01976nas a2200313   4500000000100000008004100001653001300042653002500055653002700080653002200107653003700129653001700166100001500183700001300198700001400211700001300225700001400238700001400252700001900266700001300285700001600298700001500314245015400329300001000483490000800493050001800501520112900519022001401648       2014                            d10aReaction10aParadoxical reaction10aMycobacterium ulcerans10aMaladie tropicale10aFrench Guiana; Guyane française10aBuruli ulcer1 aSambourg E1 aDufour J1 aEdouard S1 aMorris A1 aMosnier E1 aReynaud Y1 aSainte-Marie D1 aNacher M1 aGuégan J-F1 aCouppié P00a[Paradoxical reactions and responses during antibiotic treatment for Mycobacterium ulcerans infection (Buruli ulcer). Four cases from French Guiana].  a413-80 v141  aSAMBOURG 20143 a<p><strong>BACKGROUND: </strong>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.</p>

<p><strong>PATIENTS AND METHODS: </strong>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.</p>

<p><strong>DISCUSSION: </strong>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.&nbsp;ulcerans, resulting from the action of the antibiotics.</p>
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