ABSTRACT
BACKGROUND: Nontuberculous mycobacterial (NTM) infections have radically increased worldwide due to the increase in HIV infections. The disease activity increases with progressive immunodeficiency. METHODS: A total of 216 HIV seropositive patients suspected of having mycobacterial infection were recruited for this study. Clinical samples were collected from each patient and cultured on Lowenstein-Jensen media. Detection and species identification were simultaneously done using Reverse Blot Hybridization Assay System. Also, the minimum inhibitory concentrations (MIC) for each isolate were determined in 7H9 broth media for 10 antibiotics. RESULTS: In this study, 4 rapid and 4 slow-growing NTM species were isolated and identified. Mycobacterium fortuitum was the most common NTM species, 3/8 (37.5%), followed by Mycobacterium kansasii, 2/8 (25%). The cases were identified as pulmonary disease, 5/8 (62.5 %), disseminated infection, 2/8 (25%), and skin abscess, 1/8 (12.5%). M. chelonae and Mycobacterium avium were isolated from patients diagnosed with disseminated infection with treatment failure. The skin abscess was caused by infection with M. simiae. The results of the MIC testing were as follows: M. kansasii and M. fortuitum were susceptible to amikacin (AMK); M. avium to clarithromycin (CLA); M. fortuitum 2/3 (67%) to ciprofloxacin (CIP); 1/2 (50%) of M. kansasii isolates to CLA, and M. chelonae to rifampin (RIF), linezolid (LIN), AMK, and CIP at medium and high concentrations. CONCLUSION: AMK showed incredible in vitro activity against M. kansasii and M. fortuitum. Also, M. avium was susceptible to CLA, whereas M. simiae and M. chelonae were resistant to the tested drugs in this study.
Subject(s)
Antibiotics, Antitubercular/immunology , HIV Infections/microbiology , Mycobacterium Infections, Nontuberculous/epidemiology , Mycobacterium Infections, Nontuberculous/microbiology , Nontuberculous Mycobacteria/isolation & purification , Adolescent , Adult , Aged , Aged, 80 and over , Ciprofloxacin/immunology , Female , Humans , Incidence , Iran/epidemiology , Male , Microbial Sensitivity Tests , Middle Aged , Mycobacterium Infections, Nontuberculous/drug therapy , Nontuberculous Mycobacteria/immunology , Rifampin/immunology , Young AdultABSTRACT
BACKGROUND: Delayed drug hypersensitivity to first-line anti-tuberculosis medication is a major challenge in tuberculosis treatment. OBJECTIVE: This study was performed to investigate the efficacy/tolerability of desensitization therapy in treatment of first-line anti-tuberculosis medication hypersensitivity and the usefulness of immunologic evaluation therein. METHODS: This study was conducted as a prospective, observational cohort study. Subjects who experienced hypersensitivity reactions, including maculopapular exanthema (MPE) and drug reaction with eosinophilia and systemic symptoms (DRESS), to first-line anti-tuberculosis medications (isoniazid [INH], ethambutol [EMB], rifampin [RFP], and pyrazinamide [PZA]) were enrolled. Patch, intradermal, lymphocyte transformation, and oral provocation tests were performed to determine culprit drugs, which were desensitized with rapid and graded challenge protocols. Breakthrough reactions (BTRs) during or after desensitization were assessed. RESULTS: In total, 31 desensitization treatments (INH, 8; EMB, 8; RFP, 11; PZA, 4) to 12 patients (8 with MPE and 4 with DRESS) were performed. The overall success rate of desensitization was 80.7%. All the study subjects except one completed the full course of anti-tuberculosis treatment. The overall BTR free rate was 64.5%. Sixteen (80%) treatments for MPE and four (36.4%) for DRESS were BTR free (Pâ¯=â¯0.023). Drugs that were positive on any two of three immunologic studies showed significantly high BTR rates (Pâ¯=â¯0.014), although this was not correlated with desensitization failure rate. CONCLUSION: Rapid desensitization therapy to multiple anti-tuberculosis medications for delayed drug hypersensitivity was safe and successful. Combination of multiple immunologic evaluations may predict BTR although it needs validation in larger studies.
