rifampin and Thrombocytopenia

Topics: Abciximab; Antibodies, Monoclonal; Carbamazepine; Gold Compounds; Heparin; Humans; Immunoglobulin Fab Fragments; Platelet Glycoprotein GPIIb-IIIa Complex; Procainamide; Quinidine; Quinine; Rifampin; Thrombocytopenia; Time Factors

Topics: Acute Kidney Injury; Anemia, Hemolytic; Digestive System; Humans; Influenza, Human; Liver; Rifampin; Skin; Syndrome; Thrombocytopenia; Tuberculosis, Pulmonary

Rifampin is a potent antituberculous drug. In the treatment of drug-resistant tuberculosis it is highly effective provided it is given in combination with other drugs to which the patient's organisms are sensitive. Rifampin and ethambutol is a particularly powerful combination and will achieve almost 100% sputum conversion. It seems likely that rifampin will replace streptomycin, and ethambutol will replace PAS in first-treatment cases. Optimum first-line treatment will thus consist of rifampin, INH and ethambutol, with the probability of almost 100% success and the possibility also that the total duration of treatment may be considerably reduced. Rifampin is well tolerated but it may give rise to liver dysfunction and thrombocytopenia in a small proportion of patients. Patients treated with rifampin must be kept under close supervision because of the risk of side effects and, more important, because irregular treatment may lead to the development of rifampin-resistant organisms.

Topics: Adult; Aged; Animals; Drug Combinations; Ethambutol; Female; Humans; Isoniazid; Jaundice; Male; Mice; Middle Aged; Mycobacterium tuberculosis; Pregnancy; Rifampin; Thrombocytopenia; Tuberculosis, Pulmonary

Topics: Acetamides; Adult; Aged; Anti-Infective Agents; Drug-Related Side Effects and Adverse Reactions; Female; Hematologic Diseases; Humans; Linezolid; Male; Methicillin Resistance; Middle Aged; Oxazolidinones; Prospective Studies; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Thrombocytopenia

Topics: Adolescent; Adult; Antibodies; Clinical Trials as Topic; Drug Resistance, Microbial; Drug Therapy, Combination; Female; Humans; Isoniazid; Male; Middle Aged; Mycobacterium tuberculosis; Rifampin; Singapore; Thrombocytopenia; Tuberculosis, Pulmonary

Topics: Chemical and Drug Induced Liver Injury; Clinical Trials as Topic; Drug Hypersensitivity; Drug Therapy, Combination; Ethambutol; Gastrointestinal Diseases; Humans; Isoniazid; Mycobacterium tuberculosis; Phenylthiourea; Pyridoxine; Recurrence; Rifampin; Streptomycin; Thrombocytopenia; Time Factors; Tuberculosis, Pulmonary

Topics: Alkaline Phosphatase; Aspartate Aminotransferases; Bilirubin; Clinical Trials as Topic; Eosinophilia; Humans; In Vitro Techniques; Intestinal Absorption; Isoniazid; Jaundice; L-Lactate Dehydrogenase; Liver; Liver Function Tests; Mycobacterium; Mycobacterium tuberculosis; Rifampin; Thrombocytopenia; Transaminases; Tuberculosis, Pulmonary

Drug-induced thrombocytopenia occurs through immune-mediated platelet destruction, and its management is challenging during tuberculosis treatment. Although rifampicin is the most common drug causing thrombocytopenia, isoniazid can also cause thrombocytopenia. We herein report a 75-year-old man who developed thrombocytopenia during tuberculosis treatment. Platelet-associated immunoglobulin G and a drug-induced lymphocyte stimulation test for isoniazid were positive; no other causes of thrombocytopenia were identified. The patient was diagnosed with isoniazid-induced immune thrombocytopenia, and the platelet count normalized after isoniazid discontinuation. We describe the immunological mechanism of thrombocytosis due to isoniazid, an uncommon cause of thrombocytopenia that physicians should be aware exists.

Topics: Aged; Humans; Isoniazid; Male; Platelet Count; Purpura, Thrombocytopenic, Idiopathic; Rifampin; Thrombocytopenia

Rifampicin is a highly effective antibacterial drug and an important component of multidrug therapy used to treat leprosy. Side effects of rifampicin are rare with the once-a-month dosage regimen of anti-leprosy multidrug therapy. Here, we report a case of rifampicin-induced thrombocytopenia during anti-leprosy treatment. Although rare, this potential side effect merits attention.

Topics: Aged; Anti-Bacterial Agents; Drug Therapy, Combination; Humans; Leprostatic Agents; Leprosy, Borderline; Male; Rifampin; Thrombocytopenia

Little knowledge about the biological functions of RP11-37B2.1, a newly defined long noncoding RNA (lncRNA) molecule, is currently available. Previous studies have shown rs160441, located in the RP11-37B2.1 gene, is significantly associated with tuberculosis (TB) in a Ghanaian and the Gambian populations.. We investigated the influence of single-nucleotide polymorphisms (SNPs) within lncRNA RP11-37B2.1 on the risk of TB and the possible correlation with adverse drug reactions (ADRs) from TB treatment in a Western Chinese population. Four SNPs within lncRNA RP11-37B2.1 were genotyped in 554 TB cases and 561 healthy subjects using the improved multiplex ligation detection reaction method, and the patients were followed up monthly to monitor the development of ADRs.. No significant association between the SNPs of lncRNA RP11-37B2.1 and TB susceptibility was observed (all P > 0.05). Surprisingly, significant association was observed between two SNPs (rs218916 and rs160441) and thrombocytopenia development during anti-TB therapy under the dominant model (P = 0.003 and 0.014, respectively).. Our findings firstly exhibit that rs218916 and rs160441 within lncRNA RP11-37B2.1 significantly associate with the occurrence of thrombocytopenia and suggest RP11-37B2.1 genetic variants are potential biosignatures for thrombocytopenia during anti-TB treatment.

