rifampin and Peripheral-Nervous-System-Diseases

Itch is a global clinical problem and finding effective treatment remains a therapeutic challenge because of the complex pathophysiology of itch. The key component of treating itch should be directed at the underlying etiologies when possible. However, without eradication of the underlying diseases, treatment is often palliative at best. Treatment with systemic therapies can vary according to the etiology of the chronic itch. The aim of this article is to review the major systemic anti-itch agents and give a summary on the possible systemic treatments for different types of itch.

Topics: Amines; Analgesics; Analgesics, Opioid; Anion Exchange Resins; Antidepressive Agents; Aprepitant; Cholagogues and Choleretics; Cholestasis; Cholestyramine Resin; Cyclohexanecarboxylic Acids; Gabapentin; gamma-Aminobutyric Acid; Histamine Antagonists; Humans; Morpholines; Narcotic Antagonists; Neurokinin-1 Receptor Antagonists; Paraneoplastic Syndromes; Peripheral Nervous System Diseases; Pregabalin; Pruritus; Receptors, Opioid, kappa; Receptors, Opioid, mu; Rifampin; Thalidomide; Uremia; Ursodeoxycholic Acid

Leprosy, a result of infection by Mycobacterium leprae, is a leading cause of peripheral neuropathy. The World Health Organization aimed to eliminate leprosy as a public health problem by 2000, but this has not been attained. Patients with leprosy continue to present in the UK. The diagnosis of leprosy is frequently not considered, with resultant pathological and psychological problems for patients.

Topics: Clofazimine; Dapsone; Diagnosis, Differential; Drug Therapy, Combination; Humans; Leprostatic Agents; Leprosy; Mycobacterium leprae; Peripheral Nervous System Diseases; Rifampin

Cases of leprosy are increasing in the United States because of immigration from countries where the disease is endemic. Infection may not become apparent for several years after immigration. Symptoms related to involvement of peripheral nervous tissue are often the presenting complaint. Prompt treatment can prevent the potentially severe sequelae of this disease. Current regimens utilize rifampin with dapsone to decrease the development of drug resistance.

Topics: Adult; Dapsone; Drug Therapy, Combination; Humans; Leprosy; Male; Peripheral Nervous System Diseases; Rifampin

Topics: Adult; Biopsy; Clofazimine; Diagnostic Errors; Female; Humans; Leprostatic Agents; Mycobacterium; Mycobacterium Infections, Nontuberculous; Ofloxacin; Peripheral Nervous System Diseases; Rifampin; Skin; Vasculitis

Toxicities due to anti-TB treatment frequently occur among TB/HIV-coinfected patients.. To determine the association between anti-TB drug concentrations and the occurrence of hepatotoxicity and peripheral neuropathy among TB/HIV-coinfected patients.. TB/HIV-coinfected patients were started on standard dose anti-TB treatment according to WHO guidelines. Anti-TB drug concentrations were measured using HPLC 1, 2 and 4 h after drug intake at 2, 8 and 24 weeks following initiation of TB treatment. Participants were assessed for hepatotoxicity using Division of AIDS toxicity tables and for peripheral neuropathy using clinical assessment of tendon reflexes, vibration sensation or symptoms. Cox regression was used to determine the association between toxicities and drug concentrations.. Of the 268 patients enrolled, 58% were male with a median age of 34 years. Participants with no hepatotoxicity or mild, moderate and severe hepatotoxicity had a median C max of 6.57 (IQR 4.83-9.41) μg/mL, 7.39 (IQR 5.10-10.20) μg/mL, 7.00 (IQR 6.05-10.95) μg/mL and 3.86 (IQR 2.81-14.24) μg/mL, respectively. There was no difference in the median C max of rifampicin among those who had hepatotoxicity and those who did not ( P  =   0.322). There was no difference in the isoniazid median C max among those who had peripheral neuropathy 2.34 (1.52-3.23) μg/mL and those who did not 2.21 (1.45-3.11) μg/mL ( P  =   0.49).. There was no association between rifampicin concentrations and hepatotoxicity or isoniazid concentrations and peripheral neuropathy among TB/HIV-coinfected patients.

