rifampin and Nervous-System-Diseases

Tuberculous meningitis is a rare, treatable neurologic disorder, in which early recognition is paramount because outcome depends greatly on the speed with which therapy is initiated. Patients with meningitis and CSF findings of low glucose, elevated protein and pleocytosis with evidence of tuberculosis elsewhere in the body (chest radiographs, positive tuberculin skin test), or a history of exposure to tuberculosis should be treated immediately with antituberculous medication. When the diagnosis remains uncertain, serial examination of the CSF for tuberculous organisms will often yield positive results. The CT scan may show hydrocephalus, a basilar arachnoiditis, or intraparenchymal lesions: tuberculomas. Hydrocephalus may respond to early shunting. Tuberculomas are best treated medically. Therapy should include INH and rifampin; ethambutol and pyrazinamide are suggested for the first 2 months of therapy. Steroids may be useful in diminishing the inflammatory response when altered consciousness or focal neurologic signs are present.

Topics: Biopsy; Cerebral Ventricles; Cerebrospinal Fluid; Ethambutol; Humans; Hyaluronoglucosaminidase; Isoniazid; Nervous System Diseases; Prognosis; Pyrazinamide; Rifampin; Streptomycin; Tomography, X-Ray Computed; Tuberculoma; Tuberculosis, Meningeal

Brain abscesses are a rare but potentially lethal neurological lesions, generally occurring after septic episodes in immunodeficient patients or complicating neurosurgical procedures. Even though they are known complications of surgically treated intracerebral haemorrhages (ICH), the presence of a brain abscess at the site of an untreated ICH is a rare event. Such cases may result from haematogenous spread from distant foci or contiguous sites and are often preceded by episodes of sepsis and local infection. Immunodeficiency, AIDS, age, diabetes mellitus and vitamin-K deficiency are predisposing factors. Abscess formation should be considered in case of clinical deterioration, headache, and any neurological deficit after febrile episodes. Early diagnosis with neuroradiological imaging, infection blood markers and microbiological identification of the causative pathogen is crucial for treatment with surgical drainage or excision and specific antibiotic therapy, which guarantee good outcome and long-term survival. In fact, while prompt diagnosis and treatment guarantee good outcome and long-term survival, morbidity and mortality are very high in case of misdiagnosis. We report a case of a 49-year old man presenting with a brain abscess 13 weeks after a spontaneous ICH, without previous episodes of sepsis and with a suspected septic arthritis 2 weeks after abscess drainage.

Topics: Anti-Bacterial Agents; Brain Abscess; Cerebral Hemorrhage; Chemoradiotherapy; Drainage; Dysarthria; Headache; Hodgkin Disease; Humans; Hypertension; Levofloxacin; Magnetic Resonance Imaging; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Nervous System Diseases; Oxacillin; Rifampin; Spine; Tomography, X-Ray Computed; Treatment Outcome

Linezolid therapy has shown high rates of clinical success in patients with osteomyelitis and prosthetic joint infections caused by Gram-positive cocci. Recent studies have demonstrated that linezolid/rifampicin combination therapy prevents the emergence of rifampicin-resistant mutations in vitro. However, linezolid/rifampicin combination-related haematological and neurological toxicities have not been evaluated.. To assess the tolerability of prolonged linezolid/rifampicin combination therapy compared with other linezolid-containing regimens in patients with bone and joint infections.. We reviewed the medical records of 94 patients who had received linezolid for >4 weeks after bone and joint infections. Anaemia was defined as a ≥2 g/dL reduction in haemoglobin, leucopenia as a total leucocyte count <4 × 10(9)/L, and thrombocytopenia as a reduction in platelet count to <75% of baseline.. Anaemia was less frequent among patients on linezolid/rifampicin combination therapy than among patients on linezolid alone or in combination with other drugs (9.3%, 44% and 52%, respectively; P<0.01). In multivariate analysis, age and treatment group were independently associated with anaemia. Thrombocytopenia was reported in 44% of patients on linezolid/rifampicin combination therapy, in 48% of patients on linezolid alone and in 57.7% of patients on other linezolid-containing regimens. Age was the only variable associated with thrombocytopenia (P=0.019) in univariate analysis.. Linezolid/rifampicin combination therapy was associated with a significantly reduced incidence of anaemia among patients with bone and joint infections, but it did not have an effect on thrombocytopenia and peripheral neuropathy rates. Linezolid/rifampicin combination therapy was not associated with poor clinical outcomes.

