rifampin and Tuberculosis--Miliary

Little evidence is available on the pharmacokinetics of antituberculous medication in premature infants. We report rifampicin (RMP) pharmacokinetics in an extremely premature, low-birthweight female infant born to a mother with known miliary tuberculosis. Intravenous RMP, isoniazid (INH), ciprofloxacin and amikacin were used, as the enteral route was not possible. Area under the curve calculations revealed low average RMP concentrations at doses of 5-10 mg/kg. We review the literature with regard to the dosing regimen and therapeutic drug levels of RMP and INH in premature infants and discuss issues of management. Evidence from this case suggests 10 mg/kg/day is the minimum dose required.

Topics: Antibiotics, Antitubercular; Antitubercular Agents; Area Under Curve; Female; Humans; Infant, Extremely Premature; Infant, Newborn; Infectious Disease Transmission, Vertical; Isoniazid; Mycobacterium tuberculosis; Rifampin; Tuberculosis, Miliary

Although rare, paradoxical subcutaneous abscesses may develop during appropriate treatment of miliary tuberculosis. While the pathogenesis of this phenomenon is not clear, some theories have been postulated. A case of a 37-y-old woman diagnosed as having miliary tuberculosis who developed subcutaneous abscesses within the 5 months of antituberculous treatment is described and all 6 similar cases published in English from 1954 to 1999 are discussed.

Topics: Abscess; Adolescent; Adult; Antibiotics, Antitubercular; Antitubercular Agents; Female; Humans; Isoniazid; Male; Middle Aged; Mycobacterium tuberculosis; Polymerase Chain Reaction; Radiography; Rifampin; Tuberculosis, Cutaneous; Tuberculosis, Miliary

There is no solid evidence that pregnancy has an adverse effect on tuberculosis. With early diagnosis and prompt, adequate chemotherapy, the outcome of pregnancy in a woman with tuberculosis is likely to be good. Routine therapeutic abortion is not indicated. Data in the literature do not support the notion that pregnancy is a major risk factor for the development of tuberculosis, although no well-designed studies have been conducted. Screening of pregnant patients for tuberculosis should be based on consideration of other proved risk factors not on the fact of pregnancy. Preventive therapy should be given during the second and third trimesters of pregnancy to selected patients at high risk of progressive disease developing. Treatment of disease should be instituted promptly when disease is detected. The preferred regimens are INH-EMB, INH-RIF, or INH-EMB-RIF, although other drugs may be needed if the disease is recurrent or if there is resistance to these primary drugs. Mothers taking antituberculosis drugs can nurse their infants with little risk. With proper medical management, both tuberculosis and pregnancy can be expected to reach a happy conclusion in virtually all cases.

Topics: Drug Therapy, Combination; Ethambutol; Female; Humans; Infant, Newborn; Isoniazid; Mass Screening; Pregnancy; Pregnancy Complications, Infectious; Prognosis; Rifampin; Risk; Streptomycin; Tuberculin Test; Tuberculosis, Miliary; Tuberculosis, Pulmonary

In the United States, an increasing proportion of all forms of reactivation tuberculosis occurs in patients over the age of 60 years. Atypical presentations and presence of chronic illness obscure the diagnosis of tuberculosis in the elderly. Prompt diagnosis requires a high index of suspicion and aggressive procedures for diagnostic microbiology. Short-course (9 months) chemotherapy with isoniazid and rifampin is the treatment of choice for elderly patients with uncomplicated pulmonary tuberculosis. Isoniazid chemoprophylaxis is recommended for selected elderly patients.

Topics: Aged; Chemical and Drug Induced Liver Injury; Drug Therapy, Combination; Ethambutol; Female; Humans; Isoniazid; Male; Pyridoxine; Rifampin; Streptomycin; Tuberculosis, Meningeal; Tuberculosis, Miliary; Tuberculosis, Osteoarticular; Tuberculosis, Pulmonary; Tuberculosis, Urogenital; United States

Topics: Aminosalicylic Acids; Drug Therapy, Combination; Ethambutol; Female; Humans; Isoniazid; Pyrazinamide; Rifampin; Streptomycin; Thioacetazone; Tuberculosis; Tuberculosis, Lymph Node; Tuberculosis, Meningeal; Tuberculosis, Miliary; Tuberculosis, Osteoarticular; Tuberculosis, Pulmonary; Tuberculosis, Urogenital

Topics: Acute Disease; Antitubercular Agents; Child; Diagnosis, Differential; Drug Therapy, Combination; Female; Humans; Isoniazid; Lung; Middle Aged; Mycobacterium tuberculosis; Peritonitis, Tuberculous; Pneumonia; Radiography; Rifampin; Sputum; Tuberculosis; Tuberculosis, Cardiovascular; Tuberculosis, Meningeal; Tuberculosis, Miliary