Topics: Adult; Anemia; Antitubercular Agents; Asian People; Case-Control Studies; China; Female; Genetic Predisposition to Disease; Humans; Isoniazid; Leukopenia; Male; Middle Aged; Polymorphism, Single Nucleotide; Prospective Studies; Rifampin; RNA, Long Noncoding; Thrombocytopenia; Tuberculosis

Brucellosis can lead to haematological abnormalities including cytopenia confusing with haematological malignancies. The aim of this study was to compare the main characteristics of brucellosis patients without cytopenia (Group 1) and with cytopenia (Group 2).. This five-year period study which was performed in two referral hospitals in Turkey, included all adult brucellosis patients. Abnormally, low counts of leucocyte or haemoglobin or platelets in a patient were considered as cytopenia. The demographics, clinical, laboratory, treatment and outcome data were analyzed.. A total of 484 brucellosis patients were enrolled. Among the cases, 162 (33.5%) of them had cytopenia. One hundred and four (21.5%) had anaemia, 88 (18.8%) had thrombocytopenia, 71 (14.6%) had leucopenia and 28 (5.8%) had pancytopenia. The mean age of group 2 was 35.01±16.05 yr and it was 33.31±14.39 yr in group 1. While there was no difference between the groups in terms of duration of treatment, the median length of hospital stay (LOS) was significantly longer in group 2 (9 vs 10 days; P<0.001). The most frequently applied combination therapy consisted of doxycycline plus rifampicin and doxycycline plus streptomycin regimens. No significant difference was observed in terms of duration of treatment, LOS and restoration time of cytopenia between the patients who received either of these combinations.. Our findings suggested that the patients with cytopenia should be investigated for brucellosis, especially if living in, or with a history of travel to, endemic areas, in view of the increase in world travel.

Topics: Adult; Anemia; Brucellosis; Doxycycline; Female; Hematologic Neoplasms; Humans; Male; Middle Aged; Pancytopenia; Rifampin; Streptomycin; Thrombocytopenia; Turkey

Topics: Adult; Anti-Inflammatory Agents, Non-Steroidal; Antitubercular Agents; Blister; Diclofenac; Drug Eruptions; Female; Humans; Male; Oral Hemorrhage; Rifampin; Thrombocytopenia

This study aims to examine the use and safety of rifampin in the hospitalized infants.. Observational study of clinical and laboratory adverse events among infants exposed to rifampin from 348 neonatal intensive care units managed by the Pediatrix Medical Group between 1997 and 2012.. Overall, 2,500 infants received 4,279 courses of rifampin; mean gestational age was 27 weeks (5th, 95th percentile; 23, 36) and mean birth weight was 1,125 g (515; 2,830). Thrombocytopenia (121/1,000 infant days) and conjugated hyperbilirubinemia (25/1,000 infant days) were the most common laboratory adverse events. The most common clinical adverse events were medical necrotizing enterocolitis (64/2,500 infants, 3%) and seizure (60/2,500 infants, 2%).. The overall incidence of adverse events among infants receiving rifampin appears low; however, additional studies to further evaluate safety and dosing of rifampin in this population are needed.

Topics: Antibiotics, Antitubercular; Birth Weight; Enterocolitis, Necrotizing; Female; Gestational Age; Hospitalization; Humans; Hyperbilirubinemia; Infant; Infant, Extremely Premature; Infant, Newborn; Infant, Very Low Birth Weight; Intensive Care Units, Neonatal; Male; Rifampin; Seizures; Thrombocytopenia

We aimed to examine cases of brucellosis that presented with severe thrombocytopenia and hemorrhagic diathesis.. A total of 10 brucellosis cases with severe thrombocytopenia were included in this case-series study. Patients' files were reviewed for their clinical and laboratory findings, as well as clinical outcomes and complications. Platelet counts of < 20,000/mm³ were diagnosed as severe thrombocytopenia.. The lowest thrombocyte count was 3000/mm³ while the highest was 19,000/mm³ (mean: 12,000/mm³). Patients had the following symptoms: epistaxis (7 cases), petechia with epistaxis (4 cases), bleeding gums (3 cases), ecchymosis with epistaxis (2 cases), melena and renal failure (2 cases), and hematuria (1 case). Patients were given rifampicin and doxycycline along with supportive hematological therapy. All were treated successfully with no evidence of recurrence at follow-up visits.. Since brucellosis is endemic in developing countries, it must be considered in the differential diagnosis of cases that present with severe thrombocytopenia and hemorrhagic diathesis.

Topics: Brucellosis; Hemorrhagic Disorders; Humans; Platelet Count; Rifampin; Thrombocytopenia

A 49-year-old man was admitted to the hospital with complaints of fatigue, epistaxis and a skin rash. The whole blood count revealed isolated thrombocytopenia (4,000/mL), and the patient was admitted to the hematology department with a diagnosis of immune thrombocytopenia. He did not respond to steroid treatment for 15 days, and a subfebrile fever developed during this period. A diagnosis of acute brucellosis was considered due to positive serological tests and a blood culture positive for Brucella spp. After starting doxycycline and rifampicin therapy, the patient's thrombocyte count increased to 15,000/mL on the third day, to 41,000/mL on the sixth day and was normal on the 21st day of treatment. A diagnosis of brucellosis must be considered in patients presenting with severe and isolated thrombocytopenia in countries where brucellosis is endemic.

Topics: Animals; Anti-Bacterial Agents; Brucellosis; Diagnosis, Differential; Doxycycline; Drug Therapy, Combination; Humans; Male; Middle Aged; Platelet Count; Purpura, Thrombocytopenic, Idiopathic; Rifampin; Thrombocytopenia; Turkey; Zoonoses

A 49-year-old-woman was diagnosed with tuberculosis of the left humerus. She had received treatment, including rifampicin, for tuberculosis 17 years previously. Treatment was begun with isoniazid, rifampicin, ethambutol, and pyrazinamide, but these were discontinued because of mild neutropenia and thrombocytopenia 2 weeks posttreatment. Rifampicin and ethambutol were readministered after a 4-day interruption; however, generalized purpura appeared several hours later. By the next day, her platelet count was reduced from 160 × 10(3) to 3 × 10(3)/μl. The patient improved rapidly after platelet transfusion and steroid treatment. Readministration of drugs other than rifampicin did not induce thrombocytopenia; therefore, thrombocytopenia was likely due to rifampicin.

