rifampin and Lymphatic-Diseases

Bartonella spp. are responsible for emerging and re-emerging diseases around the world. The majority of human infections are caused by Bartonella henselae, Bartonella quintana and Bartonella bacilliformis, although other Bartonella spp. have also been associated with clinical manifestations in humans. The severity of Bartonella infection correlates with the patient's immune status. Clinical manifestations can range from benign and self-limited to severe and life-threatening disease. Clinical conditions associated with Bartonella spp. include local lymphadenopathy, bacteraemia, endocarditis, and tissue colonisation resulting in bacillary angiomatosis and peliosis hepatis. Without treatment, Bartonella infection can cause high mortality. To date, no single treatment is effective for all Bartonella-associated diseases. In the absence of systematic reviews, treatment decisions for Bartonella infections are based on case reports that test a limited number of patients. Antibiotics do not significantly affect the cure rate in patients with Bartonella lymphadenopathy. Patients with Bartonella spp. bacteraemia should be treated with gentamicin and doxycycline, but chloramphenicol has been proposed for the treatment of B. bacilliformis bacteraemia. Gentamicin in combination with doxycycline is considered the best treatment regimen for endocarditis, and erythromycin is the first-line antibiotic therapy for the treatment of angioproliferative lesions. Rifampicin or streptomycin can be used to treat verruga peruana. In this review, we present recent data and recommendations related to the treatment of Bartonella infections based on the pathogenicity of Bartonella spp.

Topics: Angiomatosis, Bacillary; Anti-Bacterial Agents; Bacteremia; Bartonella; Bartonella Infections; Chloramphenicol; Doxycycline; Drug Administration Schedule; Endocarditis; Gentamicins; Humans; Lymphatic Diseases; Rifampin; Streptomycin; Treatment Outcome; Virulence

The Xpert (GeneXpert) MTB/RIF, an integrated polymerase chain reaction assay, has not been systematically studied in extrapulmonary and in particular mediastinal tuberculosis (TB).. To investigate the performance of Xpert MTB/RIF in the diagnosis of intrathoracic nodal TB in a large tertiary urban medical center in the UK.. We collected clinical, cytological, and microbiological data from two cohorts: 116 consecutive patients referred with mediastinal lymphadenopathy with detailed diagnostic information obtained, and an immediately subsequent second cohort of 52 consecutive patients with microbiologically confirmed mediastinal TB lymphadenopathy. All data were derived between January 2010 and October 2012. All patients underwent endobronchial ultrasound and transbronchial needle aspiration (TBNA). The performance of a single Xpert MTB/RIF assay alongside standard investigations, cytology, and microscopy/culture was evaluated against culture-confirmed TB.. Microbiologically confirmed TB mediastinal lymphadenopathy was diagnosed in a total of 88 patients from both cohorts. Three culture-negative cases with associated caseating granulomatous inflammation on TBNA were given a probable diagnosis. A single Xpert MTB/RIF assay demonstrated overall sensitivity for culture-positive TB of 72.6% (62.3-81.0%). Xpert specificity from cohort 1 was 96.3% (89.1-99.1%). The positive predictive value was 88.9% (69.7-97.1%), negative predictive value was 86.5% (76.9-92.1%), and odds ratio was 51.3 (24.0-98.0) for correctly identifying culture-positive disease. Xpert captured all microscopy-positive cases (14 of 14) and the majority of microscopy-negative cases (48 of 71, 67.6%). Among the cases that were culture positive by TBNA, Xpert identified two-thirds of the multiple drug-resistant TB cases, leading to immediate regimen change up to 5 weeks ahead of positive cultures. The use of Xpert combined with cytology increased the sensitivity to 96.6%.. Xpert MTB/RIF provides a rapid, useful, and accurate test to diagnose mediastinal nodal TB in intermediate-incidence settings. The additional use of TBNA cytology further enhances the sensitivity of Xpert. This combination can facilitate rapid risk assessment and prompt TB treatment.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antibiotics, Antitubercular; Bronchoscopy; Cohort Studies; Drug Resistance, Bacterial; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Female; Humans; Lymphatic Diseases; Male; Mediastinal Diseases; Middle Aged; Mycobacterium tuberculosis; Polymerase Chain Reaction; Rifampin; Sensitivity and Specificity; Tuberculosis, Multidrug-Resistant; Young Adult

Topics: Antitubercular Agents; Biopsy; Combined Modality Therapy; Deglutition Disorders; Drainage; Ethambutol; Goiter; Hormone Replacement Therapy; Humans; Hypothyroidism; Isoniazid; Lymphatic Diseases; Male; Middle Aged; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Pyrazinamide; Rifampin; Thyroiditis; Thyroxine; Tuberculosis, Endocrine

Brucellosis is considered a known widespread zoonotic disease and is endemic in Mediterranean region, like Iran. This study reviewed the clinical manifestations, laboratory findings, and therapeutic regimen in childhood brucellosis in Iran. In this retrospective study, we reviewed hospital-records of 34 consecutive children with a confirmed diagnosis of brucellosis among a total number of 10,864 patients admitted to Children's Medical Center, Tehran, Iran, between 2002 and 2010. Among the patients diagnosed with brucellosis, 22 (65%) were admitted during spring and summer. Clinical findings of these patients at admission were arthritis, splenomegaly, hepatomegaly, lymphadenopathy, maculopapular skin rashes, and fever. Anaemia (53%) and leukopenia (33%) were the most common findings in the children. Only one patient had presented with leukocytosis. Four children (12%) were thrombocytopenic, and none of patients had pancytopenia. Blood cultures were positive in 5 patients (23%). Only one patient underwent bone-marrow aspiration and had positive culture for Brucella spp. Positive titres were found in 33 cases (97%) in Wright test, 23 cases (96%) in Coombs test, and 16 patients (72.7%) in 2ME (2-Mercaptoethanol) test. In one case, Wright and Coombs test titres were below 1:80 while Brucella spp. were isolated from blood at the same time. It is concluded, prolonged fever with joint involvement and organomegaly may increase possibility of infection with Brucella spp. Appropriate treatment regimen by more tolerable oral drugs, with a duration of at least 8 weeks, is recommended.

