Response to Treatment in a Prospective Cohort of Patients with Large Ulcerated Lesions Suspected to Be Buruli Ulcer (Mycobacterium ulcerans Disease)
Autor(a) principal: | |
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Data de Publicação: | 2010 |
Outros Autores: | , , , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UNESP |
Texto Completo: | http://dx.doi.org/10.1371/journal.pntd.0000736 http://hdl.handle.net/11449/42332 |
Resumo: | Background: The World Health Organization (WHO) advises treatment of Mycobacterium ulcerans disease, also called Buruli ulcer'' (BU), with a combination of the antibiotics rifampicin and streptomycin (R+S), whether followed by surgery or not. In endemic areas, a clinical case definition is recommended. We evaluated the effectiveness of this strategy in a series of patients with large ulcers of >= 10 cm in longest diameter in a rural health zone of the Democratic Republic of Congo (DRC).Methods: A cohort of 92 patients with large ulcerated lesions suspected to be BU was enrolled between October 2006 and September 2007 and treated according to WHO recommendations. The following microbiologic data were obtained: Ziehl-Neelsen (ZN) stained smear, culture and PCR. Histopathology was performed on a sub-sample. Directly observed treatment with R+S was administered daily for 12 weeks and surgery was performed after 4 weeks. Patients were followed up for two years after treatment.Findings: Out of 92 treated patients, 61 tested positive for M. ulcerans by PCR. PCR negative patients had better clinical improvement than PCR positive patients after 4 weeks of antibiotics (54.8% versus 14.8%). For PCR positive patients, the outcome after 4 weeks of antibiotic treatment was related to the ZN positivity at the start. Deterioration of the ulcers was observed in 87.8% (36/41) of the ZN positive and in 12.2% (5/41) of the ZN negative patients. Deterioration due to paradoxical reaction seemed unlikely. After surgery and an additional 8 weeks of antibiotics, 98.4% of PCR positive patients and 83.3% of PCR negative patients were considered cured. The overall recurrence rate was very low (1.1%).Interpretation: Positive predictive value of the WHO clinical case definition was low. Low relapse rate confirms the efficacy of antibiotics. However, the need for and the best time for surgery for large Buruli ulcers requires clarification. We recommend confirmation by ZN stain at the rural health centers, since surgical intervention without delay may be necessary on the ZN positive cases to avoid progression of the disease. PCR negative patients were most likely not BU cases. Correct diagnosis and specific management of these non-BU ulcers cases are urgently needed. |
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Repositório Institucional da UNESP |
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Response to Treatment in a Prospective Cohort of Patients with Large Ulcerated Lesions Suspected to Be Buruli Ulcer (Mycobacterium ulcerans Disease)Background: The World Health Organization (WHO) advises treatment of Mycobacterium ulcerans disease, also called Buruli ulcer'' (BU), with a combination of the antibiotics rifampicin and streptomycin (R+S), whether followed by surgery or not. In endemic areas, a clinical case definition is recommended. We evaluated the effectiveness of this strategy in a series of patients with large ulcers of >= 10 cm in longest diameter in a rural health zone of the Democratic Republic of Congo (DRC).Methods: A cohort of 92 patients with large ulcerated lesions suspected to be BU was enrolled between October 2006 and September 2007 and treated according to WHO recommendations. The following microbiologic data were obtained: Ziehl-Neelsen (ZN) stained smear, culture and PCR. Histopathology was performed on a sub-sample. Directly observed treatment with R+S was administered daily for 12 weeks and surgery was performed after 4 weeks. Patients were followed up for two years after treatment.Findings: Out of 92 treated patients, 61 tested positive for M. ulcerans by PCR. PCR negative patients had better clinical improvement than PCR positive patients after 4 weeks of antibiotics (54.8% versus 14.8%). For PCR positive patients, the outcome after 4 weeks of antibiotic treatment was related to the ZN positivity at the start. Deterioration of the ulcers was observed in 87.8% (36/41) of the ZN positive and in 12.2% (5/41) of the ZN negative patients. Deterioration due to paradoxical reaction seemed unlikely. After surgery and an additional 8 weeks of