rifampin and Leukocytosis

Tuberculosis is a global burden with an unacceptably high mortality rate, especially in low- and middle-income countries. We reported the case of 34-year-old Somali female with no significant risk factors who initially presented with headache and blurred vision. The patient subsequently developed altered mental status and significant vision changes. Initial lumbar puncture showed lymphocytic pleocytosis with negative gram stain, acid-fast bacilli stain, and culture. Initial polymerase chain reaction for tuberculosis was negative. The patient worsened despite receiving broad-spectrum antibiotics. The patient had a prolonged hospital course and eventually required lumbar drain placement for hydrocephalus. Repeated polymerase chain reactions for Mycobacterium tuberculosis from the lumbar drain samples was positive, and the diagnosis of tuberculous meningitis was confirmed. The patient improved after lumbar drain placement and treatment with isoniazid, rifampin, pyrazinamide, ethambutol and steroid tapering. This case illustrated the challenge of diagnosing tuberculous meningitis.

Topics: Adult; Antitubercular Agents; Asthma; Ethambutol; Female; Headache; Hospitalization; Humans; Hydrocephalus; Isoniazid; Leukocytosis; Magnetic Resonance Imaging; Polymerase Chain Reaction; Pyrazinamide; Rifampin; Somalia; Spinal Puncture; Tuberculosis, Meningeal; United States; Vision Disorders

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

Chryseobacterium arthrosphaerae is a gram-negative bacteria, known for its intrinsic multidrug resistance, which can lead to treatment difficulties.. A 56-year-old male had an indwelling external ventricular drainage catheter for 6 months and had been frequently treated with antibiotics for nosocomial infections. He showed cerebrospinal fluid pleocytosis and an abrupt fever during hospitalization.. He was diagnosed as a ventriculitis caused by Chryseobacterium arthrosphaerae (C arthrosphaerae).. Initially, we used ciprofloxacin as the backbone in combination with minocycline (and rifampin). However, fever and pleocytosis persisted, and improvement was slow. We then switched the minocycline and rifampin regiment to trimethoprim/sulfamethoxazole. Following this switch of antibiotics, the patient's pleocytosis rapidly improved, allowing the replacement of his external ventricular drainage catheters. C arthrospharae was no longer growing in cerebrospinal fluid and he was recovered from ventriculitis.. The patient remains alive without any incidence of C arthrosphaerae recurrence.. We propose trimethoprim/sulfamethoxazole alone or in combination with ciprofloxacin to be good candidates for the treatment of ventriculitis by C arthrosphaerae.

Topics: Anti-Bacterial Agents; Catheters, Indwelling; Cerebral Ventriculitis; Chryseobacterium; Drainage; Drug Therapy, Combination; Humans; Leukocytosis; Male; Middle Aged; Minocycline; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Bacterial Agents; Bronchiectasis; Chest Pain; Clarithromycin; Cough; Drug Therapy, Combination; Dyspnea; Ethambutol; Humans; Leukocytosis; Male; Middle Aged; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Rifampin; Tracheobronchomegaly; Veterans