rifampin and Pleural-Effusion

We compared diagnostic accuracy of pleural fluid Xpert MTB/RIF (Xpert) and Xpert MTB/RIF Ultra (Ultra) assays for diagnosing tuberculous pleural effusion (TPE), through systematic review and comparative meta-analysis.. We searched PubMed and Embase databases for publications reporting diagnostic accuracy of Xpert or Ultra for TPE. We used bivariate random-effects modeling to summarize diagnostic accuracy information from individual studies using either mycobacterial culture or composite criteria as reference standard. We performed meta-regression through hierarchical summary receiver operating characteristic (HSROC) modeling to evaluate comparative performance of the two tests from studies reporting diagnostic accuracy of both in the same study population.. We retrieved 1097 publications, and included 74 for review. Summary estimates for sensitivity and specificity for Xpert were 0.52 (95% CI 0.43-0.60, I2 82.1%) and 0.99 (95% CI 0.97-0.99, I2 85.1%), respectively, using culture-based reference standard; and 0.21 (95% CI 0.17-0.26, I2 81.5%) and 1.00 (95% CI 0.99-1.00, I2 37.6%), respectively, using composite reference standard. Summary estimates for sensitivity and specificity for Ultra were 0.68 (95% CI 0.55-0.79, I2 80.0%) and 0.97 (95% CI 0.97-0.99, I2 92.1%), respectively, using culture-based reference standard; and 0.47 (95% CI 0.40-0.55, I2 64.1%) and 0.98 (95% CI 0.95-0.99, I2 54.8%), respectively, using composite reference standard. HSROC meta-regression yielded relative diagnostic odds ratio of 1.28 (95% CI 0.65-2.50) and 1.80 (95% CI 0.41-7.84) respectively in favor of Ultra, using culture and composite criteria as reference standard.. Ultra provides superior diagnostic accuracy over Xpert for diagnosing TPE, mainly because of its higher sensitivity.

Topics: Antibiotics, Antitubercular; Humans; Mycobacterium tuberculosis; Pleural Effusion; Rifampin; Sensitivity and Specificity; Tuberculosis

A systematic review investigating the role of Xpert MTB/RIF in the diagnosis of tuberculous pleural effusion (TPE) was conducted. The pooled sensitivities and specificities of Xpert MTB/RIF were 51.4% and 98.6%, respectively, with culture used as a reference standard and 22.7% and 99.8%, respectively, with a composite reference standard (CRS) used as the benchmark. Xpert MTB/RIF has low sensitivity but excellent specificity in the diagnosis of TPE.

Topics: Antitubercular Agents; Drug Resistance, Bacterial; Humans; Molecular Diagnostic Techniques; Mycobacterium tuberculosis; Pleural Effusion; Rifampin; Sensitivity and Specificity; Tuberculosis, Multidrug-Resistant; Tuberculosis, Pleural

Tuberculosis Centre, University Medical Centre, Groningen, The Netherlands.. To study intralesional concentrations of isoniazid (INH), rifampicin (RMP) and pyrazinamide (PZA) in tuberculous pleural effusions and psoas abscesses, and to compare these to reference serum values and minimal inhibitory concentration (MIC).. Intralesional concentrations were measured 2 h after drug administration (six pleural effusions, 10 psoas abscesses).. A wide range of concentrations was found for pleural effusions and psoas abscesses. Concentrations were below MIC values in none of 15 patients for INH, in two of 13 for RMP, and in eight of nine for PZA. The Cmax:MIC ratio was always >4 for INH, in four of 13 for RMP, and in none of nine for PZA. In 5/8 patients receiving all three drugs, both RMP and PZA had Cmax:MIC ratios <4, indicating sub-therapeutic drug levels.. Penetration of INH was always sufficient, penetration of RMP mostly below the desired ratio, and for PZA on average 10 times too low. Five of eight patients on all three drugs had Cmax:MIC ratios <4. This indicates intralesional sub-therapeutic drug levels for RMP and PZA, and local monotherapy with INH. This could induce drug resistance. Drainage as additional therapy seems indicated.

Topics: Adolescent; Adult; Aged; Antitubercular Agents; Female; Humans; Isoniazid; Male; Microbial Sensitivity Tests; Middle Aged; Netherlands; Pleural Effusion; Psoas Abscess; Pyrazinamide; Rifampin; Tuberculosis, Pulmonary; Young Adult

Evaluation of the effectiveness of rifampicin and some agents used in the pleurodesis of pleural effusions, such as autologous blood and purified mineral talc.. A total of 56 hydroceles were treated by sclerotherapy, in a random fashion, using purified mineral talc, rifampicin and autologous blood as sclerosant agents. The control group of patients were handled with aspiration only.. The cohort of patients in the blood group had a success rate comparable to the control group (p > 0.05). the rifampicin group did better than both control and blood groups (p < 0.05) but not better than the talc group (p < 0.01). Success rate was highest in the talc group of patients who needed no re-sclerotherapy procedures.. Purified mineral talc was shown to be potentially the best sclerosant for the sclerotherapy of hydroceles and epididymal cysts.

Topics: Adult; Aged; Aged, 80 and over; Blood Transfusion, Autologous; Humans; Male; Middle Aged; Pleural Effusion; Pleurodesis; Rifampin; Sclerotherapy; Testicular Hydrocele

Electrophonophoresis (EP) has been widely used in various clinical fields. The purpose of this study was to evaluate the dermal permeability of rifampicin (RIF) in patients with tuberculous pleurisy assisted by EP and to verify the clinical application of this percutaneous drug delivery system in the treatment of tuberculous pleurisy, verify the system's influencing factors, and determine whether plasma drug concentration was increased.. Patients were given oral isoniazid 0.3-0.4 g, rifampicin 0.45-0.60 g, pyrazinamide 1.0-1.5 g and ethambutol 0.75 g according to their body weight once a day. After 5 days of anti-tuberculosis treatment, 3 ml of rifampicin was delivered transdermally with EP. Pleural effusion and peripheral blood samples in patients were collected at and after dosing. The drug concentration in the samples was determined by high-performance liquid chromatography.. The median plasma concentration (interquartile ranges) of RIF in 32 patients was 8.80 (6.65, 13.14) μg/ml before RIF transdermal injection plus EP and decreased to 8.09 (5.58, 11.82) μg/ml after 30 min of RIF transdermal injection plus EP. The RIF concentration in pleural effusion was higher than that before RIF-transdermal plus EP. In patients who received RIF via EP transdermal administration, the concentration of the drug at the local site was statistically higher than the concentration at the local site prior to penetration. However, no such enhancement was observed in plasma after transdermal administration of RIF.. EP can effectively increase the concentration of rifampicin in the pleural effusion of tuberculous pleurisy and has no effect on the circulating plasma concentration. The increased concentration of the drug in the lesion helps to destroy the bacteria.