Topics: Adult; Antitubercular Agents; Chemical and Drug Induced Liver Injury; Coinfection; Female; HIV Infections; Humans; Isoniazid; Male; Middle Aged; Peripheral Nervous System Diseases; Prospective Studies; Regression Analysis; Rifampin; Tuberculosis; Tuberculosis, Pulmonary; Young Adult

Topics: Clofazimine; Dapsone; Humans; Leprostatic Agents; Leprosy; Peripheral Nervous System Diseases; Rifampin; United Kingdom

Topics: Clofazimine; Dapsone; Facies; Humans; Leprostatic Agents; Leprosy, Lepromatous; Male; Mycobacterium leprae; Nasal Septal Perforation; Nasal Septum; Peripheral Nervous System Diseases; Rifampin; Treatment Outcome; Young Adult

Brucellosis is a significant health problem especially in developing countries as Turkey. Skeletal system involvement is relatively a common complication of human brucellosis, however genitourinary, cardiovascular, neurovascular and skin involvements are less frequent. In this case report, a 36-years-old female patient with fever, arthralgia, disseminated macular rash at the extremities and body and peripheral polineuropathy has been presented. The patient, living at a rural area, had a history of consumption of raw milk products. Polyneuropathy of the patient presenting as glove-sock type paresthesia was evaluated with electromyography and reported as mild demyelinated sensorial polyneuropathy and radiculopathy compatible with right L(4-5) involvement. Brucella agglutination test was found to be positive at a titer of 1/1280 in the serum sample. Other bacterial and viral agents presenting with maculopapular rash were ruled out by serological tests. Bacterial growth was detected in the blood culture by automated BacT/ALERT 3D system (bioMerieux, USA) and the bacteria was identified as Brucella melitensis by automated VITEK-2 system (bioMerieux, France). Microbiologic diagnosis was confirmed by detection of agglutination with polyvalent and monovalent anti-M Brucella sera. The patient was successfully treated with rifampicin and doxycycline combination for six weeks. The macular rash was recruited leaving a brown pigmentation in the first week of treatment, whereas the neurologic signs and symptoms disappeared at the end of the first month. Brucella infection should be considered in the differential diagnosis of skin rash and neurologic disorders especially in endemic areas such as Turkey.

Topics: Adult; Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Diagnosis, Differential; Doxycycline; Exanthema; Female; Humans; Peripheral Nervous System Diseases; Rifampin

Several forms of arthritis and rheumatism can sometimes complicate leprosy. However, its presentation as an acute onset arthritis is unusual. We report two adult male naïve patients who presented to our rheumatology outpatient clinic with acute onset inflammatory polyarthritis, skin rash and mild sensory neurodeficit. Borderline lepromatous leprosy (in type I lepra reaction) was diagnosed. We also refer to 19 case records of Hansen arthritis in the clinic database (1998-2007) from approximately 35,000 patients and a community study to highlight the missed diagnosis of Hansen's disease and its unusual association with rheumatoid arthritis. In countries like India where leprosy is endemic, this disease also merits attention in rheumatology clinics.

Topics: Acute Disease; Aged; Arthritis; Clofazimine; Dapsone; Diagnosis, Differential; Drug Therapy, Combination; Exanthema; Glucocorticoids; Humans; Leprostatic Agents; Leprosy; Male; Middle Aged; Mycobacterium leprae; Peripheral Nerves; Peripheral Nervous System Diseases; Rifampin; Treatment Outcome

Topics: Adult; Antigens, Bacterial; Dapsone; Facial Dermatoses; Fever; Humans; Leprostatic Agents; Leprosy, Borderline; Male; Mycobacterium leprae; Peripheral Nervous System Diseases; Philippines; Prednisone; Rifampin; Uveitis

Multidrug therapy (MDT), with rifampicin, dapsone, and clofazimine, treats leprosy infection but is insufficient in arresting or preventing the nerve damage that causes impairments and disabilities. This case-series study evaluates the benefits of the combined use of steroids and MDT in preventing nerve damage in patients with pure neural leprosy (PNL). In addition to MDT, 24 patients (88% male aged 20-79 years, median=41) received a daily morning dose of 60 mg prednisone (PDN) that was gradually reduced by 10 mg during each of the following 5 months. PNL was clinically diagnosed and confirmed by nerve histopathology or PCR. A low prevalence (8.3%) of reaction was observed after release from treatment. However, most of the clinical parameters showed significant improvement; and a reduction of nerve conduction block was observed in 42% of the patients. The administration of full-dose PDN improved the clinical and electrophysiological condition of the PNL patients, contributing to the prevention of further neurological damage.

