rifampin and Lung-Diseases

Topics: Animals; Anti-Bacterial Agents; Drug Repositioning; Humans; Lung Diseases; Mycobacterium abscessus; Mycobacterium Infections, Nontuberculous; Rifabutin; Rifampin; Rifamycins

There is growing evidence that certain antibiotics exert their beneficial effects not only by killing or inhibiting the growth of bacterial pathogens but also indirectly by immunomodulation. This review aims at giving an overview of the immunomodulatory properties of antibiotics in different diseases: The antiinflammatory properties of macrolides in chronic inflammatory pulmonary disorders were recognized more than 15 years ago and have been well documented in the last decade. Recent data suggest that several antibiotics such as tetracyclines and cephalosporins may have a beneficial immunomodulatory or neuroprotective effect on neuroimmunological and neurodegenerative diseases including multiple sclerosis and amyotrophic lateral sclerosis. Moreover, the non-bacteriolytic but bactericidal antibiotics rifampicin, clindamycin and aminoglycosides kill bacteria without releasing high quantities of proinflammtory cell wall components. The use of bactericidal, non-bacteriolytic protein synthesis inhibitors reduces mortality and long-term sequelae in experimental bacterial sepsis, plague and meningitis. Clinically, macrolides have been well established as an adjunctive treatment to beta-lactam antibiotics in pulmonary diseases. For other indications, appropriate clinical trials are necessary before using the immunomodulatory properties of antibiotics in clinical practice.

Topics: Anti-Bacterial Agents; Fluoroquinolones; Humans; Immunologic Factors; Lung Diseases; Macrolides; Neurodegenerative Diseases; Protein Synthesis Inhibitors; Rifampin; Tetracyclines

Topics: Drug Resistance, Microbial; Humans; Lung Diseases; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Rifampin

The nontuberculous mycobacteria are responsible for considerable morbidity in the immunocompromised and immunocompetent host, especially in the older patient with chronic fibrotic or cavitary disease of the lung. Mycobacterium szulgai is a slow growing mycobacterium infrequent in nature and man. Except from a snail and a tropical fish, it has been isolated only from humans and nearly always represents a true pathogen. Three-drug therapy using in vitro susceptibilities as a guide for 12 to 18 months increases the likelihood of success. We present a patient who developed M szulgai pulmonary infection 30 years after an episode of pulmonary tuberculosis. After successful therapy for his M szulgai infection, this patient developed chronic pulmonary histoplasmosis. We review the 25 years of clinical experience with this mycobacteria; particular emphasis is on the presentation and treatment of this very unusual infection.

Topics: Anti-Bacterial Agents; Ciprofloxacin; Drug Therapy, Combination; Ethambutol; Humans; Isoniazid; Lung Diseases; Male; Microbial Sensitivity Tests; Middle Aged; Mycobacterium; Mycobacterium Infections; Radiography; Rifampin

Topics: Acquired Immunodeficiency Syndrome; Antitubercular Agents; Dermatitis; Humans; Lung Diseases; Lung Diseases, Obstructive; Lymphadenitis; Male; Mycobacterium Infections; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Rifampin; Risk Factors; Tuberculin Test

A 64-year-old alcoholic man had a chronic cavitary pulmonary infiltrate. Initial sputum smears and cultures yielded abundant acid-fast organisms subsequently identified as Mycobacterium terrae. Treatment with rifampin and ethambutol resulted in progressive clinical and roentgenographic resolution with an apparent cure after 18 months of therapy.

Topics: Chronic Disease; Ethambutol; Humans; Klebsiella Infections; Lung Diseases; Male; Middle Aged; Mycobacterium Infections; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Radiography; Rifampin; Time Factors

Actinomycosis was at one time a common diagnosis in this country. It still is fairly common in some parts of the world. As the numbers of antibiotics and indications for their use have increased, the disease has almost become a medical rarity in the United States. This fact might be thought a paradox in view of the universal presence of the actinomyces organisms in every human mouth. However, it is perhaps not well recognized that the actinomyces are true bacteria, and that they are particularly sensitive to most of the common antibacterials in current usage. These facts have combined to decrease the clinical frequency of the disease as well as effectively reduce the opportunity for securing a satisfactory specimen for laboratory culture in suspected cases. Actinomycosis can present in a variety of forms and may mimic other infections or even neoplasms. The clinical pattern of remission and exacerbation of symptoms occurring in parallel sequence with initiation and cessation of antibiotic administration is a phenomenon which should increase suspicion for actinomycosis in any of its manifestations.

Topics: Actinomyces; Actinomycosis; Actinomycosis, Cervicofacial; Adult; Age Factors; Aged; Anti-Bacterial Agents; Diagnosis, Differential; Female; Humans; Isoniazid; Lung Diseases; Lung Neoplasms; Male; Middle Aged; Rifampin; Sex Factors; Sputum; United States

Ethambutol ocular toxicity is a major problem during combination chemotherapy for Mycobacterium avium complex (MAC) pulmonary disease (MAC-PD) due to years-long therapy for MAC.. This study aimed to identify the lower dose of daily ethambutol that can reduce ocular toxicity.. We retrospectively reviewed the medical records of 312 patients who visited The University of Tokyo Hospital between January 2007 and December 2017 for nontuberculous mycobacterial pulmonary disease. Seventy-six patients with MAC-PD who were treated with combination chemotherapy for the first time were analyzed in this study.. Ethambutol was discontinued because of visual symptoms in 13 patients (17%), 7 of whom were diagnosed with ethambutol ocular neuropathy. The dose per body weight was significantly higher in patients who developed ocular neuropathy than in those who did not (15.4 mg/kg/d vs. 12.5 mg/kg/d, respectively; p = 0.048). We assigned patients to higher or lower dose groups according to the median dose of 12.5 mg/kg/d. Although ocular neuropathy developed in 6 out of 38 patients in the higher dose group, ocular neuropathy developed in 1 out of 38 patients in the lower dose group (16% vs. 3%, respectively; p = 0.038). The failures of sputum culture conversion and radiological improvement were not significantly different between the two groups (p = 0.638 and 0.305, respectively). Macrolide resistance developed in one patient per group during follow-up (3% per group, p = 0.945).. A lower dose of ethambutol may reduce ocular toxicity without radiological deterioration for pulmonary MAC infection.

Topics: Anti-Bacterial Agents; Antitubercular Agents; Clarithromycin; Drug Resistance, Bacterial; Drug Therapy, Combination; Ethambutol; Humans; Lung Diseases; Macrolides; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Retrospective Studies; Rifampin; Toxic Optic Neuropathy

Despite recent advances in chemotherapy, the treatment of pulmonary Mycobacterium avium complex (MAC) disease remains unsatisfactory. Judging from its MIC, fluoroquinolones including gatifloxacin (GFLX) are expected to demonstrate efficacy against MAC disease. However, there have been few clinical studies using fluoroquinolones. Therefore, a prospective study to evaluate the clinical efficacy and safety of a fluoroquinolone-containing regimen for the treatment of pulmonary MAC disease was conducted. In this trial, patients with pulmonary MAC disease received protocol-guided combined chemotherapy with rifampin (RFP) and ethambutol (EB) plus either GFLX or clarithromycin (CAM). Adult patients who fulfilled the criteria of the ATS definition of pulmonary MAC disease were enrolled in this study. The patients provided their informed consent, and treatments were administered for 1 year. Of 27 patients enrolled from three facilities, 14 patients were treated with the CAM-containing regimen and 13 patients were treated with the GFLX-containing regime. Four patients did not complete the 1-year treatment because of adverse events. Nine patients (64.3%) in the CAM group and 11 patients (84.6%) in the GFLX group achieved eradication of pathogens. Adverse events were observed more frequently in the GFLX group than in the CAM group. However, there were no severe adverse events in either group. The long-term results showed a similar relapse rate between the CAM and GFLX groups. The fluoroquinolone-containing regimen demonstrated both high efficacy and relative safety for pulmonary MAC disease that was similar to that of the CAM-containing regimen, which is considered to be the standard regimen.

Topics: Aged; Antitubercular Agents; Clarithromycin; Drug Therapy, Combination; Ethambutol; Female; Fluoroquinolones; Gatifloxacin; Humans; Lung Diseases; Male; Middle Aged; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Rifampin; Treatment Outcome

The literature concerning the management of pulmonary disease caused by Mycobacterium xenopi is scanty and consists of retrospective reports, mostly of small series of patients. Our aim was to document the clinical features and response to treatment of this rare but challenging disease. Patients were treated in a randomised, multi-centre trial with either rifampicin plus ethambutol or rifampicin, ethambutol and isoniazid. Clinical, bacteriological and radiological progress was monitored at set intervals for 5 years. As no differences emerged between the two groups, the results have been combined to provide this prospective survey. Forty-two patients were studied. Mean age was 65 years, three-quarters were male and two-thirds had other lung disease(s). Sputum was positive on direct smear in 62%. Cavitation was present in 81%, mostly large cavities, and disease was extensive in 38%. Despite good clinical response and little toxicity the death rate was high (69%), but less than 10% died primarily because of the M. xenopi disease. The failure of treatment/relapse rate was 12%. Only 11 (26%) were known to be alive at 5 years of whom seven (17%) were known to be cured. There was no correlation between failure of treatment/relapse and in vitro resistance. Better methods of susceptibility testing and more effective regimens are needed, but it is also evident that improved management of concomitant diseases and better general health will play a major part in increasing survival.

