rifampin and Skin-Ulcer

Mycobacterium ulcerans disease is common in some humid tropical areas, particularly in parts of West Africa, and current management is by surgical excision of skin lesions ranging from early nodules to extensive ulcers (Buruli ulcer). Antibiotic therapy would be more accessible to patients in areas of Buruli ulcer endemicity. We report a study of the efficacy of antibiotics in converting early lesions (nodules and plaques) from culture positive to culture negative. Lesions were excised either immediately or after treatment with rifampin orally at 10 mg/kg of body weight and streptomycin intramuscularly at 15 mg/kg of body weight daily for 2, 4, 8, or 12 weeks and examined by quantitative bacterial culture, PCR, and histopathology for M. ulcerans. Lesions were measured during treatment. Five lesions excised without antibiotic treatment and five lesions treated with antibiotics for 2 weeks were culture positive, whereas three lesions treated for 4 weeks, five treated for 8 weeks, and three treated for 12 weeks were culture negative. No lesions became enlarged during antibiotic treatment, and most became smaller. Treatment with rifampin and streptomycin for 4 weeks or more inhibited growth of M. ulcerans in human tissue, and it provides a basis for proceeding to a trial of antibiotic therapy as an alternative to surgery for early M. ulcerans disease.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Mycobacterium Infections, Nontuberculous; Mycobacterium ulcerans; Rifampin; Skin Diseases, Bacterial; Skin Ulcer; Streptomycin; Treatment Outcome

Buruli ulcer disease (BU), caused by Mycobacterium ulcerans, is endemic in many regions of Africa and causes substantial physical disability. Surgical resection, currently the mainstay of clinical management of BU, is impractical in many endemic areas. Therefore, the study was undertaken to evaluate an antibiotic regimen for medical management of BU.. A randomized, placebo-controlled pilot study of dapsone plus rifampin versus placebo was conducted.. Forty-one participants were recruited in a BU-endemic zone of Côte d'Ivoire. Thirty persons completed the 2-month trial: 15 were treated with placebo and 15 with dapsone and rifampin. On blinded evaluation of photographs of the ulcers, clinicians with experience examining BU judged that 82% of ulcers in the treatment group improved compared with 75% in the placebo group (P=0.51). The median change in ulcer size was a decrease of 14.0 cm2 in the treatment group and a decrease of 2.5 cm2 in the placebo group (P=0.02), but initial ulcer sizes were larger in the treatment group (median 26.2 cm2) compared with the placebo group (median 4.8 cm2) (P=0.04).. Results of this study indicate that larger studies of antimycobacterial therapy of BU are warranted and can be successfully undertaken.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Child; Child, Preschool; Dapsone; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Mycobacterium Infections, Nontuberculous; Mycobacterium ulcerans; Pilot Projects; Rifampin; Skin Ulcer; Treatment Outcome

Despite the high prevalence of pulmonary tuberculosis worldwide, extrapulmonary tuberculosis especially cutaneous and osteoarticular tuberculosis occurs rarely, both of which are often difficult to be recognized since their symptoms mimic those of many other cutaneous and osteoarticular diseases. Here, we present a rare case of cutaneous tuberculosis potentially accompanied by osteroarticular tuberculosis in a 36-year-old Chinese man who presented with multiple persistent skin ulcers for one year and were nonresponsive to multiple therapeutic approaches. A single anti-tuberculous regimen with rifampicin resulted in healing of all skin lesions and excellent recovery of the general condition.

