rifampin and Weight-Loss

The impact of low body mass index (BMI) at initiation of rifampicin-resistant tuberculosis (RR-TB) treatment on outcomes is uncertain. We evaluated the association between BMI at RR-TB treatment initiation and end-of-treatment outcomes.. We performed an individual participant data meta-analysis of adults aged ≥18 years with RR-TB whose BMI was documented at treatment initiation. We compared odds of any unfavorable treatment outcome, mortality, or failure/recurrence between patients who were underweight (BMI <18.5 kg/m2) and not underweight. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using logistic regression, with matching on demographic, clinical, and treatment-related factors. We evaluated effect modification by human immunodeficiency virus (HIV) status and other variables using likelihood ratio tests. We also estimated cumulative incidence of mortality during treatment stratified by HIV.. Overall, 5148 patients were included; 1702 (33%) were underweight at treatment initiation. The median (interquartile range) age was 37 years (29 to 47), and 455 (9%) had HIV. Compared with nonunderweight patients, the aOR among underweight patients was 1.7 (95% CI, 1.4-1.9) for any unfavorable outcome, 3.1 (2.4-3.9) for death, and 1.6 (1.2-2.0) for failure/recurrence. Significant effect modification was found for World Health Organization region of treatment. Among HIV-negative patients, 24-month mortality was 14.8% (95% CI, 12.7%-17.3%) for underweight and 5.6% (4.5%-7.0%) for not underweight patients. Among patients with HIV, corresponding values were 33.0% (25.6%-42.6%) and 20.9% (14.1%-27.6%).. Low BMI at treatment initiation for RR-TB is associated with increased odds of unfavorable treatment outcome, particularly mortality.

Topics: Adolescent; Adult; Antitubercular Agents; Body Mass Index; HIV Infections; Humans; Rifampin; Treatment Outcome; Tuberculosis, Multidrug-Resistant; Weight Loss

The literature relating to feline mycobacterial disease is reviewed and 19 cats with tuberculosis caused by a previously unknown strain of mycobacterium are discussed. The bacteria were found to have characteristics between those of Mycobacterium tuberculosis and M bovis. The paper considers the clinical signs, epidemiology and diagnosis of the cases, and discusses the possible origins of the organism, treatment regimens and zoonotic potential.

Topics: Animals; Anti-Bacterial Agents; Antitubercular Agents; Cat Diseases; Cats; Diagnosis, Differential; Dihydrostreptomycin Sulfate; Drug Therapy, Combination; Female; Incidence; Isoniazid; Male; Mycobacterium; Mycobacterium bovis; Mycobacterium tuberculosis; Pyrazinamide; Rifampin; Skin; Tuberculosis; Tuberculosis, Cutaneous; United Kingdom; Weight Loss

Tuberculosis (TB) is a chronic disease that mostly affects low-income countries. TB is transmitted through droplet aerosolization from a person with active pulmonary TB. Afghanistan is one of the 22 high TB burden countries where 39,445 people develop this disease and 7840 people die each year. Treatment outcome is one of the best measurements that explain how the current regimen works.. This was a retrospective cohort study, conducted in Kandahar Province, to find out the treatment outcome of anti-TB drugs regimens in TB patients. Data of pulmonary and extra-pulmonary TB patients, who fulfilled the eligible criteria of the study and were treated from 2005 to 2015, was retrieved from their medical record forms.. Among 1000 TB patients, 599 (59.9%) were females and 401 (40.1%) males; most of the patients (678/1000 [67.8%]) were from Kandahar city while 322/1000 (32.2%) were from the other districts of Kandahar. Mean age of the patients were 36.1 years with SD of 19.3 years. Main signs and symptoms of fever, cough, and weight loss were present in 949/1000 (94.9%), 880/1000 (88%), and 544/1000 (54.4%) of the patients, respectively. On first visit 459/1000 (45.9%) patients were sputum AFB (acid fast bacilli) positive. Majority (247/459 [53.8%]) of these patients were AFB 2+. After 2 months of intensive anti-TB treatment, 9/459 (1.9%) patients were still AFB positive (1+). Treatment outcome of these 1000 patients showed that 479 (47.9%) completed the treatment, 298 (29.8%) were cured, 35 (3.5%) failed the anti-TB treatment, while 5 (0.5%) patients died.. This clearly shows that TB is still one of the major threats to the people of Kandahar Province. There are cases of TB who do not respond to the first line regimens of anti-TB drugs advised by WHO and Afghan Ministry of Public Health (MoPH).

