rifampin and Tuberculoma

Topics: Aged; Antitubercular Agents; Axilla; Drug Therapy, Combination; Humans; Isoniazid; Lupus Vulgaris; Male; Mycobacterium bovis; Pyrazinamide; Rifampin; Tuberculoma; Tuberculosis, Lymph Node; Ultrasonography

A 14 year old girl presented with a 6-month history of headaches and visual blurring. CT showed a right tentorial enhancing lesion. Angiogram showed no enhancement. Histopathological examination of the excised material was consistent with tuberculoma. The presentation of such unusual intracranial tuberculoma is reported and the literature reviewed on the subject.

Topics: Adolescent; Antitubercular Agents; Brain Diseases; Drug Therapy, Combination; Female; Humans; Isoniazid; Pyrazinamide; Rifampin; Tomography, X-Ray Computed; Tuberculoma

Tuberculous meningitis is a rare, treatable neurologic disorder, in which early recognition is paramount because outcome depends greatly on the speed with which therapy is initiated. Patients with meningitis and CSF findings of low glucose, elevated protein and pleocytosis with evidence of tuberculosis elsewhere in the body (chest radiographs, positive tuberculin skin test), or a history of exposure to tuberculosis should be treated immediately with antituberculous medication. When the diagnosis remains uncertain, serial examination of the CSF for tuberculous organisms will often yield positive results. The CT scan may show hydrocephalus, a basilar arachnoiditis, or intraparenchymal lesions: tuberculomas. Hydrocephalus may respond to early shunting. Tuberculomas are best treated medically. Therapy should include INH and rifampin; ethambutol and pyrazinamide are suggested for the first 2 months of therapy. Steroids may be useful in diminishing the inflammatory response when altered consciousness or focal neurologic signs are present.

Topics: Biopsy; Cerebral Ventricles; Cerebrospinal Fluid; Ethambutol; Humans; Hyaluronoglucosaminidase; Isoniazid; Nervous System Diseases; Prognosis; Pyrazinamide; Rifampin; Streptomycin; Tomography, X-Ray Computed; Tuberculoma; Tuberculosis, Meningeal

35 children with suspected tuberculomas of the brain were given a therapeutic 4-drug trial of isoniazid, rifampicin, pyrazinamide and ethambutol. Their clinical and computed tomographic (CT) appearances were analysed retrospectively: 32 responded well to treatment with recognizable improvement on CT after 6 weeks. Three patients did not respond. One of these non-responders had a surgically removed temporal cystic astrocytoma. The majority presented with focal seizures and had a single hemispheral lesion. 14% had multiple lesions, 6% were in the cerebellum. Only 2 patients had raised intracranial pressure and required ventriculoperitoneal shunting.

Topics: Adolescent; Antitubercular Agents; Brain Diseases; Child; Child, Preschool; Combined Modality Therapy; Ethambutol; Female; Humans; Infant; Isoniazid; Male; Pyrazinamide; Retrospective Studies; Rifampin; Tomography, X-Ray Computed; Tuberculoma

A three-month old baby girl presented with fever of unknown origin and with signs of worsening of this episode. Funduscopy showed a solitary choroidal lesion in her left eye, as well as extraocular lesions suggesting disseminated tuberculosis. A favourable outcome was achieved after quadruple antibiotic course and cortisone therapy. Disseminated tuberculosis should be considered in cases of fever of unknown origin in children with an unsatisfactory evolution. Ocular examination is mandatory, due to the possible posterior uveitis signs that can help with early diagnosis and treatment of some diseases.

Topics: Adrenal Cortex Hormones; Amikacin; Antitubercular Agents; Choroid Diseases; Drug Therapy, Combination; Ethambutol; Female; Humans; Infant; Isoniazid; Ophthalmoscopy; Pyrazinamide; Rifampin; Tuberculoma; Tuberculosis, Miliary; Tuberculosis, Ocular; Uveitis, Posterior

Tuberculomas optoquiasmaticos como reaccion paradojica al tratamiento de tuberculosis meningea.