Topics: Acute Disease; Antitubercular Agents; Ethambutol; Female; Humans; Humerus; Middle Aged; Rifampin; Severity of Illness Index; Thrombocytopenia; Tuberculosis, Osteoarticular

Topics: Adult; Cross Reactions; Female; Humans; Respiratory Tract Diseases; Rifabutin; Rifampin; Thrombocytopenia

Thrombocytopenia is a major adverse effect of several drug treatments. Rifampicin has been recognized as a cause of immune thrombocytopenia. A 68-year-old woman diagnosed with pulmonary tuberculosis was taking the standard four-drug antituberculosis regimen for 4 months. She presented with decreased responsiveness and headache. Brain MRI revealed subdural hemorrhage along the falx cerebri and high convexity. The platelet count was 8,000 microL(-1). Intracranial hemorrhage due to rifampicin-induced thrombocytopenia has not, to our knowledge, been previously reported. We report a patient with acute subdural hemorrhage associated with rifampicin-induced thrombocytopenia.

Topics: Acute Disease; Aged; Antitubercular Agents; Brain; Female; Hematoma, Subdural; Humans; Magnetic Resonance Imaging; Rifampin; Thrombocytopenia; Time Factors; Tuberculosis, Pulmonary

Linezolid therapy has shown high rates of clinical success in patients with osteomyelitis and prosthetic joint infections caused by Gram-positive cocci. Recent studies have demonstrated that linezolid/rifampicin combination therapy prevents the emergence of rifampicin-resistant mutations in vitro. However, linezolid/rifampicin combination-related haematological and neurological toxicities have not been evaluated.. To assess the tolerability of prolonged linezolid/rifampicin combination therapy compared with other linezolid-containing regimens in patients with bone and joint infections.. We reviewed the medical records of 94 patients who had received linezolid for >4 weeks after bone and joint infections. Anaemia was defined as a ≥2 g/dL reduction in haemoglobin, leucopenia as a total leucocyte count <4 × 10(9)/L, and thrombocytopenia as a reduction in platelet count to <75% of baseline.. Anaemia was less frequent among patients on linezolid/rifampicin combination therapy than among patients on linezolid alone or in combination with other drugs (9.3%, 44% and 52%, respectively; P<0.01). In multivariate analysis, age and treatment group were independently associated with anaemia. Thrombocytopenia was reported in 44% of patients on linezolid/rifampicin combination therapy, in 48% of patients on linezolid alone and in 57.7% of patients on other linezolid-containing regimens. Age was the only variable associated with thrombocytopenia (P=0.019) in univariate analysis.. Linezolid/rifampicin combination therapy was associated with a significantly reduced incidence of anaemia among patients with bone and joint infections, but it did not have an effect on thrombocytopenia and peripheral neuropathy rates. Linezolid/rifampicin combination therapy was not associated with poor clinical outcomes.

Topics: Acetamides; Adult; Aged; Aged, 80 and over; Anemia; Anti-Bacterial Agents; Arthritis, Infectious; Drug Therapy, Combination; Female; Humans; Incidence; Linezolid; Male; Middle Aged; Nervous System Diseases; Osteoarthritis; Oxazolidinones; Rifampin; Thrombocytopenia; Time Factors; Treatment Outcome

Topics: Adult; Antibiotics, Antitubercular; Female; Humans; Rifampin; Thrombocytopenia; Tuberculosis, Pulmonary

We report the case of a 13-year-old girl with tuberculosis who developed persistent symptomatic thrombocytopenia whilst being treated with rifampicin and isoniazid. There was widespread agreement that rifampicin was the likely cause of the thrombocytopenia. After discussion with the family we elected to continue treatment as we believed that the potential benefits of continuing treatment outweighed the risks of thrombocytopenia. Despite continued treatment the platelet count returned to normal after a few weeks. We found that thrombocytopaenia may be transient even when therapy is continued and would recommend a watchful waiting strategy to others faced with a similar clinical dilemma.

Topics: Adolescent; Antibiotics, Antitubercular; Female; Humans; Isoniazid; Lung; Radiography; Rifampin; Thrombocytopenia; Treatment Outcome; Tuberculosis, Pulmonary

Drug-induced thrombocytopenia is an uncommon but serious side effect of many drugs including antituberculosis drugs. It is difficult to diagnose but easy to prevent just by stopping the exposure to the same drug again. In some cases, it can prove fatal if not taken care of urgently. Here, we report a case of thrombocytopenia due to rifampicin, ethambutol and pyrazinamide all in an adult male, which we believe is the first to be reported.

Topics: Aged; Antitubercular Agents; Drug Therapy, Combination; Ethambutol; Humans; Male; Pyrazinamide; Rifampin; Thrombocytopenia

Topics: Aged; Anti-Bacterial Agents; Bacteremia; Combined Modality Therapy; Daptomycin; Device Removal; Drug Therapy, Combination; Endocarditis, Bacterial; Fatal Outcome; Female; Gentamicins; Hip Prosthesis; Humans; Methicillin-Resistant Staphylococcus aureus; Mitral Valve; Postoperative Complications; Prosthesis-Related Infections; Respiratory Distress Syndrome; Rifampin; Staphylococcal Infections; Thrombocytopenia; Vancomycin

Topics: Acute Kidney Injury; Aged; Humans; Male; Rifampin; Thrombocytopenia; Vasculitis, Leukocytoclastic, Cutaneous