Topics: Adult; Antibiotics, Antitubercular; Biopsy; Humans; Male; Rifampin; Skin; Skin Ulcer; Tomography, X-Ray Computed; Treatment Outcome; Tuberculosis, Cutaneous; Tuberculosis, Osteoarticular; Wound Healing

Topics: Actinomyces; Adult; Anti-Bacterial Agents; Drug Therapy, Combination; Humans; Male; Mycetoma; Penicillin G Benzathine; Rifampin; Skin Ulcer; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Antitubercular Agents; Drug Therapy, Combination; Ethambutol; Humans; Immunocompromised Host; Isoniazid; Male; Middle Aged; Penile Diseases; Pyrazinamide; Rifampin; Skin Ulcer; Tuberculosis, Male Genital; Vitiligo

Genital ulcers in adolescent girls present a complex diagnostic dilemma. Of all the causes of painful vulval ulcer in a virgin girl, tuberculosis is an extremely rare possibility with no case reported in literature.. We are reporting a case of tubercular vulval ulcer in a sexually inactive pubertal girl. She had a close contact with active tuberculosis, positive tuberculin skin test, and chronic granulomatous inflammation on vulval biopsy. Therapeutic trial was offered and on follow up visit after 4 weeks, lesion had completely resolved.. Unlike previous case reports that describe tubercular vulval ulcers in sexually active or post menopausal women our patient was sexually inactive. In endemic areas tuberculosis should be considered in differential diagnosis of vulval ulcers irrespective of sexual history of the patient.

Topics: Adolescent; Antitubercular Agents; Drug Therapy, Combination; Ethambutol; Female; Humans; Isoniazid; Pyrazinamide; Rifampin; Skin Ulcer; Tuberculin Test; Tuberculosis, Female Genital; Vulvar Diseases

Topics: Abscess; Adult; Antibiotics, Antitubercular; Antitubercular Agents; Female; Humans; Isoniazid; Mycobacterium tuberculosis; Rifampin; Skin Ulcer; Tuberculosis, Cutaneous

Cutaneous tuberculosis is rare. Its occurrence in multifocal tuberculosis (MT) is uncommon and happens frequently in the context of immunosuppression. We report the case of MT with multiple cutaneous gummas and bone and lung involvement that occurred in an apparently immunocompetent patient.

Topics: Antitubercular Agents; Clavicle; Drug Therapy, Combination; Ethambutol; Humans; Immunocompetence; Isoniazid; Male; Morocco; Pyrazinamide; Rifampin; Skin Ulcer; Tuberculosis, Cutaneous; Tuberculosis, Osteoarticular; Tuberculosis, Pulmonary; Young Adult

Hidradenitis suppurativa (HS) may be associated with face and back lesions which are considered as acne.. To describe the skin lesions of a group of patients with HS.. Twelve patients were selected from a series of 648 patients on the basis of their specific skin lesions.. The patients (mostly male) had typical hidradenitis. On their face or back they had one or several of the following skin lesions which are not seen in acne: hypertrophic rope-like bridged scars, raised plaques with multiple carbuncle-like openings or with ulcerations, 'worm-eaten scars' and coalescent nodules with round ulcerations. All patients had deep round scars. Several had a pilonidal cyst or large epidermal cysts. Isotretinoin had been used by 7 patients with no effect.. Some HS patients have specific lesions of the face and back which are not acne and have to be treated differently.

Topics: Acne Vulgaris; Adult; Back; Cicatrix; Clindamycin; Dermatologic Agents; Epidermal Cyst; Face; Female; Hidradenitis Suppurativa; Humans; Isotretinoin; Male; Middle Aged; Pilonidal Sinus; Rifampin; Skin Ulcer; Treatment Outcome; Young Adult

Lupus vulgaris (LV) is a chronic, progressive, and potentially destructive form of cutaneous tuberculosis commonly seen in previously sensitized individuals with moderate to high immunity. We present a case of LV located on the nose of an 84-year-old female patient, discuss the diagnosis and treatment modalities, and emphasize the importance of having a high index of suspicion for this condition.

Topics: Aged, 80 and over; Antitubercular Agents; Chronic Disease; Ethambutol; Female; Humans; Isoniazid; Lupus Vulgaris; Mycobacterium tuberculosis; Nose Diseases; Pyrazinamide; Rifampin; Skin Ulcer; Treatment Outcome; Tuberculosis, Pulmonary

The Bacille-Calmette-Guérin (BCG) vaccine is used in Mycobacterium tuberculosis prophylaxis in at risk tuberculin-negative healthcare workers. Its use is contraindicated however in individuals with HIV infection.. We herein highlight the case of a healthcare worker who developed a localised reaction at a BCG vaccination site and who was subsequently found to be HIV positive.. This case emphasises the importance of eliciting risk factors for immunocompromise in individuals for whom BCG vaccination is being considered.