Subject(s)
Desensitization, Immunologic/methods , Drug Hypersensitivity/pathology , Drug Hypersensitivity/prevention & control , Tuberculosis/drug therapy , Adult , Aged , Aged, 80 and over , Antitubercular Agents/immunology , Antitubercular Agents/therapeutic use , Desensitization, Immunologic/statistics & numerical data , Ethambutol/immunology , Ethambutol/therapeutic use , Female , Humans , Incidence , Isoniazid/immunology , Isoniazid/therapeutic use , Male , Middle Aged , Prospective Studies , Pyrazinamide/immunology , Pyrazinamide/therapeutic use , Rifampin/immunology , Rifampin/therapeutic use , Tuberculosis/epidemiology , Tuberculosis/immunologyABSTRACT
BACKGROUND: A multidrug regimen including isoniazid, rifampicin, pyrazinamide and ethambutol is commonly used as first-line treatment for tuberculosis. However, this regimen can occasionally result in severe adverse drug reactions, such as drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome and drug-induced liver injury. The culprit drug and mechanistic basis for the hypersensitive reaction are unknown. OBJECTIVES: To investigate drug-specific T-cell responses in patients with antituberculosis drug (ATD)-induced cutaneous hypersensitivity and its underlying mechanism. METHODS: We enrolled eight patients with ATD-induced maculopapular exanthema and DRESS and performed a lymphocyte transformation test. Subsequently, drug-specific T-cell clones were generated from four of the patients who showed proliferation in response to ATDs. We measured the drug-specific proliferative responses and counted the drug-specific interferon (IFN)-γ/granzyme B-producing cells after drug stimulation. Antihuman leukocyte antigen (HLA) class I and class II blocking antibodies were used to analyse human leukocyte antigen-restricted T-cell responses. RESULTS: Positive proliferative responses to ATDs were mostly found in patients with cutaneous hypersensitivity. Furthermore, we isolated isoniazid/rifampicin-specific T cells from patients, which consisted primarily of CD4+ T cells. Drug-specific CD4+ T cells proliferated and secreted IFN-γ/granzyme B when stimulated with isoniazid or rifampicin, respectively. Isoniazid-responsive T-cell clones did not proliferate in the presence of rifampicin and vice versa. Drug-specific T-cell responses were blocked in the presence of anti-HLA class II antibodies. CONCLUSIONS: This study identifies the presence of isoniazid/rifampicin-specific T cells in patients with ATD-induced maculopapular exanthema and DRESS. Furthermore, it highlights the important role of drug-specific T-cell immune responses in the pathogenesis of these reactions.
Subject(s)
Antitubercular Agents/adverse effects , CD4-Positive T-Lymphocytes/immunology , Drug Hypersensitivity Syndrome/immunology , Exanthema/chemically induced , Immunity, Cellular/immunology , Adult , Antitubercular Agents/immunology , Exanthema/immunology , Female , HLA Antigens/drug effects , HLA Antigens/immunology , Humans , Isoniazid/adverse effects , Isoniazid/immunology , Male , Middle Aged , Rifampin/adverse effects , Rifampin/immunologySubject(s)
Allergens/therapeutic use , Anaphylaxis/prevention & control , Anti-Bacterial Agents/therapeutic use , Desensitization, Immunologic/methods , Drug Hypersensitivity/therapy , Drug-Related Side Effects and Adverse Reactions/therapy , Moxifloxacin/therapeutic use , Mycobacterium tuberculosis/physiology , Rifampin/therapeutic use , Tuberculosis/drug therapy , Administration, Oral , Adult , Allergens/immunology , Anaphylaxis/etiology , Anti-Bacterial Agents/immunology , Drug Hypersensitivity/complications , Drug Hypersensitivity/immunology , Drug-Related Side Effects and Adverse Reactions/immunology , Female , Humans , Moxifloxacin/immunology , Rifampin/immunology , Young AdultSubject(s)
Blood Platelets/immunology , Platelet Glycoprotein GPIIb-IIIa Complex/immunology , Purpura, Thrombocytopenic, Idiopathic/immunology , Rifampin/immunology , Animals , Glucocorticoids/therapeutic use , Humans , Immunoglobulins, Intravenous/therapeutic use , Methylprednisolone/therapeutic use , Mice, Inbred NOD , Mice, SCIDSubject(s)
Anaphylaxis/etiology , Desensitization, Immunologic , Drug Hypersensitivity/therapy , Rifampin/therapeutic use , Tuberculosis/drug therapy , Administration, Oral , Aged , Allergens/immunology , Desensitization, Immunologic/adverse effects , Drug Hypersensitivity/complications , Drug Hypersensitivity/immunology , Humans , Immunoglobulin E/metabolism , Male , Rifampin/immunology , Treatment Refusal , Tuberculosis/complicationsABSTRACT
