rifampin and Tenosynovitis

We report the clinical results and problems of combined administration of rifampicin, ethambutol, and clarithromycin (REC) for the treatment of Mycobacterium avium complex (MAC) infection of the hand (hand MAC).Participants included 7 patients with hand MAC. After resection of the infected lesion, REC was prescribed for 12 months. For these patients, the site of infection, clinical course after initiation of REC, adverse drug effects (ADEs), and incidence of recurrence were evaluated.Sites of infection were the flexor tenosynovium in 5 patients, extensor tenosynovium in 1 patient, and both flexor and extensor tenosynovium in 1 patient. ADEs of REC occurred in 5 patients, and included visual disturbance caused by ethambutol in 2 patients, liver function abnormality caused by rifampicin in 2 patients, and fever with diarrhea caused by rifampicin in 1 patient. For 2 of these 5 patients, desensitization therapy was applied and REC was able to be reinstated. In the remaining 3 patients, the causative drugs were discontinued and levofloxacin, a new quinolone, was administered. Complete healing was achieved in 5 patients, and recurrence was observed in 2 patients. These 2 patients with recurrence included 1 patient in whom REC was completed and 1 patient in whom REC therapy was modified due to ADE.REC provided relatively good clinical results as a treatment for hand MAC. However, recurrences were observed even after the completion of REC and the use of an alternative drug. Optimal duration of REC and appropriate alternative drugs need to be identified in the future.

Topics: Aged; Anti-Bacterial Agents; Clarithromycin; Drug Therapy, Combination; Ethambutol; Female; Hand; Humans; Male; Middle Aged; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Rifampin; Tenosynovitis

We report a case of non-tuberculous tenosynovitis of the wrist caused by Mycobacterium malmoense. The patient presented with a ganglion-like swelling on the flexor aspect of the wrist. The diagnosis was confirmed by fine needle aspiration biopsy. A satisfactory resolution was obtained by antibiotic therapy alone, indicating that radical synovectomy may not be necessary in all cases of M. malmoense infection.

Topics: Aged; Antibiotics, Antitubercular; Antitubercular Agents; Biopsy, Needle; Drug Therapy, Combination; Ethambutol; Humans; Isoniazid; Male; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Rifampin; Tenosynovitis; Wrist

Topics: Humans; Male; Middle Aged; Neisseria meningitidis; Rifampin; Tenosynovitis

Topics: Anti-Bacterial Agents; Antitubercular Agents; Azithromycin; Debridement; Deprescriptions; Drug Therapy, Combination; Ethambutol; Finger Joint; Fisheries; Fresh Water; Humans; Immunocompromised Host; Infliximab; Male; Metacarpophalangeal Joint; Middle Aged; Mycobacterium Infections, Nontuberculous; Mycobacterium marinum; Osteomyelitis; Rifampin; Spondylitis, Ankylosing; Synovectomy; Tenosynovitis; Tumor Necrosis Factor Inhibitors; Wrist Joint

Osteoarticular involvement is the most frequently observed complication of brucellosis. Brucellosis tenosynovitis of the extensor tendon sheath is an extremely rare manifestation of musculoskeletal brucellosis. A 36-year-old male patient presented with described pain in his right wrist that had started six days earlier. There was also a diffuse swelling in the first finger of his right hand. The patient described fever, night sweats, widespread muscle pain and fatigue that had been going on for the last six days. Standard tube agglutination for Brucella was positive at a titre of 1/320. At diagnosis, the patient showed radiographic abnormalities. Doxycycline 200 mg/d and rifampicin 600 mg/d were given for six weeks. Complete resolution was achieved with medical treatment.

Topics: Adult; Anti-Bacterial Agents; Arm; Brucella; Brucellosis; Doxycycline; Drug Therapy, Combination; Humans; Male; Rifampin; Tenosynovitis; Treatment Outcome

Chronic flexor tenosynovitis in the hand caused by non-tuberculous mycobacterial (NTM) infection is uncommon. Although some authors have recommended combining surgical and drug therapy, there are few reports about the timing of drug administration after operation. The purpose of this retrospective study was to analyse the clinical outcome of the protocol, which consisted of extensive tenosynovectomy and drug therapy administered after culture results had been obtained. Four men and one woman were included. Average age was 57.4 years and average follow-up period was 46.7 months. Extensive tenosynovectomy was performed and surgical specimen was examined histopathologically and microbiologically. After a positive culture result had been obtained, three kinds of drugs were administered. Clinical outcome including infectious condition, range of motion, and grip strength was examined. All patients were immunocompetent and had no underlying disease. Three patients were diagnosed at first operation and two were diagnosed at second operation. The average period of drug therapy was 5.5 months. In four patients, infection resolved with combination therapy. In one patient with surgical treatment, only swelling remained. Osteomyelitis of the scaphoid was found in one patient to whom systemic steroid had been administered because of a negative culture result at first operation. For immunocompetent patients, flexor tenosynovitis in the hand caused by NTM was resolved with a combination of surgical and drug treatment. Drug treatment seemed to be essential after a reduction of the infectious lesion and the timing of administration was safe enough to resolve in four patients.