Topics: Adult; Aged; Aged, 80 and over; Antitubercular Agents; Drug Resistance, Bacterial; Drug Therapy, Combination; Ethambutol; Female; Follow-Up Studies; HIV Seronegativity; Humans; Isoniazid; Lung Diseases; Male; Middle Aged; Mycobacterium Infections, Nontuberculous; Mycobacterium xenopi; Radiography; Recurrence; Rifampin; Sputum; Survival Analysis; Treatment Outcome

To investigate whether the combined therapy according to the guideline proposed by American Thoracic Society (ATS) and Japanese Society for Tuberculosis (JST) is clinically appropriate for Mycobacterium avium complex (MAC) pulmonary disease.. Seventy-one patients in whom MAC pulmonary disease was diagnosed at Kawasaki Medical School and our associated ten hospitals were prospectively studied.. Seventy-one patients with Mycobacterium avium complex (MAC) pulmonary disease were 27 males and 44 females with a mean age of 64.4 +/- 10.2 years old. Patients received 400 mg/day or 600 mg/day of clarithromycin plus ethambutol, rifampicin, and initial streptomycin for 12 months. Among 71 patients who received more than 12 months of therapy, 41 patients (57.7%) converted their sputum to negative within six months after the initiation of this regimen, 16 of 41 patients (39.0%) relapsed, and 23 of 71 patients (32.4%) obtained clinical improvement on chest X-ray and/or clinical symptoms. The mortality rate had a comparatively good prognosis with a low incidence of 2.8%. Although the species of pathogen (M. avium or M. intracellulare) did not significantly affect the conversion rate or clinical improvement, the infectious form with or without respiratory underlying disease, the characteristics and extent of lesion on chest X-ray, and the dose of clarithromycin significantly influenced the conversion rate or clinical improvement. There were no problems concerning adverse reactions for this regimen.. This combined therapy, according to the guideline proposed by ATS and JST, was one of the effective treatments compared to the clinical effect of only antituberculous drugs through this study. However, this combined therapy was unsatisfactory compared to the clinical effect for pulmonary tuberculosis. The development of new companion drugs for MAC pulmonary diseases is needed.

Topics: Adult; Aged; Aged, 80 and over; Antitubercular Agents; Clarithromycin; Drug Therapy, Combination; Ethambutol; Female; Humans; Lung Diseases; Male; Middle Aged; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Practice Guidelines as Topic; Prospective Studies; Rifampin; Streptomycin; Treatment Outcome

Previous reports on small numbers highlighted the need for a prospective study of the clinical features and response to treatment of pulmonary disease caused by Mycobacterium avium-intracellulare (MAC).. Patients with two positive cultures were randomised to 2 years of rifampicin and ethambutol or of rifampicin, ethambutol and isoniazid. Clinical, bacteriological and radiological progress was monitored for 5 years.. Seventy-five patients entered the study. They had a mean age of 64 years (range 29-87) and the sexes were balanced. Approximately two-thirds had previous/ co-existing lung disease(s). Sputum was positive on direct smear in 56%, and cavitation was observed in 61%, most having at least one large cavity. Just under half had bilateral disease and one-third extensive disease. Disease was confined to upper zone(s) in 25%. Twenty-seven (36%) died within 5 years, three because of MAC disease. There were 11 treatment failures and 10 relapses, with no correlation between those and in vitro resistance. Forty-five (60%) were alive at 5 years, of whom 23 were confirmed cured.. Pulmonary disease caused by MAC is associated with high morbidity and mortality. Standard susceptibility tests do not correlate with the response of the disease to chemotherapy. Rifampicin and ethambutol, with or without isoniazid, cured 31%, a result comparable with or better than that found previously with more toxic regimens, but mortality (36%) remains high. More effective regimens are needed, and management of coexisting illnesses and general health needs to be to maximised.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antitubercular Agents; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Ethambutol; Female; HIV Seronegativity; Humans; Isoniazid; Lung Diseases; Male; Middle Aged; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Prospective Studies; Radiography, Thoracic; Rifampin; Sputum; Treatment Outcome

Mycobacterium kansasii pulmonary disease is frequently misdiagnosed and treated as tuberculosis, especially in countries with high tuberculosis burden. This study aimed to investigate the drug resistance profile of M.kansasii in patients with M.kansasii pulmonary disease in Shanghai and to determine the variations in drug resistance after 2 months of antimycobacterial treatment.. All patients with a diagnosis of M.kansasii pulmonary disease from 2017 to 2019 in Shanghai were retrospectively analysed. Whole-genome sequencing was performed, and the minimum inhibitory concentration (MIC) to antimycobacterial drugs was measured using the broth microdilution method.. In total, 191 patients had a diagnosis of M.kansasii pulmonary disease. Of them, 24.1% (46/191) had persistent positive culture after 2 months of antimycobacterial treatment. Whole-genome sequencing revealed that the 46 paired isolates had a difference of <17 single nucleotide polymorphisms, thus excluding the possibility of exogenous reinfection. More than 90% of the baseline isolates were sensitive to rifampin, clarithromycin, moxifloxacin, or amikacin, whereas a high resistance to ethambutol (118/191, 61.8%) and 4 μg/mL of isoniazid (32/191, 16.8%) were observed. Two isolates presented high resistance to rifamycin (i.e. a rifampin MIC of >8 μg/mL and a rifabutin MIC of 8 μg/mL) both containing the rpoB mutation (S454L). The increase of MIC to rifampin, ethambutol, and/or isoniazid was identified in 50.0% (23/46) of the patients.. A high prevalence of innate resistance to ethambutol and isoniazid was observed among circulating M.kansasii clinical strains in Shanghai. The increase in drug resistance under empirical antimycobacterial treatment highlighted the urgency of definitive species identification before initiating treatment.

Topics: Anti-Bacterial Agents; Antitubercular Agents; China; Ethambutol; Humans; Isoniazid; Lung Diseases; Microbial Sensitivity Tests; Mycobacterium kansasii; Retrospective Studies; Rifampin; Tuberculosis

During the treatment of Mycobacterium avium complex pulmonary disease (MAC-PD), ethambutol or rifampin is often discontinued because of adverse events. This study investigated the treatment outcomes when broader-spectrum fluoroquinolones replace ethambutol or rifampin in MAC-PD treatment based on the radiologic type. From 2006 to 2019, patients who initiated standard treatment and whose treatment duration was ≥1 year were retrospectively identified at a tertiary referral center in South Korea, including 178 patients with cavitary disease (fibrocavitary and cavitary nodular bronchiectatic types) and 256 patients with the noncavitary nodular bronchiectatic (NC-NB) type. We compared the microbiologic cure at 1 year between the patients who maintained the initial regimen and those who replaced ethambutol or rifampin with fluoroquinolones (moxifloxacin or levofloxacin). The overall microbiologic cure rate of the 178 patients with cavitary disease was 71.3%. Among these, the microbiologic cure rates of the 16 patients who substituted fluoroquinolones for ethambutol were lower than those of the 156 patients who maintained three-drug oral antibiotics with aminoglycoside (37.5% versus 74.4%, respectively;

Topics: Anti-Bacterial Agents; Drug Therapy, Combination; Ethambutol; Fluoroquinolones; Humans; Lung Diseases; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Retrospective Studies; Rifampin

In Japan, Mycobacterium avium complex lung disease (MAC-LD) is the most common in nontuberculous mycobacterial lung disease. Patients often experience adverse events, resulting in the discontinuation of treatment, which causes treatment failure. The JADER (Japanese Adverse Drug Event Report) database is a database of adverse events that allows us to collect real-world data on adverse events. We can collect large-scale data cost-effectively and detect signals of potential adverse events such as reporting odds ratio (ROR) by using spontaneous reporting systems. In this study, we aimed to elucidate the adverse events of clarithromycin (CAM), ethambutol (EB), and rifampicin (RFP) using the JADER database.. We included cases of MAC-LD between April 2004 and June 2017. We investigated sex, age, and medications that may have caused the adverse events, outcomes, and time of onset. We calculated the safety signal index as the ROR. Time-to-event analysis was performed using the Weibull distribution.. The total number of adverse events of CAM, EB, and RFP was 2780, with 806 patients. In the overall adverse events, hematologic and lymphatic disorders were the most common adverse events, with 17.3%, followed by eye disorders (16.6%), and hepatobiliary disorders (14.0%). The outcomes were as follows: recovery, 40.0%; remission, 27.1%; non-recovery, 11.2%; and death, 7.1%. Regarding the most common onset time of CAM, EB, and RFP was within 120 days at 40%, 181-300 days at 43.6%, and within 120 days at 88.5%. For CAM, the RORs of infections and infestations, hepatobiliary system disorders, and immune system disorders were 4.13 (95% confidence interval [CI], 2.3-7.44), 2.61 (95% CI, 1.39-4.91), and 2.38 (95% CI, 1.04-5.44). For EB, the ROR of eye disorders was 215.79 (95% CI, 132.62-351.12). For RFP, the RORs of renal and urinary tract disorders and investigations were 7.03 (95% CI, 3.35-14.77) and 6.99 (95% CI, 3.22-15.18). The β value of EB was 2.07 (95% CI, 1.48-2.76), which was classified as a wear-out failure type.. For MAC-LD, the adverse event which has the highest ROR is infections and infestations in CAM, eye disorders in EB, renal and urinary tract disorders in RFP. Adverse events of EB occur after 180 days, whereas the adverse events of CAM and RFP occur early in the course of treatment.

Topics: Clarithromycin; Drug-Related Side Effects and Adverse Reactions; Ethambutol; Humans; Japan; Lung Diseases; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Rifampin

Topics: Aged; Amikacin; Antitubercular Agents; Azithromycin; Biomarkers; Drug Therapy, Combination; Ethambutol; Female; Humans; Lung Diseases; Male; Middle Aged; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Retrospective Studies; Rifampin; Stem Cells

Topics: A549 Cells; Alginates; Animals; Antioxidants; Ascorbic Acid; Biological Transport; Cell Line; Cell Line, Tumor; Chitosan; Drug Carriers; Drug Delivery Systems; Female; Humans; Lung; Lung Diseases; Macrophages, Alveolar; Male; Nanoparticles; Particle Size; Polylactic Acid-Polyglycolic Acid Copolymer; Polymers; Rats; Rats, Wistar; Respiratory Mucosa; Rifampin; Swine; Tissue Distribution

Clinical management of macrolide-resistant Mycobacterium avium complex (MR-MAC) lung disease is difficult. To date, there only exist a limited number of reports on the treatment of clarithromycin-resistant MAC (CR-MAC) lung disease. This study aimed to evaluate prognostic factors and identify effective treatments in CR-MAC lung disease. We retrospectively collected clinical data of patients newly diagnosed with CR-MAC lung disease at the Kinki-Chuo Chest Medical Center between August 2010 and June 2018. Altogether, 37 patients with CR-MAC lung disease were enrolled. The median age was 69 years; 30, 22, and 21 patients received clarithromycin, ethambutol, and rifampicin, respectively, on their own or in drug combination. The observed sputum culture conversion rate was 29.7% (11/37 patients). In univariate analysis, ethambutol significantly increased the rate of sputum culture conversion (p = 0.027, odds ratio (OR) 10; 95% confidence interval (CI) 1.11-89.77). Multivariate analysis confirmed that ethambutol increased sputum culture conversion rate (p = 0.026; OR 21.8; 95% CI 1.45-329) while the existence of lung cavities decreased it (p = 0.04; OR 0.088; 95% CI 0.009-0.887). The combined use of ethambutol with other drugs may improve sputum culture conversion rate in CR-MAC lung disease.

