The pathogen Mycobacterium avium complex (MAC) is the most common cause of nontuberculous mycobacterial pulmonary disease worldwide. The decision to initiate long-term antibiotic treatment is difficult for the physician due to inconsistent disease progression and adverse effects associated with the antibiotic treatment. The prognostic factors for the progression of MAC pulmonary disease are low body mass index, poor nutritional status, presence of cavitary lesion(s), extensive disease, and a positive acid-fast bacilli smear. A regimen consisting of macrolides (clarithromycin or azithromycin) with rifampin and ethambutol has been recommended; this regimen significantly improves the treatment of MAC pulmonary disease and should be maintained for at least 12 months after negative sputum culture conversion. However, the rates of default and disease recurrence after treatment completion are still high. Moreover, treatment failure or macrolide resistance can occur, although in some refractory cases, surgical lung resection can improve treatment outcomes. However, surgical resection should be carefully performed in a well-equipped center and be based on a rigorous risk-benefit analysis in a multidisciplinary setting. New therapies, including clofazimine, inhaled amikacin, and bedaquiline, have shown promising results for the treatment of MAC pulmonary disease, especially in patients with treatment failure or macrolide-resistant MAC pulmonary disease. However, further evidence of the efficacy and safety of these new treatment regimens is needed. Also, a new consensus is needed for treatment outcome definitions as widespread use of these definitions could increase the quality of evidence for the treatment of MAC pulmonary disease.
Amikacin ; Body Mass Index ; Clofazimine ; Consensus ; Disease Progression ; Ethambutol ; Humans ; Lung ; Lung Diseases ; Macrolides ; Mycobacterium avium Complex* ; Mycobacterium avium* ; Mycobacterium* ; Nontuberculous Mycobacteria ; Nutritional Status ; Recurrence ; Rifampin ; Sputum ; Treatment Failure ; Treatment Outcome

Mycobacterium abscessus is the second most important pathogen in pulmonary disease caused by nontuberculous mycobacteria (NTM), following Mycobacterium avium. Mycobacterium abscessus is classified into three subspecies: M. abscessus subsp. abscessus, M. abscessus subsp. massiliense, and M. abscessus subsp. bolletii. Mycobacterium abscessus is the most difficult to treat NTM due to its resistance to many antibiotics. Treatment should include an initial regimen of 2–3 injectable and oral antibiotics for several weeks or months, followed by inhaled amikacin and 1–3 oral antibiotics, depending on the subspecies and drug susceptibility patterns, including macrolide susceptibility. The continuation phase should be continued for a minimum of 12 months after culture conversion. Suitable injectable antibiotics include amikacin, imipenem, cefoxitin, and tigecycline, while oral antibiotics include macrolides (azithromycin or clarithromycin), clofazimine, linezolid, and moxifloxacin. Surgery can be a useful adjunctive therapy for some patients with refractory disease. However, the overall treatment prognosis is still unsatisfactory. Therefore, novel and more effective interventions are required for the treatment of M. abscessus pulmonary disease.
Amikacin ; Anti-Bacterial Agents ; Cefoxitin ; Clofazimine ; Humans ; Imipenem ; Linezolid ; Lung Diseases ; Macrolides ; Mycobacterium avium ; Mycobacterium ; Nontuberculous Mycobacteria ; Prognosis

PURPOSE: To report a case of secondary pigmentary glaucoma due to clofazimine treatment for extensive drug-resistant tuberculosis. CASE SUMMARY: A 23-year-old man presented with blurred vision in both eyes. The patient started to take clofazimine for extensive drug-resistant tuberculosis six months prior, after which his facial skin color changed to a dark-brown. Intraocular pressure (IOP) was 50 mm Hg in the right eye and 48 mm Hg in the left eye. Slit lamp examination revealed corneal edema, opacity, and flare in the anterior chamber in both eyes. A color vision test revealed a mild color defect in both eyes. Visual field (VF) test revealed superior temporal VF loss in the left eye. Gonioscopy revealed open angles with high pigmentation in the trabecular meshwork in both eyes. The patient was diagnosed with pigmentary glaucoma, and maximum tolerated medical therapy was performed. However, the IOP was uncontrolled. Trabeculectomy was performed in both eyes. Postoperative IOP was measured to be 12 mm Hg in both eyes without medication, and visual acuity measured 20/22 in the right eye and 20/17 in the left eye. CONCLUSIONS: To the best of our knowledge, this report is the first case of clofazimine being a possible cause of pigmentary glaucoma in a patient with extensive drug-resistant tuberculosis.
Anterior Chamber ; Clofazimine ; Color Vision ; Corneal Edema ; Glaucoma, Open-Angle* ; Gonioscopy ; Humans ; Intraocular Pressure ; Pigmentation ; Skin Pigmentation ; Slit Lamp ; Trabecular Meshwork ; Trabeculectomy ; Tuberculosis, Multidrug-Resistant* ; Visual Acuity ; Visual Fields ; Young Adult