Topics: Administration, Cutaneous; Drug Delivery Systems; Humans; Pleural Effusion; Rifampin; Tuberculosis, Pleural

The aim of the study was to determine the performance of Xpert MTB/RIF assay in diagnosing tuberculosis on thoracoscopic pleural biopsies in exudative pleural effusion.. Patients who underwent thoracoscopic pleural biopsy in the defined period were included in the study. Histopathology was done for all and Xpert MTB RIF assay and AFB culture of pleural biopsy specimen and pleural fluid were done as per the clinician's discretion.. Total of 110 patients underwent pleural biopsy and tissue Xpert MTB/RIF and MTB culture were done in 29 patients. XpertMTB/RIF assay and MTB culture had a sensitivity of 59% and 35% respectively and specificity of specificity of 100.. The study described the ability of XPERT MTB/RIF in getting additional diagnostic information from thoracoscopic Pleural biopsy. Pleural biopsy Xpert MTB/RIF had sensitivity of 59% and specificity of 100% in diagnosing TPE. In addition to the diagnosis, Xpert MTB/RIF can also give valuable information about rifampicin resistance too. XPERT MTB/RIF assay also helped in getting diagnosis when histopathology alone was not able to confirm or rule out the diagnosis of TPE. Pleural fluid ADA of 38 IU/L had a sensitivity of 71% and a specificity of 86% for diagnosis of TPE in present study.

Topics: Biopsy; Exudates and Transudates; Humans; Pleura; Pleural Effusion; Rifampin

The Xpert MTB/RIF (Xpert) assay has greatly improved the diagnosis of TB and identification of resistance to rifampicin (RIF). However, sensitivity of Xpert remains poor for pleural fluid detection. This study evaluated the performance of the novel next-generation Xpert MTB/RIF Ultra (Xpert Ultra) in comparison with Xpert for pleural TB diagnosis.. Patients with suspected pleural TB were enrolled consecutively in four hospitals, and pleural fluids were subjected to smear, culture, and Xpert. Defrosted pleural fluid (-80°C) was examined using Xpert Ultra. Drug susceptibility testing (DST) was conducted for all of the recovered isolates.. In total, 317 individuals with suspected pleural TB were recruited; 208 of them were diagnosed with pleural TB according to the composite reference standard, which was composed of clinical, laboratory, histopathologic, and radiologic examination features and ≥ 12 months of follow-up data. The direct head-to-head comparison for Mycobacterium tuberculosis detection showed that Xpert Ultra (44.23%, 92 of 208) produced a higher sensitivity than culture (26.44%, 55 of 208, P < .001), Xpert (19.23%, 40 of 208, P < .001), and smear (1.44%, three of 208, P < .001). When Xpert Ultra outcomes were integrated, the percentage of definite pleural TB cases increased from 56.25% (117 of 208) to 64.90% (135 of 208). The specificities of smear, culture, Xpert, and Xpert Ultra were 100% (84 of 84), 100% (84 of 84), 98.67% (83 of 84), and 98.67% (83 of 84), respectively. Xpert Ultra was 100% concordant with phenotype DST for the detection of RIF resistance.. Xpert Ultra has great potential in diagnosis of pleural TB and its RIF resistance, which could speed up the initiation of appropriate treatment.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antibiotics, Antitubercular; Culture Techniques; Drug Resistance, Microbial; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Mycobacterium tuberculosis; Nucleic Acid Amplification Techniques; Pleural Effusion; Polymerase Chain Reaction; Predictive Value of Tests; Rifampin; Sensitivity and Specificity; Tuberculosis, Multidrug-Resistant; Tuberculosis, Pleural; Young Adult

In most developing countries, smear-negative pulmonary TB (SNPT) often gets missed from the diagnosis of consideration, though it accounts 30-65% of total PTB cases, due to deficient or inaccessible molecular diagnostic modalities.. The cross-sectional study enrolled 360 patients with clinical-radiological suspicion of SNPT in Tribhuvan University Teaching Hospital (TUTH). The patient selection was done as per the algorithm of Nepal's National Tuberculosis Program (NTP) for Xpert MTB/RIF testing. Participants' demographic and clinical information were collected using a pre-tested questionnaire. The specimens were collected, processed directly for Xpert MTB/RIF test according to the manufacturer's protocol. The same samples were stained using the Ziehl-Neelsen technique then observed microscopically. Both findings were interpreted; rifampicin-resistant, if obtained, on Xpert testing was confirmed with a Line Probe Assay.. Of 360 smear-negative sputum samples analyzed, 85(23.61%) found positive while 3(0.8%) of them were rifampicin resistance. The infection was higher in males, i.e. 60(25.3%) compared to female 25(20.3%). The age group, > 45(nearly 33%) with median age 42 ± 21.5, were prone to the infection. During the study period, 4.6% (515/11048) sputum samples were reported as smear-positive in TUTH. Consequently, with Xpert MTB/RIF assay, the additional case 16.5% (n = 85/515) from smear-negative presumptive TB cases were detected. Among the most occurring clinical presentations, cough and chest pain were positively associated with SNPT. While upper lobe infiltrates (36.4%) and pleural effusion (40.4%) were the most peculiar radiological impression noted in PTB patient. 94 multi-drug resistant(MDR) suspected cases were enrolled; of total suspects, 29(30.8%) samples were rifampicin sensitive, 1(1.06%) indeterminate, 3(3.19%) rifampicin-resistant while remaining of them were negative. 2(2.2%) MDR cases were recovered from the patient with a previous history of ATT, of total 89 previously treated cases enrolled However, a single rifampicin-resistant from the new suspects.. With an application of the assay, the additional cases, missed with smear microscopy, could be sought and exact incidence of the diseases could be revealed.

