RESUMEN
BACKGROUND: In recent years, first-line therapy for Mycobacterium ulcerans infection in French Guiana has consisted of antibiotics active against this organism. Two regimens are used comprising rifampicin associated with clarithromycin or amikacin. PATIENTS AND METHODS: We describe four patients presenting apparent worsening of their lesions during treatment: ulceration of a nodular lesion in a 32-year-old woman and worsening of an ulcerated lesion in three patients aged 16, 27 and 79 years. DISCUSSION: In these 4 patients, we concluded that the symptoms were caused by a paradoxical response or a reaction, a phenomenon already described in tuberculosis and leprosy. Such worsening is transient and must not be misinterpreted as failure to respond to treatment. The most plausible pathophysiological hypothesis involves the re-emergence of potentially necrotizing cellular immunity secondary to the loss of mycolactone, a necrotizing and immunosuppressive toxin produced by M. ulcerans, resulting from the action of the antibiotics.
Asunto(s)
Amicacina/efectos adversos , Antibacterianos/efectos adversos , Úlcera de Buruli/tratamiento farmacológico , Claritromicina/efectos adversos , Rifampin/efectos adversos , Adolescente , Adulto , Anciano , Amicacina/administración & dosificación , Amicacina/farmacología , Amicacina/uso terapéutico , Antibacterianos/administración & dosificación , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Asia/etnología , Brasil/etnología , Úlcera de Buruli/patología , Úlcera de Buruli/cirugía , Claritromicina/administración & dosificación , Claritromicina/farmacología , Claritromicina/uso terapéutico , Terapia Combinada , Desbridamiento , Quimioterapia Combinada , Europa (Continente)/etnología , Femenino , Úlcera del Pie/tratamiento farmacológico , Úlcera del Pie/etiología , Úlcera del Pie/cirugía , Guyana Francesa , Humanos , Inmunidad Celular/efectos de los fármacos , Macrólidos/metabolismo , Masculino , Mycobacterium ulcerans/efectos de los fármacos , Mycobacterium ulcerans/metabolismo , Rifampin/administración & dosificación , Rifampin/farmacología , Rifampin/uso terapéutico , Cicatrización de HeridasRESUMEN
Eight adult patients (ages 18-58, 5 women) with Buruli ulcer (BU) confirmed by at least 2 diagnostic methods were seen in a 10-year period. Attempts to culture Mycobacterium ulcerans failed. Five patients came from jungle areas, and 3 from the swampy northern coast of Peru. The patients had 1-5 lesions, most of which were on the lower extremities. One patient had 5 clustered gluteal lesions; another patient had 2 lesions on a finger. Three patients were lost to follow-up. All 5 remaining patients had moderate disease. Diverse treatments (antituberculous drugs, World Health Organization [WHO] recommended antimicrobial drug treatment for BU, and for 3 patients, excision surgery) were successful. Only 1 patient (patient 7) received the specific drug treatment recommended by WHO. BU is endemic in Peru, although apparently infrequent. Education of populations and training of health workers are first needed to evaluate and understand the full extent of BU in Peru.