rifampin and Pericardial-Effusion

Tuberculosis-associated pericardial disorders are an excessively rare manifestation of extrapulmonary tuberculosis. The patients may present with constrictive pericarditis or pericardial fluid accumulation leading to cardiac tamponade. This paper reports a case of tuberculosis-associated pericardial effusion with dense fibrinous material not causing tamponade in a foreigner presenting with nonspecific symptoms. It also provides a discussion about the diagnostic and therapeutic methods as well as interesting echocardiographic images of the patient.

Topics: Anti-Bacterial Agents; Antibiotics, Antitubercular; Antitubercular Agents; Diagnosis, Differential; Echocardiography; Ethambutol; Female; Humans; Isoniazid; Middle Aged; Pericardial Effusion; Pericarditis, Tuberculous; Rifampin; Streptomycin

Topics: Acute Disease; Angioplasty, Balloon, Coronary; Anti-Bacterial Agents; Coronary Restenosis; Drainage; Drug Therapy, Combination; Emergencies; Humans; Male; Middle Aged; Myocardial Infarction; Pericardial Effusion; Pericarditis; Prosthesis-Related Infections; Rifampin; Staphylococcal Infections; Stents; Teicoplanin

Topics: Abscess; Adolescent; Allografts; Aorta; Aortic Rupture; Aortic Valve; Aortic Valve Insufficiency; Bicuspid Aortic Valve Disease; Cardiac Surgical Procedures; Chest Pain; Drug Resistance, Bacterial; Dyspnea; Endocarditis; Gentamicins; Heart Murmurs; Heart Valve Diseases; Humans; Male; Nafcillin; Pericardial Effusion; Rifampin; Staphylococcal Infections; Staphylococcus lugdunensis; Vancomycin; Vascular Grafting

A 76-year-old woman had a chest pain and high fever, and was admitted to the intensive care unit diagnosed as acute pericarditis. Enhanced CT-scan showed a 47-mm aneurysm in the aortic arch which seemed to be impending rupture and the part of the aorta looked like a pseudoaneurysm. Emergent total aortic arch replacement with a rifampicin-bonded Dacron graft was performed. Pericardial effusion was purulent and the aorta was infected with pus discharge in the aortic wall. There were some ulcerations on the surface of the luminal wall of the aorta. One of them was penetrating into the pericardial space causing a pseudoaneurysm. Both pericardial effusion and excised aortic wall were sent to culture study and resulted in positive for Streptococcus pneumoniae. The infection of the aorta, with erosion into the pericardial space, seemed to be the cause of purulent pericarditis. Antibiotic therapy was commenced immediately after surgery and continued for four weeks. Though she had neurological deficit after surgery, her infection was well controlled and there was no recurrence of infection 11 months after surgery.

Topics: Aged; Aneurysm, False; Aneurysm, Infected; Anti-Bacterial Agents; Aortic Aneurysm, Thoracic; Aortography; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Coated Materials, Biocompatible; Combined Modality Therapy; Drug Therapy, Combination; Female; Humans; Penicillin G; Pericardial Effusion; Pericarditis; Pneumococcal Infections; Polyethylene Terephthalates; Prosthesis Design; Rifampin; Tomography, X-Ray Computed; Treatment Outcome

We describe a case in which the rapid diagnosis of tuberculous pericarditis was made using the Mycobacterium tuberculosis (MTB)-specific enzyme-linked immunospot (ELISPOT) assay on pericardial effusion mononuclear cells (PEMCs). The analysis of MTB-specific T-cells in PEMCs by ELISPOT may be useful for rapid decision-making in anti-tuberculous treatment.

Topics: Aged, 80 and over; Antitubercular Agents; Drug Combinations; Enzyme-Linked Immunospot Assay; Humans; Isoniazid; Male; Mycobacterium tuberculosis; Pericardial Effusion; Pericarditis, Tuberculous; Pyrazinamide; Rifampin; T-Lymphocytes

A 68-year old man with fever chills and a diastolic murmur was diagnosed with aortic-valve endocarditis caused by coagulase-negative Staphylococcus lugdunensis. The clinical condition initially improved with antibiotic therapy. On day seven, transoesophageal echocardiography revealed large abscesses extending from the aortic root to the left ventricular wall. Emergency cardiac surgery was performed successfully and a stentless bioprosthetic valve was inserted. S. lugdunensis endocarditis is known for its aggressive clinical course with valve destruction, abscess formation and embolic complications despite appropriate antibiotics. Antibiotic treatment alone is associated with a high mortality rate which can be reduced by early valve replacement.

Topics: Abscess; Aged; Aorta, Thoracic; Aortic Valve; Cefuroxime; Disease Progression; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Echocardiography; Echocardiography, Transesophageal; Endocarditis, Bacterial; Humans; Male; Microbial Sensitivity Tests; Pericardial Effusion; Rifampin; Staphylococcal Infections; Staphylococcus; Vancomycin

A 36-month-old girl was treated for pulmonary tuberculosis (Mycobacterium tuberculosis) with isoniazid, rifampin and pyrazinamide. Four weeks after starting chemotherapy, she developed high fever and clinical signs of acute pericardial tamponade. Pericardial effusion was shown by echocardiography and subsequently removed by pericardiocentesis. M. tuberculosis was demonstrated in the pericardial fluid by microscopy, polymerase chain reaction and specific culture. After pericardial drainage, the actual therapy was extended to include streptomycin and prednisone. Follow-up examinations demonstrated complete recovery without signs of constrictive pericarditis.. infants treated for tuberculosis should be followed closely in order to monitor not only side-effects of antituberculous drugs but also to detect early extrapulmonary spread that may occur even with adequate chemotherapy. Rapid intervention and treatment adjustment in infants with tuberculous pericarditis may prevent pericardial constriction and may lead to full recovery.

Topics: Antitubercular Agents; Child, Preschool; Drug Therapy, Combination; Echocardiography; Female; Humans; Isoniazid; Pericardial Effusion; Pericarditis, Tuberculous; Pyrazinamide; Rifampin; Tomography, X-Ray Computed; Treatment Outcome; Tuberculosis, Pulmonary

Ten patients with tuberculous pericardial effusion, treated initially with adjunctive prednisone 120 mg daily, improved dramatically within a week. There were no complications. Such rapid resolution suggests that the duration of prednisone treatment for this condition could be shortened, which may be important in HIV seropositive patients.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antitubercular Agents; Female; HIV Seronegativity; Humans; Isoniazid; Male; Middle Aged; Mycobacterium tuberculosis; Pericardial Effusion; Pericarditis, Tuberculous; Prednisone; Rifampin