Topics: Adolescent; Adult; Algorithms; Biological Assay; Chest Pain; Cough; Cross-Sectional Studies; Developing Countries; DNA, Bacterial; Drug Resistance, Multiple, Bacterial; Female; Hospitals, University; Humans; Male; Microscopy; Middle Aged; Mycobacterium tuberculosis; Nepal; Pleural Effusion; Rifampin; Sensitivity and Specificity; Sputum; Tuberculosis, Pulmonary; Young Adult

Topics: Aged, 80 and over; Antitubercular Agents; BCG Vaccine; Biopsy; Carcinoma, Transitional Cell; Diagnosis, Differential; Humans; Isoniazid; Male; Pleural Effusion; Rifampin; Risk Factors; Treatment Outcome; Urinary Bladder Neoplasms

Extrapulmonary tuberculosis (EPTB) accounts for ~15% of all TB patients, and TB pleural effusion is the second most common site of EPTB. The diagnosis of pleural TB is challenging due to the pauci-bacillary nature of the disease. Histopathology of thoracoscopically obtained pleural biopsy provides the highest diagnostic yield. The Xpert MTB/RIF assay (Xpert) is a PCR test that can identify both Mycobacterium tuberculosis (MTB) and rifampicin resistance. Currently, there is a lack of clarity regarding the value of Xpert on pleural tissue. We report our experience of using Xpert on thoracoscopic pleural biopsy samples.. We retrospectively reviewed the records of patients who underwent thoracoscopy in our institution over a 1-year period. Relevant clinical details; indications; and results of tests on pleural tissue and fluid, including histopathology, mycobacterial cultures and Xpert, were extracted.. Of the 156 patients who underwent thoracoscopy, 73 (47%) had TB, 66 (42%) malignancy and 17 (11%) other conditions. Histopathology was diagnostic in all the 73 TB patients (100%). The yields of the microbiological tests against histopathology on thoracoscopic biopsy sample and pleural fluid were: pleural tissue Xpert 45%, pleural tissue culture 39%, pleural fluid culture 17% and pleural fluid Xpert 14%. Pleural tissue provided higher yields than fluid in both Xpert and culture (P < 0.05). Pleural tissue Xpert provided a higher yield than culture and substantially improved yield compared with closed pleural biopsy as we previously reported.. Thoracoscopic pleural biopsy results in increased sensitivity on Xpert testing.

Topics: Adolescent; Adult; Aged; Antibiotics, Antitubercular; Biopsy; DNA, Bacterial; Drug Resistance, Bacterial; Female; Humans; Male; Middle Aged; Mycobacterium tuberculosis; Pleura; Pleural Effusion; Polymerase Chain Reaction; Predictive Value of Tests; Retrospective Studies; Rifampin; Thoracoscopy; Tuberculosis, Pleural; Young Adult

Unilateral hypoplasia of the lung is a rare congenital condition, the mechanism of which is poorly understood. Primary pulmonary hypoplasia occurring in an adult is extremely rare and we present what is probably the first case of a link to a tuberculous pleural effusion in a young woman after childbirth.. Herein, we describe a 31-year-old woman with left lung hypoplasia, and she not only survived to adulthood without problems, but was able to deliver a baby in natural labor.. Left lung hypoplasia, right tuberculous pleural effusion.. We initiated an anti-tuberculosis treatment for this patient with dose adjustments to her weight of isoniazid (0.3 g/day), rifampicin (0.45 g/day), pyrazinamide (1.5 g/day), and ethambutol (0.75 g/day) for 2 months then isoniazid and rifampicin for another 4 months.. Ten days later after beginning therapy, she became afebrile and the pleural effusion resolved. No recurrence was observed during a 6-month follow-up period.. In clinical practice, if one sees a chest x-ray revealing complete or incomplete opacification of a hemithorax with volume loss and history of repeated respiratory infections, one should consider the possibility of unilateral pulmonary hypoplasia. In such cases, regular close follow-up is important to minimize infections and to prevent development of cor pulmonale or respiratory failure.

Topics: Abnormalities, Multiple; Adult; Antitubercular Agents; Ethambutol; Female; Humans; Isoniazid; Lung; Lung Diseases; Mycobacterium tuberculosis; Parturition; Pleural Effusion; Pregnancy; Pulmonary Heart Disease; Respiratory Insufficiency; Rifampin; Tomography, X-Ray Computed; Treatment Outcome; Tuberculosis, Pleural; Tuberculosis, Pulmonary

Pneumatosis intestinalis (PI), defined as intestinal intra- and extramural gas accumulation, is a rare radiographic finding in conditions of intestinal wall damage of varied etiology. Here, we report on a 56-year-old female with multiple myeloma who presented with undulating fever, fluctuating abdominal symptoms, and a distended abdomen 5 months after allogeneic hematopoietic stem cell transplantation (HSCT). Abdominal X-ray and CT scan documented PI with gas accumulation both in the intestinal and colonic bowel walls. Concurrently, thoracic CT revealed mediastinal and bihilar lymphadenopathy associated with bilateral pleural effusions. Microscopy of bronchoalveolar lavage fluid (BALF) revealed acid-fast bacilli, which were identified as Mycobacterium tuberculosis. Tuberculostatic treatment resulted in timely clinical improvement, a complete clearance of the radiological and clinical findings of PI, and the control of the tuberculosis (Tbc), determined by multiple negative BALF results. Taken together, PI occurred as the initial symptom of Tbc in an allogeneic stem cell recipient, achieving complete recovery by tuberculostatic treatment only.