Hematological disturbances that develop during linezolid treatment are a major concern when linezolid is administered for prolonged periods of time. The aim of this study was to evaluate the influences of pyridoxine, rifampin, and renal function on hematological adverse events. From January 2002 to April 2006, 52 patients received a long-term course of linezolid. Blood cell counts were monitored weekly. Thrombocytopenia was defined as a decrease to <75% of the baseline platelet count, and anemia was defined when the hemoglobin concentration decreased by > or =2 g/liter from the baseline value. Twenty-four patients received linezolid alone, and 28 patients received linezolid plus 200 mg of pyridoxine. The Kaplan-Meier survival method, followed by the log-rank test, was used to estimate the cumulative probability of adverse events, and Cox regression analysis was performed to evaluate the independent predictors of toxicity. The baseline characteristics of the patients in both groups were similar. The cumulative probability of thrombocytopenia and anemia in patients who received pyridoxine was not different from that in patients who did not receive it. Hematological adverse events were less frequent in patients taking rifampin and were more frequent in patients with renal failure. However; the Cox regression analysis showed that rifampin was the only independent predictor associated with a lower risk of thrombocytopenia (hazard ratio, 0.37; 95% confidence interval, 0.14 to 0.98; P = 0.045). In conclusion, pyridoxine did not prevent linezolid-related hematological adverse events, and the coadministration of rifampin was associated with a lower risk of thrombocytopenia.

Topics: Acetamides; Aged; Aged, 80 and over; Anemia; Anti-Infective Agents; Blood Glucose; Cohort Studies; Creatinine; Drug Therapy, Combination; Female; Glomerular Filtration Rate; Humans; Linezolid; Male; Middle Aged; Oxazolidinones; Platelet Count; Pyridoxine; Retrospective Studies; Rifampin; Thrombocytopenia

Thrombocytopenia is an uncommon but potentially life threatening complication of certain anti-tubercular drugs and is characterized by rapid destruction of platelets whenever an offending drug is taken by a susceptible person. Here is a case report of Rifampicin induced Thrombocytopenia. This case is being reported for purpose of its rare occurrence and documentation.

Topics: Adult; Antibiotics, Antitubercular; Female; Humans; Purpura; Rifampin; Thrombocytopenia; Tuberculosis, Pulmonary

Brucellosis continues to be an important cause of fever in underdeveloped countries and in rural areas of developed world. It is a multisystemic disease, associated with wide variety of symptoms. A wide variety of symptoms, including haematological abnormalities, such as anaemia, thrombocytopenia, pancytopenia, dissemine intravascular coagulation and leucopoenia could be seen, all of which are more common than usually thought. In this short study, we present a relatively uncommon haematological manifestation that of isolated thrombocytopenia mimicking idiopathic thrombocytopenic purpura, which we observed in seven of 114 patients who were diagnosed with brucellosis in our hospital over a 2-year period. Having given brucellosis treatment with rifampicin and doxycycline, complete remission was achieved and thrombocyte count returned to normal in all cases.

Topics: Adult; Aged; Antibiotics, Antitubercular; Brucellosis; Diagnosis, Differential; Doxycycline; Female; Humans; Male; Middle Aged; Purpura, Thrombocytopenic, Idiopathic; Rifampin; Thrombocytopenia

The hematological manifestations of brucellosis include anemia, leucopenia, thrombocytopenia and clotting disorders. In this case report, two patients, with clinically and serologically proven brucellosis, manifesting with thrombocytopenia were presented. The first patient who was a 32 years old man, was admitted to the hospital with the complaints of fever, malaise and night sweats. His Brucella agglutination titer was 1/1280 and thrombocyte count was 41.000/mm3. The second case was a 46 years old man with the complaints of fever and rash. His Brucella agglutination titer was 1/640, thrombocyte count was 38.000/mm3. Following treatment with doxycycline and rifampisin the thrombocyte counts of the patients returned to normal (respectively, 176.000/mm3 and 162.000/mm3. The blood cultures of both of these patients did not yield Brucella. The antibiotic therapy of patients discontinued after 6 weeks, with full recovery.

Topics: Adult; Agglutination Tests; Anti-Bacterial Agents; Antibodies, Bacterial; Brucella; Brucellosis; Doxycycline; Drug Therapy, Combination; Humans; Male; Middle Aged; Platelet Count; Rifampin; Thrombocytopenia

A 74-year-old female visited a local clinic complaining of fever on January 21, 2002. A chest X-ray and a chest computed tomography (CT) showed diffuse micronodules in all lung fields, which strongly suggested miliary tuberculosis. On January 23, she was referred to our hospital for further examinations. Though sputum was negative on smear, culture, and polymerase chain reaction (PCR) for M. tuberculosis, bone marrow aspirate examined on admission revealed epithelioid granuloma. Therefore we diagnosed her as a miliary tuberculosis, and she was treated with 300 mg of Isoniazid (INH), 450 mg of Rifampicin, and 750 mg of Streptomycin (SM) daily. Five days later, severe thrombocytopenia (platelet count 0.3 x 10(4)/microliter) was observed. We immediately discontinued all antituberculous drugs and administered concentrated platelets and immune globulin. Platelet-associated IgG was detected, and megakaryocytes were slightly increased in moderately hypocellular marrow on the bone marrow aspirate examined again after the appearance of thrombocytopenia. Eleven days after discontinuing all antituberculous drugs, platelet count recovered to 10.2 x 10(4)/microliter. INH, SM, Levofloxacin (LV) were administered afterward, and these drugs did not induce thrombocytopenia. Though challenge administration of RFP was not performed, we concluded that the thrombocytopenia was immunologically induced by RFP. We should keep in mind that RFP-induced thromobocytopenia could appear in the first week after the initiation of therapy.