Topics: Aged; Antitubercular Agents; Clarithromycin; Drug Resistance, Bacterial; Drug Therapy, Combination; Ethambutol; Female; Humans; Japan; Lung; Lung Diseases; Male; Middle Aged; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Prognosis; Respiratory Tract Infections; Retrospective Studies; Rifampin; Sputum; Tomography, X-Ray Computed; Treatment Outcome

A three-drug regimen (macrolide, ethambutol, and rifampicin) is recommended for the treatment of Mycobacterium avium complex pulmonary disease (MAC-PD). Although macrolide has proven efficacy, the role of ethambutol and rifampicin in patients without acquired immune deficiency syndrome is not proven with clinical studies. We aimed to clarify the roles of ethambutol and rifampicin in the treatment of MAC-PD.. Patients treated for MAC-PD between March 1st, 2009 and October 31st, 2018 were reviewed retrospectively. Rates of culture conversion, microbiological cure, treatment failure, and recurrence were compared according to the maintenance (≥6 months) of ethambutol or rifampicin with macrolide.. Among the 237 patients, 122 (51.5%) maintained ethambutol and rifampicin with macrolide, 58 (24.5%) maintained ethambutol and macrolide, 32 (13.5%) maintained rifampicin and macrolide, and 25 (10.6%) maintained macrolide only. Culture conversion was reached for 190/237 (80.2%) patients and microbiological cure was achieved for 129/177 (72.9%) who completed the treatment. Treatment failure despite ≥12 months of treatment was observed in 66/204 (32.4%), and recurrence was identified in 16/129 (12.4%) who achieved microbiological cure. Compared with maintenance of macrolide only, maintenance of ethambutol, rifampicin or both with macrolide were associated with higher odds of culture conversion [odds ratio (OR), 95% confidence interval (CI): 18.06, 3.67-88.92; 15.82, 2.38-105.33; and 17.12, 3.93-74.60, respectively]. Higher odds of microbiological cure were associated with maintenance of both ethambutol and rifampicin with macrolide (OR, 95% CI: 5.74, 1.54-21.42) and macrolide and ethambutol (OR, 95% CI: 5.12, 1.72-15.24) but not macrolide and rifampicin. Maintenance of both ethambutol and rifampicin with macrolide was associated with lower odds of treatment failure (OR, 95% CI: 0.09, 0.01-0.53) compared with macrolide only, while maintenance of one of these with macrolide was not. Maintenance of both ethambutol and rifampicin or one of these with macrolide did not decrease the probability of recurrence when compared with macrolide only.. Maintenance (≥6 months) of ethambutol and rifampicin with macrolide was associated with the most favorable treatment outcomes among patients with MAC-PD. Given the association between ongoing ethambutol use and microbiological cure, clinicians should maintain ethambutol unless definite adverse events develop.

Topics: Adult; Aged; Antibiotics, Antitubercular; Antitubercular Agents; Drug Therapy, Combination; Ethambutol; Female; Follow-Up Studies; Humans; Lung Diseases; Male; Middle Aged; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Radiography, Thoracic; Retrospective Studies; Rifampin; Time Factors; Treatment Outcome; Young Adult

Mycobacterium kansasii is a major pathogen associated with nontuberculous mycobacterial pulmonary disease. For treatment of M. kansasii pulmonary disease, daily therapy with isoniazid, rifampin, and ethambutol is traditionally recommended. Although a regimen containing a macrolide, instead of isoniazid, has been recently recommended, supporting data are limited. We compared the treatment outcomes of a macrolide-containing regimen (macrolide group) and an isoniazid-containing regimen (isoniazid group) on patients with M. kansasii pulmonary disease.. A total of 49 patients were identified between January 2002 and December 2016. Treatment outcomes for the isoniazid group (n = 24) and the macrolide group (n = 25) were compared.. Baseline characteristics of the isoniazid and macrolide groups were similar. Favorable outcomes did not differ between the isoniazid group (79%, n = 19) and macrolide group (88%, n = 22, P = 0.463). Total treatment duration (median 17.9 months vs. 15.4 months; P = 0.712) and time to culture conversion (median 2.0 months vs. 1.2 months; P = 0.838) were also similar between the isoniazid and macrolide groups. Five patients who completed three-times-weekly intermittent treatment containing a macrolide for non-cavitary M. kansasii pulmonary disease achieved negative sputum culture conversion within 12 months of treatment. Only one patient experienced recurrence of M. kansasii pulmonary disease in the isoniazid group.. A macrolide-containing regimen appears to be as effective as an isoniazid-containing regimen for treatment of M. kansasii pulmonary disease. Additionally, intermittent therapy containing a macrolide could be an alternative treatment option for non-cavitary M. kansasii pulmonary disease.

Topics: Aged; Antitubercular Agents; Drug Therapy, Combination; Ethambutol; Female; Humans; Incidence; Isoniazid; Lung Diseases; Macrolides; Male; Middle Aged; Mycobacterium Infections, Nontuberculous; Mycobacterium kansasii; Nontuberculous Mycobacteria; Republic of Korea; Retrospective Studies; Rifampin; Tomography, X-Ray Computed; Treatment Outcome

Topics: Aged; Antitubercular Agents; Female; Glomerulonephritis, IGA; Humans; Lung Diseases; Male; Middle Aged; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Prednisolone; Rifampin

We report a case of cavitary pulmonary disease caused by Mycobacterium shimoidei in 67-year-old female with history of asthma. Even though susceptibility testing was not available, choice of treatment regimen (streptomycin, rifampicin, ethambutol, and clarithromycin), based on a few cases with favorable outcome reported in the literature, resulted with an excellent clinical, microbiological, and radiological response. This is the first report of pulmonary disease caused by M. shimoidei, but also the first ever isolation of M. shimoidei in Croatia.

Topics: Aged; Anti-Bacterial Agents; Clarithromycin; Croatia; Female; Humans; Lung Diseases; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Rifampin; Streptomycin; Treatment Outcome

Unilateral hypoplasia of the lung is a rare congenital condition, the mechanism of which is poorly understood. Primary pulmonary hypoplasia occurring in an adult is extremely rare and we present what is probably the first case of a link to a tuberculous pleural effusion in a young woman after childbirth.. Herein, we describe a 31-year-old woman with left lung hypoplasia, and she not only survived to adulthood without problems, but was able to deliver a baby in natural labor.. Left lung hypoplasia, right tuberculous pleural effusion.. We initiated an anti-tuberculosis treatment for this patient with dose adjustments to her weight of isoniazid (0.3 g/day), rifampicin (0.45 g/day), pyrazinamide (1.5 g/day), and ethambutol (0.75 g/day) for 2 months then isoniazid and rifampicin for another 4 months.. Ten days later after beginning therapy, she became afebrile and the pleural effusion resolved. No recurrence was observed during a 6-month follow-up period.. In clinical practice, if one sees a chest x-ray revealing complete or incomplete opacification of a hemithorax with volume loss and history of repeated respiratory infections, one should consider the possibility of unilateral pulmonary hypoplasia. In such cases, regular close follow-up is important to minimize infections and to prevent development of cor pulmonale or respiratory failure.

Topics: Abnormalities, Multiple; Adult; Antitubercular Agents; Ethambutol; Female; Humans; Isoniazid; Lung; Lung Diseases; Mycobacterium tuberculosis; Parturition; Pleural Effusion; Pregnancy; Pulmonary Heart Disease; Respiratory Insufficiency; Rifampin; Tomography, X-Ray Computed; Treatment Outcome; Tuberculosis, Pleural; Tuberculosis, Pulmonary

The number of patients with non-tuberculous mycobacterial lung disease (NTM-LD) worldwide has been increasing.. To evaluate adverse reactions with long-term administration of drugs for MAC-LD.. We conducted a retrospective single-centre medical chart review of 364 patients administered two or more drugs between July 2010 and June 2015.. The prevalence and median time to onset of adverse reactions were as follows: hepatotoxicity 19.5%, 55 days; leucocytopaenia 20.0%, 41 days; thrombocytopaenia 28.6%, 61.5 days; cutaneous reactions 9.3%, 30 days; ocular toxicity 7.7%, 278 days; and increase in serum creatinine 12.4%, 430.5 days. Multivariate analysis showed that rifampicin use was independently associated with thrombocytopaenia, and ethambutol use was independently associated with increases in serum creatinine.. The main adverse reactions appeared within 3 months after start of treatment. Most patients were able to continue treatment with liver-supporting therapy, antihistamine agents or desensitisation therapy; however, ocular toxicity must be monitored for up to 1 year after start of treatment.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Drug Administration Schedule; Drug-Related Side Effects and Adverse Reactions; Ethambutol; Female; Humans; Japan; Logistic Models; Lung Diseases; Male; Middle Aged; Multivariate Analysis; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Retrospective Studies; Rifampin; Sputum; Time Factors; Young Adult

Pulmonary infection due to Mycobacterium malmoense can be difficult to diagnose. These difficulties can be responsible for a delay in the implementation of optimal treatment. Moreover, the treatment is not standardized.. We report the case of a 56-year-old patient who developed a Mycobacterium malmoense pulmonary infection whose diagnosis was delayed due to initial suspicion of pulmonary Mycobacterium tuberculosis infection. Once the diagnosis was confirmed, the patient was treated empirically with rifampicin, ethambutol, and clarithromycin for 12 months after culture conversion, giving a total of 15 months. The clinical and radiological outcomes were favorable.. This clinical case highlights the difficulties of diagnosing pulmonary atypical mycobacterial infection according to the American Thoracic Society criteria, particularly Mycobacterium malmoense, a non-tuberculous mycobacterium (NTM) quite uncommon in France. Currently, there are new diagnostic techniques such as GenoType Mycobacteria Direct. A more systematic reporting strategy could allow cohort studies and therefore provide us with data on the most efficient drugs in the treatment of the rarest NTM infections.