Topics: Antineoplastic Combined Chemotherapy Protocols; Antitubercular Agents; Bronchoalveolar Lavage Fluid; Female; Hematopoietic Stem Cell Transplantation; Humans; Isoniazid; Middle Aged; Multiple Myeloma; Mycobacterium tuberculosis; Pleural Effusion; Pneumatosis Cystoides Intestinalis; Rifampin; Tomography, X-Ray Computed; Treatment Outcome; Tuberculosis, Pulmonary

To explore the application value of GeneXpert MTB/RIF for detection of extra-pulmonary tuberculosis and resistance to rifampin.. A total of 150 samples were collected, including 33 needle aspirates from lymphoid tuberculosis, 23 needle aspirates from spinal tuberculosis, 49 from tuberculous pleural effusions, 24 from cerebrospinal fluid of tuberculous cephalomeningitis, and 21 urinary sediment samples from renal tuberculosis. Smear microscopy, mycobacterium tuberculosis culture and the MTB/RIF method were used to examine these samples and their positive rates were compared. Rifampin susceptibility tests was performed for culture-positive strains using proportion method, which was compared with the result from GeneXpert MTB/RIF method.. Of the 150 cases of extra-pulmonary tuberculosis, 17 samples were smear-positive, with a sensitivity of 11.3% (17/150); 30 were culture-positive with a sensitivity of 20.0% (30/150); and 96 were positive by MTB/RIF method with a sensitivity of 64.0% (96/150). There was a significant difference between MTB/RIF method and the culture method (χ(2)=59.61, P<0.01). The differences were also significant when the MTB/RIF method was compared with the smear method (χ(2)=88.60, P<0.01) or compared with culture plus smear methods (χ(2)=4.26, P<0.05). Separately, the differences were statistically significant between GeneXpert MTB/RIF method and other 2 methods for diagnosis of lymphoid tuberculosis (n=33, χ(2)=20.56, P<0.01 vs. culture method; χ(2)=27.13, P<0.01 vs. smear results) while no difference was found between culture and smear method (χ(2)=0.67, P>0.05), spinal tuberculosis (n=23, χ(2)=12.74, P<0.01 vs. culture method; χ(2)=14.81, P< 0.01 vs. smear method), tuberculous pleurisy (n=49, χ(2)=32.34, P<0.01 vs.culture method; χ(2)=49.69, P<0.01 vs. smear method) and renal tuberculosis (n=21, χ(2)=4.20, P<0.05 vs. culture method; χ(2) =8.40, P<0.01 vs. smear results). The sensitivity for tuberculous meningitis had no difference among these 3 methods (n=24, P>0.05). Rifampicin-resistance of the strains from the 30 culture-positive cases of extra-pulmonary tuberculosis (20.0%, 6/30) exhibited agreement with GeneXpert MTB/RIF test.. The simplicity and high sensitivity of GeneXpert MTB/RIF technology make it a good diagnostic test for rapid detection of extra-pulmonary tuberculosis and resistance to rifampin.

Topics: Antitubercular Agents; Humans; Microbial Sensitivity Tests; Molecular Diagnostic Techniques; Mycobacterium tuberculosis; Needles; Pleural Effusion; Rifampin; Sensitivity and Specificity; Tuberculosis; Tuberculosis, Lymph Node; Tuberculosis, Meningeal; Tuberculosis, Renal; Tuberculosis, Spinal

A 55-year-old Indian man presented with productive cough and a large left pleural effusion. Pleural fluid culture grew Mycobacterium tuberculosis, and he was started on antituberculosis therapy. One week later, the patient presented to hospital with drowsiness, dehydration and hypotension. He was transferred to critical care and only improved after starting hydrocortisone and stopping rifampicin. His short synACTHen test subsequently confirmed primary adrenal insufficiency, and a CT of the abdomen showed bilateral adrenal enlargement. Rifampicin is known to accelerate cortisol metabolism. We report the rare case of a rifampicin-induced adrenal crisis as a first presentation of Addison's disease in a patient with tuberculous infiltration of the adrenal glands.

Topics: Adrenal Glands; Adrenal Insufficiency; Antitubercular Agents; Cough; Dehydration; Humans; Hydrocortisone; Hypotension; Male; Middle Aged; Mycobacterium tuberculosis; Pleural Effusion; Rifampin; Sleep Stages; Treatment Outcome; Tuberculosis, Pulmonary

Pulmonary involvement is a rare complication of brucellosis. We describe the largest series to date, to our knowledge, of patients with pulmonary brucellosis.. This 10-year, retrospective, descriptive study involved 27 centers in Turkey, including all patients with brucellosis with confirmed respiratory system involvement.. Of 133 patients (67 men), 123 (92.5%) had acute infection (defined as < 2 months), with an overall mean ± SD duration of symptoms of 33.9 ± 8.5 days. The radiologic pattern of pulmonary disease was consolidation/lobar pneumonia in 91 patients (68.4%) and pleural effusion in 41 patients (30.8%), including 30 (22.5%) with both. Moreover, 23 patients (17.3%) had bronchitis (one with coexistent pneumonia), and 10 (7.5%) had nodular lung lesions (one with coexistent pneumonia and effusion). Blood culture results were positive in 56 of 119 patients, and all other cases were serologically confirmed. None of 60 sputum specimens and two of 19 pleural fluid samples (10.5%) yielded positive culture results for brucellosis. Other features of brucellosis, such as osteoarticular complications, were detected in 61 patients (45.9%); 59 (44.4%) had raised liver transaminase levels, and 59 (44.4%) had thrombocytopenia. Fifteen patients (11.3%) required management in an ICU for an average of 3.8 ± 2.2 days. All patients responded to standard combination antimicrobial therapy for brucellosis with no deaths, although treatment regimens required modification in seven patients.. Brucellosis with pulmonary involvement is rare but has a good prognosis following treatment with appropriate antibiotics. Many clues in the exposure history, presenting clinical features, and baseline blood tests should alert the clinician to consider brucellosis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bronchitis; Brucellosis; Ceftriaxone; Doxycycline; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Pleural Effusion; Pneumonia; Prognosis; Retrospective Studies; Rifampin; Streptomycin; Turkey; Young Adult

Topics: Aged; Antibiotics, Antitubercular; China; Diagnosis, Differential; Drug Resistance, Bacterial; Dyspnea; Emigrants and Immigrants; Humans; Lung; Male; Mycobacterium tuberculosis; Pleural Effusion; Predictive Value of Tests; Recurrence; Rifampin; San Francisco; Sputum; Tomography, X-Ray Computed; Tuberculosis, Pulmonary

An automated nucleic acid amplification assay that simultaneously identifies Mycobacterium tuberculosis and rifampicin resistance, the Xpert® MTB/RIF test, has undergone extensive evaluation in sputum samples. Our aim was to define its diagnostic accuracy when performed on pleural fluid specimens. In 67 patients with pleural effusions, of whom half had tuberculous pleuritis, Xpert yielded 15% sensitivity and 100% specificity in the detection of tuberculosis (TB). Positive Xpert results tended to be more common in patients with microbiologically confirmed TB. Due to its low sensitivity, Xpert testing of pleural fluids has a limited role in the work-up of pleural effusions.

