zithromax and Infectious-Mononucleosis

To provide an extensive review of case reports, epidemiological data, and the underlying mechanism of antibiotic-induced skin rash in patients with concurrent infectious mononucleosis (IM).. A MEDLINE literature search inclusive of the dates 1946 to June 2016 was performed using the search terms anti-bacterial agents and infectious mononucleosis. EMBASE (1980 to June 2016) was searched using the terms mononucleosis and antibiotic agent and drug eruption. References of all relevant articles were reviewed for additional citations and information.. We selected English-language, primary literature, review articles, and mechanistic articles that addressed antibiotic-induced skin rash in patients with concurrent IM. We assessed all case reports available for causality utilizing a modified Naranjo nomogram specifically designed for this subject. We assembled the available epidemiological data into tables to identify trends in incidence rates over the years.. We identified 17 case reports of antibiotic-associated rash in patients with IM. The median Naranjo score was 6 (range = 1 to 8). The top 3 reported drugs were ampicillin, azithromycin, and amoxicillin. Incidence of this adverse effect was higher in the 1960s (55.6%, 45%, and 33%) than in 2013 (33% and 15%). The mechanism most commonly proposed is a transient virus-mediated immune alteration that sets the stage for loss of antigenic tolerance and the development of a reversible, delayed-type hypersensitivity reaction to the antibiotic.. A reassessment of the long-held belief of the high incidence (80%-100%) of antibiotic-induced skin rash in patients with IM seems prudent. Additional studies will be necessary to clarify this issue.

Topics: Amoxicillin; Ampicillin; Anti-Bacterial Agents; Azithromycin; Drug Eruptions; Exanthema; Humans; Incidence; Infectious Mononucleosis

Topics: Adolescent; Amoxicillin; Anti-Bacterial Agents; Antibodies, Heterophile; Antifungal Agents; Azithromycin; Exudates and Transudates; Female; Humans; Infectious Mononucleosis; Palatine Tonsil; Pharyngitis; Ultrasonography

Topics: Anti-Bacterial Agents; Azithromycin; Biopsy; Child; Diagnosis, Differential; Drug Eruptions; Eosinophilia; Humans; Infectious Mononucleosis; Male; Skin

A 26-year-old male was hospitalized with fever and pharyngeal pain. Liver dysfunction and an increase in the percentage of atypical lymphocytes in the peripheral blood were detected. Computed tomography showed pneumonia involving the right lung and synpneumonic pleural effusion. Serum immunological tests showed positive results for Epstein-Barr virus (EBV) viral capsid antigen (VCA) IgM and IgG antibodies and Chlamydophila (Chlamydia) pneumoniae (C. pneumoniae) IgM and IgA antibodies on admission. The pneumonia and pleural effusion were no longer detectable after a week of treatment with starting azithromycin. At 7 weeks after admission, the liver function test results returned to within normal limits, the serum became negative for EBV VCA IgM antibody, the C. pneumoniae IgM antibody titer decreased, and the C. pneumoniae IgA and IgG antibody titers increased. This case was suspected to have infectious mononucleosis caused by primary coinfection with C. pneumoniae and EBV.

Topics: Adult; Azithromycin; Chlamydophila Infections; Chlamydophila pneumoniae; Community-Acquired Infections; Herpesvirus 4, Human; Humans; Infectious Mononucleosis; Male; Pneumonia, Bacterial; Serologic Tests

Antibiotic-induced skin eruption in the setting of infectious mononucleosis is a common and well-documented clinical scenario. The skin lesions are non-specific and the mechanisms causing them are unclear. Several reports have described this entity with different antibiotic classes, mainly penicillins. Only 1 case of azithromycin-induced skin eruption has previously been described in this setting. Herein, we report the second case.

Topics: Adult; Ampicillin; Anti-Bacterial Agents; Azithromycin; Drug Eruptions; Exanthema; Herpesvirus 4, Human; Humans; Infectious Mononucleosis; Male

Topics: Anti-Bacterial Agents; Azithromycin; Cytokines; Drug Eruptions; Humans; Infectious Mononucleosis; Th1 Cells

The penicillin family of antibiotics may induce drug eruptions when prescribed to patients with infectious mononucleosis. Very similar phenomena have also been cited with other antibiotic families. We report the first case of a cutaneous reaction in a patient with infectious mononucleosis treated with azithromycin. We propose an immune-based hypothesis to explain the transient sensitivity resulting in this secondary cutaneous eruption.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Drug Eruptions; Drug Therapy, Combination; Follow-Up Studies; Humans; Hydroxyzine; Infectious Mononucleosis; Male; Treatment Outcome; Triamcinolone