Topics: Adult; Antitubercular Agents; Brain Infarction; Diagnostic Errors; Disease Progression; Drug Resistance, Microbial; Drug Substitution; Ethambutol; Female; Host-Pathogen Interactions; Humans; Isoniazid; Magnetic Resonance Imaging; Meningitis, Viral; Moxifloxacin; Mycobacterium tuberculosis; Neuroimaging; Optic Chiasm; Paresis; Prednisone; Pyrazinamide; Rifampin; Thalamus; Tuberculoma; Tuberculosis, Meningeal; Vision Disorders

Tuberculosis, which typically presents as a pulmonary disease, has a complex pathology. The primary site of infection, the Ghon focus, recruits immune cells and a granuloma forms. At earlier stages the granuloma is still vascularized, offering the best opportunity for drug treatment. In the more progressive state blood flow is reduced and a distinct caseous structure develops. Effective delivery of drugs to bacilli in the core of the granuloma becomes very difficult. It is perceivable that granuloma cores could create conditions where bacilli persist and develop resistance. In this study we analyze drug delivery to granulomas by means of a nanoparticle delivery system. The model consists of two parts; the overall distribution of the nanoparticles is described by a simple circulatory model and this result is used in the second part, focusing on transport in a capillary lined with macrophages. Nanoparticles enter the macrophages where they are metabolized and the drugs are released. The model reveals significant differences in drug concentrations between the plasma and macrophages. Based on the results of the model, strategies for improved drug delivery are proposed.

Topics: Algorithms; Animals; Antitubercular Agents; Biological Transport; Drug Delivery Systems; Host-Pathogen Interactions; Humans; Macrophages; Models, Theoretical; Mycobacterium tuberculosis; Nanoparticles; Rifampin; Time Factors; Tuberculoma

Topics: Aged; Antitubercular Agents; Choroid Diseases; Drug Therapy, Combination; Ethambutol; Eye Infections, Bacterial; Eye Pain; Female; Humans; Interferon-gamma Release Tests; Isoniazid; Mycobacterium tuberculosis; Pyrazinamide; Radiography, Thoracic; Rifampin; Scleritis; Skin Tests; Tuberculoma; Tuberculosis, Ocular

We herein report a clinical pitfall regarding the treatment of a case of pulmonary tuberculoma in a patient with chronic hepatitis C. The patient presented with both chronic hepatitis C and pulmonary tuberculoma, and we initiated treatment of the chronic hepatitis C first due to the potential for liver injury; however, the patient's condition worsened in terms of the pulmonary tuberculosis. This case highlights the need to select the initial treatment for pulmonary tuberculoma, not chronic hepatitis C. In addition, we report that, although the administration of anti-tuberculosis chemotherapy regimens containing pyrazinamide (PZA) substantially increases the incidence of drug-induced hepatitis in patients with chronic hepatitis, we were fortunately able to use PZA without observing drug-induced hepatitis in this case because we closely monitored the patient's liver function.

Topics: Antitubercular Agents; Antiviral Agents; DNA, Viral; Drug Therapy, Combination; Female; Follow-Up Studies; Hepacivirus; Hepatitis C, Chronic; Humans; Image-Guided Biopsy; Isoniazid; Lung; Middle Aged; Mycobacterium tuberculosis; Practice Guidelines as Topic; Pyrazinamide; Rifampin; Tomography, X-Ray Computed; Tuberculoma; Tuberculosis, Pulmonary

Topics: Adult; Aged, 80 and over; Antitubercular Agents; Aphasia; Child, Preschool; Drug Therapy, Combination; Dystonia; Ethambutol; Facial Pain; Female; Humans; Isoniazid; Magnetic Resonance Imaging; Male; Nigeria; Prednisone; Pyrazinamide; Reflex, Abnormal; Rifampin; Tremor; Tuberculoma; Tuberculosis, Meningeal; Tuberculosis, Miliary

