Paradoxical Responses After Start of Antimicrobial Treatment in Mycobacterium ulcerans Infection

Willemien A. Nienhuis; Ymkje Stienstra; K. Mohammed Abass; Wilson Tuah; William A. Thompson; Peter C. Awuah; Nana Yaa Awuah-Boateng; Ohene Adjei; Gisela Bretzel; Jan P. Schouten; Tjip S. van der Werf

doi:10.1093/cid/cir856

Paradoxical Responses After Start of Antimicrobial Treatment in Mycobacterium ulcerans Infection

Willemien A. Nienhuis, Ymkje Stienstra, K. Mohammed Abass, Wilson Tuah, William A. Thompson, Peter C. Awuah, Nana Yaa Awuah-Boateng, Ohene Adjei, Gisela Bretzel, Jan P. Schouten, Tjip S. van der Werf^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

78 Citations (Scopus)

Abstract

Background. Antimicrobial killing in mycobacterial infections may be accompanied by (transient) clinical deterioration, known as paradoxical reaction. To search for patterns reflecting such reactions in the treatment of Buruli ulcer (Mycobacterium ulcerans infection), the evolution of lesions of patients treated with antimicrobials was prospectively assessed.

Methods. The lesion size of participants of the BURULICO antimicrobial trial (with lesions

Results. Of 151 participants, 134 were included in the lesion size analysis. Peak paradoxical response occurred at week 8; >30% of participants showed an increase in lesion size as compared with the previous (week 6) assessment. Seventy-five of 90 (83%) of nonulcerative lesions ulcerated after start of treatment. Nine participants developed new lesions during or after treatment. All lesions subsequently healed.

Conclusions. After start of antimicrobial treatment for Buruli ulcer, new or progressive ulceration is common before healing sets in. This paradoxical response, most prominent at the end of the 8-week antimicrobial treatment, should not be misinterpreted as failure to respond to treatment.

Original language	English
Pages (from-to)	519-526
Number of pages	8
Journal	Clinical Infectious Diseases
Volume	54
Issue number	4
DOIs	https://doi.org/10.1093/cid/cir856
Publication status	Published - 15-Feb-2012

Keywords

LYMPH-NODE TUBERCULOSIS
BURULI ULCER
ANTIBIOTIC-TREATMENT
CLINICAL-EFFICACY
DISEASE
STREPTOMYCIN
MYCOLACTONE
COMBINATION
RIFAMPIN
MANAGEMENT

Access to Document

10.1093/cid/cir856

Handle.net

Persistent link

Cite this

@article{60c4df4117154a53a3ac84d170499a4a,

title = "Paradoxical Responses After Start of Antimicrobial Treatment in Mycobacterium ulcerans Infection",

abstract = "Background. Antimicrobial killing in mycobacterial infections may be accompanied by (transient) clinical deterioration, known as paradoxical reaction. To search for patterns reflecting such reactions in the treatment of Buruli ulcer (Mycobacterium ulcerans infection), the evolution of lesions of patients treated with antimicrobials was prospectively assessed.Methods. The lesion size of participants of the BURULICO antimicrobial trial (with lesionsResults. Of 151 participants, 134 were included in the lesion size analysis. Peak paradoxical response occurred at week 8; >30% of participants showed an increase in lesion size as compared with the previous (week 6) assessment. Seventy-five of 90 (83%) of nonulcerative lesions ulcerated after start of treatment. Nine participants developed new lesions during or after treatment. All lesions subsequently healed.Conclusions. After start of antimicrobial treatment for Buruli ulcer, new or progressive ulceration is common before healing sets in. This paradoxical response, most prominent at the end of the 8-week antimicrobial treatment, should not be misinterpreted as failure to respond to treatment.",

keywords = "LYMPH-NODE TUBERCULOSIS, BURULI ULCER, ANTIBIOTIC-TREATMENT, CLINICAL-EFFICACY, DISEASE, STREPTOMYCIN, MYCOLACTONE, COMBINATION, RIFAMPIN, MANAGEMENT",