Hematogenous disseminated tuberculosis predisposes to concurrent tuberculous meningitis (TBM), the most devastating and disabling form of tuberculosis. However, children often have atypical clinical symptoms, difficulty in specimen collection, low specimen content, and an increasing incidence of drug-resistant tuberculosis. Thus, the accurate diagnosis and timely treatment of childhood tuberculosis face monumental challenges.. The 14-year-old female presented to the hospital with intermittent fever, headache, and blurred vision. Her cerebrospinal fluid (CSF) showed a lymphocytic pleocytosis, an elevated protein level, and a decreased chloride level. And her CSF tested positive for TB-RNA. Xpert MTB/RIF detected Mycobacterium tuberculosis in her CSF, but the rifampin resistance test was unknown. Subsequently, her CSF culture was positive for Mycobacterium tuberculosis. The drug sensitivity test (DST) revealed resistance to isoniazid, rifampin, and fluoroquinolones. A computed tomography (CT) of the chest showed diffuse miliary nodules in both lungs. Intracranial enhanced magnetic resonance imaging (MRI) showed "multiple intensified images of the brain parenchyma, cisterns, and part of the meninges." The final diagnosis is miliary pulmonary tuberculosis and pre-extensive drug-resistant TBM. After 19 months of an oral, individualized antituberculosis treatment, she recovered with no significant neurological sequelae.. For patients with miliary pulmonary tuberculosis, especially children, even if there are no typical clinical symptoms, it is necessary to know whether there is TBM and other conditions. Always look for the relevant aetiological basis to clarify whether it is drug-resistant tuberculosis. Only a rapid and accurate diagnosis and timely and effective treatment can improve the prognosis and reduce mortality and disability rates.

Topics: Adolescent; Child; Female; Humans; Mycobacterium tuberculosis; Rifampin; Sensitivity and Specificity; Tuberculosis, Meningeal; Tuberculosis, Miliary; Tuberculosis, Multidrug-Resistant; Tuberculosis, Pulmonary

Topics: Administration, Intravesical; Aged; Antitubercular Agents; BCG Vaccine; Ethambutol; Humans; Isoniazid; Male; Middle Aged; Mycobacterium bovis; Rifampin; Tomography, X-Ray Computed; Treatment Outcome; Tuberculosis, Miliary; Urinary Bladder Neoplasms

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

Topics: Aged; Drug Therapy, Combination; Female; Humans; Nitriles; Primary Myelofibrosis; Pyrazoles; Pyrimidines; Rifampin; Treatment Outcome; Tuberculosis, Miliary

An 86-year-old woman with severe dementia had been treated with oral prednisolone at 2 mg/day for autoimmune bullous dermatosis for several years. One year ago, she referred to our hospital due to an ulcerative skin lesion over the right tibial tuberosity. The lesion was treated by an iodine-containing ointment, but did not heal. Subsequently, a new skin lesion appeared in the right popliteal fossa. One month ago, the patient had increased sputum production that was accompanied by fever, anorexia, and dyspnea; consequently, she visited our department. Chest computed tomography revealed diffuse micronodules with ground-glass attenuation. Acid-fast bacteria staining of the sputum was positive and the polymerase chain reaction detected Mycobacterium tuberculosis. In addition, the bacilli were also found in the skin lesions of the right limb. Therefore, a diagnosis of cutaneous, and miliary tuberculosis was made. Although the anti-tuberculous combination chemotherapy consisting of isoniazid, rifampicin, and ethambutol was immediately initiated, her condition did not improve. She died on day 19 of hospitalization. Drug susceptibility testing revealed no resistance to all the three drugs; hence, it was concluded that the time-delay in diagnosis of cutaneous tuberculosis lead to the progression to miliary tuberculosis and subsequent death.

Topics: Aged, 80 and over; Antitubercular Agents; Diagnosis, Differential; Drug Therapy, Combination; Ethambutol; Fatal Outcome; Female; Humans; Isoniazid; Mycobacterium tuberculosis; Rifampin; Tomography, X-Ray Computed; Tuberculosis, Cutaneous; Tuberculosis, Miliary

A 48-year-old female with a past history of systemic lupus erythematosus had developed autoimmune hepatitis (AIH) at the age of 45 years, and administration of PSL 30 mg/day was initiated. However, AIH exacerbation was suspected based on elevation of hepatic and biliary tract enzymes such as ALP (1207U/L) with a fever of 38 degrees C after tapering off the steroids to PSL 7.5 mg daily, and she was thus hospitalized. A liver biopsy was recommended, but she refused. Thus, we suspected concomitant AIH and autoimmune cholangitis (AIC). Although high-dose steroid treatment including steroid pulse therapy was administered, there was no improvement. We performed a liver biopsy on the 66th hospital day, after obtaining the patient's consent. Epithelioid granuloma was detected in the liver leaflet as the background of the AIH and AIC findings. In addition, acid fast bacteria were detected with auramine and Ziehl-Neelsen staining, raising the possibility of tuberculosis. Additionally, granuloma was also seen in her bone marrow, and miliary tuberculosis was suspected. Anti-tuberculous therapy with isoniazid, rifampicin, ethambutol and pyrazinamide was initially administered, but the regimen was changed to levofloxacin, ethambutol, and streptomycin due to the side effects of the earlier medications. Liver functions improved and the inflammatory reaction became negative. The patient was discharged on the 138th hospital day. Ultimately, no acid fast bacteria were detected with culture, PCR of her bone marrow, or liver biopsy. However, miliary tuberculosis was definitively diagnosed from the pathological findings and her clinical course. AIH was an underlying disease, and the discrimination from AIH exacerbation was difficult. Consequently, the diagnosis was miliary tuberculosis without the lung involvement and the main lesion was in the liver. It is important to take account of miliary tuberculosis in the differential diagnosis of fevers of unknown origin with elevation of hepatic and biliary tract enzymes, and to make a definitive diagnosis with a liver biopsy.

