Pilot study of treatment of Buruli ulcer with rifampin and dapsone

Espey, David K.; Djomand, Gaston; Diomande, Idrissa; Dosso, Mireille; Saki, Mathieu Z.; Kanga, J. M.; Spiegel, Richard A.; Marston, Barbara J.; Gorelkin, Leo; Meyers, Wayne M.; Portaels, Françoise; Deming, Michael S.; Horsburgh, C. Robert

doi:10.1016/s1201-9712(02)90138-4

Cited by 41 publications

(33 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In an attempt to establish the diagnosis by punch biopsies, acid-fast bacilli were identified and cultured for four patients. Cultures of lesions are infrequently positive, and this figure is consistent with that reported by others (9). It may be possible to achieve more positive diagnoses by using a PCR for M. ulcerans DNA, which was not available to us at the time of the study.…”

Section: Discussionsupporting

confidence: 88%

“…This expensive treatment is not available in most areas where the disease is endemic (3). Chemotherapy with antimicrobial agents has been used (11), but the only published controlled trials suggest that clofazamine is ineffective (19) and that rifampin and dapsone combined have limited efficacy (9). Many types of topical treatment have been reported, but none has been subjected to the rigors of a controlled clinical trial (2).…”

mentioning

confidence: 99%

See 1 more Smart Citation

Pilot Randomized Double-Blind Trial of Treatment ofMycobacterium ulceransDisease (Buruli Ulcer) with Topical Nitrogen Oxides

Phillips

Adjei

Lucas

et al. 2004

Antimicrob Agents Chemother

View full text Add to dashboard Cite

Mycobacterium ulcerans disease (Buruli ulcer) is a serious ulcerating skin disease which is common in many tropical countries. Standard treatment, by extensive excision and skin grafting, is not available in rural communities where the disease is common. We evaluated the efficacy and safety of treatment with topical nitrogen oxides. Thirty-seven patients with a clinical diagnosis of Buruli ulcer caused by M. ulcerans disease were randomly assigned to one of two groups. In one group, two creams containing sodium nitrite (6%, wt/wt) or citric acid monohydrate (9%, wt/wt) were applied daily for 6 weeks, while the other group received a placebo. In the second 6 weeks, both groups received the nitrogen oxide-generating combination of creams. Treatment was continued for another 4 weeks for patients whose ulcers were not healed after 12 weeks. The ulcer surface area was monitored by weekly tracings made by assessors blinded to the treatment. In the first 6 weeks, patients on sodium nitrite and citric acid monohydrate (group I, active treatment) showed a rapid decrease in ulcer size from 28.6 ؎ 5.6 cm 2 (mean ؎ standard error) to 12.6 ؎ 3.2 cm 2 , a decrease significantly greater than that in group II (from 15.3 ؎ 3.1 to 11.7 ؎ 3.7 cm 2 ; P ‫؍‬ 0.03). Five ulcers in the placebo group enlarged during this period, compared with one in the active group. In the second 6 weeks (both groups on active treatment), the rates of healing were similar for the two groups and there was a significant reduction in ulcer size in group II (previously on placebo) compared to the first 6 weeks. Yellow pigmentation of the skin, which disappeared 3 days after treatment was stopped, was the only side effect to date. We conclude that creams releasing nitrogen oxides increase the healing rate of ulcers caused by M. ulcerans infection with minimal adverse events. This is the first controlled trial of any form of therapy which demonstrates efficacy in treating this disease.

show abstract

Section: Discussionsupporting

confidence: 88%

mentioning

confidence: 99%

Pilot Randomized Double-Blind Trial of Treatment ofMycobacterium ulceransDisease (Buruli Ulcer) with Topical Nitrogen Oxides

Phillips

Adjei

Lucas

et al. 2004

Antimicrob Agents Chemother

View full text Add to dashboard Cite

show abstract

“…In vitro, a number of agents (including clarithromycin, several quinolones, and rifampin) are active, but few clinical studies have been done. A pilot study using dapsone plus rifampin in Côte d'Ivoire showed modest effect [41].…”

Section: Buruli Ulcer (Mycobacterium Ulcerans)mentioning

confidence: 99%

Dermatologic infectious diseases in international travelers

Wilson

Chen²

2004

Curr Infect Dis Rep

View full text Add to dashboard Cite

Skin lesions provide an important clue to the diagnoses of many infections in returned travelers. New information related to epidemiology, recognition, diagnosis, or management is described for the systemic infections--dengue fever, several of the rickettsial infections, African trypanosomiasis, and coccidioidomycosis. Many pathogens cause focal skin findings. Recent findings are presented for cutaneous leishmaniasis, Buruli ulcer, gnatho-stomiasis, cutaneous larva migrans, myiasis, tungiasis, and scabies. This paper describes the most common skin problems in returning travelers and outlines the types of infections that cause skin lesions, as defined by morphologic characteristics.

show abstract

“…In a mouse footpad model of M. ulcerans infection, treatment with a combination of rifampin and amikacin has yielded promising results (7), and clinical trials with combinations of antibiotics are currently in progress (11). Monitoring of the response to chemotherapy may represent another useful application of the IS2404 TaqMan assay.…”

Section: Vol 41 2003mentioning

confidence: 99%

Development and Application of Real-Time PCR Assay for Quantification of Mycobacterium ulcerans DNA

Rondini

Mensah-Quainoo

Troll³

et al. 2003

J Clin Microbiol

View full text Add to dashboard Cite

Buruli ulcer, an infection caused by Mycobacterium ulcerans, is, after tuberculosis and leprosy, the third most common mycobacterial disease. The mode of transmission of M. ulcerans is not exactly known, but since Buruli ulcer often occurs in focalized swampy areas, it is assumed that there is a reservoir of the pathogen in stagnant water. Buruli ulcer usually starts as a painless nodule and can lead to massive destruction of skin, subcutaneous tissue, and eventually muscle and bone. Currently the only recommended treatment is wide surgical excision. In this report we describe the development of a real-time PCR method for the quantification of M. ulcerans DNA (IS2404 TaqMan). The highly specific assay is based on the detection of the M. ulcerans specific insertion sequence IS2404. The IS2404 TaqMan assay turned out to be about 10 times more sensitive than the available conventional PCR-based diagnostic test. It is demonstrated that the IS2404 TaqMan assay is suitable for the quantitative assessment of the dissemination of the mycobacteria in Buruli ulcer lesions. Prototype results obtained with excised tissue from a patient with a late preulcerative Buruli ulcer lesion reconfirmed earlier histopathological findings indicating that tissue damage occurs far beyond the regions in which large numbers of mycobacteria are detectable. The IS2404 TaqMan assay should be a useful tool for both diagnosis and research into the pathology and mode of transmission of this still inadequately investigated mycobacterial disease.

show abstract

Pilot study of treatment of Buruli ulcer with rifampin and dapsone

Abstract: Results of this study indicate that larger studies of antimycobacterial therapy of BU are warranted and can be successfully undertaken.

Cited by 41 publications

References 17 publications

Pilot Randomized Double-Blind Trial of Treatment ofMycobacterium ulceransDisease (Buruli Ulcer) with Topical Nitrogen Oxides

Pilot Randomized Double-Blind Trial of Treatment ofMycobacterium ulceransDisease (Buruli Ulcer) with Topical Nitrogen Oxides

Dermatologic infectious diseases in international travelers

Development and Application of Real-Time PCR Assay for Quantification of Mycobacterium ulcerans DNA

Contact Info

Product

Resources

About