author = "Nienhuis, {Willemien A.} and Ymkje Stienstra and Abass, {K. Mohammed} and Wilson Tuah and Thompson, {William A.} and Awuah, {Peter C.} and Awuah-Boateng, {Nana Yaa} and Ohene Adjei and Gisela Bretzel and Schouten, {Jan P.} and {van der Werf}, {Tjip S.}",

year = "2012",

month = feb,

day = "15",

doi = "10.1093/cid/cir856",

language = "English",

volume = "54",

pages = "519--526",

journal = "Clinical Infectious Diseases",

issn = "1058-4838",

publisher = "Oxford University Press",

number = "4",

}

TY - JOUR

T1 - Paradoxical Responses After Start of Antimicrobial Treatment in Mycobacterium ulcerans Infection

AU - Nienhuis, Willemien A.

AU - Stienstra, Ymkje

AU - Abass, K. Mohammed

AU - Tuah, Wilson

AU - Thompson, William A.

AU - Awuah, Peter C.

AU - Awuah-Boateng, Nana Yaa

AU - Adjei, Ohene

AU - Bretzel, Gisela

AU - Schouten, Jan P.

AU - van der Werf, Tjip S.

PY - 2012/2/15

Y1 - 2012/2/15

N2 - Background. Antimicrobial killing in mycobacterial infections may be accompanied by (transient) clinical deterioration, known as paradoxical reaction. To search for patterns reflecting such reactions in the treatment of Buruli ulcer (Mycobacterium ulcerans infection), the evolution of lesions of patients treated with antimicrobials was prospectively assessed.Methods. The lesion size of participants of the BURULICO antimicrobial trial (with lesionsResults. Of 151 participants, 134 were included in the lesion size analysis. Peak paradoxical response occurred at week 8; >30% of participants showed an increase in lesion size as compared with the previous (week 6) assessment. Seventy-five of 90 (83%) of nonulcerative lesions ulcerated after start of treatment. Nine participants developed new lesions during or after treatment. All lesions subsequently healed.Conclusions. After start of antimicrobial treatment for Buruli ulcer, new or progressive ulceration is common before healing sets in. This paradoxical response, most prominent at the end of the 8-week antimicrobial treatment, should not be misinterpreted as failure to respond to treatment.

AB - Background. Antimicrobial killing in mycobacterial infections may be accompanied by (transient) clinical deterioration, known as paradoxical reaction. To search for patterns reflecting such reactions in the treatment of Buruli ulcer (Mycobacterium ulcerans infection), the evolution of lesions of patients treated with antimicrobials was prospectively assessed.Methods. The lesion size of participants of the BURULICO antimicrobial trial (with lesionsResults. Of 151 participants, 134 were included in the lesion size analysis. Peak paradoxical response occurred at week 8; >30% of participants showed an increase in lesion size as compared with the previous (week 6) assessment. Seventy-five of 90 (83%) of nonulcerative lesions ulcerated after start of treatment. Nine participants developed new lesions during or after treatment. All lesions subsequently healed.Conclusions. After start of antimicrobial treatment for Buruli ulcer, new or progressive ulceration is common before healing sets in. This paradoxical response, most prominent at the end of the 8-week antimicrobial treatment, should not be misinterpreted as failure to respond to treatment.

KW - LYMPH-NODE TUBERCULOSIS

KW - BURULI ULCER

KW - ANTIBIOTIC-TREATMENT

KW - CLINICAL-EFFICACY

KW - DISEASE

KW - STREPTOMYCIN

KW - MYCOLACTONE

KW - COMBINATION

KW - RIFAMPIN

KW - MANAGEMENT

U2 - 10.1093/cid/cir856

DO - 10.1093/cid/cir856

M3 - Article

SN - 1058-4838

VL - 54

SP - 519

EP - 526

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

IS - 4

ER -

Paradoxical Responses After Start of Antimicrobial Treatment in Mycobacterium ulcerans Infection

Abstract

Keywords

Access to Document

Handle.net

Fingerprint

Cite this