rifampin and Pneumonia

Haemophilus influenzae remains a common cause of illness in children throughout the world. Before the introduction of vaccination, H influenzae type b (Hib) disease was the leading cause of bacterial meningitis in young children and a frequent cause of pneumonia, epiglottitis, and septic arthritis. Clinicians should remain diligent in counseling parents on the dangers of Hib and provide vaccination starting at 2 months of age. The epidemiology of invasive H influenzae disease is shifting. It is imperative that clinicians recognize the changing epidemiology and antibiotic resistance patterns for H influenzae to optimize care in hospital and ambulatory settings.

Topics: Anti-Bacterial Agents; Bacteremia; Cephalosporins; Child; Child, Preschool; Female; Haemophilus Infections; Haemophilus influenzae type b; Humans; Incidence; Infant; Male; Meningitis, Bacterial; Pneumonia; Post-Exposure Prophylaxis; Rifampin; Vaccination

An 84-year-old woman being treated for miliary tuberculosis (TB) with rifampicin (RFP), isoniazid (INH), ethambutol (EB) and corticosteroids suffered from a persistent fever for five months. While tapering the dose of prednisolone, chest computed tomography (CT) revealed diffuse ground glass opacities (GGO) and bronchoalveolar lavage fluid (BALF) showed an increase in lymphocytes. After the anti-TB drugs were discontinued and the dose of the corticosteroids was increased, the CT findings and fever improved considerably. However, readministration of RFP provoked an inflammatory reaction, leading to a diagnosis of RFP-induced pneumonitis. This condition is very rare. This is the first report of RFP-induced pneumonitis occurring during adjunct steroid therapy.

Topics: Aged, 80 and over; Antibiotics, Antitubercular; Female; Humans; Pneumonia; Rifampin

A 65-year-old man was admitted to hospital for treatment of pulmonary tuberculosis. He was treated with isoniazid (INH), rifampicin (RFP), ethambutol (EB), and pyrazinamide (PZA). On the 14th day, he developed a fever and interstitial pneumonia, which improved promptly after discontinuation of the antituberculous drugs. Drug lymphocyte stimulation tests against INH, RFP and PZA were negative. However, the provocation test on INH (only) was positive, leading to a diagnosis of pneumonitis caused by INH. We then tried desensitization of INH over a period of two weeks, which was successful and occurred without any clinical event. In the past, five cases of INH-induced pneumonitis were reported, but desensitization of INH did not occur in any. We conclude that physicians should be aware not only of paradoxical reactions but also of drug-induced pneumonitis when a new pulmonary infiltrate develops in the course of tuberculosis treatment. Furthermore, drug desensitization may be possible in some cases of drug-induced pneumonitis.

Topics: Aged; Antibiotics, Antitubercular; Antitubercular Agents; Desensitization, Immunologic; Ethambutol; Humans; Isoniazid; Male; Pneumonia; Rifampin; Tuberculosis, Pulmonary

Rhodococcus equi is an emerging opportunistic pathogen of HIV-I infected patients. It is an aerobic, Gram-positive coryneform bacterium which acts as a facultative intracellular micro-organism, multiplying in the phagosome of macrophages. Eighteen cases of R. equi infection in HIV-I positive patients have now been reported. Sixteen of these had pneumonia, of which 12 had cavitating lung lesions. A history of contact with farm animals, which are the primary hosts of R. equi, was found in only three patients. There was a delay in establishing a definite diagnosis in most cases as this depended upon the isolation of R. equi from sputum, bronchoalveolar lavage fluid, or blood. Treatment included surgical resection in five patients and erythromycin with a second antibiotic in 13 cases, but II of the 18 patients died from the infection. In this report we describe our experience of R. equi pneumonia in two AIDS patients and review the published cases of the disease in man.

Topics: Acquired Immunodeficiency Syndrome; Actinomycetales Infections; Adult; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Clavulanic Acids; Doxycycline; Drug Therapy, Combination; HIV Seropositivity; HIV-1; Humans; Male; Microbial Sensitivity Tests; Pneumonia; Rhodococcus equi; Rifampin

Rhodococcus equi is an aerobic, gram-positive, non-motile pleomorphic bacillus infecting immunocompromised patients. Forty-nine cases of Rhodococcus equi infection have been reported, mainly in patients infected with the human immunodeficiency virus (HIV). A case in which Rhodococcus equi caused severe pulmonary infection, the most common presentation, is described. Clinically, patients have symptoms of pneumonia with hemoptysis as a prominent feature. X-ray will often show a cavitating upper-lobe infiltrate, resembling infection with mycobacteria. Rhodococcus equi is easily cultured from blood or sputum on standard media, but is frequently regarded as a contaminant. Mortality from Rhodococcus equi pneumonia is high (25%) and early surgical intervention has been recommended. Based on this review, the benefit of surgery seems dubious, whereas good results have been obtained using long-term antibiotic treatment with erythromycin plus rifampicin, or vancomycin in combination with either of these antibiotics.

