ArticlePLoS neglected tropical diseases2017
Clearance of viable Mycobacterium ulcerans from Buruli ulcer lesions during antibiotic treatment as determined by combined 16S rRNA reverse transcriptase /IS 2404 qPCR assay.
Article in PLoS neglected tropical diseases, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05169554 (Beta-Lactam Containing Regimen for the Shortening of Buruli Ulcer Disease Therapy), which is not on this map. Cited by 16 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Beta-Lactam Containing Regimen for the Shortening of Buruli Ulcer Disease Therapy: Comparison of 8 Weeks Standard Therapy (Rifampicin Plus Clarithromycin) vs. 4 Weeks Standard Plus Amoxicillin/Clavulanate Therapy [RC8 vs. RCA4]
Who cites it
16 citing papers in PubMed, 31 citations in OpenAlex.
- High-dose rifampicin and clarithromycin for 4 weeks versus standard-dose rifampicin and clarithromycin for 8 weeks to treat Buruli ulcer: An open-label, individually randomized, controlled trial in Ghana.PLoS neglected tropical diseases · 2026Trial
- Paradoxical reactions in Buruli ulcer after initiation of antibiotic therapy: Relationship to bacterial load.PLoS neglected tropical diseases · 2019Trial
- Characterization of secondary bacterial infections in Buruli ulcer disease in Ghana: a focus on antimicrobial resistant Staphylococcus aureus.BMC infectious diseases · 2026Article
- Field deployment of a mobile suitcase laboratory for Buruli ulcer diagnosis in Ghana.PLoS neglected tropical diseases · 2026Article
- Buruli ulcer.Nature reviews. Disease primers · 2025Review
- Antimicrobial resistant bacteria isolated from Buruli ulcer lesions in Ghana.PLoS neglected tropical diseases · 2025Article
- Improved protocols for isolation of Mycobacterium ulcerans from clinical samples.BMC microbiology · 2025Article
- Micronutrient-deficient diets and possible environmental enteric dysfunction in Buruli ulcer endemic communities in Ghana: Lower dietary diversity and reduced serum zinc and vitamin C implicate micronutrient status a possible susceptibility factor.PLoS neglected tropical diseases · 2025Article
- Amoxicillin/clavulanate in combination with rifampicin/clarithromycin is bactericidal against Mycobacterium ulcerans.PLoS neglected tropical diseases · 2024Article
- Clinical and microbiological predictors of healing in Buruli ulcer disease.Journal of clinical tuberculosis and other mycobacterial diseases · 2024Article
- Article
- Co-infection of HIV in patients with Buruli ulcer disease in Central Ghana.BMC infectious diseases · 2021Article
- Pharmacologic management ofExpert review of clinical pharmacology · 2020Review
- Ghana: Accelerating neglected tropical disease control in a setting of economic development.PLoS neglected tropical diseases · 2019Article
- Triple oral beta-lactam containing therapy for Buruli ulcer treatment shortening.PLoS neglected tropical diseases · 2019Article
- Article
Corrections and comments
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Authors and funding
13 authors at 4 institutions in 3 countries.
Funding
Abstract
introductionBuruli ulcer (BU) caused by Mycobacterium ulcerans is effectively treated with rifampicin and streptomycin for 8 weeks but some lesions take several months to heal. We have shown previously that some slowly healing lesions contain mycolactone suggesting continuing infection after antibiotic therapy. Now we have determined how rapidly combined M. ulcerans 16S rRNA reverse transcriptase / IS2404 qPCR assay (16S rRNA) became negative during antibiotic treatment and investigated its influence on healing.
methodsFine needle aspirates and swab samples were obtained for culture, acid fast bacilli (AFB) and detection of M. ulcerans 16S rRNA and IS2404 by qPCR (16S rRNA) from patients with IS2404 PCR confirmed BU at baseline, during antibiotic and after treatment. Patients were followed up at 2 weekly intervals to determine the rate of healing. The Kaplan-Meier survival analysis was used to analyse the time to clearance of M. ulcerans 16S rRNA and the influence of persistent M ulcerans 16S rRNA on time to healing. The Mann Whitney test was used to compare the bacillary load at baseline in patients with or without viable organisms at week 4, and to analyse rate of healing at week 4 in relation to detection of viable organisms.
resultsOut of 129 patients, 16S rRNA was detected in 65% of lesions at baseline. The M. ulcerans 16S rRNA remained positive in 78% of patients with unhealed lesions at 4 weeks, 52% at 8 weeks, 23% at 12 weeks and 10% at week 16. The median time to clearance of M. ulcerans 16S rRNA was 12 weeks. BU lesions with positive 16S rRNA after antibiotic treatment had significantly higher bacterial load at baseline, longer healing time and lower healing rate at week 4 compared with those in which 16S rRNA was not detected at baseline or had become undetectable by week 4.
conclusionsCurrent antibiotic therapy for BU is highly successful in most patients but it may be possible to abbreviate treatment to 4 weeks in patients with a low initial bacterial load. On the other hand persistent infection contributes to slow healing in patients with a high bacterial load at baseline, some of whom may need antibiotic treatment extended beyond 8 weeks. Bacterial load was estimated from a single sample taken at baseline. A better estimate could be made by taking multiple samples or biopsies but this was not ethically acceptable.
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