Topics: Antitubercular Agents; Diagnosis, Differential; Female; Hepatitis, Autoimmune; Humans; Isoniazid; Lung; Middle Aged; Rifampin; Tuberculosis, Miliary

In Japan, the incidence of severe pediatric tuberculosis (TB) has decreased dramatically in recent years. However, children in Japan can still have considerable opportunities to contract TB infection from adult TB patients living nearby, and infants infected with TB may develop severe disseminated disease. A 3-month-old girl was admitted to our hospital with dyspnea and poor feeding. After admission, miliary TB and multiple brain tuberculomas were diagnosed. Anti-tuberculous therapy was initiated with streptomycin (SM), isoniazid (INH), rifampicin and pyrazinamide. Symptoms persisted after starting the initial treatment and mycobacterial cultures of gastric fluid remained positive. Drug sensitivity testing revealed the TB strain isolated on admission as completely resistant to INH and SM. Treatments with INH and SM were therefore stopped, and treatment with ethambutol and ethionamide was started in addition to rifampicin and pyrazinamide. After this change to the treatment regimen, symptoms and laboratory data gradually improved. The patient was treated with these four drugs for 18 months, and then pyrazinamide was stopped. After another 2 months, ethambutol was stopped. Treatment of tuberculosis was completed in 24 months. No adverse effects of these anti-TB drugs were observed. The patient achieved a full recovery without any sequelae. On the other hand, the infectious source for this patient remained unidentified, despite the extensive contact investigations. The incidence of drug-resistant TB is increasing in many areas of the world. Continuous monitoring for pediatric patients with drug-resistant TB is therefore needed.

Topics: Antitubercular Agents; Drug Substitution; Drug Therapy, Combination; Ethambutol; Ethionamide; Female; Humans; Infant; Isoniazid; Microbial Sensitivity Tests; Pyrazinamide; Radiography, Thoracic; Rifampin; Streptomycin; Treatment Outcome; Tuberculoma, Intracranial; Tuberculosis, Miliary; Tuberculosis, Multidrug-Resistant; Tuberculosis, Pulmonary

In this paper we present a case of a 58 years old male with a rare form of extrapulmonary tuberculosis--tuberculous meningitis (TBM). Tuberculous meningitis is usually caused by hematogenous spread of Mycobacterium from lungs. The TBM is a severe disease with high mortality. The symptoms usually increase gradually and in the course of the disease 3 clinical stages (prodromal phase, phase of neurological symptoms and phase of paresis) may be differentiated. Cerebrospinal fluid examination, chest x-ray and sputum culture are crucial for diagnosis of TBM. The proper diagnosis and early causative treatment significantly improve the outcome of the disease.

Topics: Antitubercular Agents; Drug Therapy, Combination; Humans; Isoniazid; Male; Middle Aged; Mycobacterium tuberculosis; Poland; Rifampin; Tuberculosis, Meningeal; Tuberculosis, Miliary

Topics: Aged; Anti-Bacterial Agents; Arthroplasty, Replacement, Hip; Combined Modality Therapy; Device Removal; Diagnosis, Differential; Drug Therapy, Combination; Dyspnea; Femoral Neck Fractures; Hip Prosthesis; Humans; Male; Ofloxacin; Pneumonia, Staphylococcal; Prosthesis-Related Infections; Rifampin; Staphylococcal Infections; Tomography, X-Ray Computed; Tuberculosis, Miliary

Topics: Adult; Antitubercular Agents; Choroid Diseases; Ethambutol; Female; Humans; Isoniazid; Pregnancy; Pregnancy Outcome; Pyrazinamide; Radiography; Rifampin; Treatment Outcome; Tuberculosis, Miliary

Topics: Acute Disease; Antitubercular Agents; Drug Combinations; Female; Humans; Isoniazid; Lupus Erythematosus, Systemic; Middle Aged; Pyrazinamide; Rifampin; Steroids; Tuberculosis, Cutaneous; Tuberculosis, Miliary

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

Renal tuberculosis is rare in children and particularly in infants. We present a case of miliary tuberculosis with focal renal involvement in a 5-month-old male infant recently adopted from Ethiopia, and review the literature on miliary and renal tuberculosis in infants and children. Salient points regarding tuberculosis screening in internationally adopted patients are also addressed.

Topics: Adoption; Antitubercular Agents; Developing Countries; Ethiopia; Humans; Infant; Isoniazid; Male; Mycobacterium tuberculosis; Pyrazinamide; Rifampin; Tuberculosis, Miliary; Tuberculosis, Renal; United States

We herein report a rare occurrence of Addison's disease caused by acute adrenal gland tuberculosis occurring in association with miliary tuberculosis and the administration of rifampicin. An 82-year-old woman with miliary tuberculosis was treated with antituberculous chemotherapeutic agents including rifampicin (RFP), but she still demonstrated general malaise in addition to hyponatremia. Abdominal CT showed an enlargement of the right adrenal gland. However, after discontinuing RFP, the patient's symptoms improved. We carefully reinitiated the administration of RFP. The patient's condition thereafter did not worsen, and the treatment could thus be maintained. It is extremely important to immediately recognize adrenal crisis precipitated by the administration of RFP.