Topics: Adolescent; Adult; Afghanistan; Antitubercular Agents; Cohort Studies; Cough; Drug Therapy, Combination; Duration of Therapy; Ethambutol; Female; Fever; Humans; Isoniazid; Male; Middle Aged; Mortality; Prognosis; Pyrazinamide; Retreatment; Retrospective Studies; Rifampin; Sex Distribution; Sputum; Treatment Failure; Treatment Outcome; Tuberculosis, Pulmonary; Weight Loss; Young Adult

A 65-year-old man presented with a six-month history of lethargy, weight loss and dry cough. He had a background of mild chronic obstructive pulmonary disease. Chest radiograph showed new right upper lobe cavitary opacification. Sputum cultures were acid-fast bacilli smear positive and yielded Mycobacterium marinum - a non-tuberculous mycobacterium (NTM) often found in aquatic environments and rarely associated with respiratory disease. The suspected source was silent aspiration of contaminated water, likely due to his initiating the siphon of his fish-tank by mouth. He completed a one-year course of rifampicin, ethambutol and clarithromycin, with negative repeat sputum mycobacteria cultures and radiological improvement. This case report demonstrates a successful approach to investigation and further management of Mycobacterium marinum pulmonary disease - a rare condition, particularly in immunocompetent individuals, with limited treatment guidelines.

Topics: Aged; Animals; Antibiotics, Antitubercular; Clarithromycin; Cough; Ethambutol; Fishes; Humans; Lethargy; Male; Mycobacterium Infections, Nontuberculous; Pulmonary Disease, Chronic Obstructive; Rifampin; Treatment Outcome; Wastewater; Weight Loss

Tuberculosis caused by Mycobacterium tuberculosis presents a major health challenge in endemic countries and spares no organ in the human body. This infection is a mimicker of various disease processes such as metastasis, lymphoproliferative diseases, and other granulomatous conditions such as sarcoidosis and fungal infections. The most challenging and important differential is metastasis, especially in the disseminated form of tuberculosis. We present a histopathologically proven case of isolated hepatosplenic tuberculosis that was provisionally diagnosed as lymphoma due to its unusual, restricted involvement of the liver and spleen.

Topics: Abdominal Pain; Antitubercular Agents; Diagnosis, Differential; Ethambutol; Female; Humans; Isoniazid; Middle Aged; Pyrazinamide; Rifampin; Tomography, X-Ray Computed; Treatment Outcome; Tuberculosis, Hepatic; Tuberculosis, Splenic; Weight Loss

Esophageal anthracosis with tuberculous lymphadenitis is a very rare disease. Almost all reported cases are diagnosed using multiple endoscopic biopsies or thoracic esophagectomy. The present case report describes a case of esophageal anthracosis with tuberculous lymphadenitis that was diagnosed using transesophageal endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) alone. After taking antituberculosis drugs, the patient's chest pain was relieved and she recovered. The patient achieved an excellent outcome following the use of less invasive methods than mediastinoscopy. If no esophageal anthracotic lesions are found on the mucous membrane layer of the esophagus, transesophageal endoscopic ultrasound-guided fine-needle aspiration is a suitable approach for diagnosing esophageal anthracosis.

Topics: Aged; Anthracosis; Antitubercular Agents; Chest Pain; Drug Therapy, Combination; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Esophagus; Ethambutol; Female; Humans; Isoniazid; Mycobacterium tuberculosis; Pyrazinamide; Rifampin; Treatment Outcome; Tuberculosis, Lymph Node; Weight Loss

Carnosic acid is a phenolic diterpene isolated from rosemary (Rosmarinus officinalis), which may have anticancer, antiadipogenic, and anti-inflammatory properties. Recently, carnosic acid was shown to prevent weight gain and hepatic steatosis in a mouse model of obesity and type II diabetes. Based on these results, carnosic acid has been suggested as a potential treatment for obesity and nonalcoholic fatty liver disease; however, little is known about the safety of carnosic acid at doses needed to elicit a pharmacological effect. For this reason, hepatotoxicity and cytochrome P450 inhibition and induction studies were performed in primary human hepatocytes and microsomes. Measuring cellular ATP, carnosic acid showed a dose-dependent increase in hepatotoxicity with an EC(50) value of 94.8 ± 36.7 μM in three human hepatocyte donors without a concurrent increase in the apoptosis markers caspase-3/7. In human liver microsomes, carnosic acid did not exhibit significant time-dependent inhibition for any of the cytochrome P450 enzymes investigated, although it did inhibit CYP2C9- and CYP3A4-catalyzed reactions with K(i) values of 9.2 and 4.3 μM, respectively. Carnosic acid also induced CYP2B6 and CYP3A4 mRNA and enzyme activity in a dose-dependent manner. At 10 μM, carnosic acid increased CYP2B6 enzyme activity 61.6 and 49.3% in two donors compared with phenobarbital, and it increased CYP3A enzyme activity 82.6 and 142% compared with rifampicin. These results indicate the potential for drug interactions with carnosic acid and illustrate the need for an appropriate safety assessment before being used as a weight loss supplement.