Topics: Adult; Aged; Anti-Bacterial Agents; Antitubercular Agents; Clarithromycin; Drug Therapy, Combination; Ethambutol; Female; Hand; Hand Strength; Humans; Immunocompetence; Isoniazid; Levofloxacin; Male; Middle Aged; Mycobacterium Infections, Nontuberculous; Mycobacterium kansasii; Mycobacterium marinum; Osteomyelitis; Range of Motion, Articular; Retrospective Studies; Rifampin; Scaphoid Bone; Synovectomy; Tenosynovitis

Topics: Anti-Bacterial Agents; C-Reactive Protein; Clarithromycin; Diagnosis, Differential; Drug Therapy, Combination; Ethambutol; Female; Fingers; Humans; Middle Aged; Mycobacterium Infections, Nontuberculous; Mycobacterium kansasii; Physical Examination; Rifampin; Tenosynovitis

Mycobacterial infection in an organ transplant recipient is a diagnostic and therapeutic challenge. Diagnosis is often delayed, resulting in significant morbidity. Anti-microbial chemotherapy needs careful selection to prevent potentially significant complications, such as organ rejection and dose-related toxicities. We present the case of a 61-year-old Caucasian male kidney transplant recipient with chronic tenosynovitis of the left wrist. Histological findings of the synovial biopsy revealed multinucleated giant cell epithelioid granuloma. Culture of synovial fluid grew Mycobacterium kansasii. Treatment with rifampicin, ethambutol, and clarithromycin proved curative, but the patient developed irreversible ethambutol-related optic neuritis.

Topics: Clarithromycin; Ethambutol; Humans; Kidney Transplantation; Male; Middle Aged; Mycobacterium Infections, Nontuberculous; Mycobacterium kansasii; Optic Neuritis; Rifampin; Tenosynovitis; Wrist

Remitting seronegative symmetrical synovitis with pitting oedema (RS3PE syndrome) is a very rare condition incorporating a tenosynovitis of the hands and wrists, as well as the feet, ankles and shoulders. The aetiology of RS3PE syndrome is unknown, although it has been linked with infectious agents (including mycobacteria), other rheumatological conditions, HLA serotypes and malignancies.. This report examines the case of a 72-year-old man with a heart transplant and infected knee prosthesis, who developed RS3PE syndrome after introducing antibiotic treatment with rifampicin. His symptoms resolved with cessation of this agent.. This case demonstrates a possible direct aetiological link between rifampicin and RS3PE.

Topics: Aged; Antibiotics, Antitubercular; Edema; Humans; Knee Prosthesis; Male; Prosthesis-Related Infections; Rifampin; Syndrome; Synovitis; Tenosynovitis

Topics: Aged; Antitubercular Agents; Diagnosis, Differential; DNA Probes; Drug Therapy, Combination; Ethambutol; Fingers; Humans; Male; Mycobacterium Infections; Postoperative Care; Rifampin; Tenosynovitis

Infective tenosynovitis is an uncommon cause of a common condition namely carpal tunnel syndrome. Following an extensive review of the literature, we report what we understand to be the first published case of Mycobacterium kansasii (M. kansasii) causing tenosynovitis of flexor tendons resulting in carpal tunnel syndrome in Australia. Our case highlights the need for a high level of suspension, histology and appropriate culture with specific microbiological tests for atypical mycobacteria where tenosynovitis is present at carpal tunnel surgery, even in patients who do not appear to have risk factors.

Topics: Anti-Bacterial Agents; Carpal Tunnel Syndrome; Clarithromycin; DNA, Bacterial; Ethambutol; Humans; Male; Middle Aged; Mycobacterium Infections, Nontuberculous; Mycobacterium kansasii; Occupational Exposure; Rifampin; Rivers; Tenosynovitis

Infection with Mycobacterium marinum is rare and usually produces cutaneous lesions. We report here two cases of tenosynovitis of abductor muscles.. The first case presented isolated involvement of the abductors of the left thumb, and the second the abductors of the middle finger. In both cases, the bacteriological examinations found M. marinum. Antibiotic therapy for three months with rifampin and clarithromycin cured the infection.. These cases of tenosynovitis followed deep inoculation. A mycobacterial infection should be considered in cases of synovitis, especially when limited to an area of the hand in patients without other rheumatic disorders.

