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Adusumilli S, Mve-Obiang A, Sparer T, Meyers W, Hayman J, 2005. Mycobacterium ulcerans toxic macrolide, mycolactone modulates the host immune response and cellular location of M. ulcerans in vitro and in vivo. Cell Microbiol 7: 1295ā1304.
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Yeboah-Manu D, Kpeli GS, Ruf M-T, Asan-Ampah K, Quenin-Fosu K, 2013. Secondary bacterial infections of Buruli ulcer lesions before and after chemotherapy with streptomycin and rifampicin. PLoS Negl Trop Dis 7: e2191.
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Christinet V, Comte E, Ciaffi L, Odermatt P, Serafini M, Antierens A, Rossel L, Nomo AB, Nkemenang P, Tsoungui A, Delhumeau C, Calmy A, 2014. Impact of HIV on the severity of Buruli ulcer disease: results of a retrospective study in Cameroon. Open Forum Infect Dis 1: ofu021.
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18.
Komenan K, ElidjƩ EJ, Ildevert GP, Yao KI, Kanga K, Kouame KA, Abdoulaye S, Hamdam KS, Yao YP, Jean-Marie K, 2013. Multifocal Buruli ulcer associated with secondary infection in HIV positive patient. Case Rep Med 2013: 348628.
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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
Joseph Tuffour
Joseph Tuffour
Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana; Ga West Municipal Hospital, Ghana Health Service, Amasaman, Ghana; Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Reconstructive and Plastic Surgery Unit, Korle-BU Teaching Hospital, Accra, Ghana
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Evelyn Owusu-Mireku
Evelyn Owusu-Mireku
Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana; Ga West Municipal Hospital, Ghana Health Service, Amasaman, Ghana; Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Reconstructive and Plastic Surgery Unit, Korle-BU Teaching Hospital, Accra, Ghana
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Marie-Therese Ruf
Marie-Therese Ruf
Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana; Ga West Municipal Hospital, Ghana Health Service, Amasaman, Ghana; Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Reconstructive and Plastic Surgery Unit, Korle-BU Teaching Hospital, Accra, Ghana
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Samuel Aboagye
Samuel Aboagye
Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana; Ga West Municipal Hospital, Ghana Health Service, Amasaman, Ghana; Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Reconstructive and Plastic Surgery Unit, Korle-BU Teaching Hospital, Accra, Ghana
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Grace Kpeli
Grace Kpeli
Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana; Ga West Municipal Hospital, Ghana Health Service, Amasaman, Ghana; Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Reconstructive and Plastic Surgery Unit, Korle-BU Teaching Hospital, Accra, Ghana
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Victor Akuoku
Victor Akuoku
Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana; Ga West Municipal Hospital, Ghana Health Service, Amasaman, Ghana; Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Reconstructive and Plastic Surgery Unit, Korle-BU Teaching Hospital, Accra, Ghana
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Janet Pereko
Janet Pereko
Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana; Ga West Municipal Hospital, Ghana Health Service, Amasaman, Ghana; Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Reconstructive and Plastic Surgery Unit, Korle-BU Teaching Hospital, Accra, Ghana
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Albert Paintsil
Albert Paintsil
Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana; Ga West Municipal Hospital, Ghana Health Service, Amasaman, Ghana; Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Reconstructive and Plastic Surgery Unit, Korle-BU Teaching Hospital, Accra, Ghana
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Kofi Bonney
Kofi Bonney
Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana; Ga West Municipal Hospital, Ghana Health Service, Amasaman, Ghana; Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Reconstructive and Plastic Surgery Unit, Korle-BU Teaching Hospital, Accra, Ghana
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William Ampofo
William Ampofo
Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana; Ga West Municipal Hospital, Ghana Health Service, Amasaman, Ghana; Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Reconstructive and Plastic Surgery Unit, Korle-BU Teaching Hospital, Accra, Ghana
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Gerd Pluschke
Gerd Pluschke
Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana; Ga West Municipal Hospital, Ghana Health Service, Amasaman, Ghana; Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Reconstructive and Plastic Surgery Unit, Korle-BU Teaching Hospital, Accra, Ghana
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Dorothy Yeboah-Manu
Dorothy Yeboah-Manu
Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana; Ga West Municipal Hospital, Ghana Health Service, Amasaman, Ghana; Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Reconstructive and Plastic Surgery Unit, Korle-BU Teaching Hospital, Accra, Ghana
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The synergy between Mycobacterium tuberculosis infection and human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome is well established but not so in Buruli ulcer (BU). We screened confirmed BU cases for HIV infection and followed seven BU/HIV-coinfected patients. Management of BU/HIV was based on the World Health Organization guidelines and patient condition. The HIV positivity among BU patients (8.2%; 11/134) was higher compared with that of general patients attending the facility (4.8%; 718/14,863; P = 0.07) and that of pregnant women alone (2.5%; 279/11,125; P = 0.001). All seven BU/HIV-coinfected cases enrolled in the study presented with very large (category III) lesions with four having multiple lesions compared with 54.5% of category III lesions among HIV-negative BU patients. During the recommended BU treatment with streptomycin and rifampicin (SR) all patients developed immune infiltrates including CD4 T cells in their lesions. However, one patient who received antiretroviral therapy (ART) 1 week after beginning SR treatment developed four additional lesions during antibiotic treatment, while two out of the four who did not receive ART died. Further evidence is required to ascertain the most appropriate time to commence ART in relation to SR treatment to minimize paradoxical reactions.
