title: Challenges Associated with Management of Buruli Ulcer/Human Immunodeficiency Virus Coinfection in a Treatment Center in Ghana: A Case Series Study.
abstract: The synergy between Mycobacterium tuberculosis infection and human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome is well established but not so in Buruli ulcer (BU). We screened confirmed BU cases for HIV infection and followed seven BU/HIV-coinfected patients. Management of BU/HIV was based on the World Health Organization guidelines and patient condition. The HIV positivity among BU patients (8.2%; 11/134) was higher compared with that of general patients attending the facility (4.8%; 718/14,863; P = 0.07) and that of pregnant women alone (2.5%; 279/11,125; P = 0.001). All seven BU/HIV-coinfected cases enrolled in the study presented with very large (category III) lesions with four having multiple lesions compared with 54.5% of category III lesions among HIV-negative BU patients. During the recommended BU treatment with streptomycin and rifampicin (SR) all patients developed immune infiltrates including CD4 T cells in their lesions. However, one patient who received antiretroviral therapy (ART) 1 week after beginning SR treatment developed four additional lesions during antibiotic treatment, while two out of the four who did not receive ART died. Further evidence is required to ascertain the most appropriate time to commence ART in relation to SR treatment to minimize paradoxical reactions.
authors.affiliation: Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana; Ga West Municipal Hospital, Ghana Health Service, Amasaman, Ghana; Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Reconstructive and Plastic Surgery Unit, Korle-BU Teaching Hospital, Accra, Ghana.
authors.forename: Joseph
authors.initials: J
authors.lastname: Tuffour
authors.affiliation: Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana; Ga West Municipal Hospital, Ghana Health Service, Amasaman, Ghana; Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Reconstructive and Plastic Surgery Unit, Korle-BU Teaching Hospital, Accra, Ghana.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Owusu-Mireku
authors.affiliation: Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana; Ga West Municipal Hospital, Ghana Health Service, Amasaman, Ghana; Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Reconstructive and Plastic Surgery Unit, Korle-BU Teaching Hospital, Accra, Ghana.
authors.forename: Marie-Therese
authors.initials: MT
authors.lastname: Ruf
authors.affiliation: Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana; Ga West Municipal Hospital, Ghana Health Service, Amasaman, Ghana; Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Reconstructive and Plastic Surgery Unit, Korle-BU Teaching Hospital, Accra, Ghana.
authors.forename: Samuel
authors.initials: S
authors.lastname: Aboagye
authors.affiliation: Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana; Ga West Municipal Hospital, Ghana Health Service, Amasaman, Ghana; Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Reconstructive and Plastic Surgery Unit, Korle-BU Teaching Hospital, Accra, Ghana.
authors.forename: Grace
authors.initials: G
authors.lastname: Kpeli
authors.affiliation: Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana; Ga West Municipal Hospital, Ghana Health Service, Amasaman, Ghana; Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Reconstructive and Plastic Surgery Unit, Korle-BU Teaching Hospital, Accra, Ghana.
authors.forename: Victor
authors.initials: V
authors.lastname: Akuoku
authors.affiliation: Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana; Ga West Municipal Hospital, Ghana Health Service, Amasaman, Ghana; Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Reconstructive and Plastic Surgery Unit, Korle-BU Teaching Hospital, Accra, Ghana.
authors.forename: Janet
authors.initials: J
authors.lastname: Pereko
authors.affiliation: Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana; Ga West Municipal Hospital, Ghana Health Service, Amasaman, Ghana; Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Reconstructive and Plastic Surgery Unit, Korle-BU Teaching Hospital, Accra, Ghana.
authors.forename: Albert
authors.initials: A
authors.lastname: Paintsil
authors.affiliation: Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana; Ga West Municipal Hospital, Ghana Health Service, Amasaman, Ghana; Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Reconstructive and Plastic Surgery Unit, Korle-BU Teaching Hospital, Accra, Ghana.
authors.forename: Kofi
authors.initials: K
authors.lastname: Bonney
authors.affiliation: Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana; Ga West Municipal Hospital, Ghana Health Service, Amasaman, Ghana; Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Reconstructive and Plastic Surgery Unit, Korle-BU Teaching Hospital, Accra, Ghana.
authors.forename: William
authors.initials: W
authors.lastname: Ampofo
authors.affiliation: Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana; Ga West Municipal Hospital, Ghana Health Service, Amasaman, Ghana; Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Reconstructive and Plastic Surgery Unit, Korle-BU Teaching Hospital, Accra, Ghana.
authors.forename: Gerd
authors.initials: G
authors.lastname: Pluschke
authors.affiliation: Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana; Ga West Municipal Hospital, Ghana Health Service, Amasaman, Ghana; Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Reconstructive and Plastic Surgery Unit, Korle-BU Teaching Hospital, Accra, Ghana dyeboah-manu@noguchi.ug.edu.gh.
authors.forename: Dorothy
authors.initials: D
authors.lastname: Yeboah-Manu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D054312:Buruli Ulcer / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D060085:Coinfection; D019468:Disease Management; D005260:Female; D005869:Ghana / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019911:Mycobacterium ulcerans / Q000187:drug effects; D012293:Rifampin / Q000627:therapeutic use; D013307:Streptomycin / Q000627:therapeutic use; D014944:World Health Organization; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D012293:Rifampin; D013307:Streptomycin