Topics: Adult; Allied Health Personnel; Antibiotics, Antitubercular; BCG Vaccine; Contraindications; HIV Seropositivity; Humans; Male; Mycobacterium bovis; Rifampin; Skin Ulcer; Tuberculosis

Topics: Combined Modality Therapy; Debridement; Ethambutol; Forearm; Humans; Male; Middle Aged; Mycobacterium avium-intracellulare Infection; Postoperative Care; Rifampin; Skin Diseases, Bacterial; Skin Ulcer; Surgical Flaps

To identify the most active curative treatment of Buruli ulcer, two regimens incorporating the use of rifampin (RIF) were compared with the use of RIF alone in a mouse footpad model of Mycobacterium ulcerans infection. Treatments began after footpad swelling from infection and continued for 12 weeks with five doses weekly of one of the following regimens: (i) 10 mg of RIF/kg alone; (ii) 10 mg of RIF/kg and 100 mg of amikacin (AMK)/kg; and (iii) 10 mg of RIF/kg, 100 mg of clarithromycin (CLR)/kg, and 50 mg of sparfloxacin (SPX)/kg. The activity of each regimen was assessed in terms of the reduction of the average lesion index and acid-fast bacillus (AFB) and CFU counts. All three regimens displayed various degrees of bactericidal activity against M. ulcerans. The ranking of bactericidal activity was found to be as follows: RIF-AMK > RIF-CLR-SPX > RIF. RIF-AMK was able to cure M. ulcerans-infected mice and prevent relapse 26 weeks after completion of treatment. To determine the impact of different rhythms of administration of RIF-AMK on the suppression of M.ulcerans growth, mice were given the RIF-AMK combination for 4 weeks but doses were administered either 5 days a week or twice or once weekly. After completion of treatment, the mice were kept under supervision for 30 additional weeks. M. ulcerans was considered to have grown in the footpad if swelling was visually observed and harvests contained more than 5 x 10(5) AFB per footpad. The proportion of mice in which growth of M. ulcerans occurred, irrespective of drug dosage, was compared with the control mice to determine the proportion of M. ulcerans killed. Each dosage of RIF-AMK was bactericidal for M. ulcerans (P < 0.001), but the effect was significantly stronger in mice treated 5 days per week. The promising results of RIF-AMK treatment in M. ulcerans-infected mice support the clinical trial that is currently in progress under World Health Organization auspices in Ghana.

Topics: Amikacin; Animals; Anti-Bacterial Agents; Clarithromycin; Colony Count, Microbial; Disease Models, Animal; Drug Therapy, Combination; Female; Fluoroquinolones; Foot; Mice; Mice, Inbred BALB C; Mycobacterium Infections, Nontuberculous; Mycobacterium ulcerans; Rifampin; Skin Ulcer