Topics: Acquired Immunodeficiency Syndrome; Actinomycetales Infections; Adult; Drug Therapy, Combination; Erythromycin; Humans; Immunocompromised Host; Male; Pneumonia; Rhodococcus equi; Rifampin; Vancomycin

As in other countries, pneumonia due to Legionella bacteria occurs in Denmark. Even so, legionellosis is rarely diagnosed and often late in the course of illness. This may be due both to the variable and nonspecific clinical picture of the infection, and to the fact that currently available diagnostic methods are inadequate in a clinical context. Even in severe cases, the prognosis of Legionnaires' disease is quite good, if adequate antibiotic therapy is instituted early in the course of illness. The treatment of Legionnaires' disease differs from the treatment of most other pneumonias; frequently, therapy must be completed solely on a basis of clinical suspicion. The present diagnostic state may be improved by an increased awareness of the disease and its clinical manifestations, as well as by improved laboratory diagnosis.

Topics: Diagnosis, Differential; Erythromycin; Humans; Legionellosis; Pneumonia; Rifampin; Serologic Tests

Topics: Clinical Laboratory Techniques; Cross Infection; Disease Outbreaks; England; Erythromycin; Humans; Legionella; Legionnaires' Disease; Pneumonia; Prognosis; Rifampin; Risk; Tetracycline; United States

Following the discovery of Legionella pneumophila as the cause of an epidemic of pneumonia at an American Legion Convention in Philadelphia, a group of related bacteria were recognized as additional human pathogens. This newly established bacteria genus, Legionella, includes the agents of Legionnaires' Disease, Pittsburgh pneumonia and several related infections. A number of researches have been performed in the past few years about these bacteria; many of these data are here summarized to give an idea of the most important characteristics of Legionella and of the diseases they cause.

Topics: Antibody Formation; Bacterial Infections; Disease Outbreaks; Erythromycin; Humans; Legionella; Legionnaires' Disease; Phenotype; Pneumonia; Postoperative Complications; Rifampin; Serotyping; Tetracycline

Legionella pneumophila infections frequently manifest themselves as a multisystem disease with acute pneumonia. Certain clinical and laboratory features are helpful in diagnosis but none are pathognomonic. Diagnosis frequently must be made clinically and erythromycin given presumptively because of the delay in seroconversion but culture and direct fluorescent antibody testing are quite useful for rapid diagnosis. Epidemiologic and laboratory investigations will undoubtedly yield considerable information about this fascinating bacterial disease.

Topics: Air Conditioning; Bacteria; Cross Infection; Disease Outbreaks; Erythromycin; Humans; Legionnaires' Disease; Pneumonia; Rifampin; Tetracycline; United States

It were Liebow et al. (1965) who, for the first time, described the desquamative interstitial pneumonia (DIP) as one clinical and morphological unit. The etiopathology of this disease is still unknown and there exist many controversial opinions as to its role within the interstitial pneumonias. For the clinical-physician the DIP represents a difficult problem because there seems to be no uniform appearance to this disease. So a lung-biopsy is the unique way to make a definitive diagnosis. The following description represents a case of DIP observed at our hospital. At the same time we tried to give a review of our present knowledge concerning the morphology, course and therapy of this disease. We think it should be note that the DIP was accompanied by an extreme peripheral eosinophilia. To our knowledge this is the first time such a phenomenon is described. In the course of the treatment with steroids the eosinophilia disappeared parallel to the normalization of the radiographic findings.

Topics: Adrenal Cortex Hormones; Adult; Alveolitis, Extrinsic Allergic; Collagen Diseases; Diagnosis, Differential; Eosinophilia; Female; Histiocytosis, Langerhans-Cell; Humans; Isoniazid; Lung; Pneumonia; Pulmonary Eosinophilia; Radiography; Rifampin; Tetracycline

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: Anti-Bacterial Agents; Anti-Infective Agents; Antitubercular Agents; Bronchitis; Drug Resistance, Microbial; Drug Synergism; Ethambutol; Humans; Microbial Sensitivity Tests; Pneumonia; Respiratory Tract Infections; Rifampin; Tuberculosis, Pulmonary