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

Tuberculosis is an endemic disease responsible for death and morbidity in developing countries.. A 50-year-old man with no medical history was admitted to the emergency department for meningism associated with fever and confusion. The ophthalmic exam showed a decline in left visual acuity, reduced to light perception, VIth nerve left oculomotor paralysis, ocular fundus demonstrating a yellow tumor located on the posterior segment, measuring 1.5-2mm, papillomatous and prominent in the vitreous cavity. Fluorescein angiography showed a peritumoral choroiditis area, miliary tubercles of the choroid, and sectorial papillomatous edema. Color retinography unmasked inflamed posterior vitreous areas. Echography demonstrated a 4- to 5-mm oval hyperechogeneous and calcified tumor along with hyperechogeneous vitreous areas. Lumbar puncture showed lymphocytic meningitis associated with hyponatremia. The CT scan and MRI demonstrated optic neuritis. The antibiotic therapy was initiated and the outcome was favorable.. This case report shows the importance of systematic ocular fundus in the presence of systemic tuberculosis and outlines the assessment of color retinography to unmask vitreous lesions. It shows the importance of radiological imaging in the semiological study of orbital and cerebral lesions.

Topics: Adrenal Cortex Hormones; Anti-Inflammatory Agents; Antitubercular Agents; Calcinosis; Confusion; Diplopia; Drug Therapy, Combination; Fever; Humans; Isoniazid; Magnetic Resonance Imaging; Male; Meningoencephalitis; Middle Aged; Optic Neuritis; Papilledema; Pyrazinamide; Rifampin; Spinal Puncture; Streptomycin; Tuberculoma; Tuberculosis, Meningeal; Ultrasonography

Topics: Adult; Antitubercular Agents; Diagnosis, Differential; Drug Therapy, Combination; Humans; Isoniazid; Magnetic Resonance Imaging; Male; Mycobacterium tuberculosis; Rifampin; Spinal Cord Diseases; Tuberculoma; Tuberculosis, Spinal

Neuromeningeal tuberculosis of deleterious, paradoxical, progression despite appropriate antibiotic therapy is rare.. An immunocompetent woman exhibited an immediately disseminated form of tuberculosis with progressive neurological involvement associating expanding intracranial tuberculomas and meningeal-radiculitis despite adapted anti-tuberculosis quadritherapy.. During anti-tuberculosis therapy clinical worsening is rare, particularly when 2 different manifestations are associated and the worsening occurs in an immunocompetent patient. This possibility should be systematically evoked in such cases. The explanation of this phenomenon is still unclear.

Topics: Aged; Anti-Inflammatory Agents; Antitubercular Agents; Confusion; Disease Progression; Drug Therapy, Combination; Female; Fever; Humans; Immunocompetence; Isoniazid; Magnetic Resonance Imaging; Ofloxacin; Prednisone; Radiculopathy; Rifampin; Spinal Puncture; Tomography, X-Ray Computed; Treatment Outcome; Tuberculoma; Tuberculoma, Intracranial; Tuberculosis, Meningeal

Topics: Adult; Antitubercular Agents; Choroid Diseases; Diagnosis, Differential; Drug Therapy, Combination; Ethambutol; Fluorescein Angiography; Humans; Immunocompetence; Isoniazid; Male; Rifampin; Tuberculin Test; Tuberculoma; Tuberculosis, Ocular

Topics: Anti-Bacterial Agents; Antitubercular Agents; Biopsy, Fine-Needle; Child; Combined Modality Therapy; Drug Therapy, Combination; Ethambutol; Fever; Humans; Isoniazid; Laparotomy; Male; Mycobacterium tuberculosis; Pyrazinamide; Rifampin; Tomography, X-Ray Computed; Tuberculoma; Tuberculosis, Urogenital; Ultrasonography, Interventional; Urination Disorders

