Treatment and prevention of Mycobacterium ulcerans infection (Buruli ulcer) in Australia: guideline update

O’Brien, D. P.; Jenkin, Grant A.; Buntine, John A.; Steffen, Christina M.; McDonald, Anthony; Horne, S. F.; Friedman, N. Deborah; Athan, Eugene; Hughes, Andrew; Callan, Peter; Johnson, Paul D R

doi:10.5694/mja13.11331

Cited by 61 publications

(74 citation statements)

References 41 publications

(103 reference statements)

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“…The prednisolone was well tolerated and did not result in any adverse effects. The usual recommended dose is 0.5-1.0 mg/kg daily tapered over 4-8 weeks [21]. Of note, despite the use of prednisolone, the duration of BU antibiotic treatment was not prolonged and the antiretroviral regimen was not ceased or altered and this did not appear to adversely affect outcomes.…”

Section: Case Presentationmentioning

confidence: 99%

Clinical features and management of a severe paradoxical reaction associated with combined treatment of Buruli ulcer and HIV co-infection

Franck¹,

Nkemenang²,

Ehounou³

et al. 2014

BMC Infect Dis

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BackgroundIn West and Central Africa Buruli ulcer (BU) and HIV co-infection is increasingly recognised and management of these two diseases combined is an emerging challenge for which there is little published information. In this case we present a severe paradoxical reaction occurring after commencing antibiotic treatment for BU combined with antiretroviral therapy for HIV, and describe its clinical features and management. This includes to our knowledge the first reported use of prednisolone in Africa to manage a severe paradoxical reaction related to BU treatment.Case presentationA 30 year old immunosuppressed HIV positive man from Cameroon developed a severe paradoxical reaction 24 days after commencing antibiotic treatment for BU and 14 days after commencing antiretroviral therapy for HIV. Oral prednisolone was successfully used to settle the reaction and prevent further tissue loss. The antiretroviral regimen was continued unchanged and the BU antibiotic treatment not prolonged beyond the recommended duration of 8 weeks. A second small local paradoxical lesion developed 8 months after starting antibiotics and settled with conservative treatment only. Complete healing of lesions occurred and there was no disease recurrence 12 months after commencement of treatment.ConclusionsClinicians should be aware that severe paradoxical reactions can occur during the treatment of BU/HIV co-infected patients. Prednisolone was effectively and safely used to settle the reaction and minimize the secondary tissue damage.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-423) contains supplementary material, which is available to authorized users.

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Section: Case Presentationmentioning

confidence: 99%

Clinical features and management of a severe paradoxical reaction associated with combined treatment of Buruli ulcer and HIV co-infection

Franck¹,

Nkemenang²,

Ehounou³

et al. 2014

BMC Infect Dis

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“…Severe antibiotic complications occurred throughout the antibiotic course. However the median time to develop severe complications was 4 weeks, corresponding to the halfway point of the currently recommended 8‐week course of treatment . We have recently published our experience where in selected patients shorter antibiotic treatment durations were found to be effective .…”

Section: Discussionmentioning

confidence: 99%

“… We found the severe complication rates of clarithromycin and ciprofloxacin to be similar, individually or in combination with rifampicin, and thus their toxicity rates do not justify the use of one over the other. However, despite only being used in a small number of patients, the higher severe complication rate associated with amikacin led to it not being used in our study population after 2009 and supports the recommended use of oral antibiotic regimens in preference to this injectable agent in current Australian guidelines . Ethambutol was used in the early years of the study prior to the publication of antibiotic treatment guidelines which no longer recommended its use …”

Section: Discussionmentioning

confidence: 99%

“…However the median time to develop severe complications was 4 weeks, corresponding to the halfway point of the currently recommended 8-week course of treatment. 5,21 We have recently published our experience where in selected patients shorter antibiotic treatment durations were found to be effective. 22 According to results in this current study, antibiotic courses shortened to 4-6 weeks offer the potential to avoid up to 50% of the severe antibiotic complications.…”

Section: Discussionmentioning

confidence: 99%

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Antibiotic complications during the treatment of Mycobacterium ulcerans disease in Australian patients

