rifampin and Mediastinal-Diseases

A 57-year-old man with an HIV infection, diagnosed a year ago, complained of fever and cough. The haemoglobin level was 7.5 g/dl, white cell count 3800/microliters, T-helper cell count 60/microliters and the CD4-CD8 ratio 0.1. Erythrocyte sedimentation rate was raised to 21/39 mm. Bacteriological tests were at first negative. The chest radiograph showed slight widening of the upper mediastinum which further increased over the next 10 days, at which time it also revealed a shadow in the right upper lobe. Computed tomography suggested necrotizing mediastinal lymph-nodes. Treatment was begun with rifampicin (600 mg daily) ethambutol (1.2 g daily), pyrazinamide (1.5 g daily) and ciprofloxacin (500 mg twice daily). Oesophagoduodenoscopy, performed after 3 weeks, revealed several fistulae which, after ingestion of contrast medium, were demonstrated to communicate with the mediastinum, presumably as a result of lymph-node liquefaction. Mycobacterium tuberculosis was demonstrated in gastric juice, sputum and stool only after tuberculostatic drugs had been started.

Topics: AIDS-Related Opportunistic Infections; Ciprofloxacin; Drug Therapy, Combination; Esophageal Fistula; Ethambutol; Fistula; HIV-1; Humans; Male; Mediastinal Diseases; Middle Aged; Pyrazinamide; Rifampin; Tuberculosis, Lymph Node

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA) is accepted as a safe and minimally invasive modality for evaluation of mediastinal pathologies in adults. There is scanty literature on the utilization and performance characteristics of Convex probe EBUS-TBNA in children. The authors herein describe two pediatric patients with mediastinal lymphadenopathy wherein the underlying diagnosis was unclear based on the clinico-radiological profile. A possibility of lymphoma was considered in one of the patients. EBUS-TBNA was performed for obtaining tissue samples from the enlarged mediastinal lymph nodes and diagnosis of tuberculosis was established in both the patients. The authors review the available literature on Pediatric EBUS TBNA. EBUS-TBNA is an exciting and promising approach towards safe and accurate evaluation of mediastinal pathologies in children. Pediatric EBUS-TBNA needs further evaluation in prospective studies.

Topics: Antibiotics, Antitubercular; Bronchoscopy; Child; Diagnosis, Differential; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Female; Humans; Lymph Nodes; Male; Mediastinal Diseases; Mediastinum; Mycobacterium tuberculosis; Rifampin; Treatment Outcome; Tuberculosis, Lymph Node

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

Mediastinal mass of tuberculous origin is exceedingly rare in infant.. to report an exceedingly rare case of mediastinal mass of tuberculous origin.. We report a three-month-old boy who presented a one month history of wheezing and persistent pneumopathy. Radiological investigations showed a large posterior mediastinal mass which infiltrates lungs. Thoracoscopic biopsy showed caseous necrosis with granuloma suggestive of tuberculosis. The outcome was favourable with antituberculous chemotherapy.. Mediatinal mass of tuberculous origin should considered in differential diagnosis of mediastinal masses in children; be suggested in mediastinal mass in children.

Topics: Adrenal Cortex Hormones; Antibiotics, Antitubercular; Antitubercular Agents; Drug Therapy, Combination; Ethambutol; Follow-Up Studies; Humans; Infant; Isoniazid; Magnetic Resonance Imaging; Male; Mediastinal Diseases; Pyrazinamide; Rifampin; Time Factors; Treatment Outcome; Tuberculosis

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

In a 44-year-old female esophagomediastinal fistula was found secondary to tuberculous mediastinal lymphadenitis. Chest computed tomography revealed amorphous air collection in the subcarinal region of the mediastinum with mediastinal lymphadenopathy. Esophagography with gastrografin confirmed esophagomediastinal fistula. The patient was treated with antituberculous therapy with rifampicin, isoniazid, pyrazinamide and ethambutol, resulting in resolution of the esophagomediastinal fistula and mediastinal lymphadenopathy.

Topics: Adult; Antibiotics, Antitubercular; Esophageal Fistula; Ethambutol; Female; Fistula; Humans; Isoniazid; Mediastinal Diseases; Pyrazinamide; Radiography, Thoracic; Rifampin; Tomography, X-Ray Computed; Tuberculosis, Lymph Node

Topics: Abscess; Cyclosporine; Cytochrome P-450 Enzyme System; Drug Interactions; Heart Transplantation; Humans; Mediastinal Diseases; Middle Aged; Rifampin; Staphylococcal Infections

In a one year old female infant BCG-vaccinated as a neonate, a large mediastinal mass was found after routine examination. X-ray and CT scan suggested a teratoma. Histology and microbiology, however, revealed the diagnosis of an active tuberculosis. Thus, the tumor was caused by mediastinal BCGitis. To our knowledge this complication of BCG-vaccination has not yet been described.

Topics: Bacteriological Techniques; BCG Vaccine; Combined Modality Therapy; Female; Humans; Infant; Isoniazid; Mediastinal Diseases; Mediastinum; Rifampin; Thoracotomy; Tuberculoma

A retrospective radiographic comparison of two regimens, RHE2/RH10 (n = 32) and RHZ2/RH10 (n = 37), used in the treatment of tuberculous mediastinal lymphadenopathy is reported. The two groups did not differ in age, pretreatment or post-treatment values. The rate of improvement in serial radiographs was compared between the two groups, each patient acting as his own control. There was no difference in the incidence of initial gland enlargement at 1 month, but at 2 months RHZ2/RH10 had less enlargement (0.05 greater than P greater than 0.01). The rate of improvement was faster in the RHZ2/RH10 group from 2-7 months' treatment, being significantly better than RHE2/RH10 at 2 (P = 0.003), 5 (0.01 greater than P) and 7 months (0.02 greater than P). Pyrazinamide (25-40 mg/kg) appears to be superior to ethambutol 15 mg/kg for the initial 2 months of treatment of tuberculous mediastinal lymphadenopathy. The findings may be applicable to peripheral tuberculous lymphadenopathy.

Topics: Adolescent; Adult; Aged; Drug Therapy, Combination; Ethambutol; Female; Humans; Isoniazid; Male; Mediastinal Diseases; Middle Aged; Pyrazinamide; Radiography; Rifampin; Time Factors; Tuberculosis, Lymph Node

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