The aim of this study was to confirm the synergistic effect of colistin/rifampicin combination therapy compared with colistin monotherapy in pneumonia caused by colistin-resistant Acinetobacter baumannii (CoRAB). The utility of the Etest was also assessed.. Nine subjects with pneumonia caused by CoRAB were enrolled from 20 July 2016 to 21 June 2018. Subjects were randomised to colistin/rifampicin combination therapy or colistin monotherapy. After exclusion of one patient who dropped out, the microbiological response (MR) and clinical response (CR) on Day 14 and mortality on Day 30 were assessed. Etest was conducted using CoRAB isolated at study enrolment.. The MR rate in the colistin/rifampicin combination group (100.0%) was better than that in the colistin group (40.0%), however the difference was not statistically significant (P=0.196). The CR rate was not significantly different between the two groups. The MR (100.0%) and CR (100.0%) rates in subjects with 'partial synergy' as shown by Etest were higher than those (25.0% and 50.0%, respectively) in subjects with 'indifferent' results (i.e. no synergistic effect), however the difference was not statistically significant (P=0.143 and 0.429, respectively). Mortality occurred in two subjects with 'indifferent' results by Etest.. Colistin/rifampicin combination therapy may have potential to achieve MR in pneumonia caused by CoRAB; however, achieving CR with this treatment is doubtful. 'Partial synergy' of colistin and rifampicin, as shown by Etest, may be a good prognostic factor [ClinicalTrial.gov ID: NCT03622918].

Topics: Acinetobacter baumannii; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Colistin; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Pneumonia; Rifampin; Young Adult

Methicillin-resistant Staphylococcus aureus (MRSA) is recognized as a bacterial pathogen in patients with cystic fibrosis (CF) although its clinical effects can be variable. The aim of this study was to evaluate the efficacy of a three-step decolonization protocol for MRSA (Belfast CF MRSA decolonization protocol). Of the 17 paediatric patients treated during the five years of the study, eight (47%) were successfully decolonized following one five-day course of oral rifampicin and fusidic acid. The success rate increased to 12 (71%) patients after a second five-day oral treatment course in the 11 patients who remained culture positive at the end of the first treatment cycle. In a further four patients, clearance was achieved with a course of intravenous teicoplanin, increasing the decolonization rate to 16 of 17 patients (94%). These results compare favourably with other published studies and show that MRSA decolonization can be successful in a high proportion of paediatric CF patients.

Topics: Adolescent; Anti-Bacterial Agents; Child; Child, Preschool; Cystic Fibrosis; Drug Therapy, Combination; Female; Fusidic Acid; Humans; Infant; Male; Methicillin Resistance; Pneumonia; Rifampin; Severity of Illness Index; Sputum; Staphylococcal Infections; Staphylococcus aureus; Teicoplanin

The selection of lipid-soluble antibiotics capable of intracellular penetration is considered critical for the successful treatment of Rhodococcus equi pneumonia and lung abscesses in foals. Two such antibiotics: erythromycin (25 mg kg-1, three times daily) and rifampin (5 mg kg-1 twice daily) have been used in combination for this purpose at the University of Florida since 1981. Positive evidence of R. equi was present on culture of tracheal aspirates in 57 foals, most of which exhibited radiographic evidence of extensive lung abscessation. The duration of therapy ranged from 4 to 9 weeks. Mild diarrhea was sometimes noted, but was never severe enough to require the termination of therapy. No other adverse side effects were apparent. Judged by a return of chest radiographs and hematologic parameters to normal, 50 of the 57 foals were considered to have recovered from the disease; a success rate of 88%.

Topics: Actinomycetales Infections; Animals; Animals, Newborn; Clinical Trials as Topic; Drug Therapy, Combination; Erythromycin; Horse Diseases; Horses; Pneumonia; Rhodococcus; Rifampin

H. influenzae can cause not only meningitis in children but epiglottitis, cellulitis, pneumonia, pericarditis, and bacteremia. It is possible to radically reduce, if not abolish, the spread of this pathogen. But effective prophylaxis requires answers to questions of practicability relative to the availability, cost, and logistics of administering rifampin to contacts, as has been recommended.

Topics: Adolescent; Adult; Carrier State; Cellulitis; Child; Child, Preschool; Clinical Trials as Topic; Double-Blind Method; Drug Therapy, Combination; Epiglottis; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Meningitis, Haemophilus; Pericarditis; Pneumonia; Pregnancy; Rifampin; Sepsis; Trimethoprim

Topics: Adult; Aged; Bronchopneumonia; Clinical Trials as Topic; Female; Humans; Male; Middle Aged; Pneumonia; Rifampin

Topics: Adult; Anti-Bacterial Agents; Brucellosis; Doxycycline; Female; Humans; Myocarditis; Pneumonia; Rifampin

This study aimed to study the application value of a new multichannel sensor in pathogen detection and drug resistance analysis of neonatal pneumonia. 180 newborns with infectious pneumonia were selected, and a new multichannel piezoelectric sensor was constructed. The traditional Kirby-Bauer (K-B) method and the piezoelectric sensor were adopted to detect the pathogens and drug resistance in newborn samples, respectively. The results showed that the sensitivity and specificity under the K-B method (99.58% and 99.32%) and the multichannel piezoelectric sensor (99.43% and 94.29%) were not statistically different (

