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Paradoxical reactions in Buruli ulcer after initiation of antibiotic therapy: Relationship to bacterial load.

Frimpong, M; Agbavor, B; Duah, MS; Loglo, A; Sarpong, FN; Boakye-Appiah, J; Abass, KM; Dongyele, M; Amofa, G; Tuah, W; et al. Frimpong, M; Agbavor, B; Duah, MS; Loglo, A; Sarpong, FN; Boakye-Appiah, J; Abass, KM; Dongyele, M; Amofa, G; Tuah, W; Frempong, M; Amoako, YA; Wansbrough-Jones, M; Phillips, RO (2019) Paradoxical reactions in Buruli ulcer after initiation of antibiotic therapy: Relationship to bacterial load. PLoS Negl Trop Dis, 13 (8). e0007689. ISSN 1935-2735 https://doi.org/10.1371/journal.pntd.0007689
SGUL Authors: Wansbrough-Jones, Mark Harding

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Abstract

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.

Item Type: Article
Additional Information: © 2019 Frimpong et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Keywords: 06 Biological Sciences, 11 Medical And Health Sciences, Tropical Medicine
SGUL Research Institute / Research Centre: Academic Structure > Infection and Immunity Research Institute (INII)
Journal or Publication Title: PLoS Negl Trop Dis
ISSN: 1935-2735
Language: eng
Dates:
DateEvent
26 August 2019Published
5 August 2019Accepted
Publisher License: Creative Commons: Attribution 4.0
Projects:
Project IDFunderFunder ID
MR/J01477X/1Medical Research Councilhttp://dx.doi.org/10.13039/501100000265
UNSPECIFIEDDepartment for International Developmenthttp://dx.doi.org/10.13039/501100000278
PubMed ID: 31449522
Web of Science ID: WOS:000490919400071
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/111447
Publisher's version: https://doi.org/10.1371/journal.pntd.0007689

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