antibiotics, 98.4% of PCR positive patients and 83.3% of PCR negative patients were considered cured. The overall recurrence rate was very low (1.1%).Interpretation: Positive predictive value of the WHO clinical case definition was low. Low relapse rate confirms the efficacy of antibiotics. However, the need for and the best time for surgery for large Buruli ulcers requires clarification. We recommend confirmation by ZN stain at the rural health centers, since surgical intervention without delay may be necessary on the ZN positive cases to avoid progression of the disease. PCR negative patients were most likely not BU cases. Correct diagnosis and specific management of these non-BU ulcers cases are urgently needed.Directorate-General for Development and Cooperation (DGDC), Brussels, BelgiumEuropean CommissionHealth Services of Fundação Calouste GulbenkianPNLUB, Kinshasa, ZaireInst Natl Rech Biomed, Kinshasa, ZaireUniv Kinshasa, Dept Surg, Kinshasa, ZaireInst Trop Med, Epidemiol Unit, B-2000 Antwerp, BelgiumUniv Minho, Sch Hlth Sci, Life & Hlth Sci Res Inst ICVS, Braga, PortugalGen Reference Hosp Nsona Mpangu, Lower Congo, ZaireRural Hlth Zone Nsona Mpangu, Lower Congo, ZaireSão Paulo State Univ, Fac Med, Dept Pathol, LIM 14, São Paulo, BrazilAssoc Pathol Cytol Dev, Hosp Chambery, Anat Pathol Unit, Chambery, FranceArmed Forces Inst Pathol, Washington, DC 20306 USAInst Trop Med, Mycobacteriol Unit, B-2000 Antwerp, BelgiumSão Paulo State Univ, Fac Med, Dept Pathol, LIM 14, São Paulo, BrazilEuropean Commission: INCO-CT-2005-051476-BURULICOPublic Library SciencePNLUBInst Natl Rech BiomedUniv KinshasaInst Trop MedUniv MinhoGen Reference Hosp Nsona MpanguRural Hlth Zone Nsona MpanguUniversidade Estadual Paulista (Unesp)Assoc Pathol Cytol DevArmed Forces Inst PatholKibadi, KapayBoelaert, MarleenFraga, Alexandra G.Kayinua, MakanzuLongatto-Filho, Adhemar [UNESP]Minuku, Jean-BedelMputu-Yamba, Jean-BaptisteMuyembe-Tamfum, Jean-JacquesPedrosa, JorgeRoux, Jean-JacquesMeyers, Wayne M.Portaels, Francoise2014-05-20T15:33:50Z2014-05-20T15:33:50Z2010-07-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/article8application/pdfhttp://dx.doi.org/10.1371/journal.pntd.0000736Plos Neglected Tropical Diseases. San Francisco: Public Library Science, v. 4, n. 7, p. 8, 2010.1935-2727http://hdl.handle.net/11449/4233210.1371/journal.pntd.0000736WOS:000280412300007WOS000280412300007.pdfWeb of Sciencereponame:Repositório Institucional da UNESPinstname:Universidade Estadual Paulista (UNESP)instacron:UNESPengPLoS Neglected Tropical Diseases2,589info:eu-repo/semantics/openAccess2023-11-20T06:11:21Zoai:repositorio.unesp.br:11449/42332Repositório InstitucionalPUBhttp://repositorio.unesp.br/oai/requestopendoar:29462023-11-20T06:11:21Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)false |
dc.title.none.fl_str_mv |
Response to Treatment in a Prospective Cohort of Patients with Large Ulcerated Lesions Suspected to Be Buruli Ulcer (Mycobacterium ulcerans Disease) |
title |
Response to Treatment in a Prospective Cohort of Patients with Large Ulcerated Lesions Suspected to Be Buruli Ulcer (Mycobacterium ulcerans Disease) |
spellingShingle |
Response to Treatment in a Prospective Cohort of Patients with Large Ulcerated Lesions Suspected to Be Buruli Ulcer (Mycobacterium ulcerans Disease) Kibadi, Kapay |
title_short |
Response to Treatment in a Prospective Cohort of Patients with Large Ulcerated Lesions Suspected to Be Buruli Ulcer (Mycobacterium ulcerans Disease) |
title_full |
Response to Treatment in a Prospective Cohort of Patients with Large Ulcerated Lesions Suspected to Be Buruli Ulcer (Mycobacterium ulcerans Disease) |
title_fullStr |
Response to Treatment in a Prospective Cohort of Patients with Large Ulcerated Lesions Suspected to Be Buruli Ulcer (Mycobacterium ulcerans Disease) |
title_full_unstemmed |
Response to Treatment in a Prospective Cohort of Patients with Large Ulcerated Lesions Suspected to Be Buruli Ulcer (Mycobacterium ulcerans Disease) |
title_sort |
Response to Treatment in a Prospective Cohort of Patients with Large Ulcerated Lesions Suspected to Be Buruli Ulcer (Mycobacterium ulcerans Disease) |
author |
Kibadi, Kapay |
author_facet |
Kibadi, Kapay Boelaert, Marleen Fraga, Alexandra G. Kayinua, Makanzu Longatto-Filho, Adhemar [UNESP] Minuku, Jean-Bedel Mputu-Yamba, Jean-Baptiste Muyembe-Tamfum, Jean-Jacques Pedrosa, Jorge Roux, Jean-Jacques Meyers, Wayne M. Portaels, Francoise |
author_role |
author |
author2 |