Topics: Adult; Aged; Clofazimine; Dapsone; Drug Therapy, Combination; Electrophysiology; Female; Follow-Up Studies; Glucocorticoids; Humans; Leprostatic Agents; Leprosy, Tuberculoid; Longitudinal Studies; Male; Middle Aged; Peripheral Nervous System Diseases; Prednisone; Prospective Studies; Rifampin; Treatment Outcome

Antituberculous treatment is effective but has numerous side effects. Among these isoniazid induced neuropathy is easily preventable.. A female patient of 42 years, infected with HIV, presented with general deterioration associated with an interstitial pulmonary infiltrate and mediastinal lymphadenopathy. Tuberculosis was not confirmed bacteriologically but she responded to antituberculous treatment. Three months later she developed distal leg pains extending proximally. There was superficial sensory impairment up to the groins and loss of the ankle reflexes. The dose of isoniazid was reduced from 5 to 2.5 mg/kg/day on account of slow acetylator status and treatment with pyridoxine 250 mg/day commenced. The clinical signs resolved in a few weeks.. Isoniazid neuropathy develops in the presence of risk factors (HIV, alcoholism, diabetes, renal failure, malnutrition, pregnancy and lactation, neurotoxic medication) and manifests itself initially by burning feet. Pyridoxine is preventative in low dosage and curative in high dosage. The development of symptoms should lead to measurement of acetylator status, and a reduction of the isoniazid dose to 3 mg/kg/day or even less in slow acetylators.

Topics: Acetylation; Achilles Tendon; Adult; Antiretroviral Therapy, Highly Active; Antitubercular Agents; Ethambutol; Female; Guinea; Hepatitis B, Chronic; HIV Infections; Humans; Hypesthesia; Inactivation, Metabolic; Isoniazid; Peripheral Nervous System Diseases; Reflex, Abnormal; Rifampin; Tuberculosis, Pulmonary; Vitamin B 6; Vitamin B 6 Deficiency

Leprosy is an infectious disease of prevalence still high in endemic areas in Brazil. The neurological presentation depends on the involved nerve and is usually associated with skin lesions and the formation of multiple abscesses. We present a case of isolated tuberculoid leprosy, discuss the occurrence, the differential diagnosis and the treatment of this rare presentation and reaffirm the importance of considering leprosy in the differential diagnosis of patients with polyneuropathy or nerve enlargement with no skin lesions.

Topics: Adult; Antibiotics, Antitubercular; Brazil; Dapsone; Forearm; Granuloma; Humans; Leprostatic Agents; Leprosy, Tuberculoid; Male; Peripheral Nervous System Diseases; Rifampin; Treatment Outcome

A study conducted in 74 TT/TB patients, with gross thickening of nerves together with nerve abscess, showed calcification in 8 patients. Calcification was most common in the ulnar nerve followed by the lateral popliteal nerve. All eight patients were males with significantly longer duration of illness before start of treatment. Patients with late onset of nerve abscess were found to be more prone to calcium deposition in the nerves. Caseous pus of the abscess had high lipid content with raised cholesterol and cholesterol ester ratio to total lipids suggesting a dystrophic nature of calcification.