Topics: Clarithromycin; Diagnosis, Differential; Ethambutol; Humans; Lung Diseases; Male; Middle Aged; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Respiratory Tract Infections; Rifampin; Tuberculosis, Pulmonary

The revised 2007 American Thoracic Society/Infectious Diseases Society of America statement recommend clarithromycin-based combination therapy for treatment of Mycobacterium avium complex lung disease and stipulates approximately 1 year of continuous treatment after bacilli negative conversion. However, supporting data are insufficient. Our objective was to obtain data on the clinical outcome of clarithromycin-based daily regimens by conducting a nationwide retrospective post-marketing study of M. avium complex lung disease. In accordance with the Japanese guidelines, patients were enrolled in this survey according to their chest radiographic findings and microbiologic test results. They were treated with a multidrug regimen including clarithromycin, rifampicin, and ethambutol (clarithromycin-based regimen) until bacilli negative conversion, and the treatment was continued for approximately 1 year after the initial conversion. Data were collected before administration, at the time of bacilli negative conversion, at the end of treatment, and at 6 months after the end of treatment. Of the 466 subjects enrolled in the study, 271 patients who received clarithromycin at 800 mg/day underwent evaluation for M. avium complex disease. The final bacilli negative conversion rate in those patients was 94.7%. The bacteriological relapse rate was 5.0% (5/100 patients). Bacteriological relapse was noted in patients treated for less than 15 months after conversion. No life-threatening or serious adverse drug reactions were observed. This study demonstrated that a clarithromycin-based daily regimen can yield a high bacteriological conversion rate in M. avium complex disease. After conversion, treatment for less than 15 months might be insufficient to prevent bacteriological relapse.

Topics: Aged; Antitubercular Agents; Clarithromycin; Drug Therapy, Combination; Ethambutol; Female; Humans; Lung Diseases; Male; Marketing; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Retrospective Studies; Rifampin; Sputum; Treatment Outcome

Nontuberculous mycobacteria (NTM) caused pulmonary disease is on increase worldwide, especially in countries with decreasing time trend of tuberculosis incidence. NTM skeletal affection is rare. Mycobacterium avium related disease, with still unclear clinical and radiologic features, is in current focus of both clinicians and researchers. An exhausted severely ill 71-year-old man was admitted on emergency due to cough, dyspnea and lumbar back pain to be diagnosed with terminal phase M. avium disease. Three sputum smears were positive for acid fast bacilli and M. avium was identified with hybridization reaction by means of GenoType ® MTBC (Hain). Apart from pulmonary disease, compressive fractures of the 12th thoracic and 1-4th lumbar vertebrae were detected. We found age, chronic alcoholism, previous professional exposure, tobacco smoking, chronic obstructive pulmonary disease and previous tuberculosis as risk factors for NTM disease in the HIV-negative patient. Despite combined antibiotic treatment, disease had lethal outcome. This case report might contribute to clinicians' awareness and improved knowledge on this sort of pathology, and lead to earlier diagnosis with possibly better disease outcome.

Topics: Aged; Clarithromycin; Drug Therapy, Combination; Ethambutol; Fatal Outcome; Humans; Lung Diseases; Male; Mycobacterium avium; Mycobacterium Infections, Nontuberculous; Respiratory Insufficiency; Rifampin; Risk Factors; Spinal Diseases; Sputum

Topics: Anti-Bacterial Agents; Azithromycin; Bronchial Fistula; Cysts; Ethambutol; Humans; Hydropneumothorax; Immunocompromised Host; Liver Diseases; Lung; Lung Diseases; Male; Middle Aged; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Pleura; Rifampin; Tomography, X-Ray Computed

Little information is available regarding changes in immune status for patients with Mycobacterium avium complex (MAC) lung disease during antibiotic therapy. Serum immunomolecules from 42 patients with MAC lung disease were assayed comparatively using an array-based system according to (i) patients with MAC lung disease at the time of diagnosis versus healthy controls and (ii) alterations after 12 months of antibiotic therapy in the MAC lung disease group. In addition, cytokine analyses were performed to determine whether cytokine responses were associated specifically with the disease phenotype, treatment outcome and aetiological agent. Notably, the serum concentrations of type 1 cytokine-associated molecules, such as CD40L, interferon (IFN)-γ, interleukin (IL)-8 and IL-23, were decreased significantly in patients at the time of diagnosis, suggesting that these molecules may serve as indicators of host susceptibility to MAC disease. Although the overall serum level of T helper type 1 (Th1)-related molecules, such as CD40L and IFN-γ, was restored after treatment, Th17-related cytokines, such as IL-17 and IL-23, were down-regulated significantly at 12 months post-treatment compared to pretreatment. Furthermore, these cytokine patterns differed among patient subgroups. Decreased serum concentrations of IL-17 and/or IL-23 were associated with failure of sputum conversion, the fibrocavitary disease phenotype and M. intracellulare lung disease. Thus, the reciprocal balance between Th1 and Th17 immunity during antibiotic therapy for MAC lung disease is critical for dictating the treatment response. In conclusion, a low level of Th1-related immunomolecules may perpetuate MAC lung disease, and the serum concentrations of Th17-related cytokines can reflect the treatment outcome, disease phenotype and aetiological agent.

Topics: Aged; Anti-Bacterial Agents; Clarithromycin; Cytokines; Drug Therapy, Combination; Ethambutol; Female; Humans; Lung Diseases; Male; Middle Aged; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Prospective Studies; Rifampin; Th1 Cells; Th17 Cells; Th2 Cells

Due to the differences in the management of Mycobacterium kansasii disease and tuberculosis, an accurate diagnosis is required. This report, which describes what we believe to be the first documented case of M. kansasii infection in a patient suffering from anorexia nervosa, sheds light on the possible occurrence of a non-tuberculous mycobacterial infection that can mimic tuberculosis, on the risk of a misleading interpretation of interferon-gamma release assays, and on the temporal response to these tests.

Topics: Anorexia Nervosa; Antibodies, Bacterial; Antitubercular Agents; Ethambutol; Female; Humans; Interferon-gamma; Isoniazid; Lung Diseases; Lymphocytes; Mycobacterium Infections, Nontuberculous; Mycobacterium kansasii; Rifampin; Young Adult

Little is known regarding the application of therapeutic drug monitoring for treatment of Mycobacterium avium complex (MAC) lung disease.. To evaluate drug interactions of multidrug regimens and clinical usefulness of therapeutic drug monitoring in the management of MAC lung disease.. A total of 130 patients with MAC lung disease and 60 patients with Mycobacterium abscessus complex lung disease were enrolled in this study. All of the MAC patients were treated with multidrug regimens that included clarithromycin (CLR), rifampin (RIF) or rifabutin (RFB), and ethambutol (EMB), and the plasma drug concentrations of CLR, RIF, and EMB were measured.. Peak plasma CLR concentrations were lower in patients with MAC lung disease who received daily (median, 0.3 μg/ml) or intermittent (median, 0.2 μg/ml) therapy with CLR in conjunction with RIF in both groups, compared with those diagnosed with M. abscessus complex lung disease who received CLR without RIF (median, 3.8 μg/ml; P < 0.05). The proportion of patients with MAC lung disease who received daily therapy and whose plasma CLR levels were below the target range of 2 μg/ml was 97% (96 of 99), and this rate was 100% (21 of 21) among patients with MAC lung disease who received intermittent therapy. The peak plasma drug concentrations and the peak plasma drug concentration/minimal inhibitory concentration ratios of CLR, RIF, and EMB did not differ between patients with unfavorable treatment outcomes and those with favorable outcomes.. Low plasma CLR concentrations were common in patients treated for MAC lung disease. However, there was no association between low plasma CLR concentrations and treatment outcomes. Therefore, therapeutic drug monitoring may not be beneficial in managing the therapy of patients with MAC lung disease.

Topics: Aged; Anti-Bacterial Agents; Antibiotics, Antitubercular; Clarithromycin; Drug Interactions; Drug Monitoring; Drug Therapy, Combination; Ethambutol; Female; Humans; Logistic Models; Lung Diseases; Male; Microbial Sensitivity Tests; Middle Aged; Multivariate Analysis; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Republic of Korea; Retrospective Studies; Rifabutin; Rifampin

An abnormal shadow was observed on the chest radiograph of a 39-year-old man during health examination. The chest CT scan showed a consolidation around the cysts in the left upper lobe. The patient was diagnosed with Mycobacterium xenopi lung infection based on the presence of acid-fast bacilli in the sputum culture several times, which were identified as Mycobacterium xenopi by DNA-DNA hybridization. Two weeks after the initation of chemotherapy with 4 drugs (isoniazid, rifampicin, ethambutol, and clarithromycin), the patient's sputum smear and culture test results were negative; additionally, the consolidation on the chest CT scan improved after 10 months of treatment. There have been several case reports on Mycobacterium xenopi lung infection in Japan. However, few have studied Mycobacterium xenopi lung infections associated with multiple lung cysts that responded well to chemotherapy are rare.

Topics: Adult; Clarithromycin; Cysts; Ethambutol; Humans; Isoniazid; Lung Diseases; Male; Mycobacterium Infections, Nontuberculous; Mycobacterium xenopi; Rifampin; Tuberculosis, Pulmonary

Mycobacterium gordonae is a slow-growing mycobacterium that is the least pathogenic of the mycobacteria. Infection with M. gordonae is most commonly reported in immunocompromised patients. We present a rare case of M. gordonae infection in an immunocompetent individual. A 37-year-old woman was found to have a pulmonary nodule in the left upper lobe. The patient denied any respiratory symptoms, including cough, sputum production, fever, chest pain, or shortness of breath. The patient was a lifetime nonsmoker. Physical examination was normal. Computed tomography (CT) scan of the chest revealed several discrete pleural-based inflammatory infiltrates bilaterally. The patient was treated with oral amoxicillin-clavulinic acid initially and a repeat CT scan chest was scheduled after 2 weeks. Laboratory data were nonsignificant. Repeat CT scan did not show any resolution. Patient positron emission tomography scan revealed marked hypermetabolic uptake involving bilateral parenchymal nodules, mediastinal lymph nodes, and the spleen. A thoracotomy with biopsy of the left upper lobe nodule revealed necrotizing granulomatous pneumonitis with rare acid-fast bacilli. Cultures were positive for M. gordonae. The patient was started on a multidrug regimen of azithromycin, rifampin, and ciprofloxacin, based on drug sensitivities, for 12 months. Repeat CT scan and positron emission tomography scan after treatment showed complete resolution. The patient has remained disease-free 5 years after treatment. Instead of always dismissing M. gordonae as a contaminant, we should include it in our differential diagnosis of pulmonary infection in both immunocompetent and immunocompromised hosts. Further studies are needed to understand the pathogenesis of M. gordonae infection in humans.

