rifampin and Pulmonary-Fibrosis

Lung transplantation remains an important potential therapeutic option for end-stage lung disease. It can improve quality of life and in some cases be a life-lengthening therapy. Despite the possible benefits, there are also many potential complications following transplantation. Here we describe a novel presentation of nontuberculous mycobacterium manifesting as an endobronchial mass developing 4 years after lung transplantation.. A 66-year-old African-American woman presented with progressive dyspnea, cough, and persistent wheezing of 2 months' duration. She had a distant history of breast cancer and received bilateral lung transplantation due to end-stage pulmonary fibrosis 4 years prior to her current presentation. She denied fevers, but did endorse night sweats. She had diffuse expiratory wheezing on auscultation. Chest computed tomography imaging showed an endobronchial soft tissue lesion nearly occluding the left mainstem bronchus, which was concerning for endobronchial carcinoma. Rigid bronchoscopy demonstrated a fibrinous mass protruding into the left mainstem proximal to the anastomosis. A pathology report noted fragments of partially necrotic granulation tissue in addition to scant fragments of focally ulcerated bronchial mucosa. Both the tissue culture and bronchial wash stained positively for acid-fast bacilli and grew Mycobacterium avium complex.. Nontuberculous mycobacterium pulmonary disease is common post lung transplant and risk factors are related to immunosuppression and history of structural lung disease. Mycobacterium avium complex presenting as an endobronchial lesion in a patient post lung transplant is a novel presentation.

Topics: Aged; Antitubercular Agents; Ethambutol; Female; Fluoroquinolones; Graft Rejection; Humans; Immunosuppressive Agents; Lung; Lung Transplantation; Moxifloxacin; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Prednisone; Pulmonary Fibrosis; Rifampin; Tacrolimus; Tomography, X-Ray Computed; Tuberculosis, Pulmonary

Gaucher disease (GD) is an autosomal recessive glycolipid storage disorder, due to deficiency of the lysosomal enzyme glucocerebrosidase, leading to accumulation of the substrate glucocerebroside in the cells of the macrophage-monocyte system. Patients with GD have alteration in their immune system and impaired microbicidal capacity of mononuclear phagocytes. It has also been demonstrated that monocyte dysfunction may correlate with the plasma glucocerebrosidase concentrations. Tuberculosis (TB) is a major public health problem in developing countries. Pleural TB is one of the most common forms of extra-pulmonary TB. Since immune system can be impaired due to the deficiency of glucocerebrosidase in various ways, TB can be observed in patients with GD especially when left untreated. Cytopenia(s) is also general finding in untreated Gaucher patients, and they may be observed most frequently due to the infiltration of the bone marrow with Gaucher cells together with the additional factor of splenomegaly. We herein present a case of an adult patient with heterozygous untreated GD1, who developed pleural TB complicated by ipsilateral pulmonary fibrosis. Before his admission to our clinic, pleurectomy operation was performed and 4-drug combination anti-TB therapy was initiated including isoniazid, rifampicin, ethambutol and pyrazinamide. Fever complaint was disappeared with anti-TB treatment but he also had fatigue and pain. After initiation of enzyme replacement therapy in addition to anti-TB treatment, clinical and hematological improvement was observed. To our knowledge, this is the first reported case of GD1 with pleural TB.

Topics: Adult; Antitubercular Agents; Drug Therapy, Combination; Ethambutol; Gaucher Disease; Humans; Isoniazid; Male; Pulmonary Fibrosis; Pyrazinamide; Rifampin; Tuberculosis, Pleural; Turkey

To assess the relationship between mixed dust fibrosis (MDF) and tuberculosis.. We performed a comparative analysis with MDF, silicosis, and macular pneumoconiosis (Mac), using autopsy records from 1975 to 1994.. Prevalences of having tuberculosis among MDF, silicosis, and Mac were not significantly different, albeit a tendency of higher prevalence in silicosis. Cure rates of tuberculosis were, in order, silicosis < MDF < Mac (P=0. 085). Death rates associated with tuberculosis were, in order, silicosis > MDF=Mac (P=0.911). With respect to the two types of association with tuberculosis, i.e., combined type (tuberculopneumoconiosis) and complicated one (pneumoconiosis with tuberculosis); the former was significantly dominant in silicosis, the latter was significantly dominant in Mac, and intermediate in MDF. As a whole, the complicated type had a tendency of a higher cure rate than the combined type (P=0.071). Although the differences of profiles between the combined and complicated types were not statistically significant, the combined type had a tendency to have longer duration of exposure to dusts, earlier registration for treatment, higher profusion score, and earlier death compared with the complicated type.. From our findings, MDF takes an intermediate position between silicosis and Mac regarding the relationship with tuberculosis. The type of association with tuberculosis rather than the kind of background pneumoconiosis seemed to be more important in light of responsiveness to the treatment.

Topics: Autopsy; Dust; Female; Humans; Japan; Male; Mining; Occupational Exposure; Pneumoconiosis; Pulmonary Fibrosis; Rifampin; Silicon Dioxide; Silicosis; Tuberculosis, Pulmonary

The follow-up of 301 patients with fibrous-cavernous pulmonary tuberculosis has demonstrated that the disease outcome and treatment effectiveness depend on the nature of its course. A long-term specific therapy for 9-10 months brings about cessation of bacillary excretion in 50-60% of cases even in a progressive course of the disease and closure of destruction cavities occurred in 12.5% of cases with rapid progression and in 21.7% of cases with slow progression of the disease. Despite all measures taken, stabilization of the process fails in one-fourth of the patients with rapidly progressing fibrous-cavernous tuberculosis and in 9% of those with a slowly progressing course. In 90% of cases bacillary excretion in patients with stable fibrous-cavernous tuberculosis ceased in 3 months and in 100% after 6 months of treatment.

Topics: Adult; Aged; Combined Modality Therapy; Drug Resistance, Microbial; Ethambutol; Female; Hemoperfusion; Humans; Male; Middle Aged; Mycobacterium tuberculosis; Prednisolone; Pulmonary Fibrosis; Rifampin; Time Factors; Tuberculosis, Pulmonary; Wound Healing

Topics: Aged; Humans; Male; Pulmonary Fibrosis; 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

Topics: Animals; Body Weight; Coal; Dust; Guinea Pigs; Lung; Lung Diseases; Macrophages; Mycobacterium; Mycobacterium Infections; Organ Size; Pneumoconiosis; Pulmonary Fibrosis; Radiography; Rifampin; Silicon Dioxide; Tracheal Diseases

Topics: Adult; Chronic Disease; Drug Combinations; Drug Resistance, Microbial; Ethambutol; Female; Humans; Male; Middle Aged; Pneumoconiosis; Pulmonary Fibrosis; Rifampin; Sputum; Time Factors; Tuberculosis, Pulmonary