OBJECTIVES: In the present study, we reviewed 44 cases of disseminated BCG infection during a 10-year period in an Iranian referral children medical centre hospital. MATERIAL AND METHODS: In this study, all of the patients with clinical and laboratory findings that were compatible with a diagnosis of disseminated BCG were included. RESULTS: Through 10 years evaluation, 44 patients were found with disseminated BCG disease. Hepatomegaly and splenomegaly were seen in 68% and 66% of patients, respectively. Osteomyelitis was observed in 9% of our cases. Decrease in blood cells including anaemia, leucopoenia, neutropenia and thrombocytopenia were associated with more severe disease and even deaths. Moreover, 80% and 70% of patients who died had high level of C reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Among the dead patients, 80% had abnormal sonography. Thirty nine percent of patients had immunodeficiency, while more than half of the patients who died had no identified immunodeficiency. CONCLUSION: These findings confirm the need to do sonography as well as bone imaging immediately in all patients with BCGitis. Assessment of the inflammatory factors in order to predict the prognosis of the disease is recommended. Furthermore, complete blood count would provide important information and should perform in all patients with BCGitis
No disponible
Subject(s)
Humans , Male , Female , Mycobacterium bovis/immunology , Mycobacterium bovis/isolation & purification , Isoniazid/immunology , Isoniazid/therapeutic use , Rifampin/immunology , Rifampin/therapeutic use , Ethambutol/immunology , Ethambutol/therapeutic use , Candidiasis, Oral/complications , Candidiasis, Oral/immunology , Leukocytosis/complications , Leukocytosis/immunologyABSTRACT
Drug hypersensitivity reactions can occur to almost all drugs and antibiotics are among the most common cause for this kind of reactions. Drug hypersensitivity may affect any organ or system, and manifestations range widely in clinical severity from mild pruritus to anaphylaxis. In most cases, the suspected drug is avoided in the future. In case of infection, there is usually a safe antibiotic alternative. Nonetheless, in some cases, no alternative treatment exists for optimal therapy. Under these circumstances, desensitization may be performed. Drug desensitization is defined as the induction of a temporary state of tolerance to a drug which can only be maintained by continuous administration of the medication responsible for the hypersensitivity reaction. Desensitization is mainly performed in IgE-mediated reactions. Increasing doses of the implicated drug are administered over a short period of time, until the therapeutic dose is achieved and tolerated. Very few studies confined to children are found in literature. Most of them are case reports. In general, the proposed desensitization schemes are similar to those used in adults differing only in the final dose administered. The purpose of this study is to review desensitization to antibiotics in children presenting and discussing three clinical practical cases of desensitization in this age group.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Desensitization, Immunologic/methods , Drug Hypersensitivity/prevention & control , Adult , Anti-Bacterial Agents/adverse effects , Anti-Bacterial Agents/immunology , Ceftazidime/administration & dosage , Ceftazidime/adverse effects , Ceftazidime/immunology , Child , Child, Preschool , Drug Administration Schedule , Drug Hypersensitivity/epidemiology , Female , Humans , Immune Tolerance/immunology , Immunoglobulin E/blood , Male , Penicillins/administration & dosage , Penicillins/adverse effects , Penicillins/immunology , Rifampin/administration & dosage , Rifampin/adverse effects , Rifampin/immunology , Treatment OutcomeABSTRACT
A 47-year-old Turkish female patient was diagnosed with tuberculosis of the sacro-iliac joints and terminal ileum. She developed a severe adverse drug reaction while taking first-line tuberculosis therapy consisting of isoniazid, pyrazinamide and rifampicin as Rifater and ethambutol. Within 5 min of ingestion she developed pruritic rash, angioedema and breathing difficulties, resulting in an A&E admission. The tuberculosis therapy was discontinued. Intradermal and oral challenge tests for rifampicin were conducted but abandoned early on due to reactions which included audible wheeze, vomiting, throat pain and violent rigours. Clinical manifestations were swiftly treated with appropriate medications. This resulted in a change to the tuberculosis treatment regime, where streptomycin, isoniazid, ethambutol and pyrazinamide were given for 2 months and isoniazid and ethambutol for 12 months. Allergic reactions to rifampicin are rare and should be distinguished from flushing due to pyrazinamide. Prompt diagnosis and treatment by clinicians can be life saving.
