rifampin and Peritonitis--Tuberculous

A case of tuberculous peritonitis complicating continuous ambulatory peritoneal dialysis (CAPD) in a 37-year-old man who presented with fever, abdominal pain, and a malfunctioning Tenckhoff catheter is reported. The patient was initially treated for presumed bacterial peritonitis but remained febrile and had persistent abdominal pain and peritoneal fluid pleocytosis, despite broad-spectrum antibiotic therapy. Mycobacterium tuberculosis was isolated in a culture of peritoneal fluid, and the patient responded promptly to antituberculous therapy. More than 50 cases of tuberculous peritonitis complicating CAPD that have been reported in the English-language literature since the initial case was reported in 1980 are reviewed. The most common symptoms are fever (78%), abdominal pain (92%), and cloudy dialysate (90%); 76% of cases had a predominance of polymorphonuclear cells in peritoneal fluid. A smear for acid-fast bacilli or a culture was positive in 73% of cases. The peritoneal dialysis catheter was removed in 53% of cases, although this was rarely considered necessary for cure of tuberculosis. The attributable mortality rate is 15%, with the most significant factor being treatment delay (mean time from presentation to initiation of treatment, 6.74 weeks). We conclude that tuberculosis is an important diagnostic consideration for CAPD patients with peritonitis that is refractory to broad-spectrum antibiotics.

Topics: Adult; Antitubercular Agents; Ethambutol; Humans; Isoniazid; Male; Mycobacterium tuberculosis; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis, Tuberculous; Pyrazinamide; Rifampin

Tuberculous liver abscess has been reported in only fourteen patients in Japan and in twenty-nine patients outside Japan. Only nine of the non-Japanese patients and none of the Japanese patients have been treated for this condition without laparotomy. We report a patient who developed tuberculous liver abscess during treatment of tuberculous peritonitis. Diagnosis was made by ultrasound-guided aspiration biopsy, and the patient was treated with percutaneous drainage and transcatheter infusion of antituberculous agents. Direct infusion of antituberculous agents has more direct effects in the treatment of an abscess than systemic chemotherapy alone. Therefore, if a percutaneous catheter can be safely placed, the use of transcatheter infusion of antituberculous agents should be considered.

Topics: Administration, Cutaneous; Antitubercular Agents; Drug Therapy, Combination; Ethambutol; Female; Humans; Isoniazid; Liver Abscess; Middle Aged; Peritonitis, Tuberculous; Rifampin; Tuberculosis, Hepatic

Topics: Acute Disease; Antitubercular Agents; Child; Diagnosis, Differential; Drug Therapy, Combination; Female; Humans; Isoniazid; Lung; Middle Aged; Mycobacterium tuberculosis; Peritonitis, Tuberculous; Pneumonia; Radiography; Rifampin; Sputum; Tuberculosis; Tuberculosis, Cardiovascular; Tuberculosis, Meningeal; Tuberculosis, Miliary

Topics: Adolescent; Adult; Aged; Child; Clinical Trials as Topic; Female; Hospitals, Special; Humans; Isoniazid; Japan; Male; Middle Aged; Peritonitis, Tuberculous; Prognosis; Rifampin; Tuberculosis, Gastrointestinal

A 53-year-old woman was admitted to our hospital due to abdominal pain, diarrhea, and shunt occlusion caused by dehydration. She had undergone hemodialysis due to diabetic nephropathy over a ten-year period. She was hospitalized again with fever and a persistent high serum CRP level. We started antibiotic administration using cefotiam hexetil hydrochloride because of ascites and peritoneum thickening observed by abdominal computed tomography. Although her symptoms, such as abdominal pain and diarrhea, improved after the administration of antibiotics, the ascites and the peritoneum thickening did not improve. On the fourth hospital day, we attempted ascites aspiration to investigate the etiology of the peritonitis. Cytological examination suggested tuberculous peritonitis because of predominant macrophage cell proliferation, a high level of ADA concentration, and a high level of CA125 of ascites. Although QuantiFERON-tuberculosis (QFT) and the Gaffky scale were negative, we started multidrug therapy (isoniazid + rifampicin + pyrazinamide + ethambutol) on the 20th hospital day. She was finally diagnosed as mycobacterium tuberculous peritonitis based on biopsy of the tissue of the ileum and the results of colonoscopy. Administration of antituberculosis chemotherapy improved abdominal fullness and ascites and the patient was discharged on the 97th hospital day. Moreover Kuno et al. reported that serum soluble interleukin-2 receptor(sIL-2R) and CA-125 levels can be used to monitor the response to anti-tuberculosis treatment. In this case, we use these markers to monitor the response to treatment. We experienced a case of tuberculous peritonitis undergoing hemodialysis. Tuberculosis should be suspected when patients undergoing dialysis have long-term fever of unknown etiology. There are many reports stating that the sensitivity and specificity of QuantiFERON-tuberculosis (QFT) and sputum culture are low in latent tuberculosis infection of dialysis patients. Accordingly it is necessary to diagnose mycobacterium tuberculous peritonitis comprehensively by the clinical symptoms and image analysis.