Topics: Adult; Anti-Bacterial Agents; Antitubercular Agents; Choroid Diseases; Drug Therapy, Combination; Enzyme-Linked Immunosorbent Assay; Ethambutol; Fluorescein Angiography; Humans; Isoniazid; Male; Mycobacterium tuberculosis; Pyrazinamide; Rifampin; Sputum; Tomography, X-Ray Computed; Tuberculoma; Tuberculosis, Miliary; Tuberculosis, Ocular; Ultrasonography

Diabetes mellitus accompanying tuberculosis complicates the course of the latter and remains a topical problem of phthisiology. Surgical treatment of patient with both conditions presents a high risk and is employed unreasonably rarely. The results of medical (173 patients) and surgical (107 patients) treatments were studied in patients with destructive tuberculosis concurrent with diabetes mellitus. Analyzing early and late results of treatment showed a more steady-state effect in the group of surgically treated patients. Thus, surgery should be desirably used in all patients with preserving destructive changes after the basic course of antibacterial therapy.

Topics: Adult; Antibiotics, Antitubercular; Antitubercular Agents; Diabetes Complications; Diabetes Mellitus, Type 1; Female; Follow-Up Studies; Humans; Isoniazid; Male; Middle Aged; Pneumonectomy; Rifampin; Risk Factors; Thoracoplasty; Time Factors; Tuberculoma; Tuberculosis, Pulmonary

Topics: Adult; Amenorrhea; Antibiotics, Antitubercular; Diagnostic Techniques, Endocrine; Female; Humans; Neck; Norethindrone; Progesterone Congeners; Rifampin; Soft Tissue Infections; Treatment Outcome; Tuberculoma

The author describes the successful medical management of intramedullary tuberculous lesions in four patients who received treatment between 1994 and 1997. The role of magnetic resonance imaging and the treatment protocol for intramedullary tuberculous lesions are also discussed.

Topics: Adolescent; Adult; Antibiotics, Antitubercular; Antitubercular Agents; Clinical Protocols; Female; Follow-Up Studies; Humans; Isoniazid; Magnetic Resonance Imaging; Male; Pyrazinamide; Rifampin; Spinal Cord Diseases; Streptomycin; Tuberculoma; Tuberculosis, Central Nervous System; Tuberculosis, Meningeal; Tuberculosis, Pulmonary

Topics: Antitubercular Agents; Brain Neoplasms; Diagnosis, Differential; Female; Glioma; Humans; Isoniazid; Magnetic Resonance Imaging; Middle Aged; Pyrazinamide; Rifampin; Tuberculoma

Topics: Antitubercular Agents; Central Nervous System Infections; Dexamethasone; Drug Therapy, Combination; Ethionamide; Glucocorticoids; Humans; Immunocompetence; Infant; Isoniazid; Male; Prednisolone; Pyrazinamide; Rifampin; Streptomycin; Treatment Failure; Tuberculoma; Tuberculosis, Meningeal; Tuberculosis, Miliary; Tuberculosis, Multidrug-Resistant

In a one year old female infant BCG-vaccinated as a neonate, a large mediastinal mass was found after routine examination. X-ray and CT scan suggested a teratoma. Histology and microbiology, however, revealed the diagnosis of an active tuberculosis. Thus, the tumor was caused by mediastinal BCGitis. To our knowledge this complication of BCG-vaccination has not yet been described.

Topics: Bacteriological Techniques; BCG Vaccine; Combined Modality Therapy; Female; Humans; Infant; Isoniazid; Mediastinal Diseases; Mediastinum; Rifampin; Thoracotomy; Tuberculoma

A consecutive series of six adult patients ranging in age from 29 to 53 years is presented. The clinical and radiological features in each patient are described. Attention is drawn to the features demonstrated on computed axial tomography. In only one patient, the first encountered, was surgical excision undertaken and histological verification obtained. One patient died before any form of treatment could be instituted. The remaining four patients were treated with antituberculous chemotherapy alone and their progress monitored by sequential computed tomography. The excellent response and good outcome in this conservatively treated group are documented.