Topics: Adult; Antitubercular Agents; Automation, Laboratory; Bacterial Proteins; Case-Control Studies; DNA-Directed RNA Polymerases; DNA, Bacterial; Drug Resistance, Bacterial; Female; Humans; Likelihood Functions; Male; Mycobacterium tuberculosis; Odds Ratio; Pleural Effusion; Polymerase Chain Reaction; Predictive Value of Tests; Prospective Studies; Rifampin; Spain; Tuberculosis, Pleural

Topics: Antitubercular Agents; Biopsy; Carcinoma; Combined Modality Therapy; Diagnosis, Differential; Ethambutol; Female; Humans; Isoniazid; Lymphatic Diseases; Middle Aged; Mycobacterium tuberculosis; Osteolysis; Osteomyelitis; Pleural Effusion; Pleural Neoplasms; Pyrazinamide; Rifampin; Sputum; Sternum; Tomography, X-Ray Computed; Tuberculosis, Osteoarticular

Topics: Agglutination Tests; Animal Husbandry; Animals; Brucella; Brucellosis; Dairy Products; Doxycycline; Food Contamination; Humans; Male; Milk; Occupational Diseases; Pleural Effusion; Pneumonia, Bacterial; Rifampin; Sheep; Spain; Tomography, X-Ray Computed; Young Adult

Drug-induced immune thrombocytopenia (DITP) can be triggered by a wide range of medications. Although many cases of DITP are mild, some are characterised by life-threatening bleeding symptoms. In the treatment of tuberculosis there are special therapeutic problems related to adverse effects of drugs, compliance to treatment and microbial resistance. Thrombocytopenia is an uncommon but potentially fatal adverse effect of certain antituberculous drugs when the incriminating drug is taken by a susceptible individual. Here the authors report a case of rifampicin-induced thrombocytopenia, which although rare, needs attention.

Topics: Adult; Antibiotics, Antitubercular; Diagnosis, Differential; Female; Humans; Pleural Effusion; Purpura, Thrombocytopenic; Rifampin

To study the efficacy and safety of Category III DOTS treatment (intermittent thrice-weekly rifampicin [RMP], isoniazid [INH] and pyrazinamide for 2 months, followed by RMP and INH for 4 months) under India's Revised National Tuberculosis Control Programme in patients with uncomplicated small unilateral pleural effusion (<1500 ml).. This prospective, multicentre, observational study recruited 351 patients between 2006 and 2010. Patients were regularly followed up clinically as well as with ultrasound examination of the chest.. Successful outcome (clinical response with complete resolution on ultrasound examination at 6 months) was seen in 274 patients (78.1%). Efficacy was 88.9% (excluding defaulters), and 94% among those completing follow-up as per protocol. None of the patients received corticosteroids. Other outcomes included treatment extension (n = 26, 7.4%), default (n = 43, 12.2%), treatment failure (n = 3, 0.9%) and death (n = 3, 0.9%). Seventy-nine mild/moderate adverse events and one treatment-related serious adverse event were noted; one patient developed recurrent drug-induced hepatotoxicity. Two patients (0.7%) had relapse/re-infection at 24 months follow-up.. Intermittent thrice-weekly treatment for 6 months with three drugs in the intensive phase is effective and safe for unilateral small pleural effusion in immunocompetent patients. Although Category III no longer exists in the programme, the results are reassuring for intermittent treatment in extra-pulmonary TB under programme conditions.

Topics: Adolescent; Adult; Antitubercular Agents; Directly Observed Therapy; Drug Administration Schedule; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Immunocompetence; India; Isoniazid; Male; Pleural Effusion; Prospective Studies; Pyrazinamide; Recurrence; Rifampin; Treatment Outcome; Tuberculosis; Ultrasonography; Young Adult

Topics: Adult; Antibiotics, Antitubercular; Drug Therapy, Combination; Ethambutol; Fever; HIV Seropositivity; Humans; Isoniazid; Male; Pleural Effusion; Pyrazinamide; Radiography; Rifampin; Tuberculosis, Pulmonary; Young Adult

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

A 75-year-female with a history of Isoniazid (INH) therapy for latent tuberculosis, was admitted with a 4-week duration of dyspnea, cough, and pleuritic chest pain. She was treated with intravenous antibiotics for a diagnosis of pneumonia. Her stay was complicated by development of recurrent, exudative eosinophilic pleural effusions (EPEs). When symptoms continued to worsen and she developed joint pain and anasarca and did not respond to the antibiotics, a rheumatologic work-up was performed. She was found to have positive anti-double stranded-DNA antibodies and anti-histone antibodies; thus, a diagnosis of drug-induced lupus, secondary to INH, was made. INH was discontinued, and the patient was started on prednisone; within weeks her symptoms resolved. This case illustrates a unique side effect of INH that caused exudative EPEs and drug-induced lupus with positive anti-dsDNA.

Topics: Aged; Antibodies, Antinuclear; Antitubercular Agents; DNA; Drug Substitution; Eosinophilia; Exudates and Transudates; Female; Glucocorticoids; Humans; Isoniazid; Latent Tuberculosis; Lupus Erythematosus, Systemic; Pleural Effusion; Prednisone; Rifampin; Treatment Outcome

A 38-year-old man presented to us with a left sided pleural effusion. Pleural fluid was aspirated and analysis revealed it to be an exudate with predominant lymphocytes and an elevated ADA level. He was discharged on antituberculous treatment. Patient returned with re-accumulation of pleural fluid. Computed tomography done in our institute picked up not only parenchymal disease in the lung which was not evident on chest radiographs but also picked up an abdominal mass in the left renal fossa. Pathological examination of excised mass revealed its tuberculous nature. The repeated recollection of pleural fluid was attributed to a "paradoxical response"; the patient was reassured and his anti-tuberculous treatment continued. Recognition of the fact that evidence of tuberculosis at distant sites may occasionally be needed to substantiate the diagnosis of tuberculous pleural effusion in a difficult and bacteriologically "negative" case prompted us to report this case.

