title: Secondary bacterial infections of buruli ulcer lesions before and after chemotherapy with streptomycin and rifampicin.
abstract: Buruli ulcer (BU), caused by Mycobacterium ulcerans is a chronic necrotizing skin disease. It usually starts with a subcutaneous nodule or plaque containing large clusters of extracellular acid-fast bacilli. Surrounding tissue is destroyed by the cytotoxic macrolide toxin mycolactone produced by microcolonies of M. ulcerans. Skin covering the destroyed subcutaneous fat and soft tissue may eventually break down leading to the formation of large ulcers that progress, if untreated, over months and years. Here we have analyzed the bacterial flora of BU lesions of three different groups of patients before, during and after daily treatment with streptomycin and rifampicin for eight weeks (SR8) and determined drug resistance of the bacteria isolated from the lesions. Before SR8 treatment, more than 60% of the examined BU lesions were infected with other bacteria, with Staphylococcus aureus and Pseudomonas aeruginosa being the most prominent ones. During treatment, 65% of all lesions were still infected, mainly with P. aeruginosa. After completion of SR8 treatment, still more than 75% of lesions clinically suspected to be infected were microbiologically confirmed as infected, mainly with P. aeruginosa or Proteus miriabilis. Drug susceptibility tests revealed especially for S. aureus a high frequency of resistance to the first line drugs used in Ghana. Our results show that secondary infection of BU lesions is common. This could lead to delayed healing and should therefore be further investigated.
authors: Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana. dyeboah-manu@noguchi.mimcom.org
authors: Dorothy
authors: D
authors: Yeboah-Manu
authors: Grace S
authors: GS
authors: Kpeli
authors: Marie-Thérèse
authors: MT
authors: Ruf
authors: Kobina
authors: K
authors: Asan-Ampah
authors: Kwabena
authors: K
authors: Quenin-Fosu
authors: Evelyn
authors: E
authors: Owusu-Mireku
authors: Albert
authors: A
authors: Paintsil
authors: Isaac
authors: I
authors: Lamptey
authors: Benjamin
authors: B
authors: Anku
authors: Cynthia
authors: C
authors: Kwakye-Maclean
authors: Mercy
authors: M
authors: Newman
authors: Gerd
authors: G
authors: Pluschke
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001419:Bacteria / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification; D054312:Buruli Ulcer / Q000150:complications* / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D060085:Coinfection / Q000453:epidemiology / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D005260:Female; D005869:Ghana; D006801:Humans; D008297:Male; D008875:Middle Aged; D012293:Rifampin / Q000627:therapeutic use*; D013307:Streptomycin / Q000627:therapeutic use*; D014946:Wound Infection / Q000453:epidemiology* / Q000382:microbiology*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D012293:Rifampin; D013307:Streptomycin
references: J Trauma. 1976 Feb;16(2):89-94
references: 1255833
references: Infect Immun. 2000 Feb;68(2):877-83
references: 10639458
references: Science. 1999 Feb 5;283(5403):854-7
references: 9933171
references: Am J Clin Pathol. 1966 Apr;45(4):493-6
references: 5325707
references: Cell Microbiol. 2005 Sep;7(9):1295-304
references: 16098217
references: AACN Clin Issues. 2002 Aug;13(3):382-97
references: 12151992
references: Australas J Dermatol. 1985 Aug;26(2):67-73
references: 4084161
references: BMC Infect Dis. 2006 Jul 28;6:125
references: 16875502
references: J Clin Pathol. 1981 Jul;34(7):701-5
references: 6790579
references: J Exp Med. 2007 Jun 11;204(6):1395-403
references: 17517970
references: J Hosp Infect. 1992 May;21(1):29-37
references: 1351494
references: Mil Med. 1969 Jan;134(1):19-24
references: 4990704
references: J Immunol. 1999 Oct 1;163(7):3928-35
references: 10490994
references: Int Wound J. 2006 Sep;3(3):225-31
references: 16984578
references: Emerg Infect Dis. 1999 May-Jun;5(3):367-78
references: 10341173
references: Antimicrob Agents Chemother. 2005 Aug;49(8):3182-6
references: 16048922
references: Cell Microbiol. 2005 Aug;7(8):1187-96
references: 16008585
references: Annu Rev Microbiol. 1993;47:875-912
references: 8257119
references: Anal Chem. 1988 Oct 15;60(20):2299-301
references: 3239801
references: Int Angiol. 1995 Dec;14(4):381-4
references: 8708431
references: Emerg Infect Dis. 2003 Jun;9(6):651-656
references: 12780997
references: Mod Pathol. 2011 Apr;24(4):579-84
references: 21131917
references: Clin Microbiol Rev. 2001 Apr;14(2):244-69
references: 11292638
references: Ann R Coll Surg Engl. 1990 Mar;72(2):123-4
references: 2334093
references: Home Healthc Nurse. 1999 Mar;17(3):159-64; quiz 165
references: 10362961
references: Wkly Epidemiol Rec. 2009 Feb 6;84(6):43-8
references: 19198050
references: J Wound Care. 1998 Oct;7(9):452-6
references: 9887736
references: Ann Surg. 1973 Feb;177(2):133-8
references: 4633387
references: BMC Microbiol. 2011 May 05;11:92
references: 21545717
references: Lancet. 2010 Feb 20;375(9715):664-72
references: 20137805
references: Am J Trop Med Hyg. 2011 Nov;85(5):900-4
references: 22049046
references: Trop Med Int Health. 2008 Feb;13(2):191-8
references: 18304265