Topics: Abietanes; Adenosine Triphosphate; Adipogenesis; Cells, Cultured; Cytochrome P-450 Enzyme Inhibitors; Cytochrome P-450 Enzyme System; Dietary Supplements; Dose-Response Relationship, Drug; Drug Interactions; Hepatocytes; Humans; Microsomes, Liver; Plant Extracts; Rifampin; Weight Loss

Abstract: Mycobacterium avium paratuberculosis (Map) was cultured from the feces of a wild-caught, female, adult Southern black rhinoceros. The animal, which presented with a 4-mo history of diarrhea and weight loss, was prescribed a course of antimycobacterial drugs. The clinical signs resolved, and the feces were repeatedly culture negative thereafter. Although the Rhinocerotidae are likely to be resistant to Johne's disease, this case raises the possibility that they can become transiently infected with the causative organism.

Topics: Animals; Antitubercular Agents; Diarrhea; Feces; Female; Mycobacterium avium subsp. paratuberculosis; Paratuberculosis; Perissodactyla; Pyrazinamide; Rifampin; Streptomycin; Weight Loss

Topics: Adult; Antitubercular Agents; Bone and Bones; Combined Modality Therapy; Drug Therapy, Combination; Ethambutol; Fever; Humans; Isoniazid; Knee; Male; Pain; Pyrazinamide; Radiography; Radius; Rifampin; Treatment Outcome; Tuberculosis, Osteoarticular; Weight Loss; Wrist

We evaluated the use of a simple and easy-to-obtain potential marker of tuberculosis (TB) drug efficacy, body weight, and correlated weight loss or gain with the number of CFU of Mycobacterium tuberculosis in lungs and spleens of infected mice. C3H mice were infected intravenously with 10(6) CFU of virulent M. tuberculosis H37Rv, and body weight was evaluated for several weeks after infection. At day 20, infected untreated mice consistently lost more than 25% of their body weight. Chemotherapy with selected orally active anti-TB drugs was initiated 7 days following infection and continued for 13 days. Drugs that were administered daily by gavage included isoniazid (INH), ethambutol (EMB), rifampin (RIF), and moxifloxacin (MXF). At the most effective doses, each of these drugs inhibited bacterial growth and abolished infection-induced body weight loss. Chemotherapy with 1/10 the standard dose of INH determined in accepted long-term murine models of TB also prevented body weight loss, while chemotherapy with 1/10 the standard dose of RIF did not. With only 2 weeks of chemotherapy, we observed a good reverse correlation between CFU in lung or spleen and body weight of mice. The simple measurement of weight in TB-infected drug-treated mice required only a weight balance, and go/no-go drug efficacy data was available on day 20 without the necessity of prolonged drug treatment and long (3 weeks or more) in vitro culture times to obtain organ CFU values.

Topics: Animals; Antitubercular Agents; Colony-Forming Units Assay; Drug Evaluation, Preclinical; Female; Isoniazid; Lung; Mice; Mice, Inbred C3H; Mice, Inbred C57BL; Mycobacterium tuberculosis; Rifampin; Spleen; Tuberculosis; Weight Loss

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

We report two patients treated with the combination of itraconazole plus rifampin for more than 4 months. While on itraconazole plus rifampin, patient 1 lost weight at a rate of 30 g/d. After stopping rifampin, he gained 14 g/d. While on itraconazole plus rifampin, patient 2 lost 41 grams/day. After stopping rifampin, he gained 33 g/d. Weight loss while taking the combination of itraconazole plus rifampin, followed by weight gain after stopping rifampin, suggests the possibility of a clinically significant drug interaction between itraconazole and rifampin.