O’Brien

Friedman

Hughes

et al. 2017

Internal Medicine Journal

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“…From October 2010, our standard treatment practice for initial M. ulcerans lesions has comprised combination antimicrobial therapy, with limited surgical debridement performed to aid wound healing, unless antibiotics are declined or contraindicated (10). The following data were extracted from medical records: patient demographics, comorbid conditions, size of the BU lesion(s), date of diagnosis, antimicrobial regimen and duration, and details of any adjunctive surgical procedures.…”

Section: Methodsmentioning

confidence: 99%

Increasing Experience with Primary Oral Medical Therapy for Mycobacterium ulcerans Disease in an Australian Cohort

Friedman

Athan

Walton

et al. 2016

Antimicrob Agents Chemother

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c Buruli ulcer (BU) is a necrotizing infection of subcutaneous tissue that is caused by Mycobacterium ulcerans and is responsible for disfiguring skin lesions. The disease is endemic to specific geographic regions in the state of Victoria in southeastern Australia. Growing evidence of the effectiveness of antibiotic therapy for M. ulcerans disease has evolved our practice to the use of primarily oral medical therapy. An observational cohort study was performed on all confirmed M. ulcerans cases treated with primary rifampin-based medical therapy at Barwon Health between October 2010 and December 2014 and receiving 12 months of follow-up. One hundred thirty-two patients were managed with primary medical therapy. The median age of patients was 49 years, and nearly 10% had diabetes mellitus. Lesions were ulcerative in 83.3% of patients and at WHO stage 1 in 78.8% of patients. The median duration of therapy was 56 days, with 22 patients (16.7%) completing fewer than 56 days of antimicrobial treatment. Antibiotic-associated complications requiring cessation of one or more antibiotics occurred in 21 (15.9%) patients. Limited surgical debridement was performed on 30 of these medically managed patients (22.7%). Cure was achieved, with healing within 12 months, in 131 of 132 patients (99.2%), and cosmetic outcomes were excellent. Primary rifampin-based oral medical therapy for M. ulcerans disease, combined with either clarithromycin or a fluoroquinolone, has an excellent rate of cure and an acceptable toxicity profile in Australian patients. We advocate for further research to determine the optimal and safest minimum duration of medical therapy for BU. B uruli ulcer (BU) is a necrotizing infection of subcutaneous tissue that is caused byMycobacterium ulcerans and is responsible for disfiguring skin lesions (1). While the disease is most common in West African countries (2), it is also endemic to specific geographic regions in the state of Victoria in southeastern Australia (3). Within the Bellarine Peninsula region of Victoria, BU is generally most common among older adults (3), in contrast to the affected demographic in West Africa, which is predominantly children (4).Antibiotics have been shown to be highly effective at sterilizing lesions and preventing disease recurrences when used alone or in combination with surgery (1, 5-9). Mounting evidence of the effectiveness of antibiotic therapy for M. ulcerans disease has substantially shifted the balance in favor of medical therapy over surgery, and our practice has evolved to using primarily oral medical therapy (1, 5). In 2013, we described the results of medical therapy in a group of 43 patients, among whom 42 patients (98%) healed without recurrence within 12 months (1). Here we provide details of our increasing experience with the use of primary oral medical therapy in a large observational Australian cohort. MATERIALS AND METHODSThis is an observational cohort study approved by Barwon Health's Human Research and Ethics Committee. All previously collected medical data...

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Treatment and prevention of Mycobacterium ulcerans infection (Buruli ulcer) in Australia: guideline update

Cited by 61 publications

References 41 publications

Clinical features and management of a severe paradoxical reaction associated with combined treatment of Buruli ulcer and HIV co-infection

Clinical features and management of a severe paradoxical reaction associated with combined treatment of Buruli ulcer and HIV co-infection

Antibiotic complications during the treatment of Mycobacterium ulcerans disease in Australian patients

Increasing Experience with Primary Oral Medical Therapy for Mycobacterium ulcerans Disease in an Australian Cohort

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