Topics: Aged; Female; Humans; Rifampin; Thrombocytopenia; Tuberculosis, Miliary

The side effects of rifampicine due to an immunoallergic mechanism are rare and usually observed during discontinued treatment or administration of high doses.. An immediate hypersensitivity reaction with anaphylactic manifestations and increase in IgE occurred in a 39 year-old man suffering from resistant tuberculosis. The reaction occurred within the first hour following a low dose of rifampicin administered in a desensitisation attempt, the outcome of which was favourable after administration of corticosteroids and antihistamines. A type II hypersensitivity reaction occurred in a 76 year-old male patient in the form of thrombopenia on D76 of a twice weekly treatment, diagnosed because of hemoptysis with normalisation of platelet level on withdrawal of rifampicin. An immune complex hypersensitivity reaction was responsible for hepato-renal failure on D68 of twice weekly treatment and required permanent withdrawal of rifampicin and dialysis, which led to subsequent improvement.. These clinical cases illustrate the variability of the hypersensitivity mechanisms observed with rifampicin, the difficulty in imputability tests and methods for immunological confirmation, the interest of continuous treatment which avoids a certain number of these accidents, and that of desensitisation during immediate hypersensitive reactions which permits the continuation this major anti-tuberculosis drug.

Topics: Acute Kidney Injury; Adult; Aged; Anaphylaxis; Antibiotics, Antitubercular; Antigen-Antibody Complex; Desensitization, Immunologic; Drug Hypersensitivity; Humans; Hypersensitivity, Immediate; Liver Failure; Male; Platelet Count; Rifampin; Thrombocytopenia; Time Factors

Topics: Adrenal Cortex Hormones; Antineoplastic Combined Chemotherapy Protocols; Antitubercular Agents; Asparaginase; Comorbidity; Daunorubicin; HIV Infections; Humans; Immunocompromised Host; Immunosuppressive Agents; Incidence; India; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prednisone; Purpura, Thrombocytopenic, Idiopathic; Retrospective Studies; Rifampin; Thrombocytopenia; Tuberculosis; Vincristine

Topics: Adult; Anemia, Hemolytic; Female; Humans; Immunoglobulin E; In Vitro Techniques; Lymphocytes; Rifampin; Thrombocytopenia; Toxicity Tests

The drug-dependent antibody of a patient with rifampicin-induced thrombocytopenia was characterized using the antigen-capture enzyme-linked immunosorbent assay (MAIPA assay), flow cytometry, and immunoprecipitation. The antibody was found to bind glycoprotein (GP) Ib-IX but not GPIIb-IIIa because (1) it immunoprecipitated drug-dependently the former but not the latter glycoprotein complex and (2) the MAIPA assay showed strong rifampicin-dependent antibody binding when anti-GPIb-IX monoclonal antibodies (mAbs) (AK2 and FMC25) but not anti-GPIIb-IIIa mAbs (AP2, SZ21, and SZ22) were used to capture the antigen. The antibody binding site was further localized to the GPIX subunit of the GPIb-IX complex because flow cytometric analysis revealed drug-dependent antibody binding to L cells transfected with human GPIbbeta and GPIX complementary DNA (L betaIX cells) but not with human GPIbalpha and GPIbbeta complementary DNA (L alphabeta cells). Finally, in the MAIPA assay, the rifampicin-dependent antibody almost completely cross-blocked the binding of the anti-GPIX mAb (SZ1) to platelets. Similar cross-blocking of SZ1binding to platelets by the quinine-dependent antibodies was also observed. This finding not only confirms that the epitope of the rifampicin-dependent antibody is on GPIX but it is also identical to or located in close proximity to that of the quinine-dependent antibody and SZ1. Further characterization of the epitopes of these antibodies may have important implications for a general understanding of the mechanism of drug-induced thrombocytopenia. (Blood. 2000;95:1988-1992)

Topics: Aged; Animals; Antibodies, Monoclonal; Binding Sites; Cell Line; CHO Cells; Cricetinae; Enzyme-Linked Immunosorbent Assay; Epitope Mapping; Epitopes; Female; Flow Cytometry; Humans; Mice; Models, Biological; Platelet Glycoprotein GPIb-IX Complex; Precipitin Tests; Protein Structure, Tertiary; Quinine; Rifampin; Thrombocytopenia; Transfection

Topics: Antibiotics, Antitubercular; Female; Humans; Middle Aged; Rifampin; Thrombocytopenia

Topics: Adult; Antibiotics, Antitubercular; Follow-Up Studies; Humans; Male; Rifampin; Risk Assessment; Thrombocytopenia; Tuberculosis, Pulmonary

Since 1971, 55 case-reports of rifampicin-induced ARF have been published, but systematic data on this condition are not available, in view of the disparate nature of the observations.. We retrospectively assessed prevalence, clinical and biochemical features, and prognostic factors of 60 consecutive cases (41 males/19 females, age 22-68 years), who were admitted to the Iasi Dialysis Centre from 1987 to 1995 for acute renal failure (ARF) following re-treatment with rifampicin.. The clinical appearance consisted mainly of gastrointestinal and 'flu-like' symptoms and clinical signs of intravascular haemolysis (the latter in 17% of cases). Frequent laboratory findings were anaemia (96% of cases), leukocytosis (63%), and thrombocytopenia (50%). Severe anaemia was associated with marked haemolysis (25% cases), thrombocytopenia, longer anuria, and slower rate of renal function recovery. Signs of hepatic injury were found in 25% of patients, but it did not seem to affect the outcome of renal function. Prognostic factors in post-rifampicin ARF proved to be the following: the duration of the anuric phase (correlated with the number of dialysis sessions and with the rate of decrease of azotaemia) and the severity of the immunological abnormalities and inflammatory syndrome (haemolysis, leukocytosis, hypergammaglobulinaemia). Post-rifampicin ARF accounted for 16.6% of all ARF cases hospitalized in our Centre during the studied period. Its clinical course was favourable; the mortality rate was only 1.6% (1 case), compared to a 20% general mortality rate among all ARF patients. Full recovery of renal function was achieved in 40% and 96% of patients, 30 and 90 days respectively from onset.. ARF after treatment with rifampicin is not an uncommon condition, especially when tuberculosis prevalence is high, but renal prognosis is usually favourable. Thrombocytopenia, immune haemolytic anaemia, and intravascular haemolysis are frequent complications which are associated with a more severe renal injury.