Topics: Adult; Brain Diseases; Drug Therapy, Combination; Humans; Isoniazid; Male; Middle Aged; Pyrazinamide; Rifampin; Streptomycin; Tomography, X-Ray Computed; Tuberculoma

A personal series of 14 patients with tuberculomas of the brain were treated with anti-tuberculous drugs. There were eight patients with solitary and six with multiple lesions, the size of the lesions varying from 3 x 2 cm to 7.5 x 6 cm. The symptoms and signs of tuberculomas of the brain are non-specific. The initial diagnosis is therefore presumptive and based on their characteristic CT patterns on contrast enhancement. These patterns are usually solid enhancing lesions, ring enhancing lesions or mixed solid and ring forms. The final diagnosis is established by the patient's clinical improvement and the CT scan evidence of decrease in the extent of the oedema and the size of the lesion after a therapeutic test by means of triple anti-tuberculous drug therapy lasting for 12 weeks. All patients but one were treated successfully with triple anti-tuberculous drug therapy, for a continued total period of 18 months. A failure of medical treatment occurred in one patient due to non-compliance. In this patient, the residual cerebral lesion after the tuberculoma had healed required excision to control intractable epilepsy. Associated obstructive hydrocephalus in another patient needed a ventriculo-peritoneal shunt. The patients were followed for six months to five years. There were no recurrences. It is concluded that medical treatment with anti-tuberculous drugs is the treatment of choice for tuberculomas of the brain. With the use of steroids to control the brain oedema and its resultant mass effect and increased intracranial pressure, and a ventriculo-peritoneal shunt for hydrocephalus, almost all tuberculomas of the brain, irrespective of their size, can be cured by medical treatment.

Topics: Adult; Antitubercular Agents; Brain Diseases; Drug Combinations; Female; Humans; Isoniazid; Male; Middle Aged; Rifampin; Tomography, X-Ray Computed; Tuberculoma

A nine-year-old Somalian boy was treated in Denmark for a posterior fossa tumor, which proved to be a tuberculoma. This disease is virtually unknown in our highly industrialized country, which emphasizes the fact that due to increased international traveling, knowledge of endemic diseases in other parts of the world is necessary. The treatment of tuberculoma and their diagnostic features are reviewed.

Topics: Cerebellar Diseases; Child; Drug Therapy, Combination; Ethambutol; Humans; Isoniazid; Male; Radiography; Rifampin; Tuberculoma

A patient with tuberculous meningitis is described, who developed brainstem tuberculoma after 7 months of adequate drug therapy and while improving satisfactorily. The possible factors resulting in the development of tuberculoma are discussed. The tuberculoma responded to the medical therapy. Tuberculoma should be looked for if the condition of the patient worsens or if the patient develops new neurological signs during the course of TB meningitis.

Topics: Adolescent; Brain Stem; Female; Humans; Isoniazid; Prednisolone; Pyrazinamide; Rifampin; Tomography, X-Ray Computed; Tuberculoma; Tuberculosis, Meningeal

Topics: Adult; Brain Diseases; Brain Stem; Drug Therapy, Combination; Ethambutol; Female; Humans; Isoniazid; Rifampin; Tomography, X-Ray Computed; Tuberculoma

A case of tuberculous meningitis associated with cerebral tuberculomas, and resistant to antituberculous therapy is reported. Repeated injections of rifampin, administered through an intraventricular Ommaya drain, provided an effective control of the meningeal infection.

Topics: Adult; Antitubercular Agents; Drug Resistance, Microbial; Drug Therapy, Combination; Humans; Injections, Intraventricular; Male; Recurrence; Rifampin; Tuberculoma; Tuberculosis, Meningeal

A case of clinically unsuspected mesencephalic tuberculoma that was diagnosed at operation is presented. After intraoperative diagnosis, the surgical procedure was interrupted and specific treatment with tuberculostatic agents was started. The symptoms remitted totally in a few months. This conservative management is preferable to surgical removal when diagnosis of brain-stem tuberculoma has been established.