Topics: Acute Disease; Addison Disease; Adrenal Gland Diseases; Aged; Aged, 80 and over; Antibiotics, Antitubercular; Female; Humans; Rifampin; Tomography, X-Ray Computed; Tuberculosis, Endocrine; Tuberculosis, Miliary

A 26-year-old man was admitted to a hospital complaing of continuous high fever and abdominal swelling. As his sputum and ascites culture was positive for acid-fast bacilli and PCR-TB, he was diagnosed as miliary tuberculosis, tuberculous with pleuritis and peritonitis, and transferrd to our hospital. After initiation of treatment with isoniazid, rifampicin (RFP), ethambutol, and pyrazinamide, RFP was suspended because of direct-reacting hyperbilirubinemia. As the liver function recovered after discontinuation of RFP, low dose of RFP was re-administrated and renal dysfunction was observed. The renal dysfunction continued after discontinuation of suspicious drugs including RFP. As renal biopsy revealed interstitial nephritis, prednisolon 20 mg/day was started and renal function recovered quickly. From the clinical course and examination, we considered interstitial nephritis was due to re-administration of RFP and steroid therapy was effective.

Topics: Adult; Antitubercular Agents; Glucocorticoids; Humans; Male; Nephritis, Interstitial; Prednisolone; Rifampin; Tuberculosis, Miliary

Topics: Acute Disease; Adult; Antitubercular Agents; Humans; Isoniazid; Male; Pyrazinamide; Radiography; Rifampin; Streptomycin; Treatment Outcome; Tuberculosis, Miliary

Severe pulmonary tuberculosis may be complicated by deep vein thrombosis due to a state of hypercoagulability.. We report a case of pulmonary miliary tuberculosis associated with cerebral venous thrombosis and multiple intracranial tuberculomas. A 65-year-old woman developed a confusional syndrome one week after starting treatment for pulmonary military tuberculosis. Neuroimaging reveals a thrombus in the right lateral sinus and multiple silent intracranial tuberculoma.. The patient was given anticoagulants and fully recovered.

Topics: Acenocoumarol; Aged; Anticoagulants; Antitubercular Agents; Confusion; Drug Therapy, Combination; Female; Heparin; Humans; Immunocompromised Host; Isoniazid; Lateral Sinus Thrombosis; Pyrazinamide; Radiography; Rifampin; Streptomycin; Thrombophilia; Tuberculoma, Intracranial; Tuberculosis, Miliary; Tuberculosis, Pulmonary

Topics: Addison Disease; Aged; Antitubercular Agents; Chemical and Drug Induced Liver Injury; Female; Humans; Isoniazid; Pyrazinamide; Rifampin; Tuberculosis, Miliary

Dermatological reactions are frequent drug-related complications in patients with HIV infection. The most serious disorders are Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), a.k.a. Lyell's syndrome, that are potentially fatal. The purpose of this report is to describe 8 cases of SJS/TEN observed in Lomé teaching hospital (Togo) after intake of a combination of rifampicin-isoniazid by HIV-infected patients. There were 5 men and 3 women with a mean age of 28 years. All patients presented AIDS. The disorder was SJS in 3 cases and TEN in 5. In 6 cases, manifestations occurred during initiation of treatment (mean delay for onset, 16 days). In the remaining two cases, manifestations occurred 6 days and 8 days respectively after beginning treatment for recurrent tuberculosis. Mean skin detachment was 8% in patients with SJS and 55.7% in patients with TEN. Five patients including 4 with TEN and 1 with SJS died. This study documents incrimination of combined rifampin-isoniazid treatment in the occurrence of SJS/TEN in patients with HIV infection and confirms the severity and poor prognosis of these disorders. The presence of opportunistic infections such as pulmonary tuberculosis may be an unfavourable prognostic factor in immunocompromised patients with these severe dermatological disorders.

Topics: Adult; Antibiotics, Antitubercular; Antitubercular Agents; Drug Therapy, Combination; Female; HIV Infections; Humans; Isoniazid; Male; Rifampin; Stevens-Johnson Syndrome; Togo; Tuberculosis, Miliary; Tuberculosis, Pulmonary

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

A 36-year-old man was referred to our hospital with complaints of high fever and headache. A diagnosis of miliary tuberculosis with tuberculous meningitis was made. He was treated with isoniazid (400 mg/day), rifampicin (300 mg/day), ethambutol (750 mg/day), pyrazinamide (1.0 g/day) and prednisolone (60 mg/day). However, he lost consciousness because of hydrocephalus on the second day of hospitalization. Emergency cerebrospinal fluid drainage improved his neurological symptoms. After two months, he again complained of headache with nausea and double vision. Numerous tuberculomas were found not only in the cerebrum but also in the liver, the spleen and the retina. Recurrent hydrocephalus was treated with a V-P shunt, and combination therapy with four antituberculous agents was maintained for 18 months. He was discharged in a healthy condition, although a mild left facial palsy remained. In addition, we examined the inflammatory cytokine levels in both the CSF and the serum over the period of the patient's hospitalization. We concluded that the cytokine levels in the CSF may be associated with the progress and the prognosis of tuberculous meningitis.

Topics: Adult; Antitubercular Agents; Cytokines; Drug Therapy, Combination; Ethambutol; Humans; Isoniazid; Male; Prognosis; Rifampin; Tuberculosis, Meningeal; Tuberculosis, Miliary

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

Extrapulmonary tuberculosis is known to be the infection in an organ with or without pulmonary involvement. The infection in extrapulmonary tuberculosis is insidious and the symptoms and signs are generally nonspecific. We describe a 56-year-old male patient complaining of weight loss, fever, and night sweats. Although there were no signs and symptoms attributable to pulmonary tuberculosis, polymerase chain reaction (PCR), microscobical and cultural examination of bone marrow aspirate revealed isolated bone marrow tuberculosis. A treatment protocol of isoniazid, rifampicin, pyrazinamide, and streptomycin was administered. After 9 months of treatment, re-examination of the bone marrow revealed no signs of tuberculosis. Tuberculosis should be kept in mind especially in endemic areas and bone marrow should be examined in case of suspected tuberculosis infection.