Topics: Acute Kidney Injury; Adult; Aged; Anemia; Antibiotics, Antitubercular; Female; Humans; Liver; Male; Middle Aged; Prognosis; Retrospective Studies; Rifampin; Thrombocytopenia

Rifampin is a drug able to induce adverse reactions involving both the kidney and the hematological system. We observed a case, throughly studied and we deemed worth-while to report it, for some important features that were evident. Transient hemolytic anemia, recoverable acute renal failure, persistent increased titer of anti-platelet antibody lasting also after 3 weeks from the withdrawal of the drug and in spite of corticosteroid therapy, could be explained by the immune mechanisms that are, therefore, postulated.

Topics: Aged; Anemia, Hemolytic; Antibiotics, Antitubercular; Autoantibodies; Blood Platelets; Humans; Male; Rifampin; Thrombocytopenia

Topics: Adult; Anti-Inflammatory Agents; Drug Therapy, Combination; Epistaxis; Humans; Leprostatic Agents; Leprosy, Lepromatous; Male; Prednisolone; Rifampin; Thrombocytopenia

Rifampicin-induced thrombocytopenia is reported in three patients with pulmonary tuberculosis. All three patients gave a definite history of having had prior exposure to rifampicin. Immunological studies in all three patients showed the presence of antiplatelet antibodies, resulting in thrombocytopenia. Moreover, binding of these antibodies to the platelet membrane was more avid in the presence of rifampicin, thereby implicating the drug. The avidity of the rifampicin-dependent antibodies was demonstrated by platelet aggregation inhibition test, and estimation of the rifampicin-dependent antibody was done by studying the platelet-associated immunoglobulin [PAlgG] by ELISA which was also used to quantitate antiplatelet antibodies. Immunofluorescence test was also performed to detect antiplatelet antibodies.

Topics: Adult; Antibiotics, Antitubercular; Autoantibodies; Autoimmune Diseases; Female; Hemagglutination Tests; Humans; Middle Aged; Platelet Aggregation; Rifampin; Thrombocytopenia; Tuberculosis, Pulmonary

Topics: Adult; Antibiotics, Antitubercular; Antitubercular Agents; Drug Therapy, Combination; Female; Humans; Lupus Erythematosus, Systemic; Rifampin; Thrombocytopenia; Tuberculosis, Pulmonary

A 67 year old woman presented with miliary tuberculosis. She was treated with streptomycin, isoniazid, rifampicin, ethambutol and pyrazinamide. However, she developed rifampicin-induced thrombocytopenia after 6 weeks of treatment, and skin rash, blood eosinophilia and pulmonary infiltrates after 8 weeks of therapy. The latter was found to be ethambutol related. Additional evidence, including blood and sputum eosinophilia and the rapidity of its response to corticosteroid, suggested that the pulmonary infiltrates might also be eosinophilic in nature. To the best of our knowledge, this constitutes the first report of such adverse drug reaction, induced by ethambutol.

Topics: Aged; Drug Eruptions; Drug Therapy, Combination; Eosinophilia; Ethambutol; Female; Humans; Isoniazid; Pulmonary Eosinophilia; Pyrazinamide; Radiography; Rifampin; Streptomycin; Thrombocytopenia; Tuberculosis, Miliary

Topics: Adult; Antibiotics, Antitubercular; Antitubercular Agents; Chemical and Drug Induced Liver Injury; Drug Administration Schedule; Drug Hypersensitivity; Ethambutol; Humans; Isoniazid; Male; Middle Aged; Purpura; Pyrazinamide; Rifampin; Streptomycin; Thrombocytopenia; Tuberculosis, Pulmonary

Topics: Adult; Drug Administration Schedule; Ethambutol; Humans; Isoniazid; Male; Rifampin; Thrombocytopenia; Tuberculosis, Pulmonary

We report on a patient who developed life-threatening thrombocytopenia and acute renal failure after the reinstitution of rifampicin therapy for pulmonary tuberculosis. This combined reaction is rarely reported. Supportive treatment and withdrawal of rifampicin led to complete recovery. The increased incidence of drug-resistant tuberculosis and the need for the reintroduction of rifampicin therapy may lead to more such reactions being observed.

Topics: Acute Kidney Injury; Adult; Humans; Male; Rifampin; Severity of Illness Index; Thrombocytopenia; Tuberculosis, Pulmonary

Topics: Adult; Epistaxis; Humans; Leprosy; Male; Rifampin; Thrombocytopenia

Topics: Aged; Aged, 80 and over; Humans; Male; Rifampin; Thrombocytopenia; Tuberculosis, Pulmonary

Topics: Adult; Humans; Male; Rifampin; Thrombocytopenia; Time Factors; Tuberculosis

In this report, a case of rifampin-induced immune thrombocytopenia with the following characteristics is described: (a) thrombocytopenia follows intermittent drug administration; (b) onset occurs within hours of drug ingestion; (c) IgG antirifampin antibody binds in vitro to normal platelets only in the presence of rifampin; (d) thrombocytopenia resolves quickly in the absence of rifampin; (e) using immunofluorescence microscopy, IgG binding to normal platelets was seen with the patient's serum only in the presence of rifampin, and (f) using fluorescence spectrofluorometry, an absence of rifampin binding to normal platelets was demonstrated. Although the serological studies are not definitive, the mechanism of thrombocytopenia in the patient can best be explained by the formation of immune complexes composed of rifampin-antirifampin antibody binding to platelets causing their rapid clearance from the circulation.

Topics: Adolescent; Blood Platelets; Drug Administration Schedule; Female; Humans; Immunoglobulin G; Leprosy, Lepromatous; Rifampin; Thrombocytopenia; Time Factors

Rifampin can be associated with severe adverse effects such as hepatitis, acute renal failure, hemolytic anemia, and thrombocytopenia. Thrombocytopenia has traditionally been associated with intermittent therapy. This article reports the occurrence of rifampin-associated thrombocytopenia in an indigent patient after a four-month lapse in therapy for pulmonary tuberculosis. The patient's platelet count dropped rapidly to a level of 1000/mm3 after receiving a single 600 mg dose of rifampin. After returning to a normal level of greater than 100,000/mm3, the patient's platelets again dropped to 1200/mm3 with readministration of rifampin. The long-term therapy necessary to eradicate the Mycobacterium tuberculosis organism makes economic considerations important. This patient and other indigent patients who may be poor compliers because they are unable to buy the necessary medication may be at a higher risk for adverse reactions.