Despite global efforts to control tuberculosis (TB), multidrug-resistant TB (MDR-TB) is still a serious problem worldwide. The diagnosis of MDR-TB is based on mycobacterial culture followed by drug susceptibility testing, with results available in weeks to months. This requirement calls for rapid direct tests, especially genotypic tests, in which specimens are amplified directly for the detection of MDR-TB. The treatment of MDR-TB is challenging because of the high toxicity of second-line drugs and the longer treatment duration required compared to drug-susceptible TB. The selection of drugs in MDR-TB is based on the treatment history, drug susceptibility results, and TB drug resistance patterns in each region. Recent World Health Organization guidelines recommend the use of at least four second-line drugs (i.e., a newer fluoroquinolone, an injectable agent, prothionamide, and cycloserine or para-aminosalicylic acid) in addition to pyrazinamide. Kanamycin is the initial choice of an injectable drug, and newer fluoroquinolones include levofloxacin and moxifloxacin. For extensively drug-resistant TB, group 5 drugs such as linezolid and clofazimine need to be included. New drugs such as delamanid and bedaquiline have recently been approved for treating MDR-TB and other agents with novel mechanisms of action that can be given for shorter durations (6-12 months) for MDR-TB are under investigation.
Clofazimine ; Cycloserine ; Diagnosis* ; Drug Resistance ; Fluoroquinolones ; Kanamycin ; Levofloxacin ; Prothionamide ; Pyrazinamide ; Tuberculosis ; Tuberculosis, Multidrug-Resistant* ; World Health Organization

Leprosy is a chronic, infectious disease caused by Mycobacterium leprae. One of the main problems faced by clinicians and patients, is the development of leprosy-specific immunologic phenomena known as reactions. Lepra reactions are characterized by acute inflammation that appears suddenly before, during and after treatment of leprosy. When immune reaction increases, serious complications such as irreversible nerve damage, permanent disability, iridocyclitis and other organ involvement may ensue. There are two types of leprosy reactions: type I which is a type IV cell-mediated reaction, and type II lepra reaction, also called erythema nodosum leprosum (ENL), which is a type III hypersensitivity reaction. We report a case of a 37-year-old female who has been diagnosed with lepromatous type of Hansen's Disease and has been treated with multi-drug multibacillary therapy composed of rifampicin 600mg monthly, dapsone 100 mg daily, clofazimine 300 mg monthly and clofazimine 10 mg daily for 18 months. For two years, she has been experiencing recurrent type II lepra reaction which was treated with systemic corticosteroids. Appearance of ulcers with associated myalgia, arthralgia and fever prompted the addition of clofazimine, which is the drug of choice for female patients with childbearing potential. Prednisone was started at 1mg/kg and clofazimine 100mg three times a day for three months, which were subsequently tapered off. We stress the importance of early diagnosis for proper treatment of this condition is important to prevent further complications and other organ involvement.

Human ; Female ; Adult ; Adrenal Cortex Hormones ; Arthralgia ; Clofazimine ; Communicable Diseases ; Dapsone ; Early Diagnosis ; Erythema Nodosum ; Fever ; Immune Complex Diseases ; Inflammation ; Iridocyclitis ; Leprostatic Agents ; Leprosy ; Myalgia ; Mycobacterium Leprae ; Prednisone ; Rifampin ; Ulcer

Anti-Inflammatory Agents ; administration & dosage ; Arthritis ; diagnosis ; drug therapy ; etiology ; physiopathology ; Arthritis, Rheumatoid ; diagnosis ; Clofazimine ; administration & dosage ; Dapsone ; administration & dosage ; Delayed Diagnosis ; Diagnosis, Differential ; Humans ; Leprostatic Agents ; administration & dosage ; Leprosy ; complications ; diagnosis ; drug therapy ; physiopathology ; Male ; Middle Aged ; Prednisolone ; administration & dosage ; Rifampin ; administration & dosage ; Treatment Outcome