Topics: Antitubercular Agents; Bone Marrow; Diagnosis, Differential; Fever; Humans; Isoniazid; Male; Middle Aged; Pyrazinamide; Rifampin; Streptomycin; Sweating; Tuberculosis, Miliary; Weight Loss

Topics: Abdominal Pain; Antibiotics, Antitubercular; Antitubercular Agents; Diagnosis, Differential; Drug Therapy, Combination; Humans; Isoniazid; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Middle Aged; Prognosis; Radiography, Abdominal; Rifampin; Tomography, X-Ray Computed; Tuberculosis, Miliary

The classical presentation of neurotuberculosis is meningitis. Intracranial tuberculomas are a rare manifestation of neurotuberculosis and are due to hematogenous dissemination of distant focuses of Mycobacterium tuberculosis infection. Around 1% of patients with central nervous system tuberculosis develop intracranial tuberculomas some weeks or months after the beginning of the specific treatment with tuberculostatic chemotherapy. The involution of the lesions is slow and does not mean drug resistance nor lack of adequate treatment. We describe the case, diagnosed and treated at the 25th Infirmary of Santa Casa da Misericórdia do Rio de Janeiro, of an immunocompetent male patient who developed meningitis and multiple intracranial tuberculomas during the specific treatment of miliary tuberculosis. The literature is revised and the diagnosis, treatment and possible immunological mechanisms are discussed.

Topics: Adult; Antitubercular Agents; Humans; Isoniazid; Magnetic Resonance Imaging; Male; Pyrazinamide; Rifampin; Tomography, X-Ray Computed; Tuberculoma, Intracranial; Tuberculosis, Meningeal; Tuberculosis, Miliary; Tuberculosis, Pulmonary

Topics: Antitubercular Agents; Choroid Diseases; Diagnosis, Differential; Drug Therapy, Combination; Ethambutol; Female; Fluorescein Angiography; Fundus Oculi; Humans; Isoniazid; Macula Lutea; Middle Aged; Rifampin; Tuberculosis, Miliary; Tuberculosis, Ocular; Vision, Ocular

Topics: Adult; Antibiotics, Antitubercular; Antitubercular Agents; Diagnosis, Differential; Female; Humans; Isoniazid; Ovarian Diseases; Pelvis; Rifampin; Tuberculosis, Female Genital; Tuberculosis, Miliary; Uterine Neoplasms

Topics: Aged; Antitubercular Agents; Drug Therapy, Combination; Female; Humans; Isoniazid; Kidney Failure, Chronic; Purpura, Thrombotic Thrombocytopenic; Rifampin; Streptomycin; Tuberculosis, Miliary

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

Although tuberculosis is common and well recognised in many countries, unusual presentations of the disease sometimes raise difficulties in differential diagnosis. We report a young patient who presented with weight loss, shortness of breath and easy fatiguability. Extensive lymphadenopathy involving the cervical, axillary and inguinal regions were found on physical examination. Chest X-ray and computed tomography revealed generalized lymphadenopathy of cervical, mediastinal and para-aortic chains, bilateral pulmonary miliary reticulonodular infiltrates, pleural effusion, hepatomegaly with low density, macronodular hypodense areas in spleen, ascites, peritoneal irregularity and thickening of bowel walls. Mantoux test was negative. Peritoneal fluid was exudative, but pleural fluid was transudative, probably due to mediastinal lymphatic obstruction. The initial clinical diagnosis was malignant lymphoma; however, positive sputum smears for mycobacteria and excisional cervical lymph node biopsy revealing caseating granulomatous lymphadenitis were consistent with tuberculosis. The patient responded well to appropriate therapy with regression of radiological abnormalities.

Topics: Adult; Antitubercular Agents; Biopsy; Diagnosis, Differential; Drug Therapy, Combination; Ethambutol; Follow-Up Studies; Humans; Isoniazid; Lymph Nodes; Lymphatic Diseases; Male; Neck; Pleural Effusion; Prednisolone; Pyrazinamide; Rifampin; Sputum; Tomography, X-Ray Computed; Tuberculosis, Gastrointestinal; Tuberculosis, Miliary

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

A 35 year old black Somalian woman with miliary tuberculosis developed hepatotoxicity after a few days of treatment with isoniazid, rifampicin, pyrazinamide, and ethambutol. After withdrawal of all drugs the liver profile returned to normal and remained so after challenge with isoniazid. Hepatotoxicity recurred when rifampicin was added, but it was well tolerated when reintroduced without isoniazid.

Topics: Adult; Chemical and Drug Induced Liver Injury; Drug Therapy, Combination; Female; Humans; Isoniazid; Rifampin; Tuberculosis, Miliary

Topics: Adult; Antibiotics, Antitubercular; Humans; Male; Pigmentation Disorders; Rifampin; Skin Pigmentation; Syndrome; Tuberculosis, Miliary

We report two cases of fulminant hepatitis induced by antitubercular drugs. The mechanism is both immunoallergic and toxic. The fatal case appears in patient with acquired immunodeficiency syndrome. Liver tests must be realized during antitubercular treatment, that is difficult in sub-Saharan Africa.