Author Notes
Financial support: The Stop Buruli Consortium funded by UBS Optimus Foundation provided funding for this study.
Authors' addresses: Joseph Tuffour, Victor Akuoku, and Janet Pereko, Ga West Municipal Hospital, Ghana Health Service, Buruli Ward, Amasaman, Ghana, E-mails: josephtuffour@rocketmail.com, vaksgh@yahoo.com, and jpereko@yahoo.com. Evelyn Owusu-Mireku, Samuel Aboagye, Grace Kpeli, Kofi Bonney, William Ampofo, and Dorothy Yeboah-Manu, Bacteriology Department, Noguchi Memorial Institute for Medical Research, Legon, Accra, Ghana, E-mails: nanaamaowusumireku@yahoo.com, saboagye@noguchi.ug.edu.gh, gkpeli@noguchi.ug.edu.gh, kbonney@noguchi.ug.edu.gh, wampofo@noguchi.og.edu.gh, and dyeboah-manu@noguchi.mimcom.org. Marie-Therese Ruf and Gerd Pluschke, Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland, E-mails: therese.ruf@unibas.ch and gerd.pluschke@unibas.ch. Albert Paintsil, Korle-BU Teaching Hospital, Reconstructive and Plastic Surgery Unit, Accra, Ghana, E-mail: albert@paintsil.com.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Sizaire V, Nackers F, Comte E, Portaels F, 2006. Mycobacterium ulcerans infection: control, diagnosis and treatment. Lancet Infect Dis 6: 288ā296.
-
2.
Van der Werf TS, Van der Graaf WTA, Tappero JW, Asiedu K, 1999. Mycobacterium ulcerans infection. Lancet 353: 1013ā1101.
-
3.
Agbenorku P, 2014. Buruli ulcer disability in Ghana: the problems and solutions. BJMMR 4: 1355ā1365.
-
4.
Pszolla N, Sarkar RM, Strecker W, Kern P, Kinzl L, 2003. Buruli ulcer: a systemic disease. Clin Infect Dis 37: 78ā82.
-
5.
Converse PJ, Nuermberger EL, Almeida DV, Grosset JH, 2011. Treating Mycobacterium ulcerans disease (Buruli ulcer): from surgery to antibiotics, is the pill mightier than the knife? Future Microbiol 6: 1185ā1198.
-
6.
O'Brien DP, Comte E, Serafi M, Ehounou G, Antierens A, 2013. The urgent need for clinical, diagnostic, and operational research for management of Buruli ulcer in Africa. Lancet Infect Dis 14: 435ā440.
-
7.
Etuaful S, Carbonnelle B, Lucas S, Horsefield C, Philips R, 2005. Efficacy of the combination rifampin-streptomycin in preventing growth of Mycobacterium ulcerans in early lesions of Buruli ulcer in humans. Antimicrob Agents Chemother 49: 3182ā3186.
-
8.
Chauty A, Ardant MF, Adeye A, Euverte H, Guedenon A, 2007. Promising clinical efficacy of streptomycin-rifampin combination for treatment of Buruli ulcer (Mycobacterium ulcerans disease). Antimicrob Agents Chemother 51: 4029ā4035.
-
9.
Sarfo FS, Philips R, Asiedu K, Ampadu E, Bobi N, 2010. Clinical efficacy of rifampin and streptomycin for treatment of Mycobacterium ulcerans disease. Antimicrob Agents Chemother 54: 3678ā3685.
-
10.
Adusumilli S, Mve-Obiang A, Sparer T, Meyers W, Hayman J, 2005. Mycobacterium ulcerans toxic macrolide, mycolactone modulates the host immune response and cellular location of M. ulcerans in vitro and in vivo. Cell Microbiol 7: 1295ā1304.