Topics: Adult; Humans; Male; Patient Compliance; Platelet Count; Rifampin; Thrombocytopenia; Tuberculosis

Thrombocytopenia is occasionally caused by rifampicin, when high-doses are given twice-weekly. This complication is rare when the medication is given in small daily doses, or following a prolonged interruption of therapy. Two cases of rifampicin-induced thrombocytopenia are reported. One occurred within four days of the initiation of small daily doses and the other following a prolonged interruption of therapy.

Topics: Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Rifampin; Thrombocytopenia; Time Factors; Tuberculosis, Pulmonary

Topics: Acute Disease; Adult; Anti-Bacterial Agents; Brucellosis; Drug Therapy, Combination; Humans; Male; Rifampin; Tetracyclines; Thrombocytopenia

Rifampin-induced thrombocytopenia has been recognized as an immunological reaction associated with intermittent high-dose therapy, and rarely seen with daily low-dose regimens. Our patient was a 33-year-old male with Marfan's syndrome who was given rifampin 600 mg/d po along with intravenous vancomycin for the treatment of Staphylococcus epidermidis endocarditis. His platelet count dropped from a baseline of 519,000/mm3 to 4000/mm3 after four doses of rifampin. Petechiae were present on the lower extremities without the presence of other bleeding sites. Rifampin, low-dose aspirin, and dipyridamole were discontinued. His platelet count returned to normal nine days after discontinuation of therapy. With the increasing use of rifampin for the treatment of nontuberculosis infections, clinicians should recognize the possibility of this drug causing such serious immunological reactions as thrombocytopenia, hemolytic anemia, acute renal failure, and shock with daily or intermittent therapy.

Topics: Adult; Endocarditis, Bacterial; Humans; Male; Rifampin; Staphylococcal Infections; Thrombocytopenia

The benign, or infection-associated, haemophagocytic syndrome (IAHS) is a rare bone marrow disorder of macrophage cell proliferation diagnosed most commonly in immune compromised patients who develop herpes type viral infections (Risdall et al. 1979). It has also been reported in association with bacterial infections and rarely with mycobacterial infection (Chandra et al. 1975; Mamoharon & Catovsky 1981; Bultmann et al. 1982). Despite being potentially reversible it may produce a life-threatening pancytopenia (Seligman et al. 1972). We report a further case of the haemophagocytic syndrome associated with Mycobacterium tuberculosis in which thrombocytopenia was the predominant feature. There were unusual features in the clinical presentation and the patient's treatment and recovery were subsequently complicated by rifampicin-induced renal failure.

Topics: Bone Marrow; Humans; Male; Middle Aged; Myeloproliferative Disorders; Nephritis, Interstitial; Phagocytosis; Platelet Count; Rifampin; Syndrome; Thrombocytopenia; Tuberculosis, Pulmonary

Leucopenia (= leucocyte count 3000 cells/microliters or less) caused by 2 rifampicin preparations used in daily tuberculosis chemotherapy was studied. In a group of 140 patients treated with Rimapen (Orion, Finland ), 11 cases (7.9%) of leucopenia were detected. In a group of 132 patients treated with Rimactan (Ciba-Geigy, Switzerland) one case of leucopenia (0.8%) occurred. The difference is statistically significant (p less than 0.01). The frequency of leucopenia in the Rimapen group was much higher than that reported in the literature. In cases of leucopenia caused by rifampicin the recommended measure is withdrawal of the drug or continued treatment under careful observation. If possible, rifampicin treatment should not be resumed after a pause, irrespective of its length.

Topics: Bone Marrow; Drug Therapy, Combination; Humans; Leukocyte Count; Leukopenia; Platelet Count; Rifampin; Thrombocytopenia; Tuberculosis, Pulmonary

Rifampicin occasionally causes thrombocytopenia when given as part of an intermittent regimen. A case is reported of severe thrombocytopenia developing after one dose of rifampicin, following a 4-month gap in daily therapy. The literature on rifampicin-induced thrombocytopenia is reviewed.

Topics: Adult; Drug Administration Schedule; Humans; Male; Rifampin; Thrombocytopenia

Topics: Anemia; Anti-Inflammatory Agents; Antibiotics, Antineoplastic; Aspirin; Bone Marrow Diseases; Hematologic Diseases; Humans; Leukemia, Myeloid, Acute; Neutropenia; Rifampin; Thrombocytopenia

Although short-course, largely twice weekly chemotherapy for treatment of tuberculosis has been shown to be effective in other countries, when given under closely controlled conditions, it has not been adopted in this country where most patients are older and are treated as outpatients. Since January, 1976, 315 patients (mean age 55.5 years) with proven pulmonary tuberculosis have been treated with rifampin (RIF) 600 mg and isoniazid (INH) 300 mg daily for one month, followed by RIF 600 mg and INH 900 mg twice-weekly for another eight months, self-administered except for a few patients. By three months, 95 percent had converted to negative culture. There were only ten failures among 185 patients in whom final results could be assessed. There has been only one relapse during 1-21 months of follow-up in 175 patients. Serious side effects were few: six instances of jaundice, two of "flu-like syndrome," and one of thrombocytopenia. This form of initial therapy for tuberculosis is safe, effective, and economical.