Topics: Adolescent; Anti-Infective Agents; Arthritis; Brucellosis; Child; Child, Hospitalized; Child, Preschool; Doxycycline; Drug Therapy, Combination; Exanthema; Female; Fever; Hepatomegaly; Humans; Iran; Laboratories; Lymphatic Diseases; Male; Referral and Consultation; Retrospective Studies; Rifampin; Splenomegaly; Sulfamethoxazole; Trimethoprim

Topics: Antitubercular Agents; Biopsy; Carcinoma; Combined Modality Therapy; Diagnosis, Differential; Ethambutol; Female; Humans; Isoniazid; Lymphatic Diseases; Middle Aged; Mycobacterium tuberculosis; Osteolysis; Osteomyelitis; Pleural Effusion; Pleural Neoplasms; Pyrazinamide; Rifampin; Sputum; Sternum; Tomography, X-Ray Computed; Tuberculosis, Osteoarticular

Tularemia is a rare zoonosis. The most common way is ingestion of contaminated meat or water, but the infection may also be acquired by insect bite. The clinical picture of the disease may be nonspecific. Due to polymorphisms of clinical picture, specific treatment is often delayed. In the last 50 years, in Poland, the most infections were acquired by handling hares. In our article, we present the case of a patient who was infected with Francisella tularensis due to arthropod bite. In the presented case, the diagnosis was difficult, because of the nonspecific clinical picture. Information of the epidemiology and the clinical picture changes of tularemia may have great clinical significance. Tularemia requires the special attention of physicians. All patients with lymphadenopathy and arthropod bite history should be screened for tularemia in the outpatient department and, if necessary, treated in hospital.

Topics: Adult; Animals; Anti-Bacterial Agents; Antibodies, Bacterial; Arthropod Vectors; Bites and Stings; Ceftriaxone; Fever; Francisella tularensis; Humans; Lymphatic Diseases; Male; Poland; Rifampin; Streptomycin; Treatment Outcome; Tularemia; Zoonoses

The use of anthrax as a weapon of biological terrorism has moved from theory to reality in recent weeks. Following processing of a letter containing anthrax spores that had been mailed to a US senator, 5 cases of inhalational anthrax have occurred among postal workers employed at a major postal facility in Washington, DC. This report details the clinical presentation, diagnostic workup, and initial therapy of 2 of these patients. The clinical course is in some ways different from what has been described as the classic pattern for inhalational anthrax. One patient developed low-grade fever, chills, cough, and malaise 3 days prior to admission, and then progressive dyspnea and cough productive of blood-tinged sputum on the day of admission. The other patient developed progressively worsening headache of 3 days' duration, along with nausea, chills, and night sweats, but no respiratory symptoms, on the day of admission. Both patients had abnormal findings on chest radiographs. Non-contrast-enhanced computed tomography of the chest showing mediastinal adenopathy led to a presumptive diagnosis of inhalational anthrax in both cases. The diagnoses were confirmed by blood cultures and polymerase chain reaction testing. Treatment with antibiotics, including intravenous ciprofloxacin, rifampin, and clindamycin, and supportive therapy appears to have slowed the progression of inhalational anthrax and has resulted to date in survival.

Topics: Anthrax; Anti-Bacterial Agents; Bacillus anthracis; Bioterrorism; Blood; Ciprofloxacin; Clindamycin; District of Columbia; Dyspnea; Fever; Humans; Lymphatic Diseases; Male; Mediastinal Diseases; Middle Aged; Occupational Exposure; Pleural Effusion; Polymerase Chain Reaction; Postal Service; Radiography, Thoracic; Respiratory Tract Infections; Rifampin; Spores, Bacterial; Survivors; Tomography, X-Ray Computed

Although tuberculosis is common and well recognised in many countries, unusual presentations of the disease sometimes raise difficulties in differential diagnosis. We report a young patient who presented with weight loss, shortness of breath and easy fatiguability. Extensive lymphadenopathy involving the cervical, axillary and inguinal regions were found on physical examination. Chest X-ray and computed tomography revealed generalized lymphadenopathy of cervical, mediastinal and para-aortic chains, bilateral pulmonary miliary reticulonodular infiltrates, pleural effusion, hepatomegaly with low density, macronodular hypodense areas in spleen, ascites, peritoneal irregularity and thickening of bowel walls. Mantoux test was negative. Peritoneal fluid was exudative, but pleural fluid was transudative, probably due to mediastinal lymphatic obstruction. The initial clinical diagnosis was malignant lymphoma; however, positive sputum smears for mycobacteria and excisional cervical lymph node biopsy revealing caseating granulomatous lymphadenitis were consistent with tuberculosis. The patient responded well to appropriate therapy with regression of radiological abnormalities.

Topics: Adult; Antitubercular Agents; Biopsy; Diagnosis, Differential; Drug Therapy, Combination; Ethambutol; Follow-Up Studies; Humans; Isoniazid; Lymph Nodes; Lymphatic Diseases; Male; Neck; Pleural Effusion; Prednisolone; Pyrazinamide; Rifampin; Sputum; Tomography, X-Ray Computed; Tuberculosis, Gastrointestinal; Tuberculosis, Miliary