Topics: Anti-Bacterial Agents; Antibiotics, Antitubercular; Clarithromycin; Female; Hand Injuries; Humans; Male; Mycobacterium Infections, Nontuberculous; Mycobacterium marinum; Rifampin; Tenosynovitis; Time Factors; Treatment Outcome

This report analyzes a rare case of flexor tenosynovitis caused by Mycobacterium malmoense. A synovectomy was carried out on the index finger (no other finger was afflicted) of a 66-year-old farmer, followed by antibiotic therapy with ethambutol, rifampin, and clarithromycin. Because of strong side effects, the treatment with ethambutol and rifampicin had to be discontinued after 4 months. There was no recurrence after 14 months, and the patient's finger had a full range of motion.

Topics: Aged; Anti-Bacterial Agents; Antibiotics, Antitubercular; Antitubercular Agents; Clarithromycin; Ethambutol; Fingers; Follow-Up Studies; Humans; Male; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Rifampin; Synovectomy; Tenosynovitis

We present five cases of mycobacterial tenosynovitis of the flexor tendons of the fingers. These cases were observed during the last 12 years and treated by the same surgeon. This pathology is uncommon now, but it is becoming more frequent, especially in patients with diminished immunity. The diagnosis was most commonly made after synovectomy in patients presenting with carpal tunnel syndrome associated with slightly painful swelling at the wrist. Histological and bacteriological examinations are very important and revealed tuberculosis in four of our patients and mycobacterium in one, and the treatment consists of synovectomy and appropriate antibiotics. The functional result is usually good, but recurrence is not uncommon. Long-term follow-up is necessary. Local corticosteroid therapy could have a part in the causation of this condition.

Topics: Adult; Aged; Antibiotics, Antitubercular; Antitubercular Agents; Carpal Tunnel Syndrome; Combined Modality Therapy; Ethambutol; Female; Hand; Humans; Isoniazid; Male; Middle Aged; Mycobacterium avium-intracellulare Infection; Rifampin; Tenosynovitis; Tuberculosis

Two case reports of deep hand infections with Mycobacterium avium-intracellulare are presented. Both occurred in elderly men. Aggressive surgical débridement combined with antitubercular chemotherapy resulted in an excellent outcome in both cases. Atypical mycobacterial infections should be considered in the differential diagnosis of any patient with prolonged and progressive tenosynovitis. A complete history, including temporally remote inoculation injuries or immunocompromised host status, should be elicited. Acid-fast staining and mycobacterial cultures, including reduced-temperature cultures, must be included in the diagnostic evaluation. Therapy should include immediate and aggressive surgical débridement, as well as appropriate chemotherapy.

Topics: Aged; Antibiotics, Antitubercular; Debridement; Drug Therapy, Combination; Hand; Humans; Male; Mycobacterium avium-intracellulare Infection; Rifampin; Soft Tissue Infections; Tenosynovitis

Inadequate débridement, extensive scarring, and breakdown of the wound have been commonly encountered after surgical débridement has been employed as the initial treatment of infection with Mycobacterium marinum involving the deep structures of the hand. Because of our disappointment with the results of this form of treatment, from 1982 to 1986 we treated twenty-four patients who had such an infection with rifampicin and ethambutol after a diagnostic biopsy was done. Surgical treatment was deferred until it was determined that the infection had not been controlled by the chemotherapy. The clinical outcome for these patients could be divided into three patterns: eleven patients (Group I) had a good result with no complications, three patients (Group II) had delayed healing of the wound, and ten patients (Group III) did not have a good response to conservative treatment and required one or more surgical débridements. Complications were sometimes associated with use of the drugs, and loss of visual acuity was a concern in three patients. In twenty-one (87 per cent) of the patients, at follow-up the function of the treated hand was equal to that of the other hand. Persistent pain, a discharging sinus, and previous local injection of steroids were unfavorable prognostic factors. If these factors are present, surgical débridement is advised.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Combined Modality Therapy; Debridement; Ethambutol; Female; Hand; Humans; Male; Middle Aged; Mycobacterium Infections; Physical Therapy Modalities; Prognosis; Prospective Studies; Rifampin; Tenosynovitis; Wound Healing; Wrist

Mycobacterium szulgai, a scotochromogenic mycobacterium, is a newly recognized pathogen of man and has been reported to cause pulmonary infections, olecranon bursitis and cervical adenitis. We isolated M. szulfai from granulomatous tissue removed at surgery from a young florist with the carpal tunnel syndrome. The organism was susceptible to ethambutol and rifampin but resistant to isoniazid. Cure was achieved by debridement and chemotherapy with ethambutol and rifampin. Neither the source in our patient nor the natural habitat of M. szulgai is known. Because it resembles M. gordonae and M. flavescens, common scotochromogenic mycobacteria in tapwater, care must be taken to avoid dismissing M. szulgai as a contaminant when it is isolated from tissue.

Topics: Adult; Carpal Tunnel Syndrome; Debridement; Ethambutol; Hand; Humans; Male; Mycobacterium Infections; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Rifampin; Tenosynovitis