title: Severe multifocal form of buruli ulcer after streptomycin and rifampin treatment: comments on possible dissemination mechanisms.
abstract: 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.
authors.affiliation: Centre de Dépistage et de Traitement de l'Ulcère de Buruli d'Allada, Bénin. ghislainsop@yahoo.fr
authors.forename: Ghislain Emmanuel
authors.initials: GE
authors.lastname: Sopoh
authors.forename: Ange Dodji
authors.initials: AD
authors.lastname: Dossou
authors.forename: Luc Valère
authors.initials: LV
authors.lastname: Brun
authors.forename: Yves Thierry
authors.initials: YT
authors.lastname: Barogui
authors.forename: Jean Gabin
authors.initials: JG
authors.lastname: Houézo
authors.forename: Dissou
authors.initials: D
authors.lastname: Affolabi
authors.forename: Séverin Y
authors.initials: SY
authors.lastname: Anagonou
authors.forename: Roch Christian
authors.initials: RC
authors.lastname: Johnson
authors.forename: Luc
authors.initials: L
authors.lastname: Kestens
authors.forename: Françoise
authors.initials: F
authors.lastname: Portaels
mesh_terms: 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*
chemical_list: D000900:Anti-Bacterial Agents; D012293:Rifampin; D013307:Streptomycin