Topics: Adolescent; Adult; Aged; Drug Hypersensitivity; Humans; Isoniazid; Jaundice; Middle Aged; Rifampin; Thrombocytopenia; Time Factors; Tuberculosis, Pulmonary; Vomiting

Topics: Adult; Aminosalicylic Acid; Antitubercular Agents; Central Nervous System Diseases; Chemical and Drug Induced Liver Injury; Child; Drug Interactions; Ethambutol; Female; Humans; Immunosuppression Therapy; Isoniazid; Optic Neuritis; Phenytoin; Pregnancy; Rifampin; Streptomycin; Thrombocytopenia

Topics: Chemical and Drug Induced Liver Injury; Drug Hypersensitivity; Drug Synergism; Humans; Rifampin; Thrombocytopenia; Tuberculin Test

Topics: Adult; Female; Humans; Rifampin; Thrombocytopenia; Tuberculosis, Pulmonary

Topics: Acute Disease; Acute Kidney Injury; Anticoagulants; Contraceptives, Oral; Digitoxin; Female; Hemolysis; Humans; Nephritis, Interstitial; Rifampin; Thrombocytopenia; Tuberculosis

Topics: Bone Marrow; Bone Marrow Examination; Cholestasis; Erythema; Ethambutol; Humans; Isoniazid; Leukopenia; Male; Middle Aged; Neutropenia; Peritonitis, Tuberculous; Rifampin; Streptomycin; Thrombocytopenia; Tuberculosis; Tuberculosis, Hepatic; Tuberculosis, Osteoarticular; Tuberculosis, Splenic; Vitamin B Complex

Topics: Anemia, Hemolytic; Coombs Test; Fever; Humans; Jaundice; Pain; Rifampin; Thrombocytopenia

Topics: Antibody Formation; Drug Therapy, Combination; Ethambutol; Fever; Humans; In Vitro Techniques; Lymphocytes; Rifampin; Thrombocytopenia

Topics: Adult; Aged; Agranulocytosis; Anaphylaxis; Antitubercular Agents; Capreomycin; Cycloserine; Drug Hypersensitivity; Ethambutol; Ethionamide; Female; Humans; Isoniazid; Kanamycin; Pyrazinamide; Rifampin; Thrombocytopenia; Viomycin

Topics: Female; Gingival Diseases; Humans; Middle Aged; Oral Hemorrhage; Rifampin; Thrombocytopenia

Topics: Adult; Antitubercular Agents; Drug Hypersensitivity; Ear; Ethambutol; Female; Humans; Isoniazid; Liver; Male; Polyneuropathies; Rifampin; Streptomycin; Thrombocytopenia

Topics: Acute Kidney Injury; Adult; Drug Hypersensitivity; Humans; Jaundice; Male; Rifampin; Thrombocytopenia

Topics: Alcoholism; Aspartate Aminotransferases; Bilirubin; Chronic Disease; Ethambutol; Humans; Liver Cirrhosis; Male; Melena; Middle Aged; Recurrence; Rifampin; Sputum; Thrombocytopenia; Tuberculosis, Pulmonary

Topics: Alcoholism; Chronic Disease; Humans; Liver Cirrhosis; Male; Middle Aged; Rifampin; Thrombocytopenia; Tuberculosis

Topics: Aged; Humans; Male; Purpura, Thrombocytopenic; Rifampin; Thrombocytopenia

Topics: Aminocaproates; Asthenia; Drug Hypersensitivity; Female; Fever; Gastrointestinal Diseases; Headache; Humans; Middle Aged; Rifampin; Thrombocytopenia; Tuberculosis, Pulmonary; Vertigo

Topics: Acute Kidney Injury; Adolescent; Adult; Antibodies; Child; Complement Fixation Tests; Epistaxis; Female; Fever; Humans; Isoniazid; Male; Middle Aged; Rifampin; Streptomycin; Thrombocytopenia; Tuberculosis

Topics: Adult; Aged; Drug Hypersensitivity; Female; Humans; Male; Middle Aged; Purpura, Thrombocytopenic; Rifampin; Thrombocytopenia; Tuberculosis, Pulmonary

Daily rifampicin in a single dose of 600 mg, combined with other drugs, usually streptomycin and isoniazid, was given to 49 patients for three months. It was planned to continue for another 15 months with twice-weekly rifampicin 1,200 mg plus isoniazid 900 mg, but the high incidence of side effects led to cessation of the intermittent regimen when only two patients had completed 18 months.Though there was no serious problem with daily treatment 11 patients (22%) were unable to continue rifampicin on the intermittent regimen. In 8 (16%) a pyrexial syndrome occurred. In one of these patients there was also temporary renal failure, and in another precipitous thrombocytopenia led to epistaxis and bleeding into the tongue and lips. Symptomless thrombocytopenia developed in two other patients, making three cases (6%) of thrombocytopenia in all.In 16 (33%) of the 49 patients antibodies to rifampicin were detected in the blood. Side effects occurred in 9 (56%) of these, including the three developing thrombocytopenia, but in only 2 (6%) of the 33 patients with no antibodies detected. This association of toxic reactions with antibodies is highly significant (P<0.001).

Topics: Acute Kidney Injury; Adolescent; Adult; Aged; Antibodies; Child; Coombs Test; Epistaxis; Female; Fever; Humans; Isoniazid; Lip; Male; Middle Aged; Oral Hemorrhage; Rifampin; Streptomycin; Thrombocytopenia; Tongue Diseases; Tuberculosis, Pulmonary

Topics: Female; Humans; Rifampin; Thrombocytopenia; Tuberculosis

A case is reported in which severe thrombocytopenia occurred during administration and readministration of rifampicin. The patient's erythrocytes gave a positive direct antiglobulin test due to complement on the red cell surface; in the serum, complement-fixing antibodies were detected which were directed against the drug.Immunological studies showed antibodies, of both IgG and IgM type, capable of fixing complement to both normal and the patient's platelets, but only in the presence of rifampicin. In addition the IgM type of antibody (but not the IgG) was capable of fixing complement to normal red cells; again only in the presence of the drug.

Topics: Antibodies; Complement Fixation Tests; Coombs Test; Erythrocytes; Female; Humans; Immunoglobulin G; Immunoglobulin M; Mercaptoethanol; Middle Aged; Rifampin; Thrombocytopenia

Topics: Female; Humans; Middle Aged; Rifampin; Thrombocytopenia