RESUMO
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.
Assuntos
Amicacina/efeitos adversos , Antibacterianos/efeitos adversos , Úlcera de Buruli/tratamento farmacológico , Claritromicina/efeitos adversos , Rifampina/efeitos adversos , Adolescente , Adulto , Idoso , Amicacina/administração & dosagem , Amicacina/farmacologia , Amicacina/uso terapêutico , Antibacterianos/administração & dosagem , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Ásia/etnologia , Brasil/etnologia , Úlcera de Buruli/patologia , Úlcera de Buruli/cirurgia , Claritromicina/administração & dosagem , Claritromicina/farmacologia , Claritromicina/uso terapêutico , Terapia Combinada , Desbridamento , Quimioterapia Combinada , Europa (Continente)/etnologia , Feminino , Úlcera do Pé/tratamento farmacológico , Úlcera do Pé/etiologia , Úlcera do Pé/cirurgia , Guiana Francesa , Humanos , Imunidade Celular/efeitos dos fármacos , Macrolídeos/metabolismo , Masculino , Mycobacterium ulcerans/efeitos dos fármacos , Mycobacterium ulcerans/metabolismo , Rifampina/administração & dosagem , Rifampina/farmacologia , Rifampina/uso terapêutico , CicatrizaçãoRESUMO
Blood transfusion is the second most common transmission route of Chagas disease in many Latin American countries. In Mexico, the prevalence of Chagas disease and impact of transfusion of Trypanosoma cruzi-contaminated blood is not clear. We determined the seropositivity to T. cruzi in a representative random sample, of 2,140 blood donors (1,423 men and 647 women, aged 19-65 years), from a non-endemic state of almost 5 millions of inhabitants by the indirect hemagglutination (IHA) and enzyme linked immunosorbent assay (ELISA) tests using one autochthonous antigen from T. cruzi parasites, which were genetically characterized like TBAR/ME/1997/RyC-V1 (T. cruzi I) isolated from a Triatoma barberi specimen collected in the same locality. The seropositivity was up to 8.5% and 9% with IHA and ELISA tests, respectively, and up to 7.7% using both tests in common. We found high seroprevalence in a non-endemic area of Mexico, comparable to endemic countries where the disease occurs, e.g. Brazil (0.7%), Bolivia (13.7%) and Argentina (3.5%). The highest values observed in samples from urban areas, associated to continuous rural emigration and the absence of control in blood donors, suggest unsuspected high risk of transmission of T. cruzi, higher than those reported for infections by blood e.g. hepatitis (0.1%) and AIDS (0.1%) in the same region.
Assuntos
Anticorpos Antiprotozoários/sangue , Doadores de Sangue , Doença de Chagas/imunologia , Trypanosoma cruzi/imunologia , Adolescente , Adulto , Idoso , Animais , Doença de Chagas/diagnóstico , Doença de Chagas/epidemiologia , Ensaio de Imunoadsorção Enzimática , Testes de Hemaglutinação , Humanos , México/epidemiologia , Pessoa de Meia-Idade , Prevalência , Estudos SoroepidemiológicosRESUMO
Blood transfusion is the second most common transmission route of Chagas disease in many Latin American countries. In Mexico, the prevalence of Chagas disease and impact of transfusion of Trypanosoma cruzi-contaminated blood is not clear. We determined the seropositivity to T. cruzi in a representative random sample, of 2,140 blood donors (1,423 men and 647 women, aged 19-65 years), from a non-endemic state of almost 5 millions of inhabitants by the indirect hemagglutination (IHA) and enzyme linked immunosorbent assay (ELISA) tests using one autochthonous antigen from T. cruzi parasites, which were genetically characterized like TBAR/ME/1997/RyC-V1 (T. cruzi I) isolated from a Triatoma barberi specimen collected in the same locality. The seropositivity was up to 8.5 percent and 9 percent with IHA and ELISA tests, respectively, and up to 7.7 percent using both tests in common. We found high seroprevalence in a non-endemic area of Mexico, comparable to endemic countries where the disease occurs, e.g. Brazil (0.7 percent), Bolivia (13.7 percent) and Argentina (3.5 percent). The highest values observed in samples from urban areas, associated to continuous rural emigration and the absence of control in blood donors, suggest unsuspected high risk of transmission of T. cruzi, higher than those reported for infections by blood e.g. hepatitis (0.1 percent) and AIDS (0.1 percent) in the same region