Topics: Adult; Anti-Bacterial Agents; Antibiotics, Antitubercular; Chest Pain; Cough; Drug Therapy, Combination; Female; Humans; Lung Diseases; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Rifampin

The optimal treatment regimen for Mycobacterium avium complex (MAC) lung disease has not yet been fully established. We evaluated the efficacy of standardized combination antibiotic therapy and the factors that might affect unfavorable microbiologic responses in patients with MAC pulmonary disease.. This retrospective study reviewed data from 96 patients (56 females; median age 59 years) treated with newly diagnosed MAC lung disease between January 2003 and December 2006.. All patients received standardized combination antibiotic therapy, consisting of clarithromycin, rifampicin, and ethambutol. Streptomycin was additionally given in 72 patients (75%) for a median duration of 4.5 months. The overall favorable microbiologic response rate was 79% (76/96); 20 patients (21%) had unfavorable microbiologic responses, including failure to sputum conversion (n = 13), relapse (n = 3), and MAC-related death (n = 4). A positive sputum acid-fast bacillus smear at the start of treatment was an independent predictor of an unfavorable microbiologic response.. Standardized combination antibiotic therapy consisting of clarithromycin, rifampicin, and ethambutol with or without initial use of streptomycin is effective in treating patients with newly diagnosed MAC lung disease.

Topics: Aged; Anti-Bacterial Agents; Clarithromycin; Drug Therapy, Combination; Ethambutol; Female; Humans; Lung Diseases; Male; Middle Aged; Mycobacterium avium; Mycobacterium Infections; Retrospective Studies; Rifampin; Streptomycin; Treatment Outcome

Long-lasting therapy for Mycobacterium kansasii lung disease with rifampin-containing multidrug regimens is needed to avoid relapses. The aim of the present study is to evaluate a short multidrug treatment regimen for M. kansasii lung disease. A retrospective observational study of 75 patients with M. kansasii lung disease was conducted in a teaching hospital from January 1990 to December 2005. In total, 75 (67.6%) out of 111 patients diagnosed with M. kansasii lung disease completed a 12-month multidrug treatment regimen, including rifampin, isoniazid and ethambutol, supplemented with streptomycin during the first 2-3 months. After a 41.5-month median follow-up, five (6.6%) patients relapsed. The relapse rate was 2.19 (95% confidence interval 0.71-5.12) per 100 person.yrs. Treatment compliance was considered to be appropriate in all five patients and no drug resistance developed in any case. In conclusion, a 12-month fixed-course treatment is effective in most cases of Mycobacterium kansasii lung disease, but may not be long enough for all patients.

Topics: Adult; Antitubercular Agents; Cohort Studies; Drug Administration Schedule; Drug Therapy, Combination; Ethambutol; Female; Humans; Isoniazid; Lung Diseases; Male; Middle Aged; Mycobacterium Infections, Nontuberculous; Mycobacterium kansasii; Recurrence; Retrospective Studies; Rifampin; Streptomycin

The objective of this study was to find an optimal initial combination chemotherapy that includes clarithromycin (CAM) for treatment-naive patients with Mycobacterium avium complex (MAC) pulmonary disease, as assessed by microbiological conversion using a Mycobacterium growth indicator tube (MGIT).. Thirty-four patients with treatment-naive MAC pulmonary disease (determined using 1997 American Thoracic Society criteria) were evaluated retrospectively. They demonstrated a nodular and bronchiectatic pattern without cavity on high-resolution CT (HRCT) scans. The following three regimens were administered: regimen A (n = 9) consisted of CAM (400 mg/d), ethambutol (EB) [750 mg/d], and rifampicin (RFP) [450 mg/d]; regimen B (n = 12) consisted of CAM (800 mg/d), EB (750 mg/d), and RFP (450 mg/d); and regimen C (n = 13) consisted of CAM (800 mg/d), EB (1,000 mg/d), and RFP (600 mg/d) during the first 2 months followed by a reduction of the dosage of EB from 1,000 to 750 mg/d. Gender, age, BMI, and HRCT scan finding scores were not significantly different among the three groups. Chemotherapy was continued for 18 months. Sputum culture was periodically assessed by MGIT.. Culture conversion at 18 months in regimen A (55.6%), which included a daily dosage of 400 mg of CAM (9.5 mg/kg), was significantly inferior to that in regimen B (91.7%), which included daily 800 mg of CAM (17.6 mg/kg; p < 0.05), but regimen B and C (92.3%) showed no between-group difference after > 18 months of chemotherapy.. The higher dose of CAM allowed for better culture conversion. Daily combination chemotherapy that includes CAM (800 mg) seems appropriate as an initial treatment against treatment-naive patients with nodular and bronchiectatic MAC pulmonary disease.

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Bronchiectasis; Clarithromycin; Dose-Response Relationship, Drug; Ethambutol; Female; Humans; Lung; Lung Diseases; Male; Middle Aged; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Retrospective Studies; Rifampin; Tomography, X-Ray Computed; Treatment Outcome

In this report, we describe a case of Rhodococcus equi lung infection diagnosed in an allogeneic hematopoietic stem cell transplant with oral graft-versus-host disease 3 months after stem cell infusion. The lung lesion persisted despite an approximate 3 months of vancomycin therapy, but then responded favorably to a combination of intravenous ertapenem at 1 g daily and oral rifampin at 600 mg daily for 1 month. An overview of Rhodococcus infection in transplant recipients is presented. This case and the discussed literature suggest that combination antibiotic therapy is warranted in patients with decreased humoral and cellular immunity.

Topics: Actinomycetales Infections; Anti-Bacterial Agents; beta-Lactams; Drug Therapy, Combination; Ertapenem; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Humans; Lung Diseases; Male; Middle Aged; Radiography; Rhodococcus equi; Rifampin; Transplantation, Homologous

Human brucellosis is a worldwide re-emerging zoonosis. However, its histological appearance has only been occasionally described. We report the case of a young girl who had been suffering from a spontaneous fracture of the eighth thoracic vertebra at the age of 7. At the age of 15, X-ray showed a translucence of the seventh and ninth thoracic vertebra, and additionally, a bi-lateral episcleritis was detected. Three months later, she was admitted to the hospital because of perspiration at night and moderate fever. Computer tomography revealed coarsely spotted infiltrates in the lower fields of both lungs. Serology for rheumatic diseases was negative. Thoracoscopical wedge resection was done for histological clarification of pulmonary changes. Microscopically, a granulomatous inflammation with central necrosis was seen. A Ziehl-Neelsen stain did not demonstrate acid-fast bacteria. In spite of negative serology, real-time polymerase chain reaction detected Brucella melitensis deoxyribonucleic acid in the formalin-fixed tissue samples of the lung. Interrogation of the patient revealed visits in different Arabian countries during childhood as a presumable source of infection. In conclusion, granulomatous inflammation negative for Ziehl-Neelsen and Grocott stains presenting together with other localized lesions should lead to specific investigations on brucellosis.

Topics: Adolescent; Animals; Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Cattle; Diagnosis, Differential; DNA, Bacterial; Doxycycline; Drug Therapy, Combination; Female; Humans; Lung Diseases; Magnetic Resonance Imaging; Prednisone; Radiography, Thoracic; Rifampin; Treatment Outcome

Mycobacterium kansasii infection is one of the most common causes of nontuberculous mycobacterial lung disease in world. However, little is known about its background characteristics or drug sensitivity in nonendemic areas.. We assessed the clinical features, radiologic findings, and drug sensitivity associated with M kansasii infection in Israel.. Patients with a culture-positive diagnosis of M kansasii infection between April 1999 and April 2004 were identified from a clinic database of tuberculosis centers. Mycobacterial cultures were performed with standard methods. Data on patient background and clinical features were collected from the medical files.. Mean age (+/- SD) of the 56 patients was 58 +/- 18 years, and 64% were men; 59% had associated lung disease. Fifteen percent were receiving immunosuppressive medications. None had HIV infection. Systemic comorbid diseases were noted in 27%. The most common clinical presentations were chest pain, cough, hemoptysis, fever, and night sweats. Cavitation was noted only in 54%. Older patients had more noncavitary disease than younger patients (p = 0.01, r = 0.35). Lower-lobe predominance was very rare (4%). None of the patients presented with pleural effusion or lymphadenopathy. Only seven patients (11%) underwent bronchoscopy for diagnosis. M kansasii isolates showed the highest sensitivity to rifampin, ethambutol, clarithromycin, and ofloxacin, and the highest resistance to ciprofloxacin and capreomycin. The mean duration of treatment was 21 +/- 7.2 months. There were no disease-related deaths.. M kansasii disease in Israel has no association with HIV, more systemic comorbid diseases and associated lung disease, and fewer cavitations. Following appropriate treatment, patients with M kansasii disease have an excellent prognosis.

Topics: Adult; Antibiotics, Antitubercular; Ciprofloxacin; Clarithromycin; Cycloserine; Ethambutol; Ethionamide; Female; Humans; Israel; Lung Diseases; Male; Microbial Sensitivity Tests; Middle Aged; Mycobacterium Infections, Nontuberculous; Mycobacterium kansasii; Ofloxacin; Prognosis; Rifampin

M. malmoense could be cultivated in sputum samples of a 49-year-old patient with destructive pulmonary disease. The conventional antituberculous therapy (started because initially a presumptive diagnosis of tuberculosis was established) was altered to ethambutol, rifabutin, clarithromycin and ciprofloxacin, followed by a long-time therapy with azithromycin or clarithromycin. But till now it was not possible to eradicate the mycobacteria from the respiratory tract (insufficient compliance, interruptions of the therapy due to side effects, excessive smoking). Infections due to M. malmoense are rare events. Many patients have disposing underlying diseases. In most cases it is a pulmonary infection. The most frequent used antibiotics are rifampicin (or rifabutin), ethambutol and clarithromycin.