Boelaert, Marleen Fraga, Alexandra G. Kayinua, Makanzu Longatto-Filho, Adhemar [UNESP] Minuku, Jean-Bedel Mputu-Yamba, Jean-Baptiste Muyembe-Tamfum, Jean-Jacques Pedrosa, Jorge Roux, Jean-Jacques Meyers, Wayne M. Portaels, Francoise |
author2_role |
author author author author author author author author author author author |
dc.contributor.none.fl_str_mv |
PNLUB Inst Natl Rech Biomed Univ Kinshasa Inst Trop Med Univ Minho Gen Reference Hosp Nsona Mpangu Rural Hlth Zone Nsona Mpangu Universidade Estadual Paulista (Unesp) Assoc Pathol Cytol Dev Armed Forces Inst Pathol |
dc.contributor.author.fl_str_mv |
Kibadi, Kapay Boelaert, Marleen Fraga, Alexandra G. Kayinua, Makanzu Longatto-Filho, Adhemar [UNESP] Minuku, Jean-Bedel Mputu-Yamba, Jean-Baptiste Muyembe-Tamfum, Jean-Jacques Pedrosa, Jorge Roux, Jean-Jacques Meyers, Wayne M. Portaels, Francoise |
description |
Background: The World Health Organization (WHO) advises treatment of Mycobacterium ulcerans disease, also called Buruli ulcer'' (BU), with a combination of the antibiotics rifampicin and streptomycin (R+S), whether followed by surgery or not. In endemic areas, a clinical case definition is recommended. We evaluated the effectiveness of this strategy in a series of patients with large ulcers of >= 10 cm in longest diameter in a rural health zone of the Democratic Republic of Congo (DRC).Methods: A cohort of 92 patients with large ulcerated lesions suspected to be BU was enrolled between October 2006 and September 2007 and treated according to WHO recommendations. The following microbiologic data were obtained: Ziehl-Neelsen (ZN) stained smear, culture and PCR. Histopathology was performed on a sub-sample. Directly observed treatment with R+S was administered daily for 12 weeks and surgery was performed after 4 weeks. Patients were followed up for two years after treatment.Findings: Out of 92 treated patients, 61 tested positive for M. ulcerans by PCR. PCR negative patients had better clinical improvement than PCR positive patients after 4 weeks of antibiotics (54.8% versus 14.8%). For PCR positive patients, the outcome after 4 weeks of antibiotic treatment was related to the ZN positivity at the start. Deterioration of the ulcers was observed in 87.8% (36/41) of the ZN positive and in 12.2% (5/41) of the ZN negative patients. Deterioration due to paradoxical reaction seemed unlikely. After surgery and an additional 8 weeks of antibiotics, 98.4% of PCR positive patients and 83.3% of PCR negative patients were considered cured. The overall recurrence rate was very low (1.1%).Interpretation: Positive predictive value of the WHO clinical case definition was low. Low relapse rate confirms the efficacy of antibiotics. However, the need for and the best time for surgery for large Buruli ulcers requires clarification. We recommend confirmation by ZN stain at the rural health centers, since surgical intervention without delay may be necessary on the ZN positive cases to avoid progression of the disease. PCR negative patients were most likely not BU cases. Correct diagnosis and specific management of these non-BU ulcers cases are urgently needed. |
publishDate |
2010 |
dc.date.none.fl_str_mv |
2010-07-01 2014-05-20T15:33:50Z 2014-05-20T15:33:50Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://dx.doi.org/10.1371/journal.pntd.0000736 Plos Neglected Tropical Diseases. San Francisco: Public Library Science, v. 4, n. 7, p. 8, 2010. 1935-2727 http://hdl.handle.net/11449/42332 10.1371/journal.pntd.0000736 WOS:000280412300007 WOS000280412300007.pdf |
url |
http://dx.doi.org/10.1371/journal.pntd.0000736 http://hdl.handle.net/11449/42332 |
identifier_str_mv |
Plos Neglected Tropical Diseases. San Francisco: Public Library Science, v. 4, n. 7, p. 8, 2010. 1935-2727 10.1371/journal.pntd.0000736 WOS:000280412300007 WOS000280412300007.pdf |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
PLoS Neglected Tropical Diseases 2,589 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
8 application/pdf |
dc.publisher.none.fl_str_mv |
Public Library Science |
publisher.none.fl_str_mv |
Public Library Science |
dc.source.none.fl_str_mv |
Web of Science reponame:Repositório Institucional da UNESP instname:Universidade Estadual Paulista (UNESP) instacron:UNESP |
instname_str |
Universidade Estadual Paulista (UNESP) |
instacron_str |
UNESP |
institution |
UNESP |
reponame_str |
Repositório Institucional da UNESP |
collection |
Repositório Institucional da UNESP |
repository.name.fl_str_mv |
Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP) |
repository.mail.fl_str_mv |
|
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1792961871434743808 |