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

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dc.contributor.authorPhillips, Richard Odame
dc.contributor.authorFrimpong, Michael
dc.contributor.authorAgbavor, Bernadette
dc.contributor.authorDuah, Mabel Sarpong
dc.contributor.authorLoglo, Aloysius
dc.contributor.authoret. al
dc.date.accessioned2020-01-16T16:57:43Z
dc.date.accessioned2023-04-19T01:50:28Z
dc.date.available2020-01-16T16:57:43Z
dc.date.available2023-04-19T01:50:28Z
dc.date.issued2019-08-26
dc.descriptionAn article published by PLOS Neglected Tropical Diseases and available at https://doi. org/10.1371/journal.pntd.0007689en_US
dc.description.abstractBackground 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.en_US
dc.description.sponsorshipKNUSTen_US
dc.identifier.citationPLoS Negl Trop Dis 13(8): e0007689. https://doi. org/10.1371/journal.pntd.0007689en_US
dc.identifier.urihttps://ir.knust.edu.gh/handle/123456789/11951
dc.language.isoenen_US
dc.publisherPLOS Neglected Tropical Diseasesen_US
dc.titleParadoxical reactions in Buruli ulcer after initiation of antibiotic therapy: Relationship to bacterial loaden_US
dc.typeArticleen_US
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