rifampin and Optic-Nerve-Diseases

Multidrug chemotherapy is recommended for treating pulmonary Mycobacterium avium and Mycobacterium intracellulare disease. Although ethambutol has been demonstrated to inhibit macrolide resistance, the ethambutol dosage is sometimes decreased due to concerns about optic neuropathy. We aimed to assess whether lower ethambutol doses impact treatment outcomes.. Patients treated over 12 months between 2016 and 2020 were collected retrospectively. Clinical outcomes, including negative culture conversion, microbiological cure, adverse events, resistance to macrolides, and recurrence, were compared according to daily ethambutol dosage.. Among 146 patients, 42 were treated with ethambutol dosages over 12.5 mg/kg/day, and 104 were treated with lower dosages. Negative culture conversion was achieved for 125 patients, and 90 patients achieved microbiological cure. Recurrence was identified in 16 patients who achieved microbiological cure. No macrolide resistance was observed, and no significant difference was observed in the percentage of negative culture conversion (P = 1.00) or microbiological cure (P = 0.67) between the high- and low-dosage ethambutol groups. Sputum smear positivity was associated with a lower adjusted odds ratio (aOR) of negative culture conversion (aOR: 0.48, 95% CI: 0.29-0.80). A lower aOR of microbiological cure was independently associated with sputum smear positivity (aOR: 0.52, 95% CI: 0.37-0.74) and with the use of an intermittent regimen (aOR: 0.60, 95% CI: 0.41-0.87). Daily ethambutol dosage was not identified as a prognostic factor for any of the outcomes. Optic neuropathy was observed in 7.1% of the high-dose ethambutol group and 1.0% of the low-dosage ethambutol group (P = 0.07).. An ethambutol dosage of 12.5 mg/kg/day or less in guideline-based chemotherapy may reduce optic neuropathy without worsening clinical outcomes.

Topics: Anti-Bacterial Agents; Antitubercular Agents; Drug Therapy, Combination; Ethambutol; Humans; Mycobacterium avium; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Optic Nerve Diseases; Retrospective Studies; Rifampin; Treatment Outcome

Topics: Antitubercular Agents; Brain Mapping; Choroiditis; Confusion; Female; Humans; Isoniazid; Magnetic Resonance Imaging; Meningitis; Middle Aged; Optic Nerve Diseases; Pyrazinamide; Rifampin; Tuberculosis, Central Nervous System; Vision Disorders

To report a case of brucellosis with bilateral permanent loss of vision.. Case report.. Bilateral loss of vision developed within two weeks in a young adult with positive Brucella antibodies. There was optic disc swelling with optic neuropathy and serous retinal detachment in both eyes. The patient had chronic active brucellosis confirmed by serum antibody titers (1/640).. This case shows that optic neuropathy may result in severe visual loss in patients with brucellosis.

Topics: Adult; Anti-Bacterial Agents; Antibodies, Bacterial; Brucella; Brucellosis; Doxycycline; Drug Therapy, Combination; Eye Infections, Bacterial; Glucocorticoids; Humans; Male; Optic Nerve Diseases; Papilledema; Prednisolone; Retinal Detachment; Rifampin; Vision, Low

A male patient with tuberculous lymphadenopathy was treated with a four-fold therapy of ethambutol, isoniacide, rifampicin and pyracinamide. After 10 weeks the patient suffered from photophobia. Although ethambutol was discontinued vision decreased and visual field defects occurred as well as signs of myelopathy. Isoniacide was then discontinued and in the subsequent phase the vision was slowly restored over a period of 36 months. The combined toxicity of ethambutol and isoniacide seems to have been the main cause of the severe and protracted optic neuropathy.

Topics: Adult; Antitubercular Agents; Disease Progression; Drug Therapy, Combination; Ethambutol; Humans; Isoniazid; Male; Optic Nerve Diseases; Photophobia; Pyrazinamide; Rifampin; Risk Factors; Risk Management; Spinal Cord Diseases; Treatment Outcome; Tuberculosis, Lymph Node

A 5 year old girl with tuberculous meningitis developed progressive visual failure during in-patient anti-tuberculous chemotherapy due to an ophthochiasmatic tuberculoma. This was successfully managed by prolonged high-dose corticosteroids and continued anti-tuberculous therapy resulting in complete visual and psychosocial recovery.

Topics: Child, Preschool; Dexamethasone; Drug Therapy, Combination; Female; Humans; Isoniazid; Mental Disorders; Optic Chiasm; Optic Nerve Diseases; Pyrazinamide; Pyridoxine; Rifampin; Streptomycin; Tuberculoma, Intracranial; Vision Disorders