Paradoxical reactions in Buruli ulcer after initiation of antibiotic therapy: Relationship to bacterial load.
Background We investigated the relationship between bacterial load in Buruli ulcer (BU) lesions and the development of paradoxical reaction following initiation of antibiotic treatment. Methods This was a longitudinal study involving BU patients from June 2013 to June 2017. Fine needle aspirates (FN...
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ftdoajarticles:oai:doaj.org/article:3866a4297a3541109098f28fa0ea08a5 2023-05-15T15:12:48+02:00 Paradoxical reactions in Buruli ulcer after initiation of antibiotic therapy: Relationship to bacterial load. Michael Frimpong Bernadette Agbavor Mabel Sarpong Duah Aloysius Loglo Francisca N Sarpong Justice Boakye-Appiah Kabiru M Abass Mathias Dongyele George Amofa Wilson Tuah Margaret Frempong Yaw A Amoako Mark Wansbrough-Jones Richard O Phillips 2019-08-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0007689 https://doaj.org/article/3866a4297a3541109098f28fa0ea08a5 EN eng Public Library of Science (PLoS) https://doi.org/10.1371/journal.pntd.0007689 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0007689 https://doaj.org/article/3866a4297a3541109098f28fa0ea08a5 PLoS Neglected Tropical Diseases, Vol 13, Iss 8, p e0007689 (2019) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2019 ftdoajarticles https://doi.org/10.1371/journal.pntd.0007689 2022-12-31T07:36:44Z Background We investigated the relationship between bacterial load in Buruli ulcer (BU) lesions and the development of paradoxical reaction following initiation of antibiotic treatment. Methods This was a longitudinal study involving BU patients from June 2013 to June 2017. Fine needle aspirates (FNA) and swab samples were obtained to establish the diagnosis of BU by PCR. Additional samples were obtained at baseline, during and after treatment (if the lesion had not healed) for microscopy, culture and combined 16S rRNA reverse transcriptase/ IS2404 qPCR assay. Patients were followed up at regular intervals until complete healing. Results Forty-seven of 354 patients (13%) with PCR confirmed BU had a PR, occurring between 2 and 42 (median 6) weeks after treatment initiation. The bacterial load, the proportion of patients with positive M. ulcerans culture (15/34 (44%) vs 29/119 (24%), p = 0.025) and the proportion with positive microscopy results (19/31 (61%) vs 28/90 (31%), p = 0.003) before initiation of treatment were significantly higher in the PR compared to the no PR group. Plaques (OR 5.12; 95% CI 2.26-11.61; p<0.001), oedematous (OR 4.23; 95% CI 1.43-12.5; p = 0.009) and category II lesions (OR 2.26; 95% CI 1.14-4.48; p = 0.02) were strongly associated with the occurrence of PR. The median time to complete healing (28 vs 13 weeks, p <0.001) was significantly longer in the PR group. Conclusions Buruli ulcer patients who develop PR are characterized by high bacterial load in lesion samples taken at baseline and a higher rate of positive M. ulcerans culture. Occurrence of a PR was associated with delayed healing. Trial registration ClinicalTrials.gov NCT02153034. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic PLOS Neglected Tropical Diseases 13 8 e0007689 |
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Open Polar |
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Directory of Open Access Journals: DOAJ Articles |
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ftdoajarticles |
language |
English |
topic |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
spellingShingle |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Michael Frimpong Bernadette Agbavor Mabel Sarpong Duah Aloysius Loglo Francisca N Sarpong Justice Boakye-Appiah Kabiru M Abass Mathias Dongyele George Amofa Wilson Tuah Margaret Frempong Yaw A Amoako Mark Wansbrough-Jones Richard O Phillips Paradoxical reactions in Buruli ulcer after initiation of antibiotic therapy: Relationship to bacterial load. |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
Background We investigated the relationship between bacterial load in Buruli ulcer (BU) lesions and the development of paradoxical reaction following initiation of antibiotic treatment. Methods This was a longitudinal study involving BU patients from June 2013 to June 2017. Fine needle aspirates (FNA) and swab samples were obtained to establish the diagnosis of BU by PCR. Additional samples were obtained at baseline, during and after treatment (if the lesion had not healed) for microscopy, culture and combined 16S rRNA reverse transcriptase/ IS2404 qPCR assay. Patients were followed up at regular intervals until complete healing. Results Forty-seven of 354 patients (13%) with PCR confirmed BU had a PR, occurring between 2 and 42 (median 6) weeks after treatment initiation. The bacterial load, the proportion of patients with positive M. ulcerans culture (15/34 (44%) vs 29/119 (24%), p = 0.025) and the proportion with positive microscopy results (19/31 (61%) vs 28/90 (31%), p = 0.003) before initiation of treatment were significantly higher in the PR compared to the no PR group. Plaques (OR 5.12; 95% CI 2.26-11.61; p<0.001), oedematous (OR 4.23; 95% CI 1.43-12.5; p = 0.009) and category II lesions (OR 2.26; 95% CI 1.14-4.48; p = 0.02) were strongly associated with the occurrence of PR. The median time to complete healing (28 vs 13 weeks, p <0.001) was significantly longer in the PR group. Conclusions Buruli ulcer patients who develop PR are characterized by high bacterial load in lesion samples taken at baseline and a higher rate of positive M. ulcerans culture. Occurrence of a PR was associated with delayed healing. Trial registration ClinicalTrials.gov NCT02153034. |
format |
Article in Journal/Newspaper |
author |
Michael Frimpong Bernadette Agbavor Mabel Sarpong Duah Aloysius Loglo Francisca N Sarpong Justice Boakye-Appiah Kabiru M Abass Mathias Dongyele George Amofa Wilson Tuah Margaret Frempong Yaw A Amoako Mark Wansbrough-Jones Richard O Phillips |
author_facet |
Michael Frimpong Bernadette Agbavor Mabel Sarpong Duah Aloysius Loglo Francisca N Sarpong Justice Boakye-Appiah Kabiru M Abass Mathias Dongyele George Amofa Wilson Tuah Margaret Frempong Yaw A Amoako Mark Wansbrough-Jones Richard O Phillips |
author_sort |
Michael Frimpong |
title |
Paradoxical reactions in Buruli ulcer after initiation of antibiotic therapy: Relationship to bacterial load. |
title_short |
Paradoxical reactions in Buruli ulcer after initiation of antibiotic therapy: Relationship to bacterial load. |
title_full |
Paradoxical reactions in Buruli ulcer after initiation of antibiotic therapy: Relationship to bacterial load. |
title_fullStr |
Paradoxical reactions in Buruli ulcer after initiation of antibiotic therapy: Relationship to bacterial load. |
title_full_unstemmed |
Paradoxical reactions in Buruli ulcer after initiation of antibiotic therapy: Relationship to bacterial load. |
title_sort |
paradoxical reactions in buruli ulcer after initiation of antibiotic therapy: relationship to bacterial load. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2019 |
url |
https://doi.org/10.1371/journal.pntd.0007689 https://doaj.org/article/3866a4297a3541109098f28fa0ea08a5 |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
PLoS Neglected Tropical Diseases, Vol 13, Iss 8, p e0007689 (2019) |
op_relation |
https://doi.org/10.1371/journal.pntd.0007689 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0007689 https://doaj.org/article/3866a4297a3541109098f28fa0ea08a5 |
op_doi |
https://doi.org/10.1371/journal.pntd.0007689 |
container_title |
PLOS Neglected Tropical Diseases |
container_volume |
13 |
container_issue |
8 |
container_start_page |
e0007689 |
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1766343436993036288 |