Topics: Abdominal Pain; Antitubercular Agents; Biomarkers; CA-125 Antigen; Diagnosis, Differential; Diarrhea; Drug Combinations; Ethambutol; Female; Humans; Isoniazid; Middle Aged; Peritonitis, Tuberculous; Pyrazinamide; Receptors, Interleukin-2; Renal Dialysis; Rifampin; Treatment Outcome

Topics: 5-Aminolevulinate Synthetase; alpha-Thalassemia; Anemia, Sideroblastic; Antitubercular Agents; Aza Compounds; Bone Marrow; Chemical and Drug Induced Liver Injury; Drug Therapy, Combination; Ethambutol; Female; Fluoroquinolones; Hemolysis; Humans; Isoniazid; Middle Aged; Moxifloxacin; Peritonitis, Tuberculous; Pyrazinamide; Pyridoxine; Quinolines; Rifampin

After the start of anti-tuberculous treatment, paradoxical worsening of tuberculous lesions has been described. However, abdominal tuberculosis as paradoxical response is relatively rare. This report describes the 26-year-old female who suffered from peritoneal tuberculosis while treating tuberculous pleurisy with anti-tuberculous medications. It was considered as paradoxical response, rather than treatment failure or else. She was successfully managed with continuing initial anti-tuberculous medications. When a patient on anti-tuberculous medications is presented with abdominal symptoms, the possibility of paradoxical response should be considered to avoid unnecessary tests and treatments, which may result in more suffering of the patient. Herein, we report a case of peritoneal tuberculosis as paradoxical response while treating tuberculous pleurisy.

Topics: Adenosine Deaminase; Adult; Antitubercular Agents; Drug Therapy, Combination; Ethambutol; Female; Humans; Isoniazid; Peritonitis, Tuberculous; Pleural Effusion; Pyrazinamide; Rifampin; Tomography, X-Ray Computed; Tuberculosis, Pleural

Peritonitis due to brucellosis is extremely rare and the reported cases are mostly chronic hepatic failure patients with ascites or chronic renal failure patients on continuous ambulatory peritoneal dialysis. We report a 20-year-old male patient, with no underlying disease, who was diagnosed as peritonitis due to brucellosis mimicking tuberculosis, with ascites with pleocytosis, lymphocytic predominance and high levels of adenosine deaminase.

Topics: Anti-Bacterial Agents; Ascites; Brucellosis; Diagnosis, Differential; Doxycycline; Humans; Male; Paracentesis; Peritonitis; Peritonitis, Tuberculous; Rifampin; Young Adult

We present a case of tuberculous peritonitis in a woman with rheumatoid arthritis (RA), treated with adalimumab, and we review the association between anti-tumour necrosis factor (anti-TNF) therapy and tuberculosis. There have been only 2 case reports of peritoneal tuberculosis associated with anti-TNF and only 1 with adalimumab.

Topics: Adalimumab; Aged; Antibiotics, Antitubercular; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antirheumatic Agents; Arthritis, Rheumatoid; Female; Humans; Isoniazid; Mycobacterium tuberculosis; Opportunistic Infections; Peritonitis, Tuberculous; Pyrazinamide; Rifampin

Topics: Antibiotics, Antitubercular; Antitubercular Agents; Ascites; Drug Therapy, Combination; Follow-Up Studies; Humans; Isoniazid; Male; Middle Aged; Peritonitis, Tuberculous; Pyrazinamide; Radiography, Abdominal; Rifampin; Time Factors; Tomography, X-Ray Computed; Treatment Outcome

Topics: Antibiotics, Antitubercular; Antitubercular Agents; Ascites; Drug Therapy, Combination; Follow-Up Studies; Humans; Isoniazid; Male; Middle Aged; Peritonitis, Tuberculous; Pyrazinamide; Radiography, Abdominal; Rifampin; Time Factors; Tomography, X-Ray Computed