Topics: Adult; AIDS-Related Opportunistic Infections; Antibiotics, Antitubercular; Antifungal Agents; Drug Interactions; Drug Therapy, Combination; Histoplasmosis; Humans; Itraconazole; Male; Middle Aged; Mycobacterium avium-intracellulare Infection; Rifampin; Weight Loss

Proliferative enteropathy (PE) is a transmissible enteric disease caused by Lawsonia intracellularis. An outbreak of equine PE was diagnosed in foals from 3 breeding farms. Most foals had been weaned prior to the appearance of clinical signs, which included depression, rapid and marked weight loss, subcutaneous oedema, diarrhoea and colic. Poor body condition with a rough haircoat and a potbellied appearance were common findings in affected foals. Respiratory tract infection, dermatitis and intestinal parasitism were also found in some foals. Haematological and plasma biochemical abnormalities included hypoproteinaemia, transient leucocytosis, anaemia and increased serum creatinine kinase concentration. Postmortem diagnosis of PE was confirmed on 4 foals based on the presence of characteristic intracellular bacteria within the apical cytoplasm of proliferating crypt epithelial cells of the intestinal mucosa, using silver stains, and by results of PCR analysis and immunohistochemistry. Antemortem diagnosis of equine PE was based on the clinical signs, hypoproteinaemia and the exclusion of common enteric infections. Faecal PCR analysis was positive for the presence of L. intracellularis in 6 of 18 foals tested while the serum of all 7 foals with PE serologically evaluated had antibodies against L. intracellularis. Most foals were treated with erythromycin estolate alone or combined with rifampin for a minimum of 21 days. Additional symptomatic treatments were administered when indicated. All but one foal treated with erythromycin survived the infection. This study indicates that equine PE should be included in the differential diagnosis of outbreaks of rapid weight loss, diarrhoea, colic and hypoproteinaemia in weanling foals.

Topics: Animal Husbandry; Animals; Canada; Colic; Diarrhea; Disease Outbreaks; Drug Therapy, Combination; Enteritis; Erythromycin Estolate; Gram-Negative Bacterial Infections; Horse Diseases; Horses; Hypoproteinemia; Lawsonia Bacteria; Rifampin; Weight Loss

Effects of three antibiotics on clinical, pathologic and immunologic responses in murine Potomac horse fever caused by Ehrlichia risticii infection were examined. When antibiotics were given after the development of clinical signs, antibiotics ranked in the order of reducing clinical signs and in preventing body weight loss and an intestinal enlargement were doxycycline, demeclocycline and rifampin. Infected mice treated with doxycycline and demeclocycline developed greater splenomegaly than rifampin-treated or untreated infected mice. All antibiotics used prevented thymic atrophy due to E. risticii infection. Indirect fluorescent antibody titers were highest with doxycycline treatment. Mice treated with demeclocycline and rifampin produced higher antibody titer than those without treatment. Ehrlichia risticii was reisolated from the spleens of both untreated and rifampin-treated infected mice. The effects of administering single doses of doxycycline at different times after infection were examined. Body weight loss was prevented by the drug given at every treatment day examined, i.e. Days 3, 5 and 7 post-infection (PI). Thymic atrophy was minimum in mice treated at Day 5 PI, while splenomegaly was found on every treatment day. Splenocyte proliferative response to concanavalin A and lipopolysaccharide, and specific antibody development against E. risticii was best in mice treated at Day 5 PI followed by those treated at Day 3 and Day 7 PI.

Topics: Animals; Antibodies, Bacterial; Demeclocycline; Doxycycline; Ehrlichia; Female; Fluorescent Antibody Technique; Horse Diseases; Horses; Lymphocyte Activation; Mice; Organ Size; Rickettsiaceae Infections; Rifampin; Splenomegaly; Thymus Gland; Weight Loss

Mycobacterium paratuberculosis infection was detected in 2 goats in 1974 and in 5 goats in 1975; 5 of which were from a single herd. The magnitude of the subsequent epizootic in the goat herd was not recognized until 1977, when results of bacteriologic culture of fecal and tissue specimens, antibody determinations (agar-gel immuno-diffusion test), and histopathologic studies became available. By 1984, paratuberculosis had been diagnosed in 124 goats. Nearly all the goats were being used in antiserum production and had been given Freund complete adjuvant and human antigens. From 1974 to 1986, herd size varied from 100 to 300. The yearly incidence of paratuberculosis decreased from 13.2% (27 of 204 goats) in 1977 to 0% in 108 goats in 1985. The prevalence was higher in does. In goats that arrived on the farm in 1975 and before, 49 of 121 (40.5%) does developed paratuberculosis vs 41 of 120 (34.2%) wethers. In goats arriving on the farm in 1976 and after, 25 of 274 (8.5%) does and 9 of 216 (4.1%) wethers developed paratuberculosis. The average incubation period was approximately 4 years from arrival on the farm in every year except 1978, regardless of whether the goat was born on the farm or was purchased elsewhere.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Animals; Disease Outbreaks; Ethambutol; Female; Goats; Immunodiffusion; Isoniazid; Male; Paratuberculosis; Rifampin; Sex Factors; Weight Loss