies also provide a molecular rationale for constructing a novel paradigm that uniquely defines the molecular basis of the interface between PXR-mediated gene activation, drug metabolism, and inflammation.

Topics: Animals; Antibiotics, Antitubercular; Cytokines; Electrophoresis, Polyacrylamide Gel; Gene Expression; HeLa Cells; Hepatitis; Hepatocytes; Humans; Ligands; Mice; Mice, Inbred C57BL; Mice, Knockout; Pregnane X Receptor; Receptors, Steroid; Reverse Transcriptase Polymerase Chain Reaction; Rifampin; Small Ubiquitin-Related Modifier Proteins; Species Specificity

Topics: Antibiotics, Antitubercular; Desensitization, Immunologic; Drug Hypersensitivity; Female; Hepatitis; Humans; Hypersensitivity, Immediate; Injections, Intravenous; Middle Aged; Nephritis; Rifampin; Tuberculosis, Lymph Node; Urticaria

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

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

Clinical efficacy of rifampicin, a semisynthetic broad spectrum antibiotic was estimated in 247 patients with purulent inflammations. It was shown advisable to use rifampicin intravenously in treatment of severe bronchopulmonary pathology, disorders of the bile excretion system, osteomyelitis, severe wound infections and in prophylaxis of postoperative purulent complications in cardiovascular surgery and other cases. High rifampicin sensitivity of staphylococci and streptococci belonging to various species was revealed. Rifampicin was found to be less active against gramnegative pathogens. The isolation frequency of rifampicin sensitive strains of E. coli, Proteus spp., Klebsiella spp. and P. aeruginosa amounted to 88.4, 52.1, 58.8 and 49.3 per cent respectively.

Topics: Bacteria; Bacterial Infections; Cholangitis; Drug Resistance, Microbial; Hepatitis; Humans; Osteomyelitis; Respiratory Tract Infections; Rifampin; Wound Infection

Topics: Adult; Aged; Antipyrine; Cytochrome P-450 Enzyme System; Enzyme Induction; Female; Glucaric Acid; Hepatitis; Histamine H1 Antagonists; Humans; Liver; Liver Cirrhosis; Male; Medroxyprogesterone; Middle Aged; Pharmaceutical Preparations; Phenobarbital; Phenytoin; Prednisolone; Rifampin

A patient is presented who developed a granulomatous hepatitis and pleuritis approximately 7 months after an ileal bypass procedure for morbid obesity. Although the etiological agent was presumed to be Mycobacterium tuberculosis no pathogenic organism was grown from the liver, pleura, bone marrow, sputum, or gastric aspirate. The possibly increased susceptibility of these patients to mycobacterial infections is discussed. The value of obtaining serum levels of ethambutol, isoniazid, and rifampin, in patients with malabsorption is stressed. Although this patient seemed to respond to antituberculous therapy, other possible causes for the granulomatous process are explored.

Topics: Ethambutol; Female; Hepatitis; Humans; Ileum; Intestinal Absorption; Isoniazid; Jejunum; Middle Aged; Obesity; Phagocyte Bactericidal Dysfunction; Pleurisy; Rifampin

Topics: Adult; Aged; Fatty Liver; Hepatitis; Humans; Liver; Liver Cirrhosis; Liver Function Tests; Liver Neoplasms; Middle Aged; Rifampin

Topics: Bilirubin; Dose-Response Relationship, Drug; Half-Life; Hepatitis; Humans; Kinetics; Liver; Liver Cirrhosis; Liver Diseases; Rifampin; Time Factors

Topics: Antitubercular Agents; Chronic Disease; Ethambutol; Hepatitis; Humans; Liver Diseases; Rifampin; Streptomycin; Tuberculosis, Pulmonary

Topics: Biopsy; Chemical and Drug Induced Liver Injury; Diagnosis, Differential; Hepatitis; Hepatitis A; Hepatitis B virus; Humans; Liver; Rifampin

Topics: Biopsy; Chemical and Drug Induced Liver Injury; Hepatitis; Humans; Liver; Rifampin

Topics: Adult; Aged; Hepatitis; Humans; Middle Aged; Pyelitis; Respiratory Tract Diseases; Rifampin