Subject(s)
Antibiotics, Antitubercular/adverse effects , Drug Eruptions/immunology , Respiratory Tract Diseases/chemically induced , Rifampin/adverse effects , Tuberculosis, Spinal/drug therapy , Antibiotics, Antitubercular/immunology , Drug Eruptions/therapy , Female , Humans , Middle Aged , Respiratory Tract Diseases/immunology , Respiratory Tract Diseases/therapy , Rifampin/immunology , Withholding TreatmentABSTRACT
BACKGROUND: Intradermal skin testing of the clinically important antibiotics ciprofloxacin, clarithromycin, and rifampicin in the case of suspected allergies to antibiotics is poorly standardized. For clinical practice, standardized procedures and protocols are desired. METHODS: Fifteen healthy volunteers were tested with different concentrations of the antibiotics as well as with appropriate controls. Test readings included wheal area measured by digital image analysis and blood flow increase measured by laser Doppler flowmetry (LDF). To reduce interpersonal variability, test results were normalized with the individual controls using a novel protocol. RESULTS: Nonirritating concentrations of the three antibiotics (ciprofloxacin ~0.0067 mg/ml, clarithromycin ~0.05 mg/ml, rifampicin ~0.002 mg/ml) could be defined for healthy volunteers. Laser Doppler flowmetry generates comparable results to wheal area measurement. Normalization of the test results is necessary and can be applied in a practical algorithm. CONCLUSIONS: Standardized skin testing to detect sensitization to broadly used nonbetalactam antibiotics was presented and should be applied in truly sensitized patients. This approach should help to minimize the inter- and intraindividual differences in reactivity.
Subject(s)
Allergens/administration & dosage , Ciprofloxacin/administration & dosage , Clarithromycin/administration & dosage , Rifampin/administration & dosage , Skin Test End-Point Titration , Adult , Allergens/immunology , Ciprofloxacin/immunology , Clarithromycin/immunology , Female , Humans , Male , Middle Aged , Regional Blood Flow/immunology , Rifampin/immunology , Skin Test End-Point Titration/standards , Young AdultSubject(s)
Cross Reactions , Respiratory Tract Diseases/chemically induced , Rifabutin/administration & dosage , Rifabutin/adverse effects , Rifampin/administration & dosage , Rifampin/adverse effects , Thrombocytopenia/chemically induced , Adult , Female , Humans , Respiratory Tract Diseases/complications , Respiratory Tract Diseases/pathology , Rifabutin/immunology , Rifampin/immunology , Thrombocytopenia/complications , Thrombocytopenia/pathologySubject(s)
Desensitization, Immunologic/methods , Drug Hypersensitivity/therapy , Ethambutol/administration & dosage , Ethambutol/therapeutic use , Isoniazid/immunology , Pyrazinamide/immunology , Adult , Antitubercular Agents/administration & dosage , Antitubercular Agents/immunology , Antitubercular Agents/therapeutic use , Drug Hypersensitivity/immunology , Drug Hypersensitivity/pathology , Drug Therapy, Combination/adverse effects , Humans , Isoniazid/administration & dosage , Isoniazid/therapeutic use , Male , Pyrazinamide/administration & dosage , Pyrazinamide/therapeutic use , Rifampin/administration & dosage , Rifampin/immunology , Rifampin/therapeutic use , Skin Tests , Streptomycin/administration & dosage , Streptomycin/therapeutic use , Tuberculosis, Pulmonary/drug therapyABSTRACT
Drug-induced thrombocytopenia is a challenging diagnosis in the clinical practice because of the many drugs or alternative causes that may be implicated. Exact identification of such drug(s) is required to guide future management and avoid re-exposure. We describe two cases of isolated thrombocytopenia in which cytometric analysis, a readily available technique, allowed the identification of the causative drug in the context of complex therapies (rifampicin and abciximab causing late onset thrombocytopenia).
