Sambourg E., Dufour J., Edouard S., Morris Aaron, Mosnier E., Reynaud Y., Sainte-Marie D., Nacher M., Guégan Jean-François, Couppié P. (2014). Réponses et réactions paradoxales au cours du traitement médicamenteux de l'infection à Mycobacterium ulcerans (ulcère de Buruli). Quatre observations en Guyane française = Paradoxical reactions and responses during antibiotic treatment for Mycobacterium ulcerans infection (Buruli ulcer). Four cases from French Guiana. Annales de Dermatologie et de Vénéréologie, 141 (6-7), p. 413-418. ISSN 0151-9638.
Titre du document
Réponses et réactions paradoxales au cours du traitement médicamenteux de l'infection à Mycobacterium ulcerans (ulcère de Buruli). Quatre observations en Guyane française = Paradoxical reactions and responses during antibiotic treatment for Mycobacterium ulcerans infection (Buruli ulcer). Four cases from French Guiana
Sambourg E., Dufour J., Edouard S., Morris Aaron, Mosnier E., Reynaud Y., Sainte-Marie D., Nacher M., Guégan Jean-François, Couppié P.
Source
Annales de Dermatologie et de Vénéréologie, 2014,
141 (6-7), p. 413-418 ISSN 0151-9638
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.