-
11.
Peduzzi E, Groeper C, SchĆ¼tte D, Zajac P, Rondini S, 2007. Local activation of the innate immune system in Buruli ulcer lesions. J Invest Dermatol 12: 638ā645.
-
12.
SchĆ¼tte D, Um-Boock A, Mensah-Quainoo E, Itin P, Schmid P, 2007. Development of highly organized lymphoid structures in Buruli ulcer lesions after treatment with rifampicin and streptomycin. PLoS Negl Trop Dis 1: e2.
-
13.
Ruf M-T, Chauty A, Adeye A, Ardant MF, Koussemou H, 2011. Secondary Buruli ulcer skin lesions emerging several months after completion of chemotherapy: paradoxical reaction or evidence of immune protection? PLoS Negl Trop Dis 5: e1252.
-
14.
Wanda F, Nkemenang P, Ehounou G, Tchaton M, Comte E, 2014. Clinical features and management of a severe paradoxical reaction associated with combined treatment of Buruli ulcer and HIV co-infection. BMC Infect Dis 14: 423.
-
15.
Yeboah-Manu D, Kpeli GS, Ruf M-T, Asan-Ampah K, Quenin-Fosu K, 2013. Secondary bacterial infections of Buruli ulcer lesions before and after chemotherapy with streptomycin and rifampicin. PLoS Negl Trop Dis 7: e2191.
-
16.
Christinet V, Comte E, Ciaffi L, Odermatt P, Serafini M, Antierens A, Rossel L, Nomo AB, Nkemenang P, Tsoungui A, Delhumeau C, Calmy A, 2014. Impact of HIV on the severity of Buruli ulcer disease: results of a retrospective study in Cameroon. Open Forum Infect Dis 1: ofu021.
-
17.
Toll A, Gallardo F, Ferran M, Gilaberte M, Iglesias M, 2005. Aggressive multifocal Buruli ulcer with associated osteomyelitis in an HIV-positive patient. Clin Exp Dermatol 30: 649ā651.
-
18.
Komenan K, ElidjƩ EJ, Ildevert GP, Yao KI, Kanga K, Kouame KA, Abdoulaye S, Hamdam KS, Yao YP, Jean-Marie K, 2013. Multifocal Buruli ulcer associated with secondary infection in HIV positive patient. Case Rep Med 2013: 348628.
-
19.
Peloquin CA, Nitta AT, Burman WJ, Brudney KF, Miranda-Massari JR, McGuinness MF, Berning SE, Gerana GT, 1996. Low antituberculosis drug concentrations in patients with AIDS. Ann Pharmacother 30: 919ā925.
-
20.
Taylor J, Smith PJ, 1998. Does AIDS impair the absorption of antituberculosis agents? Int J Tuberc Lung Dis 2: 670ā675.
-
21.
Girma M, Teshome W, Petros B, Endeshaw T, 2014. Cryptosporidiosis and isosporiasis among. HIV-positive individuals in south Ethiopia: a cross sectional study. BMC Infect Dis 14: 100.
-
22.
Shastri S, Naik B, Anita Shet A, Bharat Rewari B, De Costa A, 2013. TB treatment outcomes among TB-HIV co-infections in Karnataka, India: how do these compare with non-HIV tuberculosis outcomes in the province? BMC Public Health 13: 838.
-
23.
Havlir DV, Getahun H, Sanne I, Nunn P, 2008. Opportunities and challenges for HIV care in overlapping HIV and TB epidemics. JAMA 300: 423ā430.
-
24.
Jones BE, Young SM, Antoniskis D, Davidson PT, Kramer F, Barnes PF, 1993. Relationship of the manifestations of tuberculosis to CD4 cell counts in patients with human immunodeficiency virus infection. Am Rev Respir Dis 148: 1292ā1297.
-
25.
Torrado E, Fraga AG, Castro AG, Stragier P, Mayers WM, 2006. Evidence for intramacrophage growth phase of Mycobacterium ulcerans. Infect Immun 75: 977ā987.
-
26.
Oliveira MS, Fraga AG, Torrado E, Castro AG, Pereira JP, 2005. Infection with Mycobacterium ulcerans induces persistent inflammatory response in mice. Infect Immun 73: 6299ā6310.
-
27.
Yeboah-Manu D, Peduzzi E, Mensah-Quainoo E, Asante-Poku A, Ofori-Adjei D, 2006. Systemic suppression of interferon-Ī³ responses in Buruli ulcer patients resolves after surgical excision of the lesions caused by the extracellular pathogen Mycobacterium ulcerans. J Leukoc Biol 79: 1150ā1156.
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