Subject(s)
Anti-Bacterial Agents/adverse effects , Antibodies, Monoclonal/adverse effects , Anticoagulants/adverse effects , Autoantibodies/blood , Flow Cytometry/methods , Immunoglobulin Fab Fragments/adverse effects , Immunoglobulin G/blood , Purpura, Thrombocytopenic, Idiopathic/diagnosis , Rifampin/adverse effects , Abciximab , Angioplasty, Balloon, Coronary , Anti-Bacterial Agents/immunology , Anti-Bacterial Agents/therapeutic use , Antibodies, Monoclonal/immunology , Antibodies, Monoclonal/therapeutic use , Anticoagulants/immunology , Anticoagulants/therapeutic use , Ciprofloxacin/therapeutic use , Drug Therapy, Combination , Humans , Immunoglobulin Fab Fragments/immunology , Immunoglobulin Fab Fragments/therapeutic use , Male , Middle Aged , Myocardial Infarction/therapy , Osteomyelitis/drug therapy , Purpura, Thrombocytopenic, Idiopathic/blood , Purpura, Thrombocytopenic, Idiopathic/chemically induced , Rifampin/immunology , Rifampin/therapeutic useSubject(s)
Hypersensitivity, Immediate/diagnosis , Hypersensitivity, Immediate/immunology , Immune Tolerance , Leprostatic Agents/immunology , Rifampin/adverse effects , Rifampin/immunology , Urticaria/immunology , Adult , Aged , Antibiotics, Antitubercular/administration & dosage , Antibiotics, Antitubercular/adverse effects , Antibiotics, Antitubercular/immunology , Clinical Trials as Topic , Desensitization, Immunologic/methods , Female , Humans , Hypersensitivity, Immediate/therapy , Immune Tolerance/drug effects , Immunoglobulin E/blood , Injections, Intravenous , Intradermal Tests , Leprostatic Agents/administration & dosage , Leprostatic Agents/adverse effects , Male , Middle Aged , Rifampin/administration & dosage , Urticaria/diagnosis , Urticaria/therapyABSTRACT
OBJECTIVE: To present a protocol for the administration and development technique of the desensitization regimens for cotrimoxazole, rifampicin and penicillin G hypersensibility. METHOD: A review of the available desensitization protocols for these antibiotics and a retrospective study of desensitization processes undertaken in the center from 1998. A development technique of the antibiotic dosages was designed. RESULTS: Desensitization regimens for cotrimoxazole, rifampicin and penicillin G undertaken in the center in 9 patients came from a protocol by Glucksteins et al., Holland et al. and Wendal et al., respectively. After the literature review and the satisfactory results that allowed subsequent antibiotic administration in the 9 cases, these regimens were established as protocols of the center. CONCLUSIONS: Dosage development and patient administration have a practical application and can help to decrease the potential mistakes related to the complexity of the process.