Treatment of multidrug-resistant tuberculosis (MDR-TB) is challenging because of the high toxicity of second-line drugs and the longer treatment duration required compared with drug-susceptible TB. The efficacy of treatment for MDR-TB is poorer than that for drug-susceptible TB. The selection of drugs in MDR-TB is based on previous treatment history, drug susceptibility results, and TB drug resistance patterns in the each region. Recent World Health Organization guidelines recommend the use of least 4 second-line drugs (a newer fluoroquinolone, an injectable agent, prothionamide, and cycloserine or para-aminosalicylic acid) in addition to pyrazinamide. The kanamycin is the initial choice of injectable durgs, and newer fluoroquinolones include levofloxacin and moxifloxacin. For MDR-TB, especially cases that are extensively drug-resistant, group 5 drugs such as linezolid, clofazimine, and amoxicillin/clavulanate need to be included. New agents with novel mechanisms of action that can be given for shorter durations (9-12 months) for MDR-TB are under investigation.
Clofazimine ; Cycloserine ; Drug Resistance ; Extensively Drug-Resistant Tuberculosis ; Fluoroquinolones ; Kanamycin ; Levofloxacin ; Linezolid ; Prothionamide ; Pyrazinamide ; Tuberculosis ; Tuberculosis, Multidrug-Resistant* ; World Health Organization

The Clofazimine is a rimino-phenazine dye. The color is a purplish-back. The drug is reported to be weakly bactericidal and also effective in the management of leprosy reactions apparently. The drug produces relatively few side effects in the majority of patients. The most prominent is coloration of the skin. The coloration can range anywhere from a reddish-tan to purplish-black. so, many patients avoid taking clofazimine. The Q-switched ND-YAG laser is a good medical instrument for clearing coloration of the skin. It releases two wavelength of 532nm and 1064nm. The wavelength of 532nm reachs shallow depth of the skin. So, it is effective in the clearance of a red, yellow tatto, freckle and lentigo. The wavelength of 1064nm reachs about 4-6mm depth of the skin. So, it is effective in the clearance of blue-black tatto and ota nevus. The leprosy patients who has purplish-black coloration of the skin in the face due to clofazimine is cleared by Q-switched ND-YAG laser. We operated twice with 3months interval. The wavelength is 532nm, spot size 3mm, energy 1.5J/cm2. The coloration of the skin in the face is almost cleared.
Clofazimine* ; Humans ; Lasers, Solid-State* ; Lentigo ; Leprosy ; Melanosis ; Nevus of Ota ; Skin*

Chemotherapy is a main component of treatments for leprosy. The World Health Organization (WHO) recommends multiple-drug therapy (MDT) consisting of dapsone, clofazimine and monthly rifampin as the first-line drugs against leprosy. Minocycline, clarithromycin and certain fluoroquinolones can be used as substitutes in dapsone or clofazimine. For management of reactions, type I reactions should be treated with corticosteroids while thalidomide is the drug of choice for type II reaction. This review summarizes pharmacologic effects of drugs being used in leprosy including mechanisms of action, side effects, drug interactions and drug resistance.
Adrenal Cortex Hormones ; Clarithromycin ; Clofazimine ; Dapsone ; Drug Interactions ; Drug Resistance ; Drug Therapy ; Fluoroquinolones ; Leprosy* ; Minocycline ; Rifampin ; Thalidomide ; World Health Organization

Sweet's syndrome, first described in 1964 by Sweet, is characterized by fever, neutrophilic leukocytosis, sudden onset of asymmetric, erythematous, often painful skin lesions, and dense dermal infiltrates of mature neutrophils without signs of vasculitis. The disease responds rapidly to systemic therapy with corticosteroids but recurs in about 25% of the cases. Alternative treatments include potassium iodide, colchine, dapsone, clofazimine, cyclosporin. We report a case of classic sweet's syndrome which was successfully treated with potassium iodide without adverse reactions. 33 year-old male patient became afebrile and symptom free within 24h after starting potassium iodide 900mg/day. The cutaneous eruptions subsided completely in 5 days. He received the drug only for 12days, but there has been no recurrence after 6 months under observation.
Adrenal Cortex Hormones ; Adult ; Clofazimine ; Cyclosporine ; Dapsone ; Fever ; Humans ; Leukocytosis ; Male ; Neutrophils ; Panniculitis* ; Potassium Iodide* ; Potassium* ; Recurrence ; Skin ; Sweet Syndrome* ; Vasculitis