Medical treatment of Buruli ulcer is mostly disappointing even if Mycobacterium ulcerans is susceptible to many antibacterial drugs. The inefficiency in vivo of the drugs may be due to the tissue vascularisation disorders caused by the toxin that Mycobacterium ulcerans produces. This toxin causes an endarteritis followed by a thrombosis of the dermal vessels responsible for an ischemia which prevents the antibacterial drugs from reaching the infected area. Removal or prevention of that thrombosis should allow the drugs to be more effective. To verify this assumption, we used a combined therapy with two gold standard medicines in an oedematous form of Buruli ulcer on the face which could not be surgically treated: heparin for its activity on thrombosis and rifampin for its bactericidal activity on Mycobacterium ulcerans. Rifampin was administered at 300 mg dose per day. Based on the management of envenomisation cases due to viper bites, we used standard heparin at 500 Ul dose per kg repeatedly administered by an electrical syringe releasing 1 cc per hour in the tubulure of isotonic glucose infusion. The results were encouraging. The dreadful oedema of the face started to reduce on the 15th day and disappeared on the 30th day. A small area at the temple dried. But we were obliged to stop the use of standard heparin due to an occurrence of Klebsiella oxytoca septicaemia from permanent vein route. Rifampin was still administered at the same dose. The face oedema reappeared quickly, followed by a full closure of the eyelids and an ulceration at the right temple level. The standard heparin was therefore substituted by low weight molecular heparin, enoxaparin, administered at 40 mg twice per day by subcutaneous route. 45 days later the oedema reduced and ulceration did not develop. After 90 days of treatment, usual signs of mycobacterial infection progression disappeared. We stopped therefore the use of enoxaparin but continued with rifampin until healing of the ulceration which occurred after 12 months of treatment. We observed no recurrence over a period of 16 months after complete healing. We can conclude that heparin combined with antimycobacterial drugs--which are active in vitro on Mycobacterium ulcerans--could provide an effective medical treatment for Buruli ulcer.

Topics: Adolescent; Drug Therapy, Combination; Female; Heparin; Humans; Mycobacterium Infections, Nontuberculous; Mycobacterium ulcerans; Rifampin; Skin Ulcer

Topics: Adult; Antibiotics, Antitubercular; Burkina Faso; Child; Female; Humans; Incidence; Male; Mycobacterium Infections, Nontuberculous; Mycobacterium ulcerans; Rifampin; Skin Ulcer

The effectiveness of hyperbaric oxygenation (HBO), heat, and rifampin for treating mice infected with Mycobacterium ulcerans was analyzed. Four hundred mice were innouclated in the hind footpads with 10(8) organisms. The seven treatment groups (50 mice each) were HBO (2.5 ATA for 1.5 h, twice a day), rifampin (RIF) (20 mg/kg body weight/d), heat (mice maintained at 37 degrees C), and all combinations of the three treatments. The severity of infection in the treated mice was compared weekly for 20 weeks with that of infected controls. The most effective treatments were RIF/HEAT and RIF/HBO/HEAT, RIF/HBO/HEAT treatment was further evaluated to determine the effectiveness of treating mice at various stages of infection. Three hundred mice were inoculated in the hind footpads, and, as the infection progressed, they were separated into groups (50 mice/group) according to the severity of infection. The treatment groups were compared to positive controls. The effectiveness of therapy was indirectly proportional to the severity of infection.

Topics: Animals; Hot Temperature; Hyperbaric Oxygenation; Mice; Mycobacterium Infections; Mycobacterium Infections, Nontuberculous; Rifampin; Skin Ulcer

Topics: Animals; Mice; Mycobacterium; Mycobacterium Infections; Rifampin; Skin Ulcer

Topics: Dapsone; Drug Resistance, Microbial; Humans; Leprosy; Male; Middle Aged; Mycobacterium leprae; Rifampin; Skin Ulcer

Topics: Adolescent; Adult; Amputation, Surgical; Debridement; Diagnosis, Differential; Ethambutol; Female; Fingers; Hand; Humans; Male; Middle Aged; Mycobacterium; Mycobacterium Infections; Osteomyelitis; Rifampin; Skin Diseases, Infectious; Skin Ulcer; Synovitis; Tuberculosis

Topics: Animals; Drug Combinations; Foot; Hindlimb; Male; Mice; Mycobacterium Infections; Phenazines; Pyrimethamine; Pyrimidines; Rifampin; Skin Ulcer; Sulfonamides

Topics: Animals; Antitubercular Agents; Guinea Pigs; Isoniazid; Lung Diseases; Lymph Nodes; Mycobacterium tuberculosis; Organ Size; Rifampin; Skin Ulcer; Spleen; Splenic Diseases; Tuberculin Test; Tuberculosis