Subject(s)
Anti-Infective Agents/adverse effects , Desensitization, Immunologic , Drug Hypersensitivity/therapy , Penicillin G/adverse effects , Rifampin/immunology , Trimethoprim, Sulfamethoxazole Drug Combination/adverse effects , Anti-Infective Agents/immunology , Drug Hypersensitivity/etiology , Humans , Penicillin G/immunology , Retrospective Studies , Rifampin/adverse effects , Trimethoprim, Sulfamethoxazole Drug Combination/immunologyABSTRACT
Objetivo: Protocolizar la administración y la técnica de elaboraciónde las pautas de desensibilización de cotrimoxazol, rifampicinay penicilina G.Método: Búsqueda bibliográfica en MEDLINE de los protocolosdisponibles y estudio retrospectivo de las desensibilizacionesaplicadas en el centro desde 1998. Diseño gráfico de la elaboraciónde las tomas de cada antibiótico.Resultados: Se ha realizado un total de 9 desensibilizacionesde cotrimoxazol, rifampicina y penicilina G siguiendo el protocolode Glucksteins y cols., Holland y cols. y Wendal y cols., respectivamente,permitiendo la readministración del antibiótico en todoslos casos. Los resultados tanto obtenidos en el centro como publicadosen la literatura y la no existencia de nuevos protocolos queaporten una mayor evidencia confirman la idoneidad de los protocolosaplicados.Conclusiones: La elaboración y administración al paciente delos protocolos seleccionados presentan una aplicación prácticaque permite disminuir los posibles errores derivados de la complejidaddel proceso
Objective: To present a protocol for the administration anddevelopment technique of the desensitization regimens for cotrimoxazole,rifampicin and penicillin G hypersensibility.Method: A review of the available desensitization protocolsfor these antibiotics and a retrospective study of desensitizationprocesses undertaken in the center from 1998. A developmenttechnique of the antibiotic dosages was designed.Results: Desensitization regimens for cotrimoxazole,rifampicin and penicillin G undertaken in the center in 9 patientscame from a protocol by Glucksteins et al., Holland et al. andWendal et al., respectively. After the literature review and the satisfactoryresults that allowed subsequent antibiotic administrationin the 9 cases, these regimens were established as protocols ofthe center.Conclusions: Dosage development and patient administrationhave a practical application and can help to decrease thepotential mistakes related to the complexity of the process
Subject(s)
Humans , Trimethoprim, Sulfamethoxazole Drug Combination/immunology , Drug Hypersensitivity/prevention & control , Anti-Infective Agents/immunology , Anti-Bacterial Agents/immunology , Desensitization, Immunologic , Penicillin G/immunology , Rifampin/immunology , Retrospective Studies , Clinical ProtocolsABSTRACT
BACKGROUND: Desensitization with drugs may be indicated in some clinical situations. Apart from large experiences with beta-lactam antibiotics and cotrimoxazole in HIV infection, experience with other drugs is limited. Rifampicin may elicit exanthema and urticaria, and their pathomechanisms are not known in detail. Since therapy with rifampicin may be indispensable in mycobacterial infections or against multiresistant Staphylococcus aureus, desensitization may be indicated in some patients. OBJECTIVE: Report of immediate hypersensitivity to rifampicin and description of diagnostic and desensitization procedures. METHODS: We report 3 patients with immediate urticarial reactions to rifampicin. Diagnostic procedures included skin and in vitro tests (specific IgE, lymphocyte transformation test, LTT, and CAST). The non-irritant cutoff concentration was evaluated in 24 volunteers. A 7-day desensitization procedure was used. RESULTS: Only intradermal tests at a dilution of at least 1:10,000 (concentration of rifampicin approximately 0.006 mg/ml) were true positive, whereas in vitro tests (IgE, LTT and CAST) did not correctly identify hypersensitive patients. Two patients had positive accidental reexposure. All patients were successfully desensitized with rifampicin according to a slow 7-day protocol. CONCLUSIONS: Rifampicin rarely elicits immediate hypersensitivity symptoms which may be diagnosed by intradermal skin tests. In vitro tests did not contribute to the diagnosis. Therefore, an IgE-mediated mechanism remains to be proven. Desensitization with rifampicin using different protocols has been reported. In our 3 cases, clinical tolerance to rifampicin was achieved using a 7-day protocol.