Topics: Abscess; Adolescent; Adult; Aged; Calcinosis; Child; Cholesterol; Cholesterol Esters; Dapsone; Female; Follow-Up Studies; Humans; Leprostatic Agents; Leprosy, Tuberculoid; Lipids; Male; Middle Aged; Peripheral Nervous System Diseases; Rifampin; Suppuration; Ulnar Nerve

Mycobacterium kansasii was isolated from an area of cavitating pneumonia in a man with rheumatoid arthritis. Standard antituberculosis treatment, including isoniazid 300 mg daily, had to be stopped because of peripheral neuropathy. The patient, a slow acetylator, subjectively deteriorated despite withdrawal of isoniazid and treatment with pyridoxine 150 mg daily. Improvement occurred only after the pyridoxine had also been withdrawn. Pyridoxine may cause peripheral neuropathy and this case illustrates the need for caution in the use of this vitamin in the prevention and treatment of isoniazid induced peripheral neuropathy.

Topics: Acetylation; Arthritis, Rheumatoid; Ethambutol; Humans; Isoniazid; Male; Middle Aged; Mycobacterium Infections, Nontuberculous; Peripheral Nervous System Diseases; Pyridoxine; Rifampin; Tuberculosis, Pulmonary

A 56-year old patient presented 3 months after initiation of an antituberculous regimen with Isoniacid (INH, 5 mg/kg daily), Ethambutol (20 mg/kg daily) and Rifampicin (675 mg daily) a mild sensory polyneuropathy and a bilateral retrobulbar neuritis which progressed to a severe optic atrophy. Multiple hyperintense foci were detected with NMR-imaging in the cerebral white matter suggestive of demyelination. INH and Ethambutol are known for their neurotoxic effects but suggestion was made that neurologic signs may not be due to drug neurotoxicity but could be induced by immunological processes initiated by the tubercle bacillus. In the reported patient the suspected tuberculosis of the urogenital tract was never proved histologically. Most likely his neurological symptoms were therefore cause by the administration of INH and Ethambutol. Patients with a low serum zinc level and a slow acetylation of INH are reported to be at special risk; both factors were present in our patient.

Topics: Antitubercular Agents; Ethambutol; Humans; Isoniazid; Male; Middle Aged; Optic Atrophy; Peripheral Nervous System Diseases; Rifampin

Topics: Acetylation; Asian; Chemical and Drug Induced Liver Injury; Drug Combinations; Drug Interactions; Humans; Isoniazid; Peripheral Nervous System Diseases; Rifampin; Risk; Time Factors; Tuberculosis

Topics: Animals; Leprosy; Muridae; Mycobacterium leprae; Peripheral Nervous System Diseases; Rifampin

A 33 year old male Nigerian presented with widespread involvement of peripheral nerves, several of which were tender and painful. Nerve biopsies confirmed the presence of Mycobacterium leprae in both endoneurial and perineurial areas, mainly in foamy macrophages (Virchow cells), but there were also large accumulations of an amorphous, acid-fast and alcohol-fast material which was not obviously of bacterial origin. Appropriate stains indicated that this had many characteristics of lipofuscin. Although not previously known, it was at this stage discovered that the patient had received treatment with anti-leprosy drugs nearly three years before presentation in this country. One of these was clofazimine, an aniline aposafranine derivative known to produce a ceroid-like pigment in the tissues of patients treated with this drug or lepromatous leprosy.

Topics: Adult; Ceroid; Clofazimine; Dapsone; Drug Therapy, Combination; Histocytochemistry; Humans; Leprosy; Macrophages; Male; Peripheral Nerves; Peripheral Nervous System Diseases; Pigmentation Disorders; Pigments, Biological; Rifampin

Topics: Adult; Antibody Formation; Central Nervous System Diseases; Clofazimine; Dapsone; Diagnosis, Differential; Female; Humans; Leprosy; Male; Motor Neurons; Neurologic Manifestations; Neuromuscular Diseases; Peripheral Nervous System Diseases; Rifampin

Topics: Antitubercular Agents; Chemical and Drug Induced Liver Injury; Drug Eruptions; Drug Hypersensitivity; Drug Therapy, Combination; Ethambutol; Hematologic Diseases; Humans; Isoniazid; Liver; Peripheral Nervous System Diseases; Psychoses, Substance-Induced; Rheumatic Diseases; Rifampin; Streptomycin; Tuberculosis