Topics: Adult; Antitubercular Agents; Drainage; Drug Therapy, Combination; Ethambutol; Humans; Isoniazid; Male; Pleural Effusion; Pyrazinamide; Rifampin; Tomography, X-Ray Computed; Tuberculosis, Pulmonary; Tuberculosis, Renal

To study the clinical spectrum of brucellosis in Bikaner (Northwest India).. A total of 175 cases were diagnosed as brucellosis during the period of six year (June 1997 to May 2003). They were studied for clinical profile and treated by rifampicin and doxycyclin and additionally streptomycin for initial 14 days in patients of neurobrucellosis. These patients were followed up to 3 months.. Patients of brucellosis presented with a wide spectrum of clinical manifestations. Out of 175 cases 155 were from rural area. Age ranged between 12-60 years (124 males, 51 females). Analysis of risk factors revealed history of raw milk ingestion (86.86%), occupational contact with animals (81.14%), handling of infected material (62.28%), household contact (16%) and 2 patients were veterinarian. Joint pain (83.43%) and fever (77.71%) were the commonest presenting feature. Sacroiliac joint was most commonly involved (46.86%). 31 cases had involvement of multiple joints. Other mode of presentation were neurobrucellosis (18.86%), manifested as polyradiculoneuropathy, myeloradiculopathy, meningoencephalopathy and polyradiculomyeloencephalopathy; predominant pulmonary involvement (4.0%) presented as bronchitis, pneumonia and pleural effusion; epididymoorchitis, infective endocarditis, nephrotic syndrome and recurrent abortion. All patients responded well to the treatment.. Brucellosis is an important emerging zoonotic disease but it is often under-diagnosed due to lack of suspicion and diagnostic facilities despite the fact that cattle farming (an important high risk group) is one of the main occupation in rural area. This report should infuse the awareness about this reemerging disease specifically in high-risk group.

Topics: Adolescent; Adult; Animals; Anti-Bacterial Agents; Arthritis, Infectious; Brucellosis; Child; Doxycycline; Female; Follow-Up Studies; Food Microbiology; Humans; India; Male; Meningoencephalitis; Middle Aged; Milk; Occupational Diseases; Orchitis; Pleural Effusion; Prospective Studies; Rifampin; Risk Factors; Rural Health; Streptomycin

Topics: Actinobacillus Infections; Adult; Anti-Bacterial Agents; Ceftriaxone; Ciprofloxacin; Drug Therapy, Combination; Endocarditis, Bacterial; Follow-Up Studies; Haemophilus Infections; Haemophilus parainfluenzae; Humans; Male; Middle Aged; Pleural Effusion; Rifampin; Time Factors; Treatment Outcome

M. tuberculosis is one of the leading causes of death worldwide and Multi Drug Resistant Tuberculosis (MDR-TB) is associated with a high case-fatality rate. Rapid identification of resistant strains is crucial to institute prompt appropriate therapy, and prevent the development of further resistance and spreading of MDR strains. The INNO-LiPA Rif. TB is a commercial reverse hybridisation line probe assay designed for rapid detection of rpoB gene mutations in clinical isolates. We applied this test directly to 44 smear-positive and 45 smear-negative clinical specimens collected from patients suspected of active TB. The capability of this technique to correctly identify local MDR-TB strains was tested on 50 MDR strains isolated in Italy. Results of the test were compared to conventional antibiogram performed on isolated strains. The concordance rate of the LiPA test results on clinical specimens with those obtained with "in vitro" sensitivity was 100%. These results show that the LiPA test can be useful in rapid detection and prompt management of tuberculosis when MDR disease is suspected.

Topics: Antibiotics, Antitubercular; Ascitic Fluid; Bronchoalveolar Lavage Fluid; Cerebrospinal Fluid; DNA-Directed RNA Polymerases; Drug Resistance, Bacterial; Drug Resistance, Multiple, Bacterial; Ethambutol; Genes, Bacterial; Humans; Isoniazid; Microbial Sensitivity Tests; Mutation; Mycobacterium tuberculosis; Nucleic Acid Hybridization; Pleural Effusion; Rifampin; Sputum; Streptomycin; Tuberculosis, Multidrug-Resistant; Urine

To determine the frequency and antimicrobial susceptibility pattern of extra-pulmonary tuberculosis in Rawalpindi.. Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi.. Between September 2000 and August 2002, 899 pulmonary and 460 extra-pulmonary specimens from suspected cases of tuberculosis were examined. The radiometric BACTEC 460 TB system was used for culture and antimicrobial susceptibility testing.. Mycobacteria were isolated from 291 pulmonary specimens and 98 extra-pulmonary specimens. The frequency of extra-pulmonary tuberculosis was 25.2%. The commonest source of isolation was pus (44.9%, frequency 11.3%), followed by lymph nodes (13.3%, frequency 3.3%) and pleural fluid (13.3%, frequency 3.3%). We tested the anti-microbial susceptibility of the isolates to the four first line anti-tuberculous drugs, rifampicin, isoniazid, streptomycin and ethambutol. Of the extra-pulmonary isolates 13.3% were resistant to a single drug, 21.4% were multi-drug resistant and 9.2% were resistant to all the four drugs.. Increased awareness of the magnitude of the problem posed by extra-pulmonary tuberculosis is required so that appropriate control measures can be adopted.

