Findings in Patients From Benin With Osteomyelitis and Polymerase Chain Reaction–Confirmed Mycobacterium ulcerans Infection

Pommelet, Virginie; Vincent, Quentin B.; Ardant, Marie-Françoise; Adeye, Ambroise; Tănase, A.; Tondeur, Laura; Rega, A.; Landier, Jordi; Marion, Estelle; Alcaïs, Alexandre; Marsollier, Laurent; Fontanet, Arnaud; Chauty, Annick

doi:10.1093/cid/ciu584

Cited by 26 publications

(29 citation statements)

References 31 publications

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“…cases with extensive and/or deep ulcers, or cases with osteomyelitis) may require longer treatment periods. 27,28 Surgery remains an alternative treatment, especially when diagnosis has been delayed and the patient displays large ulcers. Surgery also applies when the patient experiences severe side-effects of chemotherapy (e.g.…”

Section: Discussionmentioning

confidence: 99%

Exploration of a standard treatment for Buruli ulcer through a comprehensive analysis of all cases diagnosed in Japan

Sugawara

Ishii

Nakanaga

et al. 2015

The Journal of Dermatology

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Buruli ulcer (BU) is a refractory skin ulcer caused by Mycobacterium ulcerans or M. ulcerans ssp. shinshuense, a subspecies thought to have originated in Japan or elsewhere in Asia. Although BU occurs most frequently in tropical and subtropical areas such as Africa and Australia, the occurrence in Japan has gradually increased in recent years. The World Health Organization recommends multidrug therapy consisting of a combination of oral rifampicin (RFP) and i.m. streptomycin (SM) for the treatment of BU. However, surgical interventions are often required when chemotherapy alone is ineffective. As a first step in developing a standardized regimen for BU treatment in Japan, we analyzed detailed records of treatments and prognoses in 40 of the 44 BU cases that have been diagnosed in Japan. We found that a combination of RFP (450 mg/day), levofloxacin (LVFX; 500 mg/day) and clarithromycin (CAM; at a dose of 800 mg/day instead of 400 mg/day) was superior to other chemotherapies performed in Japan. This simple treatment with oral medication increases the probability of patient adherence, and may often eliminate the need for surgery.

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Section: Discussionmentioning

confidence: 99%

Exploration of a standard treatment for Buruli ulcer through a comprehensive analysis of all cases diagnosed in Japan

Sugawara

Ishii

Nakanaga

et al. 2015

The Journal of Dermatology

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“…Indeed, second or third samples are needed to confirm Buruli ulcer in around 15% of patients. Some clinical forms of Buruli ulcer are difficult to diagnose clinically, even for experienced medical staff, and need biological confirmation (12). Furthermore, laboratory results are particularly valuable in cases of paradoxical reaction or suspected relapse (13)(14)(15)(16).…”

mentioning

confidence: 99%

Establishment of Quantitative PCR (qPCR) and Culture Laboratory Facilities in a Field Hospital in Benin: 1-Year Results