Topics: Adult; Brain Diseases; Ethambutol; Humans; Male; Mesencephalon; Rifampin; Tuberculoma

A case of multiple cerebral tuberculomata involving the pons and cerebellum was presented. The lesions were demonstrated by CT as isodense to slightly dense foci. All four intra-axial lesions showed homogeneous enhancement following an intravenous injection of the contrast medium, and one of them was surrounded by a small area of low density, probably representing the perifocal edema. The patient responded well to chemotherapy with streptomycin, hydrazid and rifampicin : cranial nerve signs and long tract signs clearing rapidly and the enhancing lesions and mass effect on CT disappearing concomitantly. Although cerebral tuberculoma is nowadays very rare in Japan, still a high index of suspicion should always be entertained during the investigation of patients showing solitary or multiple enhancing lesions with no or slight degree of perifocal edema on CT, and a trial of antituberculous drugs should be given before the incurable malignancy is presumed or the lesion is explored surgically.

Topics: Brain Diseases; Brain Stem; Cerebellar Diseases; Drug Therapy, Combination; Humans; Male; Middle Aged; Rifampin; Streptomycin; Tomography, X-Ray Computed; Tuberculoma

Five cases of intracranial tuberculoma in Asian adults are described, all of whom presented with epilepsy. The computerised tomographic (CAT) scanner displayed the lesions particularly well, and their characteristics are described. Only two cases were explored surgically, but triple antituberculous chemotherapy has the scan abnormalities in all of them to resolve completely. It is concluded that Asian patients with lesions likely to be tuberculous should be given a trail of antituberculous drugs, and only explored if they should deteriorate clinically, or if the lesion should fail to respond on serial scans.

Topics: Adult; Brain Diseases; Ethambutol; Female; Humans; Isoniazid; Male; Middle Aged; Rifampin; Tomography, X-Ray Computed; Tuberculoma

Topics: Humans; Lung; Lymph Nodes; Rifampin; Tuberculoma; Tuberculosis, Pulmonary

Topics: Adult; Brain Diseases; Cerebral Angiography; Dexamethasone; Diagnosis, Differential; Electroencephalography; Epilepsy, Tonic-Clonic; Female; Humans; Isoniazid; Mycobacterium tuberculosis; Phenytoin; Rifampin; Streptomycin; Tuberculoma

Topics: Aged; Alanine Transaminase; Anesthesia, Inhalation; Aspartate Aminotransferases; Biopsy; Chemical and Drug Induced Liver Injury; Cholecystectomy; Drug Therapy, Combination; Female; Halothane; Humans; Liver; Liver Function Tests; Postoperative Complications; Rifampin; Surgical Wound Dehiscence; Tuberculoma

Three patients with verified intracranial tuberculomas are reported. One patient presented with attacks of hydrocephalus initially diagnosed erroneously as migraine, another had multiple tuberculomas and a fourth tuberculoma became apparent during treatment with antituberculous therapy. The third patient presented with a frontal lobe syndrome and the postoperative recovery was complicated by the development of hyperosmolar non-ketotic, non-acidotic diabetic pre-coma. Although there are no pathognomonic symptoms, signs, or radiological appearances of intracranial tuberculomas, a high index of suspicion should always be entertained during the investigation of non-European immigrants.

Topics: Adolescent; Aminosalicylic Acids; Brain Diseases; Dexamethasone; Diabetic Coma; Electroencephalography; Emigration and Immigration; Ethambutol; Female; Headache; Humans; Hydrocephalus; India; Isoniazid; Male; Papilledema; Pyrazinamide; Radionuclide Imaging; Rifampin; Streptomycin; Technetium; Tuberculoma; United Kingdom