Topics: Chloramphenicol; Drug Resistance, Bacterial; Haemophilus influenzae; Humans; Infant, Newborn; Klebsiella pneumoniae; Microbial Sensitivity Tests; Pneumonia; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Vancomycin

BACKGROUND Rifampicin-induced pneumonitis is an infrequent occurrence, with only a few cases reported in the literature. Furthermore, this condition constitutes a diagnostic challenge, particularly in the era of COVID-19 infection. Here, we report a case of rifampicin-induced pneumonitis with clinical, imaging, and histological features of acute respiratory distress syndrome (ARDS), which required severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing to exclude a diagnosis of coronavirus disease 2019 (COVID-19) pneumonia. CASE REPORT A 43-year-old man on anti-TB treatment for TB meningitis developed new-onset fever, fatigue, hypoxemic respiratory failure, and bilateral pulmonary opacities. His clinical, chest X-ray, and CT thorax findings of ARDS were similar to both rifampicin-induced pneumonitis and severe COVID-19 pneumonia. However, reverse transcription polymerase chain reaction (RT-PCR) testing from a nasopharyngeal swab and bronchoalveolar lavage (BAL) via the GeneXpert system was negative for SARS-CoV-2. A detailed workup, including lung biopsy, revealed drug-induced pneumonitis as the cause of his presentation. His pneumonitis improved after discontinuation of rifampicin and recurred following the rifampicin challenge. CONCLUSIONS This case highlights the importance of early, rapid, and accurate testing for SARS-CoV-2 during the COVID-19 pandemic for patients presenting with acute respiratory symptoms, so that accurate diagnosis and early patient management are not delayed for patients with treatable causes of acute and severe lung diseases. Timely identification of rifampicin-induced pneumonitis via a high clinical suspicion, detailed workup, and histopathological analysis is required to avoid permanent damage to the lungs.

Topics: Adult; Antibiotics, Antitubercular; Betacoronavirus; Coronavirus Infections; COVID-19; Humans; Male; Pandemics; Pneumonia; Pneumonia, Viral; Rifampin; SARS-CoV-2; Tomography, X-Ray Computed; Tuberculosis, Meningeal

Rifapentine is an anti-tuberculosis (anti-TB) drug with a prolonged half-life, but oral delivery results in low concentrations in the lungs because of its high binding (98%) to plasma proteins. We have shown that inhalation of crystalline rifapentine overcomes the limitations of oral delivery by significantly enhancing and prolonging the drug concentration in the lungs. The delivery of crystalline particles to the lungs may promote inflammation. This in vivo study characterizes the inflammatory response caused by pulmonary deposition of the rifapentine particles. The rifapentine powder was delivered to BALB/c mice by intratracheal insufflation at a dose of 20 mg/kg. The inflammatory response in the lungs and bronchoalveolar lavage (BAL) was examined at 12 h, 24 h, and 7 days post-treatment by flow cytometry and histopathology. At 12 and 24 h post-treatment, there was a significant influx of neutrophils into the lungs, and this returned to normal by day 7. A significant recruitment of macrophages occurred in the BAL at 24 h. Consistent with these findings, histopathological analysis demonstrated pulmonary vascular congestion and significant macrophage recruitment at 12 and 24 h post-treatment. In conclusion, the pulmonary delivery of crystalline rifapentine caused a transient neutrophil-associated inflammatory response in the lungs that resolved over 7 days. This observation may limit pulmonary delivery of rifapentine to once a week at a dose of 20 mg/kg or less. The effectiveness of weekly dosing with inhalable rifapentine will be assessed in murine Mycobacterium tuberculosis infection.

Topics: Administration, Inhalation; Animals; Antibiotics, Antitubercular; Female; Half-Life; Lung; Macrophages; Mice; Mice, Inbred BALB C; Mycobacterium tuberculosis; Neutrophils; Pneumonia; Powders; Rifampin; Tuberculosis

Mycobacterium avium complex (MAC) lung disease requires prolonged treatment with multiple antibiotics. Drug intolerances and interactions are common with the current recommended treatment. There is limited information on outcomes with alternative medications.. Retrospective review including adult patients with MAC lung disease who were treated and monitored for at least 6 months posttreatment. The aim was to evaluate the clinical and microbiologic outcomes in patients treated with regimens including clofazimine and/or rifampin.. One hundred and seven patients were included (79% were female; mean age, 67 years). Sputum samples were smear positive in 54% of patients. The majority (84%) were treated with clofazimine in combination with a macrolide and ethambutol. Fourteen patients (13%) were treated with rifampin, macrolide, and ethambutol. Most patients (95%) converted from positive to negative sputum culture results in an average of 4.5 ± 4.2 months (range, 0-30 months). A significantly greater proportion of patients treated with clofazimine converted to negative culture results compared with those treated with rifampin (100% vs 71%; P = .0002). Microbiologic relapse occurred in 52 of 107 patients (49%). Thirty-six percent of patients required retreatment. There was no difference in microbiologic relapse or re-treatment rates between the two treatment groups.. The majority of patients with MAC lung disease achieve negative sputum culture results. Re-treatment is needed in approximately one-third of patients. In this cohort, both initial outcomes and re-treatment rates were at least as good in patients treated with clofazimine-containing regimens as in patients receiving rifampin-containing regimens. Clofazimine should be considered as an alternative drug for the treatment of MAC lung disease.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Clofazimine; Drug Therapy, Combination; Ethambutol; Female; Follow-Up Studies; Humans; Macrolides; Male; Middle Aged; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Pneumonia; Retrospective Studies; Rifampin

