ArticlePLoS neglected tropical diseases2011
Secondary Buruli ulcer skin lesions emerging several months after completion of chemotherapy: paradoxical reaction or evidence for immune protection?
Article in PLoS neglected tropical diseases, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 35 papers.
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Who cites it
35 citing papers in PubMed, 71 citations in OpenAlex.
- Paradoxical reactions in Buruli ulcer after initiation of antibiotic therapy: Relationship to bacterial load.PLoS neglected tropical diseases · 2019Trial
- Local Heat Application for the Treatment of Buruli Ulcer: Results of a Phase II Open Label Single Center Non Comparative Clinical Trial.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2016Trial
- A very late paradoxical reaction occurring following antibiotic treatment of Buruli ulcer.PLoS neglected tropical diseases · 2026Article
- AtypicalJournal of clinical medicine · 2025Review
- Clinical and microbiological predictors of healing in Buruli ulcer disease.Journal of clinical tuberculosis and other mycobacterial diseases · 2024Article
- Recent Advances in the Management Strategies for Buruli Ulcers.Pathogens (Basel, Switzerland) · 2023Review
- Histological and quantitative polymerase chain reaction-based analysis of Buruli ulcer using mapping biopsy method.PLoS neglected tropical diseases · 2020Article
- Buruli ulcer: The Efficacy of Innate Immune Defense May Be a Key Determinant for the Outcome of Infection WithFrontiers in microbiology · 2020Review
- Phage therapy as a renewed therapeutic approach to mycobacterial infections: a comprehensive review.Infection and drug resistance · 2019Article
- Infiltrating leukocytes surround early Buruli ulcer lesions, but are unable to reach the mycolactone producing mycobacteria.Virulence · 2017Article
- Analysis of Mycobacterium ulcerans-specific T-cell cytokines for diagnosis of Buruli ulcer disease and as potential indicator for disease progression.PLoS neglected tropical diseases · 2017Article
- Genetic Susceptibility and Predictors of Paradoxical Reactions in Buruli Ulcer.PLoS neglected tropical diseases · 2016Article
- Local Cellular Immune Responses and Pathogenesis of Buruli Ulcer Lesions in the Experimental Mycobacterium Ulcerans Pig Infection Model.PLoS neglected tropical diseases · 2016Article
- Challenges Associated with Management of Buruli Ulcer/Human Immunodeficiency Virus Coinfection in a Treatment Center in Ghana: A Case Series Study.The American journal of tropical medicine and hygiene · 2015Article
- Mycolactone-Dependent Depletion of Endothelial Cell Thrombomodulin Is Strongly Associated with Fibrin Deposition in Buruli Ulcer Lesions.PLoS pathogens · 2015Article
- Treatment Outcome of Patients with Buruli Ulcer Disease in Togo.PLoS neglected tropical diseases · 2015Article
- Efficacy of Rifampin Plus Clofazimine in a Murine Model of Mycobacterium ulcerans Disease.PLoS neglected tropical diseases · 2015Article
- Establishment of quantitative PCR (qPCR) and culture laboratory facilities in a field hospital in benin: 1-year results.Journal of clinical microbiology · 2014Article
- Clinical features and management of a severe paradoxical reaction associated with combined treatment of Buruli ulcer and HIV co-infection.BMC infectious diseases · 2014Article
- Pathogenesis of skin ulcers: lessons from the Mycobacterium ulcerans and Leishmania spp. pathogens.Cellular and molecular life sciences : CMLS · 2014Review
Corrections and comments
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Authors and funding
7 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe neglected tropical disease Buruli ulcer (BU) caused by Mycobacterium ulcerans is an infection of the subcutaneous tissue leading to chronic ulcerative skin lesions. Histopathological features are progressive tissue necrosis, extracellular clusters of acid fast bacilli (AFB) and poor inflammatory responses at the site of infection. After the recommended eight weeks standard treatment with rifampicin and streptomycin, a reversal of the local immunosuppression caused by the macrolide toxin mycolactone of M. ulcerans is observed. METHODOLOGY/PRINCIPAL
findingsWe have conducted a detailed histopathological and immunohistochemical analysis of tissue specimens from two patients developing multiple new skin lesions 12 to 409 days after completion of antibiotic treatment. Lesions exhibited characteristic histopathological hallmarks of Buruli ulcer and AFB with degenerated appearance were found in several of them. However, other than in active disease, lesions contained massive leukocyte infiltrates including large B-cell clusters, as typically found in cured lesions. CONCLUSION/SIGNIFICANCE: Our histopathological findings demonstrate that the skin lesions emerging several months after completion of antibiotic treatment were associated with M. ulcerans infection. During antibiotic therapy of Buruli ulcer development of new skin lesions may be caused by immune response-mediated paradoxical reactions. These seem to be triggered by mycobacterial antigens and immunostimulators released from clinically unrecognized bacterial foci. However, in particular the lesions that appeared more than one year after completion of antibiotic treatment may have been associated with new infection foci resolved by immune responses primed by the successful treatment of the initial lesion.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.