ArticleBMC infectious diseases2013
Incidence, clinical spectrum, diagnostic features, treatment and predictors of paradoxical reactions during antibiotic treatment of Mycobacterium ulcerans infections.
Article in BMC infectious diseases, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 1 of them a synthesis that pooled it.
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Who cites it
29 citing papers in PubMed, 1 synthesis or guideline pooled it, 64 citations in OpenAlex.
- Drugs for treating Buruli ulcer (Mycobacterium ulcerans disease).The Cochrane database of systematic reviews · 2018Pooled it
- Paradoxical reactions in Buruli ulcer after initiation of antibiotic therapy: Relationship to bacterial load.PLoS neglected tropical diseases · 2019Trial
- A very late paradoxical reaction occurring following antibiotic treatment of Buruli ulcer.PLoS neglected tropical diseases · 2026Article
- Accelerating vaccine research and development for skin neglected tropical diseases: A case for leishmaniasis, leprosy, and Buruli ulcer.PLoS neglected tropical diseases · 2026Review
- Management of Mycobacterium ulcerans infection (Buruli ulcer) in Australia: consensus statement.The Medical journal of Australia · 2025Article
- Paratuberculosis in sheep and goats: Pathogenesis, diagnostic findings, and control strategies.Open veterinary journal · 2025Review
- Pilot use of a mycolactone-specific lateral flow assay for Buruli ulcer: A case report from Japan.Journal of clinical tuberculosis and other mycobacterial diseases · 2024Article
- Changes in Inflammatory Markers in Patients Treated for Buruli Ulcer and Their Ability to Predict Paradoxical Reactions.The Journal of infectious diseases · 2023Article
- Recent Advances in the Management Strategies for Buruli Ulcers.Pathogens (Basel, Switzerland) · 2023Review
- A human model of Buruli ulcer: The case for controlled human infection and considerations for selecting a Mycobacterium ulcerans challenge strain.PLoS neglected tropical diseases · 2023Review
- Application of Bayesian modeling for diagnostic assays of Mycobacterium avium subsp. paratuberculosis in sheep and goats flocks.BMC veterinary research · 2022Article
- Molecular and epidemiological characterization of recurrent Mycobacterium ulcerans infections in Benin.PLoS neglected tropical diseases · 2021Article
- Host-Related Laboratory Parameters for Leprosy Reactions.Frontiers in medicine · 2021Review
- Histological and quantitative polymerase chain reaction-based analysis of Buruli ulcer using mapping biopsy method.PLoS neglected tropical diseases · 2020Article
- Human genetics of mycobacterial disease.Mammalian genome : official journal of the International Mammalian Genome Society · 2018Review
- Wound healing: Natural history and risk factors for delay in Australian patients treated with antibiotics for Mycobacterium ulcerans disease.PLoS neglected tropical diseases · 2018Article
- Buruli Ulcer: a Review of the Current Knowledge.Current tropical medicine reports · 2018Review
- Buruli Ulcer, a Prototype for Ecosystem-Related Infection, Caused by Mycobacterium ulcerans.Clinical microbiology reviews · 2018Review
- Assessing and managing wounds of Buruli ulcer patients at the primary and secondary health care levels in Ghana.PLoS neglected tropical diseases · 2017Observational
- 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
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Authors and funding
9 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundParadoxical reactions from antibiotic treatment of Mycobacterium ulcerans have recently been recognized. Data is lacking regarding their incidence, clinical and diagnostic features, treatment, outcomes and risk factors in an Australian population.
methodsData was collected prospectively on all confirmed cases of M. ulcerans infection managed at Barwon Health Services, Australia, from 1/1/1998-31/12/2011. Paradoxical reactions were defined on clinical and histological criteria and cases were determined by retrospectively reviewing the clinical history and histology of excised lesions. A Poisson regression model was used to examine associations with paradoxical reactions.
resultsThirty-two of 156 (21%) patients developed paradoxical reactions a median 39 days (IQR 20-73 days) from antibiotic initiation. Forty-two paradoxical episodes occurred with 26 (81%) patients experiencing one and 6 (19%) multiple episodes. Thirty-two (76%) episodes occurred during antibiotic treatment and 10 (24%) episodes occurred a median 37 days after antibiotic treatment. The reaction site involved the original lesion (wound) in 23 (55%), was separate to but within 3 cm of the original lesion (local) in 11 (26%) and was more than 3 cm from the original lesion (distant) in 8 (19%) episodes. Mycobacterial cultures were negative in 33/33 (100%) paradoxical episodes. Post-February 2009 treatment involved more cases with no antibiotic modifications (12/15 compared with 11/27, OR 5.82, 95% CI 1.12-34.07, p = 0.02) and no further surgery (9/15 compared with 2/27, OR 18.75, 95% CI 2.62-172.73, p < 0.001). Six severe cases received prednisone with marked clinical improvement. On multivariable analysis, age ≥ 60 years (RR 2.84, 95% CI 1.12-7.17, p = 0.03), an oedematous lesion (RR 3.44, 95% CI 1.11-10.70, p=0.03) and use of amikacin in the initial antibiotic regimen (RR 6.33, 95% CI 2.09-19.18, p < 0.01) were associated with an increased incidence of paradoxical reactions.
conclusionsParadoxical reactions occur frequently during or after antibiotic treatment of M. ulcerans infections in an Australian population and may be increased in older adults, oedematous disease forms, and in those treated with amikacin. Recognition of paradoxical reactions led to changes in management with less surgery, fewer antibiotic modifications and use of prednisolone for severe reactions.
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