Topics: Azithromycin; Clarithromycin; Drug Therapy, Combination; Ethambutol; Humans; Lung Diseases; Male; Middle Aged; Mycobacterium Infections, Nontuberculous; Rifampin

Pulmonary involvement is a rare manifestation of brucellosis. The aim of this study was to determine the incidence and forms of pulmonary involvement in the course of brucellosis.. A prospective study was carried out in 110 patients with brucellosis. All the patients were evaluated with their pulmonary symptoms, physical examination and chest radiography. If pulmonary pathologic findings were present, patients underwent additional diagnostic evaluations including computerized tomography of the thorax and pulmonary function tests.. From 110 patients, 11 (six females and five males) were diagnosed as pulmonary brucellosis. Eight of 11 patients had pulmonary symptoms including cough, sputum and dyspnoea. Radiologic findings were parenchymal nodules, lobar pneumonia, paratracheal lymphadenopathy and pleural effusion. At the end of the treatment of brucellosis, clinical findings of pulmonary involvement were recovered in all patients except four dyspnoeic patients who had coexisting COPD. Radiological findings were normal in three and improved in four patients after 6 months of the treatment.. Pulmonary involvement is a rare event in the course of brucellosis. But especially in endemic regions, brucellosis should never be forgotten as a causative agent in patients with pulmonary symptoms.

Topics: Adult; Aged; Anti-Bacterial Agents; Brucella; Brucellosis; Doxycycline; Drug Therapy, Combination; Female; Humans; Incidence; Lung Diseases; Male; Middle Aged; Prospective Studies; Radiography; Rifampin; Streptomycin

A case was 56 years old woman, and she did not have any subjective symptom. She received multiphasic health screening, and abnormal shadow was detected on her chest radiograph. Chest radiography revealed infiltrations in the middle lobe. Computed tomography (CT) of the thorax showed clusters of small nodules in the middle lobe. The bronchial washing specimen showed acid-fast bacilli identified as Mycobacterium intracellulare by DNA-DNA hybridization (DDH) method. This case was diagnosed as Mycobacterium intracellulare lung disease. The patient received combination therapy with rifampicin, ethambutol, and clarithromycin for one year with radiological improvement. CT findings were characteristic and useful for the early diagnosis of MAC infection, which led to cure of the disease by chemotherapy.

Topics: Antitubercular Agents; Clarithromycin; Drug Administration Schedule; Drug Therapy, Combination; Ethambutol; Female; Humans; Lung Diseases; Magnetic Resonance Imaging; Middle Aged; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Rifampin; Tomography, X-Ray Computed

We report a case of Legionella pneumonia in a 10-year-old girl with idiopathic pulmonary hemosiderosis who was chronically immunosuppressed and had exposure to a hot tub. Prompt diagnosis with bronchoalveolar lavage and subsequent antimicrobial therapy resulted in full recovery. Legionellosis should be included in the differential diagnosis of the immunosuppressed child with respiratory illness. High risk patients should avoid exposure to hot tubs.

Topics: Child; Drug Therapy, Combination; Female; Follow-Up Studies; Hemosiderosis; Humans; Immunosuppressive Agents; Infusions, Intravenous; Legionnaires' Disease; Lung Diseases; Ofloxacin; Opportunistic Infections; Radiography, Thoracic; Rifampin; Risk Assessment; Treatment Outcome

Pulmonary manifestations of Brucellosis are rare. We came across seven patients with predominant symptomatology of pulmonary involvement amongst 98 patients of active brucellosis seen in last four years.. The study is related to patients of brucellosis whose principal presenting features were related to respiratory symptom (cough, expectoration, pain in chest and breathlessness) along with fever and other constitutional symptoms. It included seven patients amongst 98 patients of active brucellosis seen during June 1996 to Feb. 2000 at PBM Hospital Bikaner. Diagnosis was confirmed by demonstration of the raised brucella agglutination titre of 1:320 or more in the serum. All patients were treated with rifampicin 900 mg daily and doxycyclin 100 mg twice daily for six week. The treatment was extended for another four weeks in two patients because of persistence of skiagram abnormalities.. Three patients had abnormality in skiagram chest in the form of pleural effusion, multiple paranchymal opacities and pneumonia. The skiagram chest was normal in remaining four patients. The response of treatment started with 10-15 days and all the patients became symptom-free at the end of six weeks except one patient. Skiagram chest at this time was normal in patients of pleural effusion but there was persistence of haziness and few opacities in other two patients. Follow up skiagram chest at the end of six months and twelve months was normal in all patients except calcified opacity in one patient. There was no evidence of relapse in any patient at the end of one year follow up. Liver function tests remained within normal range and no drug toxicity was observed.. Pulmonary manifestations of brucellosis are rare. Treatment with rifampicin and doxycylin showed marked clinical and radiological improvement. All patients were completely disease-free at the end of one year follow up.

Topics: Adolescent; Adult; Brucellosis; Doxycycline; Humans; India; Lung Diseases; Male; Occupational Exposure; Rifampin; Treatment Outcome

Topics: Actinomycetales Infections; Adult; AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Anti-Infective Agents; Drug Therapy, Combination; HIV Infections; Humans; Levofloxacin; Lung Diseases; Male; Ofloxacin; Rhodococcus equi; Rifampin

Ninety-two patients were assessable in 3 consecutive, open, noncomparative, prospective, controlled, single-center trials of the use of multidrug regimens that contain azithromycin for treating pulmonary Mycobacterium avium complex (MAC) disease. Azithromycin was provided at a dose of 300-600 mg per day with oral companion drugs administered daily (regimen A, 29 patients); 600 mg 3 times weekly (t.i.w.), with oral companion drugs administered daily (regimen B, 20 patients); and 600 mg (t.i.w.), with oral companion drugs administered t.i.w. (regimen C, 43 patients). All regimens included rifabutin (or rifampin) and ethambutol as companion drugs as well as initial streptomycin. Treatment success was defined as 12 months of negative cultures while on therapy. Treatment failure was defined as sputum culture positivity after at least 6 months of therapy. Of the patients in each regimen who reached study end points, 17 of 29 (59%) were in regimen A, 11 of 20 (55%) were in regimen B, and 28 of 43 (65%) were in regimen C met the treatment success criterion. There were no statistically significant differences in outcome between the 3 regimens. These studies demonstrate the effectiveness of daily and t.i.w. regimens containing azithromycin for treatment of MAC lung disease.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antibiotics, Antitubercular; Azithromycin; Drug Therapy, Combination; Drug Tolerance; Ethambutol; Female; Humans; Lung Diseases; Male; Middle Aged; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Prospective Studies; Rifabutin; Rifampin; Streptomycin; Treatment Outcome

It is generally accepted that qualitative drug susceptibility tests established and validated for Mycobacterium tuberculosis are not applicable to opportunist (non-tuberculous) mycobacteria. Previous studies have shown that in vitro antimicrobial susceptibilities for opportunist mycobacteria, performed by the method of modal resistance (MR), correlate poorly with clinical response. Minimum inhibitory concentration (MIC) determination may provide better correlation with predicted clinical response than the conventional MR results.. To determine the relationship between quantitative in vitro sensitivity results for opportunist mycobacteria and their in vivo response to treatment.. MICs were performed radiometrically with the Bactec TB-460 system; 35 M. avium complex isolates, 29 isolates of M. malmoense and 16 isolates of M. xenopi were tested.. Susceptibility results were analysed in comparison with therapeutic outcome by Fisher's exact probability test. Only one significant association was found; in vitro resistance to ethambutol correlated with treatment failure for M. malmoense infections (P = 0.027). There were no other significant correlations between in vitro results and treatment outcome.. Prediction of treatment outcome from in vitro susceptibility tests continues to be a problem in infections with opportunist mycobacteria.

Topics: Antitubercular Agents; Ethambutol; Humans; In Vitro Techniques; Lung Diseases; Microbial Sensitivity Tests; Mycobacterium; Mycobacterium Infections; Opportunistic Infections; Predictive Value of Tests; Rifampin; Treatment Outcome

We describe a rare case of pulmonary mycobacteriosis infected with rifampicin (RFP)-resistant Mycobacterium szulgai that was successfully eradicated with clarithromycin (CAM) treatment. An 80-year-old man was admitted to our hospital with a 4-week history of high fever, productive cough and malaise. Chest roentgenogram showed an infiltrative shadow in the left lower lung field. Isolated bacteria from sputum were acid-fast bacilli and identified as M. szulgai by the DNA-DNA hybridization method. Drug susceptibility tests showed resistance to RFP (MIC>100 microg/ml). Combined treatment with ethionamide, streptomycin and isoniazid based on the results of drug susceptibility tests resulted in clinical and radiologic improvement within two years. Additional treatment with CAM for another year resulted in complete eradication of the mycobacterium.

Topics: Aged; Aged, 80 and over; Antibiotics, Antitubercular; Diagnosis, Differential; DNA, Bacterial; Drug Resistance, Microbial; Humans; Lung Diseases; Male; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Nucleic Acid Hybridization; Rifampin; Sputum; Tomography, X-Ray Computed

Brucellosis is a classical zoonosis caused by a Gram-negative bacillus of the genus Brucella. Human brucellosis can either be acute or chronic and present with a variety of manifestations, mostly with fever and signs of musculo-skeletal involvement. It may be complicated by involvement of the cardiovascular, central nervous or genito-urinary systems. However, pulmonary brucellosis is a rare complication. We report a case of miliary and reticulo-nodular brucellar pneumonia with positive blood and sputum cultures and positive serological tests. To the best of our knowledge this is the first case to be reported from Israel of miliary pneumonia with sputum positive for brucellosis.

Topics: Adult; Brucellosis; Drug Therapy, Combination; Humans; Lung Diseases; Male; Radiography; Rifampin; Tetracycline

Pyrolysis mass spectrometry (Py-MS) yields data reflecting overall cell composition. The changes in composition induced by treatment with rifampicin and ethambutol, alone and in combination, were investigated for a collection of seven strains of Mycobacterium malmoense from pulmonary infections. Two strains, both from patients that had responded to therapy with this combination, showed large changes in composition from control, untreated cultures. The difference was particularly marked for the ethambutol treated cultures. Four strains, all from patients who had failed to respond to therapy with this combination, showed minimal changes in composition for all treatments. The remaining strain also showed minimal treatment-induced change, but, for this patient, therapy with the combination had proved successful. Minimum inhibitory concentrations (MICs) were determined radiometrically. All strains showed MICs < 0.5 microgram/mL for rifampicin (sensitive) and of 8 micrograms/mL for ethambutol (resistant). MIC results did not correlate with clinical response, whereas the Py-MS results correlated with clinical response for six of the seven isolates. Py-MS may have a role in predicting effective therapy for this problem group.