Rhodococcus equi, a facultative intracellular pathogen and an important cause of pneumonia in foals, is highly susceptible to killing by gentamicin in vitro. However, gentamicin is not effective in vivo, due to its poor cellular penetration. Encapsulation of drugs in liposomes enhances cellular uptake. The objectives of this study were to compare liposomal gentamicin and free gentamicin with respect to their uptake by equine macrophages and intracellular colocalization with R. equi and to compare the efficacies of liposomal gentamicin, free gentamicin and clarithromycin with rifampin for the reduction of R. equi CFU in a mouse model of infection. After ex vivo exposure, a significantly higher mean (±SD) percentage of equine alveolar macrophages contained liposomal gentamicin (91.9±7.6%) as opposed to free gentamicin (16.8±12.5%). Intracellular colocalization of drug and R. equi, as assessed by confocal microscopy, occurred in a significantly higher proportion of cells exposed to liposomal gentamicin (81.2±17.8%) compared to those exposed to free gentamicin (10.4±8.7%). The number of R. equi CFU in the spleen was significantly lower in mice treated with liposomal gentamicin compared to that of mice treated with free gentamicin or to untreated control mice. Treatment with liposomal gentamicin also resulted in a significantly greater reduction in the number of R. equi CFU in the liver compared to treatment with clarithromycin in combination with rifampin. These results support further investigation of liposomal gentamicin as a new treatment for infections caused by R. equi.

Topics: Actinomycetales Infections; Animals; Anti-Bacterial Agents; Clarithromycin; Disease Models, Animal; Gentamicins; Horse Diseases; Horses; Liposomes; Liver; Macrophages, Alveolar; Male; Mice; Mice, Nude; Pneumonia; Rhodococcus equi; Rifampin; Spleen

We present an interesting case of Legionnaires' disease masquerading as acute pyelonephritis, with complete absence of respiratory symptoms on admission. A 45-year-old man was diagnosed with Legionnaires' disease 2 days after presenting to hospital with dysuria and right loin pain. He became critically unwell during the hospital admission, with headache, uncontrolled fever, breathlessness, decreasing oxygen saturations and increasing oxygen requirements. A CT pulmonary angiography demonstrated right upper lobar consolidation and Legionella urinary antigen was positive. He was treated with ciprofloxacin and rifampicin and made a full recovery.

Topics: Anti-Bacterial Agents; Antigens, Bacterial; Ciprofloxacin; Community-Acquired Infections; Diagnosis, Differential; Dysuria; Flank Pain; Humans; Legionnaires' Disease; Male; Middle Aged; Pneumonia; Pyelonephritis; Rifampin

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

Non-tuberculous mycobacterias (NTMs) have many clinical manifestations in humans, depending on the underlying immunological status. We present a patient with Mycobacterium avium intracellulare pulmonary infection and co-existing, biopsy proven non-granulomatous organising pneumonia in distinct regions within the lungs. Treatment consisting of anti-mycobacterial therapy and corticosteroids led to clinico-radiological resolution. This case represents a potential broader clinico-pathological manifestation of Mycobacterium avium intracellulare.

Topics: Bronchoscopy; Emphysema; Ethambutol; Female; Glucocorticoids; Humans; Lung; Middle Aged; Mycobacterium avium-intracellulare Infection; Pneumonia; Prednisolone; Rifampin; Tomography, X-Ray Computed

Topics: Antibiotics, Antitubercular; Bronchial Fistula; Humans; Pleural Diseases; Pneumonia; Radiography; Respiratory Tract Fistula; Rifampin; Tuberculosis, Pulmonary

An 81-year-old man was admitted to hospital with pulmonary Mycobacterium tuberculosis infection and was treated with rifampicin (RFP), isoniazid (INH), and ethambutol (EB). On day 9 he developed fever and dyspnoea. Chest radiographs showed new infiltration shadows in the right lung. Bronchoalveolar lavage (BAL) was performed and increased numbers of lymphocytes were recovered. Drug induced pneumonitis was suspected so the antituberculous regimen was discontinued and methylprednisolone was administered. The symptoms and infiltration shadows improved. INH and EB were reintroduced without any recurrence of the abnormal shadows. T cell subsets in the BAL fluid and a positive lymphocyte stimulation test for RFP suggest that RFP induced pneumonitis may be related to a complex immunological response.

