[Paradoxical reactions and responses during antibiotic treatment for Mycobacterium ulcerans infection (Buruli ulcer). Four cases from French Guiana].

Abstract

BACKGROUND:

In recent years, first-line therapy for Mycobacterium ulcerans infection in French Guiana has consisted of antibiotics active against this organism. Two regimens are used comprising rifampicin associated with clarithromycin or amikacin.

PATIENTS AND METHODS:

We describe four patients presenting apparent worsening of their lesions during treatment: ulceration of a nodular lesion in a 32-year-old woman and worsening of an ulcerated lesion in three patients aged 16, 27 and 79 years.

DISCUSSION:

In these 4 patients, we concluded that the symptoms were caused by a paradoxical response or a reaction, a phenomenon already described in tuberculosis and leprosy. Such worsening is transient and must not be misinterpreted as failure to respond to treatment. The most plausible pathophysiological hypothesis involves the re-emergence of potentially necrotizing cellular immunity secondary to the loss of mycolactone, a necrotizing and immunosuppressive toxin produced by M. ulcerans, resulting from the action of the antibiotics.

• Authors: E Sambourg, J Dufour, S Edouard, A Morris, E Mosnier, Y Reynaud, D Sainte-Marie, M Nacher, J-F Guégan, P Couppié
• Journal: Annales de dermatologie et de venereologie (Ann Dermatol Venereol) 2014 Jun-Jul Vol. 141 Issue 6-7 Pg. 413-8 ISSN: 0151-9638 [Print] France
• Vernacular Title: Réponses et réactions paradoxales au cours du traitement médicamenteux de l'infection à Mycobacterium ulcerans (ulcère de Buruli). Quatre observations en Guyane française.
• PMID: 24951139 (Publication Type: Case Reports, English Abstract, Journal Article)
• Copyright: Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Chemical References

• Anti-Bacterial Agents
• Macrolides
• mycolactone
• Amikacin
• Clarithromycin
• Rifampin

Topics

• Adolescent
• Adult
• Aged
• Amikacin (administration & dosage, adverse effects, pharmacology, therapeutic use)
• Anti-Bacterial Agents (administration & dosage, adverse effects, pharmacology, therapeutic use)
• Asia (ethnology)
• Brazil (ethnology)
• Buruli Ulcer (drug therapy, pathology, surgery)
• Clarithromycin (administration & dosage, adverse effects, pharmacology, therapeutic use)
• Combined Modality Therapy
• Debridement
• Drug Therapy, Combination
• Europe (ethnology)
• Female
• Foot Ulcer (drug therapy, etiology, surgery)
• French Guiana
• Humans
• Immunity, Cellular (drug effects)
• Macrolides (metabolism)
• Male
• Mycobacterium ulcerans (drug effects, metabolism)
• Rifampin (administration & dosage, adverse effects, pharmacology, therapeutic use)
• Wound Healing