Topics: Adult; Anti-Bacterial Agents; Antitubercular Agents; Chemical and Drug Induced Liver Injury; Drug Therapy, Combination; Ethambutol; Fatal Outcome; Female; HIV Infections; Humans; Isoniazid; Liver Function Tests; Pyrazinamide; Rifampin; Tuberculosis, Miliary; Tuberculosis, Pulmonary

Topics: Child, Preschool; Humans; Male; Peritonitis, Tuberculous; Rifampin; Tomography, X-Ray Computed; Tuberculosis, Meningeal; Tuberculosis, Miliary; Tuberculosis, Pulmonary

This case study reveals an unusual finding of rapidly proliferative crescentic glomerulonephritis in a patient treated with rifampin who had no other identifiable causes for developing this disease. This patient underwent a 10-month regimen of rifampin and isoniazid for pulmonary tuberculosis and was discovered to have developed signs of severe renal failure five weeks after completion of therapy. Renal biopsy revealed severe glomerulonephritis with crescents, electron dense fibrillar deposits and moderate lymphocytic interstitial infiltrate. Other possible causes of rapidly progressive glomerulonephritis were investigated and ruled out. This report documents the unusual occurrence of rapidly progressive glomerulonephritis with crescents and fibrillar glomerulonephritis in a patient treated with rifampin.

Topics: Acute Kidney Injury; Adult; Biopsy; Drug Therapy, Combination; Glomerulonephritis; Humans; Isoniazid; Kidney Glomerulus; Male; Microscopy, Electron; Rifampin; Tuberculosis, Miliary; Tuberculosis, Pulmonary

Topics: Acute Kidney Injury; Adult; Female; Humans; Male; Middle Aged; Rifampin; Tuberculosis, Miliary; Tuberculosis, Pulmonary

Topics: Child, Preschool; Fever; Fever of Unknown Origin; Humans; Hydrazines; Male; Pyrazinamide; Rifampin; Tuberculosis, Miliary; Tuberculosis, Pulmonary

The purpose of this study was to determine the clinical and laboratory characteristics, diagnostic methods, and prognostic variables in adults treated for miliary tuberculosis in the rifampicin era.. Computerized records of our community-based university teaching hospital over a 10-year period (1978 to 1987) were analyzed. A total of 109 patients were identified, including 12 who did not have miliary nodules on the chest radiograph (all of whom were shown to have hematogenous dissemination). Predisposing conditions were present in 46 patients.. Clinical features were similar to those of previously reported series. Hematologic abnormalities were common: leukopenia (less than 4 x 10(9)/L) was present in 16 of 107 patients (15%), thrombocytopenia (less than 150 x 10(9)/L) in 24 of 104 (23%), and lymphopenia (less than 1.5 x 10(9)/L) in 82 of 94 (87%). Pancytopenia was found in six patients, three of whom recovered. Disseminated intravascular coagulation occurred in four patients, all of whom died. Adenosine deaminase levels were elevated in only seven of 11 serosal exudates and in seven of 12 samples of abnormal cerebrospinal fluid. Fiberoptic bronchoscopy was diagnostic in 44 of 51 patients (86%), bone marrow examination in 19 of 22 (86%), and liver biopsy in all 10 patients. Twenty-six patients (24%) died of miliary tuberculosis a median of 6 days after starting treatment. Survivors were followed up for a median of 51 weeks. Stepwise logistic regression identified aged (greater than 60 years), lymphopenia, thrombocytopenia, hypoalbuminemia, elevated transaminase levels, and treatment delay as independent predictors of mortality.. Miliary tuberculosis commonly causes hematologic derangements, some of which are helpful prognostically. Fiberoptic bronchoscopy compares favorably to liver and bone marrow biopsy in sputum smear-negative cases. Mortality remains high and treatment should be begun as soon as the diagnosis is suspected.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Confidence Intervals; Female; Follow-Up Studies; Humans; Isoniazid; Male; Middle Aged; Prognosis; Pyrazinamide; Radiography; Regression Analysis; Retrospective Studies; Rifampin; Survival Rate; Time Factors; Tuberculosis, Miliary

Topics: Chemical and Drug Induced Liver Injury; Drug Therapy, Combination; Humans; Isoniazid; Male; Middle Aged; Rifampin; Tuberculosis, Miliary

We present a case of a 55-year-old woman requiring prolonged therapy with intravenous isoniazid and rifampin secondary to extensive bowel disease. We believe that this is the first U.S. report of a patient receiving both medications by the iv route. After months of therapy the patient has not experienced side effects secondary to this route of administration. We believe that iv isoniazid and rifampin provides a safe alternative method of delivery when clinical situations dictate this route.

Topics: Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Infusions, Intravenous; Injections, Intravenous; Isoniazid; Middle Aged; Rifampin; Tuberculosis, Miliary

Hypercalcaemia and hypercalciuria were diagnosed in a 21-week-old boy with miliary tuberculosis. The tuberculosis was treated with isoniazid, rifampin and streptomycin. After 2 months, streptomycin was replaced by ethambutol. The hypercalcaemia was treated initially with prednisone, which decreased the serum 1.25 (OH)2 cholecalciferol level but the serum calcium level remained unaltered. After calcium and vitamin D restriction, the serum calcium level normalized within 1 day. The patient's tuberculosis was treated and he remains well.

