rifampin and Spinal-Diseases

The final results up to 15 years are reported of clinical trials of the management of tuberculosis of the spine in Korea and Hong Kong. In Korea, 350 patients with active spinal tuberculosis were randomised to ambulatory chemotherapy or bed rest in hospital (in Masan) or a plaster-of-Paris jacket for nine months (in Pusan). Patients in both centres were also randomised to either PAS plus isoniazid for 18 months or to the same drugs plus streptomycin for the first three months. In Hong Kong, all 150 patients were treated with the three-drug regime and randomised to either radical excision of the spinal lesion with bone graft or open debridement. On average, the disease was more extensive in Korea, but at 15 years (or 13 or 14 years in a proportion of the patients in Korea) the great majority of patients in both countries achieved a favourable status, no evidence of CNS involvement, no radiological evidence of disease, no sinus or clinically evident abscess, and no restriction of normal physical activity. Most patients had already achieved a favourable status much earlier. The earlier results of these trials are confirmed by the long-term follow-up with no late relapse or late-onset paraplegia. The results of chemotherapy on an outpatient basis were not improved by bed rest or a plaster jacket and the only advantage of the radical operation was less late deformity compared with debridement. A second series of studies has shown that short-course regimes based on isoniazid and rifampicin are as effective as the 18-month regimes: ambulatory chemotherapy with these regimes should now be the main management of uncomplicated spinal tuberculosis.

Topics: Adolescent; Adult; Ambulatory Care; Aminosalicylic Acid; Antibiotics, Antitubercular; Antitubercular Agents; Bed Rest; Bone Transplantation; Casts, Surgical; Child; Child, Preschool; Combined Modality Therapy; Debridement; Female; Follow-Up Studies; Hong Kong; Hospitalization; Humans; Infant; Isoniazid; Korea; Longitudinal Studies; Male; Middle Aged; Paraplegia; Randomized Controlled Trials as Topic; Rifampin; Spinal Diseases; Streptomycin; Treatment Outcome; Tuberculosis, Spinal

Nontuberculous mycobacteria (NTM) caused pulmonary disease is on increase worldwide, especially in countries with decreasing time trend of tuberculosis incidence. NTM skeletal affection is rare. Mycobacterium avium related disease, with still unclear clinical and radiologic features, is in current focus of both clinicians and researchers. An exhausted severely ill 71-year-old man was admitted on emergency due to cough, dyspnea and lumbar back pain to be diagnosed with terminal phase M. avium disease. Three sputum smears were positive for acid fast bacilli and M. avium was identified with hybridization reaction by means of GenoType ® MTBC (Hain). Apart from pulmonary disease, compressive fractures of the 12th thoracic and 1-4th lumbar vertebrae were detected. We found age, chronic alcoholism, previous professional exposure, tobacco smoking, chronic obstructive pulmonary disease and previous tuberculosis as risk factors for NTM disease in the HIV-negative patient. Despite combined antibiotic treatment, disease had lethal outcome. This case report might contribute to clinicians' awareness and improved knowledge on this sort of pathology, and lead to earlier diagnosis with possibly better disease outcome.

Topics: Aged; Clarithromycin; Drug Therapy, Combination; Ethambutol; Fatal Outcome; Humans; Lung Diseases; Male; Mycobacterium avium; Mycobacterium Infections, Nontuberculous; Respiratory Insufficiency; Rifampin; Risk Factors; Spinal Diseases; Sputum

Drug-associated hypocalcemia is rare, but may occur during routinely administered drugs. We reported a case of vertebral brucellosis, which developed two hypocalcemic episodes associated with hypokalemic alkalosis with two drug combinations including rifampicin. Possible underlying mechanisms of hypocalcemia were discussed. The patient had carpopedal spasm at both hypocalcemic presentations. Laboratory analysis revealed hypocalcemia, hypokalemia, alkalosis with hypercalciuria, and low-normal parathormone (PTH) at first and elevated PTH at the second admission. The patient improved with cessation of drugs and appropriate management of hypocalcemia and hypokalemia with calcium, vitamin D, magnesium, and potassium replacement. The underlying mechanism of hypocalcemia in this patient seemed to be due to tubular damage resulting with Bartter-like syndrome, which is well defined with aminogylcosides. But the recurrence of hypocalcemia with an aminoglycoside-free antibiotic combination including rifampicin suggests a possible role of rifampicin on hypocalcemia associated Bartter-like syndrome that has never been reported before.