Marion

Ganlonon²,

Claco³

et al. 2014

J Clin Microbiol

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e No simple diagnostic tool is available to confirm Mycobacterium ulcerans infection, which is an emerging disease reported in many rural areas of Africa. Here, we report the 1-year results of a hospital laboratory that was created in an area of endemicity of Benin to facilitate the diagnosis of M. ulcerans infection. Buruli ulcer is a neglected tropical disease occurring mainly in poor, rural communities in West Africa and is caused by the environmental pathogen Mycobacterium ulcerans. This bacillus produces a unique toxin called mycolactone, which has cytotoxic and immunomodulatory activity and often causes severe skin ulcerations, disfigurement, and disability, with children the most affected. A combination of rifampin and streptomycin or rifampin and clarithromycin has been recommended by the World Health Organization (WHO) since 2004 as the first-line treatment (1, 2). M. ulcerans infection is confirmed by laboratory examination, including Ziehl-Neelsen staining, PCR, histology, and/or culture (3). A fine-needle aspiration (FNA) sample may be collected from nonulcerative lesions (nodule, plaque, or edema), and swabs are taken from the undermined edges of ulcerative lesions (4, 5). Biopsy specimens can be obtained from a punch biopsy sample or from excised necrotic tissue. Rapid diagnosis is essential for the management of patients. Since November 2012, the field laboratory established at the Buruli ulcer treatment center in Pobè, Benin, has been fully equipped to carry out M. ulcerans infection diagnosis and has three separate rooms to avoid crosscontamination. Technicians have been trained to perform quantitative PCR (qPCR) and culture in addition to smear examination. Here, we evaluated the 1-year results of this laboratory, which is the first one associated with a specialized treatment center located in a rural area of endemicity and able to carry out qPCR, culture, and direct smear examination (DSE) of a given sample. Detection and quantification of M. ulcerans by qPCR were compared with culture and Ziehl-Neelsen staining results, and the beneficial effects of this laboratory approach on patient management were evaluated.Among 394 specimens analyzed, 203 (51%) were taken by swab, 101 (26%) by FNA, and 90 (23%) by biopsy. The samples were analyzed by molecular tests (qPCR) and microbiological tests (culture and Ziehl-Neelsen staining). Briefly, swabs were rehydrated and biopsy specimens were minced in 2 ml of sterile water. The Kubica method was used to decontaminate 400 l of swab and skin biopsy specimens to isolate M. ulcerans strains (6). FNA specimens were not decontaminated, because the sampling procedure is considered sterile. After inoculation onto Lowenstein-Jensen medium, growth was monitored weekly for 5 months. Ziehl-Neelsen staining was performed as described previously (3). To prepare DNA, 400 l of suspension was centrifuged, resuspended in 50 mM NaOH solution, and heated at 95°C for 10 min. DNA was then purified with a QIAquick PCR purification kit (Qiagen), according to the manufacturer's ...

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“…Still, whether stratification of these results by BCG strains could have exposed different results remains an interrogation, as this is a factor known to influence immune cellular response [58]. Thus, based on current evidence, the usefulness of BCG in BU appears to be essentially restricted to protecting against osteomyelitis forms of the disease [59,60].…”

Section: Plos Neglected Tropical Diseasesmentioning

confidence: 99%

Individual and clinical variables associated with the risk of Buruli ulcer acquisition: A systematic review and meta-analysis

et al. 2020

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Background Buruli ulcer (BU) is a necrotizing skin disease, caused by Mycobacterium ulcerans, with poorly understood acquisition risk factors. This review aims at evaluating the importance of individual-sex, age, family ties with history of BU, gene variants-and clinical-Bacillus Calmette-Gué rin (BCG) immunization, Human Immunodeficiency Virus (HIV) infection-variables in this process. Methods A systematic review was performed considering the following databases: ClinicalTrials.gov, Cochrane Controlled Register of Trials (CENTRAL), Current Contents Connect, Embase, MEDLINE, SciELO, Scopus and Web of Science. Eligible studies were critically appraised with The Joanna Briggs Institute checklists and heterogeneity was assessed with Cochran Q-test and I 2 statistic. Published demographic data was descriptively analysed and clinical data pooled within random-effects modelling for meta-analysis. Results A total of 29 studies were included in the systematic review. Two randomized controlled trials (RCTs) and 21 case-control studies were selected for meta-analysis. Studies show that BU mainly affects age extremes, more preponderately males among children. Data pooled from RCTs do not reveal BCG to be protective against BU (odds ratio (OR) = 0.63; 95% CI = 0.38-1.05; I 2 = 56%), a finding case-control studies appear to corroborate. HIV infection (OR = 6.80; 95% CI = 2.33-19.85; I 2 = 0%) and SLC11A1 rs17235409 A allele (OR = 1.86; 95% CI = 1.25-2.77; I 2 = 0%) are associated with increased prevalence of the disease. No definite conclusions can be drawn regarding the influence of previous family history of BU.

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Findings in Patients From Benin With Osteomyelitis and Polymerase Chain Reaction–Confirmed Mycobacterium ulcerans Infection

Cited by 26 publications

References 31 publications

Exploration of a standard treatment for Buruli ulcer through a comprehensive analysis of all cases diagnosed in Japan

Exploration of a standard treatment for Buruli ulcer through a comprehensive analysis of all cases diagnosed in Japan

Establishment of Quantitative PCR (qPCR) and Culture Laboratory Facilities in a Field Hospital in Benin: 1-Year Results

Individual and clinical variables associated with the risk of Buruli ulcer acquisition: A systematic review and meta-analysis

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