Topics: Antitubercular Agents; Drug Resistance, Bacterial; Drug Resistance, Multiple; Ethambutol; Humans; Isoniazid; Lymph Nodes; Mycobacterium tuberculosis; Pleural Effusion; Rifampin; Streptomycin; Suppuration; Tuberculosis

The patient was a 74 year-old male presenting right pleural effusion with mild fever. His temperature was 37.0 degrees C. Culture of a pleural biopsy specimen revealed Mycobacterium tuberculosis, although culture of sputum and pleural effusion were negative. Therapy was begun with 300 mg of isoniazid (INH) per day, 600 mg of rifampicin (RFP) per day, and 1200 mg of pyrazinamide (PZA) per day. His temperature improved temporarily. One week after beginning of the therapy he had a fever over 38.0 degrees C. On the 17th day after starting chemotherapy, a chest radiological examination showed left pleural effusion in which numerous lymphocytes were found but Mycobacterium tuberculosis was negative. We assumed that the left pleural effusion was due to a paradoxical reaction to the anti-tuberculosis chemotherapy. After 3 days' discontinuation, the same regimen was resumed with an addition of prednisolone, but bilateral pleural effusion remained and the case finally fell into chronic respiratory failure.

Topics: Aged; Antitubercular Agents; Chronic Disease; Drug Therapy, Combination; Humans; Isoniazid; Male; Pleural Effusion; Pyrazinamide; Respiratory Insufficiency; Rifampin; Tuberculosis, Pleural

The use of anthrax as a weapon of biological terrorism has moved from theory to reality in recent weeks. Following processing of a letter containing anthrax spores that had been mailed to a US senator, 5 cases of inhalational anthrax have occurred among postal workers employed at a major postal facility in Washington, DC. This report details the clinical presentation, diagnostic workup, and initial therapy of 2 of these patients. The clinical course is in some ways different from what has been described as the classic pattern for inhalational anthrax. One patient developed low-grade fever, chills, cough, and malaise 3 days prior to admission, and then progressive dyspnea and cough productive of blood-tinged sputum on the day of admission. The other patient developed progressively worsening headache of 3 days' duration, along with nausea, chills, and night sweats, but no respiratory symptoms, on the day of admission. Both patients had abnormal findings on chest radiographs. Non-contrast-enhanced computed tomography of the chest showing mediastinal adenopathy led to a presumptive diagnosis of inhalational anthrax in both cases. The diagnoses were confirmed by blood cultures and polymerase chain reaction testing. Treatment with antibiotics, including intravenous ciprofloxacin, rifampin, and clindamycin, and supportive therapy appears to have slowed the progression of inhalational anthrax and has resulted to date in survival.

Topics: Anthrax; Anti-Bacterial Agents; Bacillus anthracis; Bioterrorism; Blood; Ciprofloxacin; Clindamycin; District of Columbia; Dyspnea; Fever; Humans; Lymphatic Diseases; Male; Mediastinal Diseases; Middle Aged; Occupational Exposure; Pleural Effusion; Polymerase Chain Reaction; Postal Service; Radiography, Thoracic; Respiratory Tract Infections; Rifampin; Spores, Bacterial; Survivors; Tomography, X-Ray Computed

Topics: Adult; Anthrax; Bacillus anthracis; Child; Ciprofloxacin; Clindamycin; Disease Susceptibility; Drug Therapy, Combination; Female; History, 20th Century; History, 21st Century; Humans; Male; Pleural Effusion; Prognosis; Rifampin; Russia; United States

Topics: Adrenal Cortex Hormones; Antibiotics, Antitubercular; Drainage; Empyema, Tuberculous; Humans; Liver Cirrhosis; Pleural Effusion; Rifampin; Tuberculosis, Pleural

A 25 year old woman developed a right pleural effusion 6 weeks after commencement of short course chemotherapy for left sided tuberculous pleural effusion. Since the patient improved following continuation of the same treatment, it is presumed to be a case of paradoxical response to anti-tuberculosis treatment.

Topics: Adult; Antitubercular Agents; Drug Therapy, Combination; Female; Humans; Isoniazid; Pleural Effusion; Pyrazinamide; Radiography, Thoracic; Rifampin; Tuberculosis

The T cell repertoire of 59 patients with untreated tuberculosis was compared with that of 46 bacille Calmette-Guérin-vaccinated controls by assaying the proliferative responses to six permissively recognized peptides from the 16-, 19-, and 38-kDa molecules of Mycobacterium tuberculosis. A trend from higher to lower reactivity following this order: vaccinated controls > lymph node disease > localized extrapulmonary > pulmonary > pleural was seen for 4 of the peptides (P < .03). The decreased response of blood lymphocytes from patients with pleural tuberculosis was partially accounted for by sequestration of peptide-responsive cells within the pleural fluid. Chemotherapy "reversed" the depressed proliferative responses of patients with pulmonary and pleural tuberculosis depending on the peptide origin, being greatest for peptides of 16 kDa, transient for those of 19 kDa, and least for those of 38 kDa. These data demonstrate antigen specificity in the decreased responsiveness of patients with tuberculosis.

Topics: Adolescent; Adult; Antigens, Bacterial; Antitubercular Agents; Bacterial Proteins; BCG Vaccine; Cell Division; Cells, Cultured; Epitopes, T-Lymphocyte; Ethambutol; Female; Humans; Interferon-gamma; Interleukin-10; Isoniazid; Leukocytes, Mononuclear; Lipoproteins; Male; Middle Aged; Mycobacterium tuberculosis; Peptides; Pleural Effusion; Pyrazinamide; Rifampin; T-Lymphocytes; Tuberculin; Tuberculosis

Although tuberculosis is common and well recognised in many countries, unusual presentations of the disease sometimes raise difficulties in differential diagnosis. We report a young patient who presented with weight loss, shortness of breath and easy fatiguability. Extensive lymphadenopathy involving the cervical, axillary and inguinal regions were found on physical examination. Chest X-ray and computed tomography revealed generalized lymphadenopathy of cervical, mediastinal and para-aortic chains, bilateral pulmonary miliary reticulonodular infiltrates, pleural effusion, hepatomegaly with low density, macronodular hypodense areas in spleen, ascites, peritoneal irregularity and thickening of bowel walls. Mantoux test was negative. Peritoneal fluid was exudative, but pleural fluid was transudative, probably due to mediastinal lymphatic obstruction. The initial clinical diagnosis was malignant lymphoma; however, positive sputum smears for mycobacteria and excisional cervical lymph node biopsy revealing caseating granulomatous lymphadenitis were consistent with tuberculosis. The patient responded well to appropriate therapy with regression of radiological abnormalities.

