Severe multifocal form of buruli ulcer after streptomycin and rifampin treatment: comments on possible dissemination mechanisms.
Buruli ulcer (BU), a disease caused by Mycobacterium ulcerans, leads to the destruction of skin and sometimes bone. Here, we report a case of severe multifocal BU with osteomyelitis in a 6-year-old human immunodeficiency virus (HIV)-negative boy. Such disseminated forms are poorly documented and generally occur in patients with HIV co-infection. The advent of antibiotic treatment with streptomycin (S) and rifampin (R) raised hope that these multifocal BU cases could be reduced. The present case raises two relevant points about multifocal BU: the mechanism of dissemination that leads to the development of multiple foci and the difficulties of treatment of multifocal forms of BU. Biochemical (hypoproteinemia), hematological (anemia), clinical (traditional treatment), and genetic factors are discussed as possible risk factors for dissemination.
Sopoh
Ghislain Emmanuel
GE
Centre de Dépistage et de Traitement de l'Ulcère de Buruli d'Allada, Bénin. ghislainsop@yahoo.fr
Dossou
Ange Dodji
AD
Brun
Luc Valère
LV
Barogui
Yves Thierry
YT
Houézo
Jean Gabin
JG
Affolabi
Dissou
D
Anagonou
Séverin Y
SY
Johnson
Roch Christian
RC
Kestens
Luc
L
Portaels
Françoise
F
D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D054312:Buruli Ulcer / Q000150:complications / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D002648:Child; D006801:Humans; D008297:Male; D010019:Osteomyelitis / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology / Q000601:surgery; D012293:Rifampin / Q000008:administration & dosage / Q000627:therapeutic use*; D013307:Streptomycin / Q000008:administration & dosage / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D012293:Rifampin; D013307:Streptomycin