Paradoxical Responses After Start of Antimicrobial Treatment in Mycobacterium ulcerans Infection
Open Access
- 7 December 2011
- journal article
- research article
- Published by Oxford University Press (OUP) in Clinical Infectious Diseases
- Vol. 54 (4), 519-526
- https://doi.org/10.1093/cid/cir856
Abstract
Background. Antimicrobial killing in mycobacterial infections may be accompanied by (transient) clinical deterioration, known as paradoxical reaction. To search for patterns reflecting such reactions in the treatment of Buruli ulcer (Mycobacterium ulcerans infection), the evolution of lesions of patients treated with antimicrobials was prospectively assessed. Methods. The lesion size of participants of the BURULICO antimicrobial trial (with lesions ≤10 cm cross-sectional diameter) was assessed by careful palpation and recorded by serial acetate sheet tracings. Patients were treated with antimicrobials for 8 weeks. For the size analysis, participants whose treatment had failed, had skin grafting, or were coinfected with human immunodeficiency virus were excluded. For every time point, surface area was compared with the previous assessment. A generalized additive mixed model was used to study lesion evolution. Nonulcerative lesions were studied using digital images recording possible subsequent ulceration. Results. Of 151 participants, 134 were included in the lesion size analysis. Peak paradoxical response occurred at week 8; >30% of participants showed an increase in lesion size as compared with the previous (week 6) assessment. Seventy-five of 90 (83%) of nonulcerative lesions ulcerated after start of treatment. Nine participants developed new lesions during or after treatment. All lesions subsequently healed. Conclusions. After start of antimicrobial treatment for Buruli ulcer, new or progressive ulceration is common before healing sets in. This paradoxical response, most prominent at the end of the 8-week antimicrobial treatment, should not be misinterpreted as failure to respond to treatment. Clinical Trials Registration. ClinicalTrials.gov, NCT00321178.This publication has 31 references indexed in Scilit:
- Chemistry of mycolactones, the causative toxins of Buruli ulcerProceedings of the National Academy of Sciences of the United States of America, 2011
- Oral Treatment for Mycobacterium ulcerans Infection: Results From a Pilot Study in BeninClinical Infectious Diseases, 2011
- Clinical Efficacy of Combination of Rifampin and Streptomycin for Treatment ofMycobacterium ulceransDiseaseAntimicrobial Agents and Chemotherapy, 2010
- Response to Treatment in a Prospective Cohort of Patients with Large Ulcerated Lesions Suspected to Be Buruli Ulcer (Mycobacterium ulcerans Disease)PLoS Neglected Tropical Diseases, 2010
- IFN-γ–Dependent Activation of Macrophages during Experimental Infections by Mycobacterium ulcerans Is Impaired by the Toxin MycolactoneThe Journal of Immunology, 2009
- Immunosuppressive Signature of CutaneousMycobacterium ulceransInfection in the Peripheral Blood of Patients with Buruli Ulcer DiseaseThe Journal of Infectious Diseases, 2009
- Dynamics of the Cytokine Response toMycobacterium ulceransduring Antibiotic Treatment forM. ulceransDisease (Buruli Ulcer) in HumansClinical and Vaccine Immunology, 2009
- Immunosuppression and treatment-associated inflammatory response in patients withMycobacterium ulceransinfection (Buruli ulcer)Expert Opinion on Biological Therapy, 2008
- Promising Clinical Efficacy of Streptomycin-Rifampin Combination for Treatment of Buruli Ulcer ( Mycobacterium ulcerans Disease)Antimicrobial Agents and Chemotherapy, 2007
- Buruli Ulcer (M. ulcerans Infection): New Insights, New Hope for Disease ControlPLoS Medicine, 2005