Subject(s)
Antibiotics, Antitubercular/immunology , Hypersensitivity, Immediate/diagnosis , Hypersensitivity, Immediate/immunology , Immune Tolerance , Leprostatic Agents/immunology , Rifampin/immunology , Urticaria/immunology , Adult , Aged , Antibiotics, Antitubercular/administration & dosage , Antibiotics, Antitubercular/adverse effects , Desensitization, Immunologic/methods , Female , Humans , Hypersensitivity, Immediate/therapy , Immune Tolerance/drug effects , Immunoglobulin E/blood , Injections, Intravenous , Intradermal Tests , Leprostatic Agents/administration & dosage , Leprostatic Agents/adverse effects , Male , Middle Aged , Rifampin/administration & dosage , Rifampin/adverse effects , Urticaria/diagnosis , Urticaria/therapyABSTRACT
We report three patients who developed haemolysis following rifampicin treatment. Initially, autoimmune haemolytic anaemia (AIHA) of the warm type and/or an acute haemolytic transfusion reaction (AHTR) was suggested. The direct antiglobulin tests (DAT) were strongly positive for IgG and C3d, and tests for rifampicin-dependent antibodies were positive in all three cases, featuring C-specificity in one case. The outcome was fatal in two out of the three cases, presumably due to belated diagnosis. This shows that rifampicin may stimulate the production of autoantibodies (aab) and/or drug-dependent antibodies (ddab), and that the resulting haemolytic syndrome bears similarities with AIHA and AHTR.
Subject(s)
Antibiotics, Antitubercular/adverse effects , Diagnostic Errors , Hemolysis/drug effects , Rifampin/adverse effects , Adult , Anemia, Hemolytic/diagnosis , Antibiotics, Antitubercular/immunology , Antibodies/blood , Autoantibodies/blood , Fatal Outcome , Female , Hemolysis/immunology , Humans , Male , Rifampin/immunology , Tuberculosis, Pulmonary/drug therapy , Tuberculosis, Pulmonary/immunologySubject(s)
Clofazimine/administration & dosage , Clofazimine/therapeutic use , Dapsone/administration & dosage , Dapsone/therapeutic use , Leprostatic Agents/administration & dosage , Leprostatic Agents/adverse effects , Leprostatic Agents/therapeutic use , Leprosy, Borderline/drug therapy , Leprosy, Tuberculoid/drug therapy , Leprosy, Lepromatous/drug therapy , Leprosy/drug therapy , Drug Hypersensitivity/etiology , Drug Therapy, Combination/therapeutic use , Rifampin/administration & dosage , Rifampin/adverse effects , Rifampin/immunology , Rifampin/therapeutic use , Sulfonamides/administration & dosage , Sulfonamides/therapeutic use , Thrombocytopenia/immunology , Thrombocytopenia/chemically inducedABSTRACT
A pesquisa teve por objetivo, compreender e avaliar os estados reacionais de pacientes portadores de hanseníase e o tratamento das reações. O método de abordagem do estudo foi indutivo, tendo como base o referencial bibliográfico, tomou-se como fonte de dados os prontuários dos portadores de hanseníase, disponíveis no Programa de Controle de Hanseníase da Secretaria Municipal de Saúde de Itajaí. Através do trabalho com os 78 pacientes inscritos no programa, observou-se que: 60,3 por cento tem de 15-49 anos; 65,4 por cento são do sexo masculino; 70,5 por cento manifestam a forma Virchowiana da doença; 60,3 por cento apresentaram estados reacionais durante tratamento; metade destes aproximadamente apresentaram quadro clínico de neurite, tendo sido tratados com prednisona. Também foram observados outros sintomas clínicos como o eritema nodoso hansênico, e o tratamento de escolha, sempre que possível foi a talidomida. A avaliação dos estados reacionais indica que, mais da metade dos portadores em tratamento, apresentam esta manifestação imunológica. É julgada pela literatura como consequência da doença e possível reação ao esquema poliquimioterápico