Topics: Adult; Antitubercular Agents; Ethambutol; Female; Humans; Laparotomy; Peritonitis, Tuberculous; Rifampin; Treatment Outcome

This report is of a case of tuberculous peritonitis that developed during antituberculous chemotherapy. A 54-year-old man had been diagnosed as all-drug susceptible pulmonary and intestinal tuberculosis, and treatment with isoniazid, ethambutol and rifampicin had been initiated. About 5 months later, while still undergoing therapy, a large amount of ascites developed. A diagnostic laparoscopy was performed but due to the adhesion between the greater omentum and the parietal peritoneum, intestinal perforation occurred. An emergency operation was performed and the diagnosis of tuberculous peritonitis was confirmed. There are few reports of abdominal tuberculosis developing during antituberculous chemotherapy. In this case a paradoxical response may have been involved in the pathogenesis.

Topics: Antibiotics, Antitubercular; Drug Therapy, Combination; Ethambutol; Humans; Isoniazid; Laparoscopy; Male; Middle Aged; Peritonitis, Tuberculous; Rifampin; Time Factors; Tuberculosis, Gastrointestinal; Tuberculosis, Pulmonary

Two primigravid immigrant women aged 20 and 24 years were diagnosed with tuberculous peritonitis. The cases showed a significant delay in diagnosis. This was probably the cause for the premature birth and death of one foetus. The other child was diagnosed with congenital tuberculosis several months after birth and was successfully treated. The women were treated with the usual combination ofisoniazid, rifampicin, ethambutol and pyrazinamide. The unfamiliarity with this clinical picture is a problem in countries with a low incidence of tuberculosis. In both cases the final diagnosis was made by the characteristic image seen during laparoscopy. An early diagnosis and also an early start with tuberculostatic drugs are important for a favourable outcome of pregnancy. Pregnancy and breast-feeding are no contraindications for treatment with tuberculostatic drugs.

Topics: Adult; Antitubercular Agents; Diagnosis, Differential; Drug Therapy, Combination; Ethambutol; Female; Fetal Death; Humans; Isoniazid; Peritonitis, Tuberculous; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Pyrazinamide; Rifampin

Topics: Antitubercular Agents; Diagnosis, Differential; Drug Eruptions; Ethambutol; False Negative Reactions; Female; Humans; Intradermal Tests; Isoniazid; Middle Aged; Patch Tests; Peritonitis, Tuberculous; Pyrazinamide; Pyridoxine; Rifampin

Tuberculosis in the genital and peritoneal region is increasing in last years. For this reason, the high value and efficacy of laparoscopy using a small caliber endoscope for the diagnosis of this disease, which often presents no specific and heterogeneous clinical features, is underlined.. A case of peritoneal tuberculosis in a young female presenting fever, asthenia and peritoneal effusion, is reported. Blood tests, X-ray and cytological examination of the peritoneal fluid all failed to point out the right diagnosis. Then multiple biopsies of the peritoneum and the external surface of uterus and ovaries were made using laparoscopy.. Laparoscopy clearly showed the miliary nodules. The histology showed multiple granulomas composed by inner caseous necrosis and outer layer of epithelioid histiocytes and Langhans cells, leading thus to the diagnosis of peritoneal tuberculosis. The patient, treated with streptomycin and rifampicin, five months after diagnosis, did not show any feature of tubercular disease.. Because of its safety, laparoscopy is a very useful and powerful diagnostic technique especially in those young women presenting with painful abdominal symptoms without any clear evident cause.

Topics: Adolescent; Female; Humans; Isoniazid; Laparoscopes; Peritoneum; Peritonitis, Tuberculous; Rifampin; Treatment Outcome; Tuberculosis, Female Genital

The protean clinical manifestations and varied complications of abdominal tuberculosis continue to challenge the diagnostic acumen and therapeutic skills of all physicians. Although abdominal tuberculosis in children has not been common in the United States over the past 2 decades, the authors found 26 case reports for the period 1980-1993. Three clinical patterns were evident: intestinal (13) peritoneal (9), and asymptomatic with incidental calcifications apparent on abdominal radiographs (4). The diagnosis was suspected for only 23% of these cases, which emphasizes the nonspecific symptomatology caused by this extrapulmonary manifestation and the need for a high index of suspicion to make a prompt diagnosis. In this study, 24 of the 26 (91%) were of Hispanic origin; the other two were indo-Chinese, another high-risk group. Most patients (88%) had a positive PPD skin test result. Mycobacteria were isolated from 15 of 21 (71.4%) cultures, with M bovis in 80% and M tuberculosis in 20%. Antituberculous chemotherapy is the mainstay of treatment; surgery is reserved for tissue diagnosis in cases of peritoneal tuberculosis and for the management of complications of intestinal tuberculosis. The response to chemotherapy usually is excellent, and long-term sequelae are uncommon. It appears that steroids do not decrease the incidence or degree of fibrosis in intestinal tuberculosis.

