Challenges Associated with Management of Buruli Ulcer/Human Immunodeficiency Virus Coinfection in a Treatment Center in Ghana: A Case Series Study

Tuffour, Joseph; Owusu-Mireku, Evelyn; Ruf, Marie‐Thérèse; Aboagye, Samuel Yaw; Kpeli, Grace; Akuoku, Victor; Pereko, Janet; Paintsil, Albert; Bonney, Kofi; Ampofo, William; Pluschke, Gerd; Yeboah-Manu, Dorothy

doi:10.4269/ajtmh.14-0571

Cited by 14 publications

(40 citation statements)

References 48 publications

(61 reference statements)

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“…Some studies have revealed association of mycobacteria infections with worsening peripheral blood cytopenia even though such has not been proven with MU infection . What is rather proven as a common cause of anemia in BU patients is nutritional anemia because the disease is mainly associated with persons of lower socioeconomic status . Susceptibility to BU is associated with polymorphism in the gene for the iron transporter protein NRAMP1 .…”

Section: Secondary Lesions Occurring After Bu Treatmentmentioning

confidence: 99%

Challenges associated with the treatment of Buruli ulcer

Aboagye

Kpeli

Tuffour³

et al. 2018

Journal of Leukocyte Biology

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Buruli ulcer (BU), caused by Mycobacterium ulcerans (MU), is the third most important mycobacterial diseases after tuberculosis and leprosy in immunocompetent individuals. Although the mode of transmission remains an enigma, disease incidence has been strongly linked to disturbed environment and wetlands. The blunt of the diseases is recorded in West African countries along the Gulf of Guinea, and children 15 years and below account for about 48% of all cases globally. Prior to 2004, wide surgical excisions and debridement of infected necrotic tissues followed by skin grafting was the accepted definitive treatment of BU. However, introduction of antibiotic therapy, daily oral rifampicin (10 mg/kg) plus intramuscular injection of streptomycin (15 mg/kg), for 8 weeks by the WHO in 2004 has reduced surgery as an adjunct for correction of deformities and improved wound healing. An all-oral regimen is currently on clinical trial to replace the injectable. It is thought that a protective cloud of the cytotoxic toxin mycolactone kills infiltrating leucocytes leading to local immunosuppression and down-regulation of the systemic immune system. Our studies of lesions from BU patients treated with SR have demonstrated treatment-associated initiation of vigorous immune responses and the development of ectopic lymphoid tissue in the BU lesions. Despite these interventions, there are still challenges that bedevil the management of BU including paradoxical reactions, evolution of lesions after therapy, prolong viability of MU in BU lesions, and development of secondary bacterial infection. In this paper, we will mainly focus on the critical and pertinent challenges that undermine BU treatment toward effective control of BU.

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Section: Secondary Lesions Occurring After Bu Treatmentmentioning

confidence: 99%

Challenges associated with the treatment of Buruli ulcer

Aboagye

Kpeli

Tuffour³

et al. 2018

Journal of Leukocyte Biology

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“…And in TB/HIV co-infection, it is recommended that ART should be started 2 weeks into antimicrobial treatment. So, the optimal time to starting ART may depend on the specific co-infection and know interactions of some ART with the anti-microbial agents [5,35] . This combined effect of IRIS associated with HIV on ART and the paradoxical reactions experienced in BU patients on antimicrobial treatment could possibly lead to real challenge for BU/HIV coinfection management [5,12] .…”

Section: Komenan K Et Al Hiv/bu Co-infection Management In Africamentioning

confidence: 99%

“…So, the optimal time to starting ART may depend on the specific co-infection and know interactions of some ART with the anti-microbial agents [5,35] . This combined effect of IRIS associated with HIV on ART and the paradoxical reactions experienced in BU patients on antimicrobial treatment could possibly lead to real challenge for BU/HIV coinfection management [5,12] . HIV infection may affect the outcome of BU treatment such as mortality, time to healing, recurrence rate and the incidence of paradoxical reactions or IRIS [30] .…”