Topics: Aged; Aged, 80 and over; Antibiotics, Antitubercular; Cough; Fever; Humans; Male; Mycobacterium tuberculosis; Pneumonia; Rifampin; Tuberculosis, Pulmonary

The effects of treatment with azithromycin plus rifampin (A+R), amoxicillin (A), or placebo (P) on the chronic course of experimental Chlamydia pneumoniae pneumonitis in mice were assessed by culture, PCR, and immunocytochemistry as well as by degree of inflammation in lung tissue. Eradication of the pathogen was significantly more frequent and inflammation in tissue was significantly reduced after treatment with A+R compared to after treatment with A or P. Combination therapy with azithromycin plus rifampin showed favorable effects in the chronic course of C. pneumoniae pneumonitis.

Topics: Amoxicillin; Animals; Anti-Bacterial Agents; Azithromycin; Chlamydia Infections; Chlamydophila pneumoniae; Drug Therapy, Combination; Mice; Pneumonia; Rifampin

To determine whether foals with pneumonia that were treated with erythromycin, alone or in combination with rifampin or gentamicin, had a higher risk of developing adverse effects, compared with foals treated with trimethoprim-sulfamethoxazole (TMS), penicillin G procaine (PGP), or a combination of TMS and PGP (control foals).. Retrospective study.. 143 foals < 240 days old.. Information on age, sex, breed, primary drug treatment, total days of treatment with the primary drug, and whether the foal developed diarrhea, hyperthermia, or respiratory distress was obtained from the medical records. Relative risk (RR) and attributable risk (AR) were calculated to compare risk of adverse reactions between foals treated with erythromycin and control foals.. Only 3 (4.3%) control foals developed diarrhea; none developed hyperthermia or respiratory distress. Foals treated with erythromycin had an 8-fold risk (RR, 8.3) of developing diarrhea, compared with control foals, and increased risks of hyperthermia (AR, 25%) and respiratory distress (AR, 15%).. Results suggest that use of erythromycin to treat foals with pneumonia was associated with an increased risk of diarrhea, hyperthermia, and respiratory distress, compared with use of TMS or PGP.

Topics: Animals; Animals, Newborn; Anti-Bacterial Agents; Anti-Infective Agents; Antibiotics, Antitubercular; Diarrhea; Drug Therapy, Combination; Erythromycin; Female; Fever; Gentamicins; Horse Diseases; Horses; Male; Penicillin G Procaine; Penicillins; Pneumonia; Respiratory Insufficiency; Retrospective Studies; Rifampin; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination

Mycobacterium thermoresistibile was isolated in pure culture from ultrasound-guided pulmonary aspirates taken from a young cat with severe, chronic, pyogranulomatous pneumonia. Thoracic radiography and ultrasonography before therapy demonstrated severe diffuse alveolar disease. Twelve months combination therapy with doxycycline, rifampicin and clarithromycin resolved the infection. Thoracic radiographs taken at the completion of therapy showed multifocal pulmonary mineralisation. M thermoresistibile has been infrequently reported as a human or animal pathogen. This is the first reported pulmonary infection by M thermoresistibile in a cat and documents the successful treatment of the organism in a feline patient.

Topics: Animals; Anti-Bacterial Agents; Cat Diseases; Cats; Chronic Disease; Clarithromycin; Doxycycline; Female; Mycobacterium; Pneumonia; Rifampin

Topics: Aged; Antitubercular Agents; Eosinophilia; Ethambutol; Humans; Isoniazid; Lymphocyte Activation; Male; Pneumonia; Rifampin

Topics: Acquired Immunodeficiency Syndrome; Actinomycetales Infections; Adult; Clarithromycin; Erythromycin; Humans; Imipenem; Male; Middle Aged; Pneumonia; Rhodococcus equi; Rifampin; Vancomycin

The clinical features and X-ray manifestations of 50 cases of legionnaires disease were analysed. 8 cases might be due to nosocomial infection through breathing in flying particles of the saliva or phlegm. According to the main clinical features, this disease could be divided into common pneumonia type; acute gastroenteritis type; encephalopathy type; shock type; acute renal insufficiency type. The differential diagnosis of legionnaires disease with mycoplasmal pneumonia, pneumococcal pneumonia and infiltrative pulmonary tuberculosis was also discussed. The first choice for treatment is erythromycin or erythromycin with rifampicin.