Topics: Calcium; Humans; Hypercalcemia; Infant; Isoniazid; Male; Prednisone; Rifampin; Streptomycin; Tuberculosis, Miliary; Vitamin D

The efficacy was studied of 130 patients with freshly detected destructive forms of pulmonary tuberculosis depending on the method of administration of rifadin and isoniazid. Treatment of pulmonary tuberculosis was realized with rifadin, isoniazid and streptomycin. Three groups of patients were distinguished. In group I rifadin and isoniazide was taken orally, in group II--rifadin was administered orally and intrabronchially, isoniazid--orally. In group III rifadin was orally and intrabronchially, isoniazid--intravenously. The treatment was more effective with combined administration of rifadin and intravenous administration of isoniazid.

Topics: Administration, Inhalation; Administration, Oral; Adult; Bronchi; Drug Evaluation; Drug Therapy, Combination; Female; Humans; Injections, Intravenous; Isoniazid; Male; Middle Aged; Rifampin; Streptomycin; Tuberculosis, Miliary; Tuberculosis, Pulmonary

A three and a half-year-old boy developed stridor after insertion of grommets for bilateral secretory otitis media. Despite treatment with steroids systemically and locally, antibiotics and an antihistamine, the stridor worsened. Microlaryngotracheobronchoscopy (MLB) demonstrated laryngeal granulations, in which, by auramine and Ziehl-Neelsen staining, acid-fast bacilli were seen, and from which subsequently Mycobacterium tuberculosis grew in culture. Following the MLB the child became comatosed and a clinical diagnosis of tuberculosis involving the central nervous system was made. Despite quadruple antituberculous chemotherapy he died 8 days later. A Mantoux test was negative and a chest radiograph was normal. Acid-fast bacilli were not demonstrated on repeated examinations of cerebrospinal fluid, nor were they grown ante mortem or post mortem from samples of cerebrospinal fluid.

Topics: Child, Preschool; Humans; Injections, Intramuscular; Injections, Spinal; Isoniazid; Larynx; Lung; Male; Pyrazinamide; Respiratory Sounds; Rifampin; Streptomycin; Tomography, X-Ray Computed; Tuberculosis, Laryngeal; Tuberculosis, Miliary

T-cell subpopulations were evaluated by several recent methods in 38 tuberculosis patients (24 active and 10 quiescent cases of pulmonary tuberculosis; two of miliary and two of active extra-pulmonary tuberculosis) before and during rifampicin (RMP) treatment. There was a significant reduction in the total number of T cells (E-RFC and OKT3+ cells) and of helper T cells (OKT4+) coinciding with an increase in the number of suppressor T cells when the 38 tuberculosis patients were compared with 21 healthy control subjects. When the changes of T-cell subpopulations in groups of subjects and patients with different clinical forms of the disease were analysed, these changes could be clearly shown with both sets of assays (receptor assays and monoclonal antibody assays) among those with the active pulmonary form of tuberculosis while similar changes could be demonstrated only by one or the other assay among those with the other forms of the disease. The effects of one month of RMP treatment on these parameters were much more obvious among the clinically active patients than the quiescent patients, i.e. a recovery of total T cells from a low pre-treatment to a near normal level accompanied by a significant reduction in the number of suppressor cells (OKT8+). In fact, among quiescent patients the number of suppressor cells (as TG) appeared to rise further with RMP treatment.

Topics: Adult; Aged; Antibodies, Monoclonal; Female; Humans; Male; Middle Aged; Rifampin; T-Lymphocytes; T-Lymphocytes, Helper-Inducer; T-Lymphocytes, Regulatory; Tuberculosis, Miliary; Tuberculosis, Pulmonary

There are no published data defining efficacious drug therapy for obese patients with active tuberculosis. Current dosage recommendations are based on total body weight (TBW); drug toxicity might result in obese patients receiving TBW doses. Peak and trough serum levels were measured for rifampin, streptomycin, ethambutol, and pyrazinamide in an obese patient (166 kg TBW, 87 kg ideal body weight (IBW] with miliary and meningeal tuberculosis. The observed drug levels and the calculated serum half-lives of these drugs were compared with the expected serum levels and serum half-lives in lean patients treated with literature-recommended doses. The observed serum levels in our obese patients were within the expected range for lean patients when dosage was based on IBW rather than on TBW. The observed cerebrospinal fluid penetrations of the drugs studied in our obese patient were similar to those reported in lean patients.

Topics: Adult; Antitubercular Agents; Ethambutol; Humans; Male; Obesity; Pyrazinamide; Rifampin; Streptomycin; Tuberculosis, Meningeal; Tuberculosis, Miliary

Topics: Aged; Antitubercular Agents; Ethambutol; Female; Humans; Isoniazid; Rifampin; Streptomycin; Tuberculin Test; Tuberculosis; Tuberculosis, Meningeal; Tuberculosis, Miliary; Tuberculosis, Osteoarticular; Tuberculosis, Pulmonary; Tuberculosis, Urogenital

Topics: Adult; Ethambutol; Female; Humans; Isoniazid; Mycobacterium tuberculosis; Rifampin; Sputum; Tuberculosis, Cutaneous; Tuberculosis, Miliary; Tuberculosis, Pulmonary

Topics: Acute Kidney Injury; Aged; Female; Humans; Peritoneal Dialysis; Radiography; Rifampin; Tuberculosis, Lymph Node; Tuberculosis, Miliary

Topics: Clostridium; Enterocolitis, Pseudomembranous; Feces; Female; Humans; Middle Aged; Rifampin; Tuberculosis, Miliary

