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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Paradoxical responses after start of antimicrobial treatment in mycobacterium ulcerans infection
Clinical Infectious Diseases, Volume 54, No. 4, Year 2012
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Description
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. © 2011 The Author.
Authors & Co-Authors
Nienhuis, W. A.
Netherlands
Infectious Diseases Service and Tuberculosis Unit
Stienstra, Ymkje
Netherlands
Infectious Diseases Service and Tuberculosis Unit
Abass, Kabiru Mohammed
Ghana, Agogo
Agogo Presbyterian Hospital
Tuah, Wilson
Ghana
Nkawie-toase Governmental Hospital
Thompson, William A.
Ghana, Agogo
Agogo Presbyterian Hospital
Awuah, Peter C.
Ghana
Nkawie-toase Governmental Hospital
Awuah-Boateng, Nana Yaa
Ghana, Kumasi
Kumasi Centre for Collaborative Research in Tropical Medicine Kccr
Adjei, Ohene
Ghana, Kumasi
Kumasi Centre for Collaborative Research in Tropical Medicine Kccr
Bretzel, Gisela
Germany, Munich
Ludwig-maximilians-universität München
Schouten, Jan P.
Netherlands, Groningen
Universitair Medisch Centrum Groningen
Van Derwerf, Tjip S.
Netherlands
Infectious Diseases Service and Tuberculosis Unit
Netherlands, Groningen
Universitair Medisch Centrum Groningen
Statistics
Citations: 100
Authors: 11
Affiliations: 6
Identifiers
Doi:
10.1093/cid/cir856
ISSN:
10584838
e-ISSN:
15376591
Study Design
Cross Sectional Study