rifampin and Remission--Spontaneous

Topics: Clinical Trials as Topic; Drug Therapy, Combination; Ethambutol; Follow-Up Studies; Humans; Isoniazid; Recurrence; Remission, Spontaneous; Rifampin; Societies, Medical; Streptomycin; Time Factors; Tuberculosis, Pulmonary; United Kingdom

Acedapsone (DADDS), a repository sulfone given by injection five times a year, has been used since 1967 for the treatment of all leprosy patients in the Karimui, an area of diffic-lt access. More than 460 patients have been treated, 336 beginning in November 1967 and continuing through the latest assessment 6 years later. The injections have been well received and they have been administered very regularly. Clinical observations were begun before 1967, as a base-line of assessments was available for the patients whose disease appeared before that time. The response to DADDS therapy has been satisfactory except in 5 of the 28 multibacillary patients in whose smears solid-staining Mycobacterium leprae have reappeared. M. leprae was isolated in mice from three of these patients; one strain has been proven to be completely susceptible to dapsone (DDS), and the other two very probably are. DDS levels in the plasma of these five patients were normal and well above the minimal inhibitory concentration. The most probable explanation is that a few viable M. leprae survived in the presence of inhibitory concentrations of DDS for the 4 to 6 years during which dead bacilli were disintegrating and disappearing from the tissues. The other 23 multibacillary patients responded satisfactorily. The decrease in the number of M. leprae in the skin smears has been most prompt in patients with low initial bacterial loads and in those with borderline lepromatous diagnoses. A high initial bacterial load and a fully lepromatous diagnosis were associated with a slow initial loss of M. leprae in the 1st year, followed by a more rapid loss the next year. All of the multibacillary patients have now been treated by the addition of a 90-day course of rifampicin.

Topics: Acetamides; Adolescent; Adult; Aged; Bacterial Infections; Child; Child, Preschool; Clinical Trials as Topic; Dapsone; Dosage Forms; Female; Humans; Infant; Leprostatic Agents; Leprosy; Male; Microbial Sensitivity Tests; Middle Aged; Mycobacterium leprae; New Guinea; Recurrence; Remission, Spontaneous; Rifampin; Time Factors

The standard antitubercular treatment (ATT), which consists of isoniazid (INH), rifampicin (RIF), ethambutol, and pyrazinamide (PZA), is the best available treatment for tuberculosis (TB). However, the hepatotoxicity of INH and PZA can be severe, and even after drug withdrawal, patients may require liver transplantation (LT). In these cases, the strategy for the treatment of TB is poorly defined. Between 1986 and 2008, 14 patients presented at our department with severe hepatitis secondary to INH and PZA treatment. Four of these patients were immunosuppressed: 2 after renal transplantation and 2 because of human immunodeficiency virus infection. In seven of the 14 patients an alternative ATT was begun on admission, which was well tolerated. Hepatitis improved spontaneously in 5 patients, and alternative ATT was continued for 9.3 ± 4.2 months; 1 patient deteriorated and underwent LT, and 1 patient died. ATT was stopped definitively in 2 patients. Six patients required urgent LT, and alternative ATT was started after transplantation and was successful. Five patients receiving RIF had an episode of acute rejection. In conclusion, hepatitis secondary to ATT can be successfully treated with alternative anti-TB regimens. The use of RIF in LT patients may lead to acute rejection. RIF should therefore be avoided in these patients.

Topics: Adolescent; Adult; Antitubercular Agents; Chemical and Drug Induced Liver Injury; Disease Progression; Drug Therapy, Combination; Female; France; Graft Rejection; Humans; Isoniazid; Liver Failure, Acute; Liver Transplantation; Male; Middle Aged; Remission, Spontaneous; Rifampin; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Tuberculosis; Young Adult

Topics: Adult; Aged; Female; Hodgkin Disease; Humans; Lung Neoplasms; Middle Aged; Remission, Spontaneous; Rifampin; Time Factors

Thirty-eight cases of subacute sclerosing panencephalitis (SSPE) were reviewed. Deterioration in school performance, personality changes, and seizures were common early symptoms. Initial examination frequently showed myoclonus, spasticity, and extrapyramidal dysfunction, and in two-thirds of patients these findings were asymmetrical or focal. Retinitis or papilledema was present on initial examination in 50% of the patients. At last follow-up 24 children had died, with a mean survival of 42 months. Most patients reached a state of severe neurological impairment within 13 months. Subsequent evidence of improvement was noted in 10 children and was sustained in 4. Fifteen patients received antiviral treatment. Ten treated patients died from 5 to 133 months (mean, 58) from onset of their illness, while 15 untreated patients survived a mean of 33 months. Duration of survival appeared to be affected most by treatment with amantadine. Three patients treated with the drug were alive 97 to 139 months after onset of SSPE, and 5 died with a mean survival of 78 months. Five of 6 individuals treated with rifampin died after a mean survival of 27 months. Prolonged remissions occurred only in patients treated with amantadine. Although the number of treated individuals was small, our data suggest that amantadine may affect the natural course of SSPE.

Topics: Amantadine; Ether; Follow-Up Studies; Humans; Remission, Spontaneous; Rifampin; Subacute Sclerosing Panencephalitis

Topics: Aged; Chemical and Drug Induced Liver Injury; Female; Humans; Liver Function Tests; Pemphigus; Prednisone; Remission, Spontaneous; Rifampin; Tuberculosis, Renal

Topics: Adult; Colposcopy; Female; Humans; Remission, Spontaneous; Rifampin; Uterine Cervical Neoplasms