Topics: Adult; Antibiotics, Antitubercular; Brucellosis; Calcitriol; Calcium; Drug Therapy, Combination; Female; Humans; Hypocalcemia; Recurrence; Rifampin; Spasm; Spinal Diseases; Streptomycin; Vitamin D Deficiency

Pyogenic Spinal Infection (PSI) is an uncommon disorder encompassing a broad spectrum of diseases including septic spondylodiscitis, osteomyelitis, epidural and paravertebral abscess formation. Presentation can be vague and highly variable but usually includes back pain and fever. Whilst predisposing factors, such as trauma and diabetes can often be identified a pathogenic organism may not be identified in up to a half of all cases leading to significant delay in both accurate diagnosis and effective treatment. Precise spinal imaging is essential and includes plain X-ray, CT and preferably MRI. The treatment of PSI can be conservative (including antibiotics); however, spinal surgery may be required for the complications in up to 50% of cases, with varying degrees of success. We present a challenging case of PSI encountered in a locally-employed 42-year-old Bangladeshi civilian working in Iraq. Despite obvious resource limitations available within a Role 2 Field Hospital, clinical suspicion coupled with repeat spinal CT was pivotal in obtaining the diagnosis. The patient was repatriated to Bangladesh for MRI and definitive surgical treatment.

Topics: Adult; Anti-Bacterial Agents; Antibiotics, Antitubercular; Bangladesh; Floxacillin; Humans; Iraq; Low Back Pain; Magnetic Resonance Imaging; Male; Osteomyelitis; Rifampin; Spinal Diseases; Tomography, X-Ray Computed

Tuberculosis is common in India, but the co-occurrence of intracranial and intramedullary tuberculomas as a manifestation of central nervous system tuberculosis is extremely rare in children. We report a case of concurrent intracranial and lumbar intramedullary tuberculomas in a 6-year-old girl. The child developed the intracranial and intramedullary tuberculomas while on antituberculous therapy for previously diagnosed tuberculous meningitis. The child improved well on antituberculous drugs and neurosurgical excision of the lumbar lesion. Histopathology confirmed tuberculous etiology of the intramedullary lesion.

Topics: Antitubercular Agents; Brain; Child; Diagnosis, Differential; Edema; Female; Humans; Isoniazid; Lumbar Vertebrae; Magnetic Resonance Imaging; Rifampin; Spinal Cord; Spinal Diseases; Tomography, X-Ray Computed; Tuberculoma; Tuberculoma, Intracranial

This report describes the case of a 45-year-old woman with a 5-month history of fever, generalized malaise, myalgia, lower back pain and difficulty in walking. Serodiagnosis for brucella, carried out at the onset of symptoms 5 months previously, was negative. When the patient was admitted to our hospital there was contracture of the paraspinal muscles but no peripheral nerve damage. Laboratory tests showed positive agglutination for Brucella and an increase in the rate of dilution from 1/160 to 1/640 over 2 weeks. Radiographs and a computed tomography scan of the spine revealed bone erosion in the posterior borders of the L4-L5 vertebral end plates and a soft tissue mass surrounding the interposed disc and protruding into the spinal canal. Magnetic resonance imaging confirmed the presence of a paraspinal abscess around the affected disc and tissue edema. Culture tests of the blood and abscess tissue, taken by biopsy, were negative. Rifampicin treatment (600 mg daily), combined with a bust cast to immobilize the spine, led to clinical healing without the need for surgery. Because onset symptoms are nonspecific and insidious, in nonrisk subjects a diagnosis of brucellosis may sometimes be suspected only if there are local symptoms. The phenomenon of the absence of positivity in patients with a high antibody titer should also be considered Cases such as that described herein demonstrate the need for culture tests and serodiagnosis, even in nonrisk patients with persistent fever and arthralgia, to prevent the later complications of brucellosis.

