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|Title: ||Paradoxical reactions in Buruli ulcer after initiation of antibiotic therapy: Relationship to bacterial load|
|Authors: ||Phillips, Richard O.|
Duah, Mabel Sarpong
|Issue Date: ||26-Aug-2019|
|Publisher: ||PLOS Neglected Tropical Diseases|
|Citation: ||PLoS Negl Trop Dis 13(8): e0007689. https://doi. org/10.1371/journal.pntd.0007689|
We investigated the relationship between bacterial load in Buruli ulcer (BU) lesions and the
development of paradoxical reaction following initiation of antibiotic treatment.
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.
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.|
|Description: ||An article published by PLOS Neglected Tropical Diseases and available at https://doi.
|Appears in Collections:||College of Health Sciences|
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