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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Secondary buruli ulcer skin lesions emerging several months after completion of chemotherapy: Paradoxical reaction or evidence for immune protection?
PLoS Neglected Tropical Diseases, Volume 5, No. 8, Article e1252, Year 2011
Notification
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Description
Background: The neglected tropical disease Buruli ulcer (BU) caused by Mycobacterium ulcerans is an infection of the subcutaneous tissue leading to chronic ulcerative skin lesions. Histopathological features are progressive tissue necrosis, extracellular clusters of acid fast bacilli (AFB) and poor inflammatory responses at the site of infection. After the recommended eight weeks standard treatment with rifampicin and streptomycin, a reversal of the local immunosuppression caused by the macrolide toxin mycolactone of M. ulcerans is observed. Methodology/Principal Findings: We have conducted a detailed histopathological and immunohistochemical analysis of tissue specimens from two patients developing multiple new skin lesions 12 to 409 days after completion of antibiotic treatment. Lesions exhibited characteristic histopathological hallmarks of Buruli ulcer and AFB with degenerated appearance were found in several of them. However, other than in active disease, lesions contained massive leukocyte infiltrates including large B-cell clusters, as typically found in cured lesions. Conclusion/Significance: Our histopathological findings demonstrate that the skin lesions emerging several months after completion of antibiotic treatment were associated with M. ulcerans infection. During antibiotic therapy of Buruli ulcer development of new skin lesions may be caused by immune response-mediated paradoxical reactions. These seem to be triggered by mycobacterial antigens and immunostimulators released from clinically unrecognized bacterial foci. However, in particular the lesions that appeared more than one year after completion of antibiotic treatment may have been associated with new infection foci resolved by immune responses primed by the successful treatment of the initial lesion. © 2011 Ruf et al.
Authors & Co-Authors
Ruf, Marie Thérèse
Switzerland, Allschwil
Swiss Tropical and Public Health Institute Swiss Tph
Switzerland, Basel
Universitat Basel
Chauty, Annick
Benin
Centre de Diagnostic et de Traitement de L'ulcère de Buruli
Adéyé, Ambroise
Benin
Centre de Diagnostic et de Traitement de L'ulcère de Buruli
Ardant, Marie Françoise
Benin
Centre de Diagnostic et de Traitement de L'ulcère de Buruli
Koussemou, Hugues
Benin
Centre de Diagnostic et de Traitement de L'ulcère de Buruli
Johnson, Roch Christian
Unknown Affiliation
Pluschke, Gerd
Switzerland, Allschwil
Swiss Tropical and Public Health Institute Swiss Tph
Switzerland, Basel
Universitat Basel
Statistics
Citations: 73
Authors: 7
Affiliations: 3
Identifiers
Doi:
10.1371/journal.pntd.0001252
ISSN:
19352727
e-ISSN:
19352735
Research Areas
Cancer