Section: Komenan K Et Al Hiv/bu Co-infection Management In Africamentioning

confidence: 99%

“…It is becoming obvious that HIV infection have an effect on BU incidence mainly in Sub-Saharan Africa and its clinical presentation and treatment similar to tuberculosis. In tuberculosis, it is clearly known that the HIV/AIDS which lead to reduced CD4 helper T-cell activity, is a risk factor for tuberculosis, but immune protection mechanism in BU disease are not fully understood [5,32] . In addition, IRIS or paradoxical reactions which is known to be common in HIV patient initiating ART with a variety of others microorganisms such as tuberculosis, Cryptococcus, mycobacterium avium complex, etc…, may occur in HIV/BU co-infection patient during or after antibiotic and antiretroviral treatment (ART).…”

Section: Management Of Patient With Bu/hiv Co-infectionmentioning

confidence: 99%

“…BU lesions are classified into 3 categories: category 1, which consist of lesions with a size of < 5cetimeters (cm) at the widest diameter; category 2, which consist of lesions with a size between 5 and 15 cm at the widest diameter, and category 3, which consist of lesions with size > 15 cm at the widest diameter, lesions at the critical sites and multiple lesions [5] . There is an increasing recognition of BU/HIV coinfection as an important challenge for treatment of Mycobacterium ulcerans disease, mostly in sub-Saharan Africa (west and central Africa), regions also burdened with high HIV prevalence.…”

Section: Introductionmentioning

confidence: 99%

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Management of HIV Infected Patients with Active Buruli Ulcer in Tropical Regions in Africa, a New Therapeutic Challenge: A Review

Kassi¹,

Serge²,

Jean-Marie³

2016

Journal of Dermatological Research

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BU is endemic in tropical and sub-tropical regions mainly with high prevalence in sub-Saharan Africa, in particular in West Africa. SubSaharan Africa is also burdened with high HIV prevalence. Therefore, there is a significant potential for BU and HIV to occur in the same individual, and it represented a treatment challenge related to paradoxical reactions or IRIS onset. A study conducted in Cameroon reported that the mortality rate was higher among HIV-positive/BU patients compared to HIV-negative /BU patients (11% dying compared to 1%). We conducted this work based on review articles on HIV/BU co-infection to summarize information and guidance data to help health care practitioners for proper patients' management. It is becoming obvious that HIV infection have an effect on BU incidence mainly in Sub-Saharan Africa and its clinical presentation and treatment similar to tuberculosis. Based on TB/HIV and HIV/others microorganism s management experience and WHO expert in HIV and BU management guidance protocol, it is recommended to health practitioner. To actively screen all HIV/MU co-infected patients for tuberculosis, before commencing BU treatment and before starting ART. To start BU treatment before commencing ART and it should be provided for 8 weeks duration. The outcomes of HIV/BU coinfection management should be monitored and evaluated, taking account the drugs interactions between ART and antimicrobial agents. And the program for HIV, BU and TB control should work in a collaborative framework. As, HIV/BU co-infection becomes frequent in Sub-Saharan Africa where both disease incidence is high. This represents a treatment challenge related to IRIS occurrence, optimal ART regimens, and when to start ART and antimicrobial treatment. Base on TB/HIV co-infection, the preliminary guidance protocol issue by WHO should be recommended, and further study should be initiated to show its efficacy and to give answers to unknown mechanism of IRIS in HIV/BU co-infection.

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Drugs for treating Buruli ulcer (Mycobacterium ulcerans disease)

Yotsu

Richardson

Ishii

2018

Cochrane Database of Systematic Reviews

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While the antibiotic combination treatments evaluated appear to be effective, we found insufficient evidence showing that any particular drug is more effective than another. How different sizes, lesions, and stages of the disease may contribute to healing and which kind of lesions are in need of surgery are unclear based on the included studies. Guideline development needs to consider these factors in designing practical treatment regimens. Forthcoming trials using clarithromycin with rifampicin and other trials of new regimens that also address these factors will help to identify the best regimens.

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Challenges Associated with Management of Buruli Ulcer/Human Immunodeficiency Virus Coinfection in a Treatment Center in Ghana: A Case Series Study

Cited by 14 publications

References 48 publications

Challenges associated with the treatment of Buruli ulcer

Challenges associated with the treatment of Buruli ulcer

Management of HIV Infected Patients with Active Buruli Ulcer in Tropical Regions in Africa, a New Therapeutic Challenge: A Review

Drugs for treating Buruli ulcer (Mycobacterium ulcerans disease)

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