Topics: Acetamides; Adult; Aged; Aged, 80 and over; Anemia; Anti-Bacterial Agents; Arthritis, Infectious; Drug Therapy, Combination; Female; Humans; Incidence; Linezolid; Male; Middle Aged; Nervous System Diseases; Osteoarthritis; Oxazolidinones; Rifampin; Thrombocytopenia; Time Factors; Treatment Outcome

The usefulness of the lymphocyte transformation test (LTT) for the analysis of adverse reactions to antituberculous drugs was evaluated. - The LTT was performed with isoniazid and rifampicin in 15 tuberculosis and 2 MOTT (Mycobacteria other than tuberculosis)-infection patients who suffered drug reactions, in 23 patients without any adverse reactions, in 7 controls previously exposed to antituberculous drugs, and in 14 controls who had never been exposed. 4/15 of the hepatotoxic reactions only showed a positive LTT with rifampicin, 3/15 only with isoniazid, and in 8/15 the LTT was negative. In an anaphylactoid shock reaction the LTT was extremely exaggerated for both rifampicin and isoniazid. In patients without any side effects only one slightly increased LTT due to isoniazid was observed. Two healthy controls with previous contact to these drugs showed a positive LTT for isoniazid, one of those with both rifampicin and isoniazid. The LTT was negative in all control persons without any former contact to antituberculous medications. In most cases hepatotoxicity seems to be a pure toxic reaction without the participation of cellular immune mechanisms. LTT can be useful for identifying the drug responsible for immunological side effects.

Topics: Adult; Anaphylaxis; Anti-Bacterial Agents; Antitubercular Agents; Bromodeoxyuridine; Cells, Cultured; Chemical and Drug Induced Liver Injury; DNA Replication; Drug Eruptions; Drug Hypersensitivity; Drug Therapy, Combination; Enzyme-Linked Immunosorbent Assay; Female; Humans; Immunity, Cellular; Isoniazid; Kidney Diseases; Leukocytes, Mononuclear; Lymphocyte Activation; Male; Middle Aged; Mycobacterium Infections; Mycobacterium Infections, Nontuberculous; Mycobacterium kansasii; Nervous System Diseases; Rifampin; Tuberculosis

Thirty nine cases of borderline tuberculoid leprosy having nerve abscesses (15 with sinuses) were treated with daily dose of rifampicin and isoniazid for six months along with standard multidrug therapy. The patients were followed up for three to five years. No recurrence of abscess or sinus was observed. Observations indicate that medical approach is required at times to supplement surgical intervention for management of these cases.

Topics: Abscess; Adult; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Isoniazid; Leprostatic Agents; Leprosy, Borderline; Leprosy, Tuberculoid; Male; Nervous System Diseases; Rifampin; Treatment Outcome

15 patients with tuberculous meningitis were treated with isoniazid, streptomycin and rifampicin and 14 with isoniazid, streptomycin and ethambutol for 12 months. Both groups received prednisolone at the beginning of treatment. The two groups were compared with regard to clinical improvement, presence of neurological sequelae and mortality. No difference in recovery rate between the groups was observed. 6 patients (21%) died (5 in group I and 1 in group II). Residual sequelae developed in 9 cases (5 in group I and 4 in group II; 31%). The difference between the groups was not significant. The regimen including rifampicin for tuberculous meningitis did not result in any superiority compared to standard therapy.

Topics: Adolescent; Adult; Drug Therapy, Combination; Ethambutol; Female; Humans; Isoniazid; Male; Middle Aged; Nervous System Diseases; Prospective Studies; Rifampin; Streptomycin; Tuberculosis, Meningeal

Hemophilus influenzae type B is no longer considered a rare cause of adult meningitis. Clinical presentation is no different from that of other types of bacterial meningitis. When H influenzae is suspected on the basis of CSF examination, the preferred treatment is chloramphenicol (Chloromycetin) with or without ampicillin until ampicillin susceptibility or beta-lactamase production is determined.