Topics: Adult; Diagnosis, Differential; Erythromycin; Female; Humans; Legionnaires' Disease; Lung; Male; Middle Aged; Pneumonia; Radiography; Rifampin

Rifametoprim (600 mg/day) was given to 64 patients with acute bacterial pneumonia, acute bronchitis and exacerbation of chronic bronchitis. 201 (83.4%) out of 241 isolates were sensitive to the action of the antibiotic. The treatment turned out effective in 84.4% of cases.

Topics: Acute Disease; Bacteria; Bronchitis; Capsules; Chronic Disease; Drug Combinations; Drug Evaluation; Humans; Microbial Sensitivity Tests; Pneumonia; Remission Induction; Rifampin; Sputum; Trimethoprim

Topics: Acquired Immunodeficiency Syndrome; Actinomycetales Infections; Adult; Anti-Bacterial Agents; Drug Resistance, Microbial; Humans; Male; Pneumonia; Recurrence; Rhodococcus equi; Rifampin

Topics: Child; Female; Humans; Minocycline; Nocardia Infections; Pneumonia; Rifampin

During a recent nosocomial outbreak, 20 critically ill patients with acute Legionnaires' disease were admitted to the intensive care unit of Hopital Bichat, Paris. Pulmonary specimens were obtained at surgery or immediately after death in 12 patients and were examined by light, immunofluorescent, and electron microscopy. Five of these 12 patients showed evidence of pulmonary fibrosis. In all of these five patients, infection with Legionella pneumophila was evidenced by bacteriologic methods, and other diseases known to cause fibrosis were excluded. The condition of four patients deteriorated rapidly with respiratory failure, and they died with pulmonary fibrosis. Only one patient finally recovered but was left with pulmonary sequelae. Two distinctive morphologic patterns were observed, one in which interstitial fibrosis was predominant and one in which intra-alveolar organization and fibrosis were also present. The alveolar epithelial lining and the basement membranes were disrupted in all patients, as evidenced by ultrastructural observations and by immunofluorescent studies showing gaps in the distribution of type 4 collagen and laminin. Types 1 and 3 collagen accumulated in areas corresponding to thickened interstitium and intra-alveolar fibrosis. Thus, some patients who survive the acute pneumonia of Legionnaires' disease may develop pulmonary fibrosis, and this process may lead to functional impairment or death despite prompt and appropriate treatment.

Topics: Adult; Aged; Basement Membrane; Erythromycin; Female; Fluorescent Antibody Technique; Humans; Legionnaires' Disease; Male; Middle Aged; Pneumonia; Pulmonary Fibrosis; Rifampin

While the term "atypical pneumonia" has been in use for many years, it cannot in fact be defined. However, there is a persuasive reason to retain the clinical use of the term, and that is to provide a guide for the clinician in the choice of empirical antibiotic therapy for patients with acute pneumonia. Atypical pneumonia, then, is a descriptive term for a common clinical syndrome. Provided certain clinicoepidemiological groups are excluded, the most common infectious causes of this syndrome are Mycoplasma pneumoniae, Chlamydia psittaci, Coxiella burneti, and Legionella species, but it should be stressed that the syndrome may occasionally be produced by other infectious and non-infectious diseases. Conversely, the atypical pneumonia syndrome occupies only one part of the clinical spectrum of disease that is caused by these organisms. This becomes important when one is selecting antibiotic therapy for patients with other respiratory syndromes, especially those with life-threatening disease. The antimicrobial therapy of the three common causes of atypical pneumonia is discussed in detail.

Topics: Anti-Bacterial Agents; Erythromycin; Humans; Legionnaires' Disease; Pneumonia; Pneumonia, Mycoplasma; Psittacosis; Rifampin; Tetracycline

Several antimicrobial agents were evaluated for activity against experimental Legionella micdadei pneumonia in guinea pigs. Erythromycin, rifampin, doxycycline, and sulfamethoxazole-trimethoprim produced significant reductions in mortality. Penicillin, cefazolin, cefoxitin, chloramphenicol, and gentamicin were not efficacious even though, at the doses administered, the peak concentrations of these agents in serum substantially exceeded their MICs for the test strain. It is suggested that the poor performance of the latter group of agents resulted from poor penetration into cells in which L. micdadei was multiplying.

Topics: Animals; Anti-Bacterial Agents; Bacterial Infections; Cefazolin; Cefoxitin; Chloramphenicol; Doxycycline; Drug Combinations; Erythromycin; Gentamicins; Guinea Pigs; Kinetics; Legionella; Male; Penicillin G; Pneumonia; Rifampin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

The genus Legionella, belonging to the family of Legionellaceae, comprises nowadays seven species, among which Legionella pneumophila might be the most important. The identification of the agent is difficult because L. pneumophila is very pretentious requiring peculiar conditions concerning culture medium, temperature, and time. The initial cultivation will succeed the best in an atmosphere enriched with CO2. The demonstration of serum antibodies will succeed by means of indirect immunofluorescence; recently the micro-agglutination test is vastly applied. The clinical picture of Legionellosis is characterized by an atypical pneumonia with a serious course in most cases. The Pontiac Fever is an illness with milder course than the classical form of Legionellosis. Erythromycin and Rifampicin are the chemotherapeutics of choice.