Topics: Adult; Antitubercular Agents; Biopsy; Diagnosis, Differential; Drug Therapy, Combination; Ethambutol; Follow-Up Studies; Humans; Isoniazid; Lymph Nodes; Lymphatic Diseases; Male; Neck; Pleural Effusion; Prednisolone; Pyrazinamide; Rifampin; Sputum; Tomography, X-Ray Computed; Tuberculosis, Gastrointestinal; Tuberculosis, Miliary

We describe a patient with drug-resistant chronic tuberculous empyema in whom substantial differences between achievable pleural fluid and serum drug concentrations were displayed. The ratio of maximum concentration in pleural fluid to serum was especially low for rifampin (4%) but was also low for streptomycin (34%) and ofloxacin (48%). Subtherapeutic drug concentrations in the pleural fluid may have contributed to acquisition of drug resistance in this case.

Topics: Aged; Antitubercular Agents; Chronic Disease; Empyema, Tuberculous; Ethambutol; Humans; Male; Ofloxacin; Pleural Effusion; Rifampin; Streptomycin; Tuberculosis, Multidrug-Resistant

Chest Clinics at Blackburn and Newham, UK.. To test the efficacy of a short-course regimen of 6 months rifampicin and isoniazid supplemented by 2 months initial pyrazinamide (2HRZ-4HR), in the treatment of smear and culture-negative pulmonary tuberculosis and tuberculous pleural effusion in routine clinical practice.. The results of 152 patients with these forms of tuberculosis treated between 1981 and 1991 were analysed retrospectively.. 127 patients, 65 with pleural effusion and 62 with culture-negative pulmonary tuberculosis, completed treatment as planned. 100 were followed up for a mean duration 20.5 months (range 4-72) for culture-negative disease and 14.6 months (range 3-46) for pleural effusion. There were no relapses, giving a relapse rate of 0% (95% confidence interval 0-3.62%).. Unsupervised self-administered treatment with 2HRZ/4HR is a highly effective regimen for culture-negative pulmonary tuberculosis and tuberculous pleural effusion in service conditions.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Antitubercular Agents; Drug Therapy, Combination; Female; Humans; Isoniazid; Male; Middle Aged; Pleural Effusion; Pyrazinamide; Rifampin; Self Administration; Tuberculosis, Pulmonary

Penicillin-resistant pneumococcal strains continue to spread. Some strains are also resistant to other antibiotics, including the cephalosporins. Better utilization of the 23-valent pneumococcal vaccine, which covers the serotypes responsible for 90% of pneumococcal infections, is an important step in combating resistance.

Topics: Aged; Algorithms; Bacterial Vaccines; Cefotaxime; Cephalosporin Resistance; Chest Tubes; Combined Modality Therapy; Decision Trees; Diagnosis, Differential; Drug Resistance, Multiple; Drug Therapy, Combination; Humans; Male; Microbial Sensitivity Tests; Penicillin Resistance; Pleural Effusion; Pneumococcal Vaccines; Pneumonia, Pneumococcal; Rifampin; Streptococcus pneumoniae; Vancomycin

Rifampin, isoniazid, and ethambutol were administered in single daily dose for nine months to 91 patients with pleural effusion and 45 patients with lymphadenitis, both of tuberculous etiology. Clinical and roentgenographic clearance of pleural effusion was successfully achieved in all cases at the end of nine months of treatment. Followup of 80 cases of pleural effusion up to nine months, in 55 cases up to one year, and up to two years in 30 cases after completion of therapy, showed no recurrence. In the cases of tuberculous lymphadenitis, resolution of lymph nodes occurred in 31 cases (68.8 percent) at the end of nine months of treatment. Therapy had to be extended for varying periods for achieving successful response, and in five cases, medical treatment had to be supplemented with surgical drainage and excision of the nodes. Short course chemotherapy can be used to treat pleural effusion, but the same mode of treatment is less effective for cases of tuberculous lymphadenitis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Drug Therapy, Combination; Ethambutol; Female; Humans; Isoniazid; Male; Middle Aged; Pleural Effusion; Rifampin; Tuberculosis, Lymph Node; Tuberculosis, Pleural

Twenty-one patients with pleural effusion and 27 patients with lymphadenitis, both tubercular in origin, were administered isoniazid, rifampicin and ethambutol in a daily single dose for 9 months. 100% response was seen in patients with pleural effusion. In the case of tuberculous lymphadenitis the therapeutic response was unsatisfactory, and complete resolution of lymph nodes was achieved in 16 out of 27 patients only (59%). Drug treatment had to be extended for another 3 months which gave 89% response. In view of our present findings, short-course chemotherapy appears not to be the ideal mode of treatment for tuberculous lymphadenitis. There were no side effects from drug therapy in either group of patients.

Topics: Adolescent; Adult; Drug Therapy, Combination; Ethambutol; Female; Humans; Isoniazid; Lymphadenitis; Male; Middle Aged; Pleural Effusion; Rifampin; Time Factors; Tuberculosis

A 46-year-old woman developed a right pleural effusion 8 weeks after standard chemotherapy for tuberculous pleurisy on the left side had been started. Pleural biospy demonstrated caseous granulomatous changes. The patient improved following continuation of the same treatment.

Topics: Drug Therapy, Combination; Ethambutol; Female; Humans; Isoniazid; Middle Aged; Pleural Effusion; Prednisone; Rifampin; Streptomycin; Time Factors; Tuberculosis, Pleural

Topics: Adult; Aged; Dose-Response Relationship, Drug; Female; Half-Life; Humans; Immunodiffusion; Male; Middle Aged; Pleural Effusion; Proteins; Regression Analysis; Rifampin; Sarcina; Time Factors

Topics: Administration, Topical; Adult; Humans; Male; Middle Aged; Pleural Effusion; Rifampin; Tuberculosis; Tuberculosis, Cutaneous; Tuberculosis, Lymph Node; Tuberculosis, Male Genital; Tuberculosis, Osteoarticular; Tuberculosis, Pleural; Tuberculosis, Spinal

Topics: Dexamethasone; Drug Hypersensitivity; Ethambutol; Glomerular Filtration Rate; Humans; Isoniazid; Pleural Effusion; Pyridoxine; Rifampin; Tuberculosis, Pulmonary; Tuberculosis, Spinal