rifampin and Otitis-Media

Female BALB/cAnNCrl (n = 170; age, 6 to 9 wk) mice were infected by intravenous inoculation of 5 × 10(6) cfu Mycobacterium tuberculosis strain Erdman (ATCC 35801). Between day 52 and 5 mo after infection, 10 of the 170 mice infected according to this protocol developed torticollis, including mice in treatment groups that received combination antibiotic therapy of rifampin-pyrazinamide or moxifloxacin-rifampin-pyrazinamide. Torticollis did not develop in mice receiving isoniazid- rifampin-pyrazinamide therapy, nor was it present in the cohort of aerogenically infected mice. Affected mice were euthanized, and complete necropsy evaluation was performed on 4 mice. Gross necropsy evaluation revealed typical tuberculosis lesions in lungs of infected mice. Histologic evaluation of tissues revealed granulomatous otitis media with intralesional acid-fast bacilli consistent with Mycobacterium tuberculosis. These cases represent an unusual finding specific to the intravenous mouse model of Mycobacterium tuberculosis and may represent a model of a similar condition in humans that is known as tuberculous otitis media.

Topics: Animals; Antitubercular Agents; Autopsy; Aza Compounds; Disease Models, Animal; Drug Therapy, Combination; Ear, Middle; Female; Fluoroquinolones; Injections, Intravenous; Isoniazid; Mice; Mice, Inbred BALB C; Moxifloxacin; Mycobacterium tuberculosis; Otitis Media; Pyrazinamide; Quinolines; Rifampin; Torticollis; Tuberculosis

Tuberculous otitis media (TOM) is a rare cause of chronic suppurative infection of the middle ear. Due to that the symptoms and signs are often indistinguishable from those of nontuberculosis chronic otitis media and the fact that the index of suspicion is low, there is frequently a considerable delay prior to diagnosis. This can lead to irreversible complications such as facial nerve paralysis and labyrinthitis. Medical therapy with antituberculous drugs is usually effective. We report three cases with TOM diagnosticated and followed up in our Service from january 1993 to july 2001. Their charts were retrospectively reviewed for relevant historical data, physical findings, complementary studies, treatment and clinical response. We performed a review of the literature, emphasizing that TOM should be considered in the differential diagnosis of chronic otitis media.

Topics: Adult; Aged; Amoxicillin; Antitubercular Agents; Cerebrospinal Fluid Otorrhea; Drug Combinations; Ear Diseases; Female; Humans; Isoniazid; Male; Mycobacterium Infections; Mycobacterium tuberculosis; Otitis Media; Penicillins; Proteus Infections; Proteus mirabilis; Pyrazinamide; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Tuberculosis

Tuberculous otitis media can provide a diagnostic challenge even to the most astute and experienced clinician. The rarity of the condition and its propensity to masquerade as commoner otological conditions further delays diagnosis and treatment. We present the case of a 22-year-old female who presented with chronic aural discharge, unilateral hearing loss and recurrent hemifacial paralysis. The paper highlights the difficulty in diagnosis and stresses the need for a high index of suspicion in cases resistant to the common methods of treatment.

Topics: Adult; Antitubercular Agents; Diagnosis, Differential; Drug Therapy, Combination; Ear Diseases; Facial Paralysis; Female; Hearing Loss; Hearing Loss, Conductive; Humans; Isoniazid; Mycobacterium Infections; Otitis Media; Pyrazinamide; Rifampin; Tinnitus; Tuberculosis

A case of sepsis and meningitis caused by Neisseria meningitidis with relative resistance to penicillin occurred in North Carolina in August 1992. This isolate was relatively resistant due to decreased affinity of its penicillin-binding protein 2 for penicillin. Such isolates have been reported in Spain, elsewhere in Europe, in South Africa, and in Canada, but invasive disease caused by meningococcal isolates relatively resistant to penicillin was not recognized in the United States before a preliminary report of this case in October 1992. The Centers for Disease Control and Prevention recently retrospectively identified 3 additional cases from 1991. A fifth case occurred in Kentucky in 1993. Surveillance studies of penicillin susceptibility of N. meningitidis isolates suggest such meningococci have existed sporadically in the past. Increases in prevalence and magnitude of penicillin resistance among strains of N. meningitidis would require reconsideration of current clinical practice with regard to treatment of meningococcal disease.