Topics: Agglutination Tests; Antibodies, Bacterial; Bacteriological Techniques; Erythromycin; Humans; Legionella; Legionnaires' Disease; Pneumonia; Rifampin

An immunocompromised patient with severe hypoxemia was found by transbronchial lung biopsy to have Torulopsis glabrata as the sole pathogen in lung. An antibody response to this organism was demonstrated, confirming its role as a pathogen and indicating a role for serodiagnosis of T glabrata infection.

Topics: Adult; Amphotericin B; Candida; Drug Therapy, Combination; Histoplasmosis; Humans; Immunosuppression Therapy; Kidney Failure, Chronic; Lung Diseases, Fungal; Male; Pneumonia; Rifampin

A new species of Legionella that caused pneumonia in a patient with chronic lymphocytic leukemia has been characterized. The Legionella wadsworthii species nova is proposed for this bacterium. The type strain is Wadsworth 81-716A (American Type Culture Collection 33877). The new species differs phenotypically from L. pneumophila in that the predominant cellular fatty acid is methyl-12-methyltetradecanoic acid (a-15:0) rather than methyl-14-methylpentadecanoic acid (i-16:0), and in its failure to react with L. pneumophila antiserum. The clinical illness caused by L. wadsworthii was not apparently different from that seen with other legionella infections, except for prolonged fever and slow resolution of pulmonary infiltrates.

Topics: Aged; Bacteriological Techniques; Erythromycin; Humans; Legionella; Legionnaires' Disease; Leukemia, Lymphoid; Male; Pneumonia; Rifampin; Serologic Tests

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: Adult; Aged; Bacteriological Techniques; Drug Therapy, Combination; Erythromycin; Female; Humans; Legionella; Legionnaires' Disease; Male; Pneumonia; Rifampin

Topics: Adolescent; Adult; Aged; Cefoxitin; Erythromycin; Female; Humans; Legionnaires' Disease; Male; Middle Aged; Pneumonia; Rifampin; Spain

Eight immunosuppressed patients had pneumonia due to Pittsburgh Pneumonia Agent (PPA), a gram-negative, weakly acid-fast bacterium cultivatable only in embryonated eggs and guinea pigs and distinct from Legionella pneumophila. The diagnosis was established by isolation of the agent from lung or visualization of the organism in lung tissue. The clinical presentations, radiographic abnormalities and pathology were not specific. The most consistent feature associated with the disease was the recent institution of daily high-dose corticosteriod therapy in all patients. Five of the eight patients died despite broad-spectrum antibiotic and antituberculous therapy. Anti-microbial activity against PPA was demonstrated for sulfamethoxazole combined with trimethoprim, for rifampin and for erythromycin with an egg-protection assay. Serologic studies with an indirect fluorescent-antibody technic suggested that seroconversion or high titers may be a sensitive test for PPA disease. PPA appears to be a newly recognized cause of life-threatening bacterial pneumonia in immunosupressed patients.

Topics: Adrenal Cortex Hormones; Adult; Aged; Anti-Bacterial Agents; Antibodies, Bacterial; Bacteria; Drug Combinations; Erythromycin; Female; Fluorescent Antibody Technique; Humans; Immunosuppressive Agents; Lung; Male; Middle Aged; Pneumonia; Rifampin; Sulfamethoxazole; Trimethoprim

Benemecin, a Polish rifampicin was tested in vitro and clinically for the treatment of 2 groups of patients, i.e. 28 patients with chronic destructive tuberculosis of the lungs and 30 patients with non-specific pneumonia. High tuberculostatic activity of the drug in vitro was found. The clinical trials showed high efficiency of benemecin in the treatment of chronic destructive tuberculosis of the lungs and pneumonia of non-specific etiology. The drug was mainly well tolerated by the patients.

Topics: Chronic Disease; Drug Evaluation; Drug Resistance, Microbial; Drug Therapy, Combination; Ethambutol; Humans; Italy; Lung Diseases; Mycobacterium tuberculosis; Pneumonia; Poland; Postoperative Care; Rifampin; Time Factors; Tuberculosis, Pulmonary; Yugoslavia

Topics: Abscess; Bronchopneumonia; Empyema; Enteritis; Humans; Pharyngitis; Pneumonia; Respiratory Tract Infections; Rhinitis; Rifampin; Skin Diseases

Topics: Adolescent; Adult; Bacteria; Bronchitis; Bronchopneumonia; Child; Female; Humans; Lung Abscess; Male; Middle Aged; Pleuropneumonia; Pneumonia; Rifampin