Topics: Ethambutol; Humans; Lung Diseases; Mass Spectrometry; Microbial Sensitivity Tests; Mycobacterium Infections; Opportunistic Infections; Rifampin

Patients with non-tuberculous mycobacteria are usually started on conventional antituberculous triple therapy once acid fast bacilli are detected, before the exact type of mycobacteria has been identified. The ability to identify the characteristics of patients with tuberculous and non-tuberculous mycobacteria may be helpful in identifying before treatment those patients more likely to have non-tuberculous infection.. A retrospective study was conducted of all patients in one unit in whom non-tuberculous mycobacteria were identified in sputum or bronchoalveolar washings in the period 1987-93. The pattern of drug resistance was determined from laboratory records, and all case notes and chest radiographs were reviewed to identify the underlying disease and treatment outcome. All cases were compared with a matched control group of patients with culture positive Mycobacterium tuberculosis diagnosed during the same period.. In the period studied there were 70 non-tuberculous and 221 tuberculous isolates. The non-tuberculous bacteria were typed as follows: M xenopi 23 (33%), M kansasii 19 (27%), M fortuitum 14 (20%), others 14 (20%). Of those with non-tuberculous mycobacteria, 83% were white subjects compared with 47% for tuberculosis. Patients with non-tuberculous mycobacteria were older than those with tuberculosis. Pre-existing lung disease or AIDS was present in 81% of patients with non-tuberculous mycobacteria and in 17% of patients with tuberculosis. Sensitivity to rifampicin and ethambutol was seen in 95% of M xenopi and 96% of M kansasii isolates. Relapse occurred in 60% of cases infected with M xenopi, 20% infected with M kansasii, and in 7% of cases with tuberculosis.. In the population studied non-tuberculous mycobacteria occurred most frequently in elderly white subjects with pre-existing lung disease. If mycobacteria are detected in this group, consideration should be given to the possibility of non-tuberculous infection before embarking on treatment. A combination containing rifampicin and ethambutol is effective. The relapse rate for infection with M xenopi is high and prospective studies of the effect of the above combination of antituberculosis drugs are needed.

Topics: Acquired Immunodeficiency Syndrome; Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Antibiotics, Antitubercular; Antitubercular Agents; Child; Drug Resistance; Drug Therapy, Combination; Ethambutol; Female; Humans; Lung Diseases; Male; Middle Aged; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Retrospective Studies; Rifampin; Treatment Outcome; Tuberculosis, Pulmonary

Pulmonary disease caused by Mycobacterium kansasii is reported in approximately 50 new patients in Britain annually. Rifampicin and ethambutol are effective in vitro but the optimal duration of treatment, and whether isoniazid should also be given, are uncertain. The British Thoracic Society has conducted a prospective, multicentre study of the treatment of this condition with rifampicin and ethambutol given for nine months.. One hundred and seventy three patients with two or more positive cultures and radiological evidence of disease were recruited via the Mycobacterium Reference Unit (PHLS) in Cardiff from 113 physicians in England, Scotland, and Wales. Rifampicin and ethambutol were given for nine months, other antituberculosis drugs being discontinued once the culture was identified as M kansasii. Patients were reviewed, sputum cultured, and chest radiographs performed before, during, and at regular intervals for 51 months after chemotherapy.. The mean (SD) age was 55.5 (11.7) years, 73% were men, and 50% had other lung problems. Cavitation was seen in 88%, bilateral shadowing in 48%, and three or more lung zones were affected in 46%. All cultures were sensitive to rifampicin and ethambutol but resistant to isoniazid and pyrazinamide. One patient who took chemotherapy irregularly still had positive cultures at seven and eight months. Fifteen patients developed positive cultures after the end of chemotherapy; factors which might account for the relapse were identified in eight. Reinfection rather than relapse was suspected in three of the 15. Radiographic improvement stabilised within three years in 80%.. M kansasii pulmonary infection responds well to nine months of treatment with rifampicin and ethambutol but patients who contract this disease have a high mortality rate from other causes. Isoniazid does not appear to be a necessary part of the regimen.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Drug Resistance, Microbial; Drug Therapy, Combination; Ethambutol; Female; Humans; Lung; Lung Diseases; Male; Middle Aged; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Prospective Studies; Radiography; Recurrence; Rifampin; Sputum

Topics: Administration, Oral; Adolescent; Alkaline Phosphatase; Child; Ciprofloxacin; Cystic Fibrosis; Drug Resistance, Microbial; Female; Follow-Up Studies; Humans; Joint Diseases; Lung Diseases; Male; Pseudomonas aeruginosa; Pseudomonas Infections; Rifampin; Safety

Topics: Actinomycetales Infections; Adult; AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Erythromycin; Humans; Lung Diseases; Male; Rhodococcus equi; Rifampin

Rifamethoprim is a new formulation containing rifampicin and trimethoprim. Its efficacy was studied in the treatment of a group of patients with various nonspecific diseases of the lungs. It was shown to be highly active against a broad spectrum of pathogens. With inclusion of trimethoprim to the formulation it appeared possible to markedly lower the bacterial ability to develop resistance to rifampicin, which solved the problem of long-term antibiotic use. The unique pharmacokinetic properties of rifampicin such as its capacity to penetrating into the sputum, lung tissues and cells make rifamethoprim be the drug of optimal choice in the treatment of respiratory diseases.

Topics: Acute Disease; Anti-Bacterial Agents; Bronchial Diseases; Chronic Disease; Drug Combinations; Drug Therapy, Combination; Humans; Lung Diseases; Rifampin; Trimethoprim

The rate of sputum conversion (continuously negative cultures for six months or more) was compared among four regimens given to 83 patients with moderately advanced, cavitary lung disease caused by Mycobacterium avium complex untreated previously. The regimens of rifampin + isoniazid + enviomycin and rifampin + isoniazid + streptomycin appeared to be superior to the regimen of rifampin + isoniazid + ethambutol. No statistically significant difference was observed between the regimens rifampin + isoniazid + enviomycin and rifampin + isoniazid + streptomycin.

Topics: Clinical Protocols; Drug Combinations; Enviomycin; Ethambutol; Female; Humans; Isoniazid; Lung Diseases; Male; Middle Aged; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Rifampin; Sputum; Streptomycin; Viomycin

We report a case of lung infection, clinically resembling tuberculosis, caused by Rhodococcus rubropertinctus. The patient had no apparent immunosuppression which is unusual for disease caused by the 'rhodochrous' complex. The infection responded successfully to oral anti-tuberculous therapy, which included rifampicin, and to oral tetracycline.

Topics: Actinomycetales Infections; Administration, Oral; Australia; Female; Humans; Lung Diseases; Rhodococcus; Rifampin; Tetracycline; Vietnam

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

Thirty seven patients whose sputum cultures had yielded positive isolates of Mycobacterium malmoense during the years 1978-1983 have been reviewed. Significant pulmonary infection was present in 34 patients (92%), 3 of whom had only single isolates cultured from their sputum. The significance of isolates in the remaining 3 patients was not established. There was pre-existing pulmonary disease in 22 patients and another 4 were taking immuno-suppressive drugs. Various drug regimens were used to treat the condition but the best responses were seen in 5 patients (13.5%) who received 3 standard drugs given for between 18-24 months. Relapse occurred in 3 of another 5 who were treated with the same combination but given for less than 18 months. Omission of ethambutol from this standard regimen was associated with an unfavourable course in another 7 patients. Regimens which included the second line drugs ethionamide and cycloserine were given to 10 patients. The responses in this group were poor and were probably related to drug toxicity and poor patient compliance. Four of these patients eventually underwent successful resectional surgery.

Topics: Adult; Aged; Antitubercular Agents; Drug Resistance, Microbial; Drug Therapy, Combination; Ethambutol; Female; Humans; Isoniazid; Lung Diseases; Male; Middle Aged; Mycobacterium Infections; Patient Compliance; Rifampin; Sputum; Tuberculosis, Pulmonary

We report a 6 year experience (1979-1984) of isolating Mycobacterium malmoense in the north-east of England. Eleven subjects were involved of whom 10 had active infection--9 pulmonary, one cervical adenitis. The 11 new isolates represent 0.7% of all new mycobacterial isolates during this period and 10% of new non-tuberculous isolates. In all but 2 cases there was pre-existing pulmonary disease and/or a recognised predisposing factor to mycobacterial infection. The organisms were generally insensitive to isoniazid but sensitive to both rifampicin and ethionamide. The results of chemotherapy are described.

Topics: Adult; Drug Therapy, Combination; England; Ethionamide; Female; Humans; Infant; Lung Diseases; Lymphadenitis; Male; Middle Aged; Mycobacterium; Mycobacterium Infections; Rifampin; Tuberculosis, Pulmonary

The authors report a case of legionnaires' disease with retractile late sequelae affecting the lingula and the dorsal segment of the culmen. They stress the need for appropriate and prolonged treatment because of the possible presence of intracellular Legionella pneumophila. The existence of an associated staphylococcal infection is also one of the hypotheses raised in explaining such sequelae.

Topics: Erythromycin; Humans; Legionnaires' Disease; Lung Diseases; Male; Middle Aged; Radiography; Rifampin; Staphylococcal Infections; Time Factors

Thirty-five patients (88% male) with pulmonary infection caused by Mycobacterium kansasii have been reviewed. Sixty-six per cent had pre-existing lung disease, chronic bronchitis and emphysema accounting for half of the disorders. Unilateral lesions were present in 69% of patients whose chest radiographs were reviewed and 90% had cavitating disease. The development of unilateral or bilateral disease appeared to be independent of any delay in starting treatment. Five patients died while receiving treatment, but none of these deaths was due to M kansasii infection. The remaining 30 patients were successfully treated with drug regimens, all of which included rifampicin and 86% of which included ethambutol. There was 100% sputum conversion, with no relapses after a mean follow-up period of five-and-a-half years. Rifampicin and ethambutol given for a mean period of 15 months appeared to be a non-toxic, effective combination.