Topics: Biopsy; Female; Humans; Infant, Newborn; Isoniazid; Lung; Male; Pregnancy; Pregnancy Complications, Infectious; Rifampin; Streptomycin; Tuberculosis, Miliary; Tuberculosis, Pulmonary

Topics: Adult; Chemical and Drug Induced Liver Injury; Drug Therapy, Combination; Epilepsy; Female; Hepatic Encephalopathy; Humans; Isoniazid; Phenobarbital; Rifampin; Tuberculosis, Miliary

Topics: Adult; Aphasia; Carotid Artery Diseases; Carotid Artery, Internal; Cerebral Infarction; Cerebral Ventricles; Cerebrospinal Fluid; Encephalitis; Female; Humans; Male; Middle Aged; Rifampin; Streptomycin; Tuberculosis, Meningeal; Tuberculosis, Miliary; Tuberculosis, Renal

Compared with the adults the child's bloodlevel after having taken Rifampicin is lower, therefore it is recommanded to take a higher dose of 15 mg/kg in the morning before having breakfasted. A combination of doses of 10 mg/kg INH and 20 mg/kg Ethambutol is possible without any doubt. If you consider the reaction which may arise, SGOT and SGPT values up to 21 mU are without any signification. If they depasse this limit a certain control is necessary and if they are still progressive the therapy must be changed. If you compare the experiences with the adults, secondary effects of Rifampicin in childhood are less, just so indigestibleness of the stomach or intestines tract or allergies.

Topics: Alanine Transaminase; Aspartate Aminotransferases; Child; Child, Preschool; Drug Administration Schedule; Drug Therapy, Combination; Ethambutol; Female; Humans; Infant; Infant, Newborn; Pregnancy; Rifampin; Tuberculosis, Lymph Node; Tuberculosis, Miliary; Tuberculosis, Pulmonary

Topics: Adult; Female; Fever; Humans; Isoniazid; Radiography; Rifampin; Sacroiliac Joint; Streptomycin; Tuberculosis, Miliary; Tuberculosis, Osteoarticular

Topics: Acute Disease; Adult; Clavicle; Drug Resistance, Microbial; Ethambutol; Ethionamide; Humans; Hypercalcemia; Isoniazid; Male; Military Medicine; Mycobacterium tuberculosis; Phosphates; Prednisone; Radiography; Rifampin; Streptomycin; Tuberculosis, Miliary; Tuberculosis, Osteoarticular; Tuberculosis, Pulmonary

Topics: Aged; Aminosalicylic Acids; Antitubercular Agents; Arthritis, Rheumatoid; Bronchitis; Diabetes Complications; Drug Therapy, Combination; England; Female; Humans; Male; Mass Chest X-Ray; Mycobacterium tuberculosis; Nose; Occupations; Pneumoconiosis; Pulmonary Emphysema; Rifampin; Silicotuberculosis; Sputum; Streptomycin; Tuberculosis, Miliary; Tuberculosis, Pulmonary

Topics: Adult; Antigens; Cell Migration Inhibition; Chlorine; Deoxyuridine; Herpes Zoster; Humans; Immunity, Cellular; Iodine Isotopes; Isoniazid; Lymphocyte Activation; Male; Nitrobenzenes; Prednisone; Rifampin; Skin; Skin Tests; Tuberculin Test; Tuberculosis, Miliary

Topics: Child, Preschool; Drainage; Ethambutol; Humans; Isoniazid; Male; Mediastinal Emphysema; Pneumothorax; Rifampin; Streptomycin; Tuberculosis, Miliary

Topics: Chemical and Drug Induced Liver Injury; Child, Preschool; Cholestasis; Humans; Isoniazid; Jaundice; Liver; Male; Rifampin; Tuberculosis, Miliary

Topics: Aged; Chemical and Drug Induced Liver Injury; Female; Humans; Imipramine; Isoniazid; Jaundice; Liver; Male; Middle Aged; Rifampin; Tuberculosis; Tuberculosis, Miliary

Topics: Anemia, Aplastic; Biopsy; Ethambutol; Female; Humans; Isoniazid; Liver; Middle Aged; Rifampin; Tuberculosis, Miliary

Topics: Adult; Aminosalicylic Acids; Animals; Drug Resistance, Microbial; Drug Synergism; Female; Guinea Pigs; Humans; Isoniazid; Male; Middle Aged; Mycobacterium tuberculosis; Rifampin; Streptomycin; Tuberculosis, Miliary; Tuberculosis, Pulmonary

Topics: Adult; Humans; Male; Middle Aged; Respiration; Respiratory Function Tests; Rifampin; Spirometry; Tuberculosis, Lymph Node; Tuberculosis, Miliary; Tuberculosis, Pulmonary

Topics: Adolescent; Adult; Aminosalicylic Acids; Chronic Disease; Ethambutol; Humans; Male; Middle Aged; Radiography; Rifampin; Time Factors; Tuberculosis, Lymph Node; Tuberculosis, Miliary; Tuberculosis, Pulmonary

Topics: Adult; Aged; Aminosalicylic Acids; Antitubercular Agents; Chronic Disease; Cycloserine; Empyema, Tuberculous; Ethambutol; Humans; Isonicotinic Acids; Kidney Function Tests; Liver Function Tests; Lung Diseases; Middle Aged; Morpholines; Pyrazines; Rifampin; Tuberculosis, Miliary; Tuberculosis, Pulmonary