Topics: Adolescent; Anti-Bacterial Agents; Antitubercular Agents; California; Child; Child, Preschool; Drug Therapy, Combination; Female; Humans; Infant; Isoniazid; Male; Peritonitis, Tuberculous; Pyrazinamide; Retrospective Studies; Rifampin; Tuberculosis, Gastrointestinal

Topics: Antitubercular Agents; Child; Diagnosis, Differential; Ethambutol; Female; Humans; Isoniazid; Mycobacterium tuberculosis; Peritonitis, Tuberculous; Pyrazinamide; Rifampin; Tuberculosis, Gastrointestinal

Topics: Child, Preschool; Humans; Male; Peritonitis, Tuberculous; Rifampin; Tomography, X-Ray Computed; Tuberculosis, Meningeal; Tuberculosis, Miliary; Tuberculosis, Pulmonary

We report 2 patients with pelvic-peritoneal tuberculosis and elevated serum and peritoneal fluid levels of Ca-125. The first was a young and infertile women who had cul-de-sac nodularity and dysmenorrhea. The other was postmenopausal and presented with weight loss and ascites. While a preoperative diagnosis of endometriosis was made in the former, intraperitoneal malignancy was considered in the latter. The diagnosis of pelvic-peritoneal tuberculosis was reached by laparoscopic-directed biopsy in both patients. Serum levels of Ca-125 returned to normal limits following antituberculous drug treatment.

Topics: Adnexal Diseases; Adult; Antigens, Tumor-Associated, Carbohydrate; Ascitic Fluid; Diagnosis, Differential; Ethambutol; Female; Humans; Infertility, Female; Isoniazid; Menopause; Middle Aged; Peritonitis, Tuberculous; Pyrazinamide; Rifampin; Tuberculosis, Female Genital; Uterine Diseases

Topics: Child; Drug Therapy, Combination; Ethambutol; Female; Humans; Isoniazid; Peritonitis, Tuberculous; Rifampin; Tomography, X-Ray Computed

It is generally accepted that hepatitis occurring during treatment with INH and rifampicine results from the hepatotoxicity of INH metabolites. A case is reported of cholestatic hepatitis occurring during such treatment, in which there was a previous history of an isolated hepatic affection. The administration of INH and rifampicin caused cholestasis alone, which reoccurred after rifampicin administration only. No immuno-allergic phenomenon has been shown to be involved in rifampicin toxicity. This observation suggests that rifampicin may be hepatotoxic itself, especially in patients with previous hepatic affections.

Topics: Aged; Chemical and Drug Induced Liver Injury; Cholestasis; Drug Therapy, Combination; Female; Humans; Isoniazid; Liver; Liver Diseases; Peritonitis, Tuberculous; Rifampin

Topics: Acute Kidney Injury; Adult; Humans; Kidney; Male; Nephritis, Interstitial; Peritonitis, Tuberculous; Rifampin

Topics: Adult; Drug Therapy, Combination; Female; Humans; Isoniazid; Male; Middle Aged; Peritonitis, Tuberculous; Rifampin; Streptomycin; Time Factors; Tuberculosis; Tuberculosis, Pulmonary

Topics: Bone Marrow; Bone Marrow Examination; Cholestasis; Erythema; Ethambutol; Humans; Isoniazid; Leukopenia; Male; Middle Aged; Neutropenia; Peritonitis, Tuberculous; Rifampin; Streptomycin; Thrombocytopenia; Tuberculosis; Tuberculosis, Hepatic; Tuberculosis, Osteoarticular; Tuberculosis, Splenic; Vitamin B Complex

Topics: Adrenal Cortex Hormones; Adult; Ethambutol; Female; Humans; Isoniazid; Laparotomy; Middle Aged; Peritonitis; Peritonitis, Tuberculous; Radiography, Abdominal; Radiography, Thoracic; Rifampin; Tuberculosis, Gastrointestinal