Topics: Abscess; Antibiotics, Antitubercular; Brucella melitensis; Brucellosis; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Reverse Transcriptase Polymerase Chain Reaction; Rifampin; RNA, Ribosomal, 16S; Spinal Diseases; Spine; Spondylitis

A case report of cervical osteomyelitis possibly associated with a Zenker's diverticulum perforation.. To present clinical, radiologic, and surgical findings of a cervical osteomyelitis due to a Zenker's diverticulum perforation.. A 56-year-old patient was in an intensive care unit for a severe head injury. He was fed via a nasogastric tube. Four months later he developed a pyogenic cervical vertebral infection.. Plain films and magnetic resonance imaging showed a diffuse cervical osteomyelitis. Investigation of his dysphagia revealed a Zenker's diverticulum.. After administration of antibiotics and surgical treatment of the diverticulum, the cervical infection resolved. Plain films and magnetic resonance imaging showed healing with vertebral fusion.. Cervical osteomyelitis is uncommon. Only one case of direct contamination leading to cervical vertebral osteomyelitis after esophageal perforation has been previously described. Direct contamination of the prevertebral soft tissues by bacteria traveling through the fistula may have occurred. The development of vertebral osteomyelitis in this case is consistent with the hypothesis of direct contamination. Management relies on appropriate antimicrobial therapy and surgical management of the diverticulum. The association of Zenker's diverticulum with vertebral osteomyelitis and discitis is a unique, previously undescribed situation.

Topics: Anti-Infective Agents; Antibiotics, Antitubercular; Cervical Vertebrae; Fistula; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Ofloxacin; Osteomyelitis; Rifampin; Spinal Diseases; Suppuration; Tomography, X-Ray Computed; Zenker Diverticulum

Report of a rare case of spinal actinomycosis in a young immunocompetent woman.. To show the difficulties in diagnosing spinal actinomycosis.. Spinal actinomycosis is rare and usually occurs as a result of a contiguous (abdominal, pelvic, or thoracic) spread of the infection. This localization represents less than 5% of the infectious sites and was mainly, before the penicillin era, a postmortem discovery.. A case is reported of a 34-year-old Algerian woman who had fever, persistent cough, right-side thoracic pain, and progressive severe back pain. Radiographs, computed tomographic scan, and magnetic resonance imaging demonstrated lytic areas on the vertebral bodies of T11 and T12 and a paravertebral mass, without disk involvement. A surgical biopsy of T12 and the paravertebral abscess was performed.. Presence of characteristic sulfur granules and gram-positive filamentous bacteria in surgical biopsy tissues and isolation of Actinobacillus actinomycetemcomitans in cultures led to the diagnosis of vertebral actinomycosis. The patient was virtually free of pain and fever after a 3-month regimen of ofloxacin and rifampicin (Rifadine, Marion-Merell, France) and was without recurrence after 18 months of follow-up.. Actinomycosis of the spine, caused by the spread of a paraspinal abscess, is extremely rare. The previously poor prognosis has been transformed by antibiotics.

Topics: Abscess; Actinomycosis; Adult; Anti-Infective Agents; Drug Combinations; Female; Humans; Magnetic Resonance Imaging; Ofloxacin; Rifampin; Spinal Diseases; Spine; Spondylitis

Primary vertebral osteomyelitis in a rare presentation of pneumococcal infection especially in an asymptomatic patient with no primary focus of infection. This report describes a patient who presented with lower back pain in which the magnetic resonance imaging showed little evidence of L1 and L2 vertebral body destruction. Cultures from these vertebral bodies grew penicillin and third-generation resistant pneumococcus. The patient was treated successfully with 6 weeks of vancomycin and rifampin.

Topics: Anti-Bacterial Agents; Antibiotics, Antitubercular; Drug Resistance, Multiple; Drug Therapy, Combination; Female; Humans; Middle Aged; Osteomyelitis; Pneumococcal Infections; Rifampin; Spinal Diseases; Streptococcus pneumoniae; Vancomycin

Skeletal tuberculosis is an uncommon form of tuberculosis. During the period 1977-87, the number of cases diagnosed in two Dublin hospitals has remained at a constant level. The present study reports on 36 adults with skeletal tuberculosis and shows more frequent extraspinal involvement than other studies. The long duration of symptoms prior to diagnosis of 10.79 (+/- 8.8) months suggests that tuberculosis is not being considered early in the course of unexplained inflammatory arthritides especially in the elderly patient. The under utilisation of the Mantoux test in diagnosis is also a matter of concern.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ethambutol; Female; Humans; Isoniazid; Male; Middle Aged; Retrospective Studies; Rifampin; Risk Factors; Spinal Diseases; Time Factors; Tuberculosis, Osteoarticular