Topics: Amoxicillin; Bacteremia; Bacterial Proteins; Carrier Proteins; Ceftriaxone; Drug Therapy, Combination; Female; Hexosyltransferases; Humans; Infant; Meningitis, Meningococcal; Meningococcal Infections; Multienzyme Complexes; Muramoylpentapeptide Carboxypeptidase; Neisseria meningitidis; North Carolina; Otitis Media; Penicillin G; Penicillin Resistance; Penicillin-Binding Proteins; Peptidyl Transferases; Rifampin

Streptococcus pneumoniae, type 23F, resistant to penicillin (MIC, 2 micrograms/mL) and multiple other antimicrobic agents, was isolated from middle ear fluid of a child with otitis media attending a day care center in Ohio. To determine the extent of spread of this strain, nasopharyngeal culture surveys were done, and 52 carriers were identified among 250 children attending the index day care center. No carriers were found among 121 children at two other day care centers in the same urban area. Use of prophylactic doses of antibiotics (P < .001) and frequent use of antibiotics (P < 0.001) were risk factors for nasopharyngeal carriage. Carriers were more likely to have had frequent otitis media episodes (P < .02) and otitis media not responsive to antimicrobial therapy (P < .001). Strategies to limit the spread of highly resistant pneumococcal strains should include encouraging judicious use of antimicrobic agents and reevaluating indications for prophylactic use of antimicrobic agents.

Topics: Adult; Age Factors; Carrier State; Child; Child Day Care Centers; Child, Preschool; Drug Resistance, Microbial; Erythromycin Ethylsuccinate; Humans; Infant; Nasopharynx; Ohio; Otitis Media; Penicillin Resistance; Pneumococcal Infections; Rifampin; Risk Factors; Streptococcus pneumoniae

The increasing incidence of Haemophilus influenzae resistant to ampicillin has clinical implications not only for pediatricians but also for family physicians, because the bacterium is recognized more frequently as the etiologic agent for diseases in adults as well as in young children. Ampicillin is no longer the automatic choice for treatment of patients thought to have life-threatening H influenzae disease, and empiric treatment of otitis media must be reexamined. Chloramphenicol, as well as ampicillin, must be considered for the treatment of meningitis and other serious systemic H influenzae infections. Once the infective organism has been isolated and tested for resistance, ampicillin alone may be used if indicated or desired. Alternatives to ampicillin for middle ear infection are trimethoprim-sulfamethoxazole (Bactrim, Septra), erythromycin-sulfonamide (Pediazole), and cefaclor (Ceclor). Isolation and susceptibility tests are seldom done because they necessitate tympanocentesis.

Topics: Adult; Amoxicillin; Ampicillin; Anti-Bacterial Agents; Child; Chloramphenicol; Drug Combinations; Haemophilus Infections; Haemophilus influenzae; Humans; Meningitis, Haemophilus; Otitis Media; Penicillin Resistance; Pneumonia; Respiratory Tract Infections; Rifampin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Aged; Diagnosis, Differential; Epiglottis; Esophageal Neoplasms; Hospitals, General; Humans; Ileocecal Valve; Isoniazid; Laryngeal Neoplasms; Laryngoscopy; Male; Otitis Media; Pharyngitis; Radiography; Respiratory Tract Infections; Rifampin; Tongue Diseases; Tonsillitis; Tuberculosis; Tuberculosis, Gastrointestinal; Tuberculosis, Laryngeal; Tuberculosis, Oral; Tuberculosis, Pulmonary

Topics: Adult; Drug Therapy, Combination; Ethambutol; Female; Humans; Isoniazid; Male; Otitis Media; Pyridoxine; Rifampin; Tuberculosis; Tuberculosis, Meningeal

Topics: Acute Disease; Ampicillin; Anti-Bacterial Agents; Child; Child, Preschool; Erythromycin; Humans; Infant; Otitis Media; Rifampin; Tetracycline

Topics: Child, Preschool; Humans; Infant; Otitis Media; Rifampin