Topics: Adult; Aged; Drug Therapy, Combination; Ethambutol; Female; Humans; Lung Diseases; Male; Middle Aged; Mycobacterium Infections; Mycobacterium Infections, Nontuberculous; Rifampin; Tuberculosis, Pulmonary

Topics: Actinomycosis; Adult; Diagnosis, Differential; Humans; Isoniazid; Lung Diseases; Male; Rifampin; Tuberculosis, Pulmonary

Topics: Adolescent; Adult; Aged; Chemical and Drug Induced Liver Injury; Female; Humans; Lung Diseases; Male; Middle Aged; Rifampin; Tuberculosis, Pulmonary

Because the accumulation of macrophages and their precursors, peripheral blood monocytes, in foci of infection is an important feature of the host reponse to mycobacterial challenge, the leukotactic responsiveness of monocytes from patients with active tuberculosis was evaluated. With a double-filter, in vitro technique, defective leukotaxis was demonstrated in monocytes from 19 of 20 untreated patients, whereas normal leukotactic responses were found in monocytes from 11 of 15 patients with chronic, nontuberculous pulmonary inflammatory diseases. This defect may be related to increased activity of a naturally occurring, heat-stable plasma substance with a molecular mass of approximately 2.3 x 10(5) daltons that inhibited leukotactic responsiveness. Monocyte leukotaxis improved and the leukotactic inhibitory activity of plasma disappeared in most patients while they were on therapy; these phenomena were unrelated to bacteriologic conversion or resolution of symptoms. In vitro studies with isoniazid, ethambutol, and rifampin excluded a direct effect of these drugs or their metabolites on monocytes or on the leukotactic inhibitor in plasma. Thus, defective leukotaxis of monocytes in patients with pulmonary tuberculosis may be an epiphenomenon of the local tissue reaction.

Topics: Adolescent; Adult; Aged; Chemotaxis, Leukocyte; Chronic Disease; Dose-Response Relationship, Immunologic; Ethambutol; Female; Humans; Immunity, Cellular; In Vitro Techniques; Isoniazid; Lung Diseases; Lymphokines; Male; Middle Aged; Monocytes; Rifampin; Tuberculosis, Pulmonary; Zymosan

Rifampicin is a broad spectrum semisynthetic antibiotic of the group of rifampicins. It is active against both grampositive and gramnegative organisms and mycobacteria. The studies on the pharmacokinetics of rifampicin showed that the drug was well absorbed from the gastro-intestinal tract. After a single administration of rifampicin in a dose of 150 mg its maximum concentration in the blood was registered in an hour. This concentration was preserved at the therapeutic level for 5 hours. Practically no accumulation of rifampicin was observed in its use in a dose of 150 mg 4 times a day for 5 days. Perspectivity of rifampicin use in the treatment of patients with inflammatory processes in the lungs of non-tuberculosis etiology was shown.

Topics: Administration, Oral; Adult; Biopharmaceutics; Humans; Intestinal Absorption; Kinetics; Lung Diseases; Middle Aged; Rifampin; Time Factors

Topics: Adult; Drug Therapy, Combination; Ethambutol; Female; Follow-Up Studies; Humans; Isoniazid; Lung Diseases; Male; Microbial Sensitivity Tests; Middle Aged; Mycobacterium Infections; Mycobacterium Infections, Nontuberculous; Rifampin; Texas

Benemecin, a Polish rifampicin was tested in vitro and clinically for the treatment of 2 groups of patients, i.e. 28 patients with chronic destructive tuberculosis of the lungs and 30 patients with non-specific pneumonia. High tuberculostatic activity of the drug in vitro was found. The clinical trials showed high efficiency of benemecin in the treatment of chronic destructive tuberculosis of the lungs and pneumonia of non-specific etiology. The drug was mainly well tolerated by the patients.

Topics: Chronic Disease; Drug Evaluation; Drug Resistance, Microbial; Drug Therapy, Combination; Ethambutol; Humans; Italy; Lung Diseases; Mycobacterium tuberculosis; Pneumonia; Poland; Postoperative Care; Rifampin; Time Factors; Tuberculosis, Pulmonary; Yugoslavia

Four patients with Mycobacterium kansaii pulmonary infection were followed without treatment for 10 to 14 years after diagnosis. Although spontaneous resolution of active disease occurred 5 years after diagnosis in one patient, slowly progressive disease in the absence of significant symptoms was documented in 3 patients during a 12-to-14-year follow-up period. Administration of antituberculous drugs resulted in rapid resolution of signs of active disease in these patients. These observations added to our limited knowledge of the natural history of M. kansasii disease.

Topics: Adult; Ethambutol; Female; Follow-Up Studies; Forced Expiratory Volume; Humans; Isoniazid; Lung Diseases; Male; Middle Aged; Mycobacterium; Mycobacterium Infections; Radiography; Rifampin; Vital Capacity

Chemotherapy of pulmonary disease due to Mycobacterium kansaii has not always been successful, and resectional surgery has been used frequently in the treatment of this infection. To ascertain the impact of new antimicrobial agents on the treatment of M. kansaii infection, we reviewed the clinical courses of 59 patients treated between 1971 and 1974. Over-all, 92 per cent of patients converted their sputum cultures while receiving drugs, with only one patient undergoing surgical resection. Regimens containing rifampin were universally effective in both initial and retreatment cases; however, they offered no significant advantage over monrifampin regimens in initial treatment cases. In vitro resistance to isoniazid and ethambutol did not adversely affect the results of treatment with these drugs. Owing to the effectiveness of current chemotherapy, parameters such as age, underlying lung disease, or extent of disease were not related to the outcome of therapy. Because 90 per cent of the conversions in successful regimens occur within 4 to 6 months of beginning therapy, patients whose cultures remain positive should be considered for alternate drugs. Because the frequency of relapse after current chemotherapy is not yet clear, and because rifampin appears to be particularly advantageous in retreatment programs, rifampin should be reserved for this role. The total course of treatment should probably span at least 18 months, or 6 months beyond any cultural or radiographic evidence of activity.

Topics: Adult; Drug Resistance, Microbial; Ethambutol; Female; Humans; Isoniazid; Lung Diseases; Male; Mycobacterium; Mycobacterium Infections; Recurrence; Rifampin; Sputum; Streptomycin; Time Factors

Topics: Aged; Aortic Valve Stenosis; Chemical and Drug Induced Liver Injury; Humans; Isoniazid; Liver; Lung Diseases; Lung Diseases, Obstructive; Male; Mycobacterium Infections; Rifampin

Renal tuberculosis will continue to be a potentially lethal disease and must be considered a diagnostic possibility in all patients with infection in order to discover it in time. Multiple drug regimens have withstood the test of time and it appears that triple drug therapy is more efficacious than 2 drugs since triple drugs permit the skipping of 1 or another of the medications with less danger of relapse. Rifampin is a new drug that is well tolerated and efficacious, although expensive. We recommend continuous use of triple drugs for 2 years at least with the continuance of pyridoxine. We advise an excretory urogram, the collection of 3 urine specimens for culture and the passage of ureteral catheters every 6 months during treatment and every 12 months thereafter for 10 years. We do not consider relapse an indication for an operation but for further therapy, using medications to which the patient's organism is proved susceptible by bacteriologic means. Under modern conditions an operation is rarely necessary.

Topics: Aminosalicylic Acids; Bilirubin; Color Perception; Cycloserine; Drug Evaluation; Drug Therapy, Combination; Ethambutol; Female; Humans; Isoniazid; Kidney; Liver; Lung Diseases; Male; Rifampin; Tuberculosis, Renal; Visual Perception

Topics: Adult; Aged; Bacterial Infections; Female; Humans; Lung Diseases; Male; Middle Aged; Postoperative Complications; Rifampin; Sepsis; Urinary Tract Infections

Topics: Capreomycin; Child; Drug Resistance, Microbial; Ethambutol; Ethionamide; Humans; Isoniazid; Kanamycin; Lung Diseases; Lymphadenitis; Mycobacterium; Mycobacterium Infections; Rifampin; Skin Diseases, Infectious; Sputum; Streptomycin

Topics: Adolescent; Adult; Aged; Aminosalicylic Acids; Antitubercular Agents; Child; Cycloserine; Ethambutol; Ethionamide; Female; Follow-Up Studies; Humans; Isoniazid; Lung Diseases; Male; Middle Aged; Mycobacterium; Mycobacterium Infections; Pneumonectomy; Pyrazinamide; Rifampin; Sputum; Streptomycin

Topics: Animals; Antigen-Antibody Complex; Antigen-Antibody Reactions; Chemical Precipitation; Humans; Lung Diseases; Molecular Weight; Rabbits; Rifampin; Rifamycins; Serum Albumin; Serum Albumin, Bovine; Skin; Skin Tests; Tuberculosis, Pulmonary

Topics: Animals; Body Weight; Coal; Dust; Guinea Pigs; Lung; Lung Diseases; Macrophages; Mycobacterium; Mycobacterium Infections; Organ Size; Pneumoconiosis; Pulmonary Fibrosis; Radiography; Rifampin; Silicon Dioxide; Tracheal Diseases

Topics: Biopsy; Bronchoscopy; Child, Preschool; Diagnosis, Differential; Ethionamide; Female; Humans; Lung Diseases; Mycobacterium; Mycobacterium Infections; Rifampin; Tuberculosis, Pulmonary

Topics: Bronchial Diseases; Chloramphenicol; Humans; Lung Diseases; Microbial Sensitivity Tests; Pseudomonas Infections; Rifampin; Staphylococcal Infections; Streptococcal Infections; Tetracycline

Topics: Adult; Diagnosis, Differential; Humans; Lung Diseases; Male; Mycobacterium; Mycobacterium Infections; Rifampin; Tuberculosis, Pulmonary

Topics: Adult; Aged; Aminosalicylic Acids; Antitubercular Agents; Chronic Disease; Cycloserine; Empyema, Tuberculous; Ethambutol; Humans; Isonicotinic Acids; Kidney Function Tests; Liver Function Tests; Lung Diseases; Middle Aged; Morpholines; Pyrazines; Rifampin; Tuberculosis, Miliary; Tuberculosis, Pulmonary

Topics: Animals; Antitubercular Agents; Guinea Pigs; Isoniazid; Lung Diseases; Lymph Nodes; Mycobacterium tuberculosis; Organ Size; Rifampin; Skin Ulcer; Spleen; Splenic Diseases; Tuberculin Test; Tuberculosis

Topics: Child; Female; Humans; Lung Diseases; Osteomyelitis; Penicillins; Rifampin; Staphylococcal Infections

Topics: Antitubercular Agents; Bronchitis; Cycloserine; Humans; Italy; Lung Diseases; Lung Neoplasms; Pyrazines; Rifampin; Tuberculosis; Tuberculosis, Pulmonary

Topics: Adult; Aged; Antitubercular Agents; Child, Preschool; Humans; Lung Diseases; Middle Aged; Rifampin