title: [Paradoxical reactions and responses during antibiotic treatment for Mycobacterium ulcerans infection (Buruli ulcer). Four cases from French Guiana].
abstract: 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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Service de dermatologie, centre hospitalier de Cayenne, BP 6006, 97300 Cayenne, Guyane française.
authors.forename: E
authors.initials: E
authors.lastname: Sambourg
authors.affiliation: Service de dermatologie, centre hospitalier de Cayenne, BP 6006, 97300 Cayenne, Guyane française; EA 3593-EPaT, université des Antilles et de la Guyane, centre hospitalier de Cayenne, BP 6006, 97300 Cayenne, Guyane française.
authors.forename: J
authors.initials: J
authors.lastname: Dufour
authors.affiliation: Service de dermatologie, centre hospitalier de Cayenne, BP 6006, 97300 Cayenne, Guyane française.
authors.forename: S
authors.initials: S
authors.lastname: Edouard
authors.affiliation: University of Bournemouth, School of Applied Sciences, Dorset, BH12 5BB, Royaume-Uni.
authors.forename: A
authors.initials: A
authors.lastname: Morris
authors.affiliation: Service de dermatologie, centre hospitalier de Cayenne, BP 6006, 97300 Cayenne, Guyane française.
authors.forename: E
authors.initials: E
authors.lastname: Mosnier
authors.affiliation: Institut Pasteur de la Guyane, 23, avenue Pasteur, BP 6010, 97300 Cayenne, Guyane française.
authors.forename: Y
authors.initials: Y
authors.lastname: Reynaud
authors.affiliation: Service de dermatologie, centre hospitalier de Cayenne, BP 6006, 97300 Cayenne, Guyane française; EA 3593-EPaT, université des Antilles et de la Guyane, centre hospitalier de Cayenne, BP 6006, 97300 Cayenne, Guyane française.
authors.forename: D
authors.initials: D
authors.lastname: Sainte-Marie
authors.affiliation: EA 3593-EPaT, université des Antilles et de la Guyane, centre hospitalier de Cayenne, BP 6006, 97300 Cayenne, Guyane française; CIC-EC Antilles-Guyane, CIE 802 Inserm, centre hospitalier de Cayenne, BP 6006, 97300 Cayenne, Guyane française.
authors.forename: M
authors.initials: M
authors.lastname: Nacher
authors.affiliation: UMR MIVEGEC IRD-CNRS - universités Montpellier 1 et 2, centre IRD de Montpellier, BP 64501, 34000 Montpellier, France.
authors.forename: J-F
authors.initials: JF
authors.lastname: Guégan
authors.affiliation: Service de dermatologie, centre hospitalier de Cayenne, BP 6006, 97300 Cayenne, Guyane française; EA 3593-EPaT, université des Antilles et de la Guyane, centre hospitalier de Cayenne, BP 6006, 97300 Cayenne, Guyane française. Electronic address: couppie.pierre@voila.fr.
authors.forename: P
authors.initials: P
authors.lastname: Couppié
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000583:Amikacin / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D001208:Asia / Q000208:ethnology; D001938:Brazil / Q000208:ethnology; D054312:Buruli Ulcer / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D017291:Clarithromycin / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003646:Debridement; D004359:Drug Therapy, Combination; D005060:Europe / Q000208:ethnology; D005260:Female; D016523:Foot Ulcer / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D005616:French Guiana; D006801:Humans; D007111:Immunity, Cellular / Q000187:drug effects; D018942:Macrolides / Q000378:metabolism; D008297:Male; D019911:Mycobacterium ulcerans / Q000187:drug effects / Q000378:metabolism; D012293:Rifampin / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D014945:Wound Healing
chemical_list: D000900:Anti-Bacterial Agents; D018942:Macrolides; C117218:mycolactone; D000583:Amikacin; D017291:Clarithromycin; D012293:Rifampin
keywords: Buruli ulcer; French Guiana; Guyane française; Maladie tropicale; Mycobacterium ulcerans; Paradoxical reaction; Réaction paradoxale; Tropical disease; Ulcère de Buruli