Topics: Age Factors; Ampicillin; Chloramphenicol; Drug Therapy, Combination; Female; Haemophilus influenzae; Humans; Meningitis, Haemophilus; Middle Aged; Nervous System Diseases; Rifampin

Topics: Brucellosis; Doxycycline; Humans; Nervous System Diseases; Rifampin

We treated six patients with nervous system brucellosis causing polyradiculitis (2 patients), myelopathy (2), encephalitis (1), or meningitis (1). Diagnosis was based on Brucella species cultured from one patient, and a twofold or greater rise in antibody titer after therapy was started in the others. Treatment with trimethoprim-sulfamethoxazole with rifampin (5 patients) or tetracycline (1 patient) produced excellent clinical and laboratory response.

Topics: Adult; Aged; Animals; Brucellosis; Drug Combinations; Female; Humans; Male; Middle Aged; Nervous System Diseases; Rifampin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Possible toxic side-effects of antituberculous chemotherapy are studied in 718 children affected with pulmonary tuberculosis. 26 (3.62%) presented adverse side-effects and one drug had to be changed in 8 (1.11%). Treatment had to be stopped in one (0.13%) due to toxicity. Liver toxicity was specially studied, showing that younger age is a risk factor (p less than 1 X 10(-10). In 44 cases (16.54%) transient increases of no more than triple of maximum normal value, were found in SGOT and/or SGPT. Toxicity observed in controlled clinical studies and guides for treatment are exposed.

Topics: Adolescent; Antitubercular Agents; Blood Coagulation Disorders; Chemical and Drug Induced Liver Injury; Child; Child, Preschool; Drug Eruptions; Drug Therapy, Combination; Humans; Infant; Infant, Newborn; Isoniazid; Nausea; Nervous System Diseases; Rifampin; Tuberculosis, Pulmonary

An unusual case of Whipple's disease is reported. The diagnosis was difficult as the characteristic digestive sign and symptoms (malabsorption, diarrhea, mucosal infiltration by PAS-positive macrophages) were absent. After a ten-year history of seronegative arthritis, myocardiopathy, with aortic insufficiency, basilar pulmonary infiltrates, enlarged lymph nodes, the patient, a 56 years old man, was referred to us for a severe vegetative and neurological dysfunction: stupor, dysarthria, akinesia, hypertonia, hypothermia and abnormal thirst. A CT-scan showed a low-density area of the right hypothalamus, and PAS-positive macrophages were found in a lymph node, in the CSF and in a cerebral biopsy. The patient then received a classical antibiotic treatment, yet the neurologic dysfunction remained severe. Finally, a trial with rifampicin brought a striking improvement of the patient's condition, which has now lasted for three years.

Topics: Humans; Hypothalamic Diseases; Male; Middle Aged; Nervous System Diseases; Rifampin; Whipple Disease

Topics: Aminosalicylic Acids; Animals; Antitubercular Agents; Capreomycin; Chemical and Drug Induced Liver Injury; Cycloserine; Deafness; Drug Hypersensitivity; Ethambutol; Ethionamide; Gastrointestinal Diseases; Goiter; Humans; Isoniazid; Kanamycin; Liver; Mental Disorders; Mice; Nervous System Diseases; Pyrazinamide; Rifampin; Streptomycin; Thioacetazone; Tuberculosis; Viomycin

Topics: Animals; Arboviruses; Bromodeoxyuridine; Cataract; Chick Embryo; Dactinomycin; Filtration; Hot Temperature; Hydrogen-Ion Concentration; Hydroxyurea; Inclusion Bodies, Viral; Kanamycin; Lens, Crystalline; Mice; Micropore Filters; Microscopy, Electron; Nervous System Diseases; Organ Culture Techniques; Particle Size; Penicillin Resistance; Penicillins; Rabbits; Rifampin; Slow Virus Diseases; Streptomycin; Trypsin; Ultraviolet Rays; Virus Replication