Antimicrobial treatment for early, limited Mycobacterium ulcerans infection: a randomised controlled trial

Nienhuis, Willemien A.; Stienstra, Ymkje; Thompson, W. A.; Awuah, P.; Abass, Kabiru Mohammed; Wilson, Tracey E.; Awua-Boateng, Nana Yaa; Ampadu, Edwin; Siegmund, Vera; Schouten, Jan P.; Adjei, Ohene; Bretzel, Gisela; Werf, Tjip S. van der

doi:10.1016/s0140-6736(09)61962-0

Cited by 257 publications

(266 citation statements)

References 30 publications

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“…The study adopted an endpoint to healing at 52 weeks at which point all ulcers that were not 100% epithelialized were censored or classified as failing to heal. 43 The healing rate at the study endpoint was 42.9% (3/7) with a median time to healing of 37 weeks (IQR: 36-37) ( Table 3). Two patients (cases 4 and 5) died within the study period and two (cases 2 and 3) had still not healed completely 56 and 64 weeks after start of treatment, respectively.…”

Section: Resultsmentioning

confidence: 99%

Challenges Associated with Management of Buruli Ulcer/Human Immunodeficiency Virus Coinfection in a Treatment Center in Ghana: A Case Series Study

Tuffour

Owusu-Mireku

Ruf

et al. 2015

The American Society of Tropical Medicine and Hygiene

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Abstract. 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.

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Section: Resultsmentioning

confidence: 99%

Challenges Associated with Management of Buruli Ulcer/Human Immunodeficiency Virus Coinfection in a Treatment Center in Ghana: A Case Series Study

Tuffour

Owusu-Mireku

Ruf

et al. 2015

The American Society of Tropical Medicine and Hygiene

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“…2 Although an effective treatment with antimicrobials has been introduced more than a decade ago, the healing process is slow, with a median time to healing of 18-30 weeks in small lesions. 3 Large scars and contractures may result in functional limitations. 4,5 A high standard of wound care reduces the burden on both the patient and the health-care system, as it shortens the time it takes for a wound to heal and prevents secondary infections of the wound.…”

mentioning

confidence: 99%

The Application of Modern Dressings to Buruli Ulcers: Results from a Pilot Implementation Project in Ghana

Velding

Klis

Abass

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Abstract. Buruli ulcer (BU) is a tropical, infectious skin disease. The resulting ulcer can take a long time to heal, and a high standard of wound care is essential. Currently, the only dressing used for BU wound care is gauze, and its removal causes pain and bleeding. We performed a pilot implementation project using HydroTac ® (HARTMANN, Heidenheim, Germany), a modern dressing combining foam with a hydrogel component. For future BU treatment, we recommend to use a more absorbent dressing than the HydroTac dressing used in the current project. However, we show that modern dressings can be applied to BUs and that HydroTac dressings yield clean, healing wounds, and prevent the pain and bleeding associated with gauze dressings. Wound care is a vital but to date neglected aspect of BU management.

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“…The lesions involve primarily the deep dermis and the subcutaneous tissue, manifesting under various clinical forms, the most dramatic being large ulcerations that may reach the bone (Leigheb et al 2008) (Figures 5, 6). The classic treatment of Buruli ulcer relies on bi-antibiotic therapy (streptomycine/rifampicine), followed by surgical excision of the necrotic tissues and skin graft (Nienhuis et al 2010). Hyperbaric oxygen therapy (Figure 6), even if not able to prevent germ growth, is an important adjuvant.…”

Section: A North-south Intervention Against a Neglected Tropical Disementioning

confidence: 99%

Building Sustainable Capacity for Disease Diagnosis in Sub-Saharan Africa: Case Studies of Cooperation in Diagnostic Pathology

Mariani–Costantini¹,

Awadelkarim²,

Barberis³

et al. 2011

New Knowledge in a New Era of Globalization

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Antimicrobial treatment for early, limited Mycobacterium ulcerans infection: a randomised controlled trial

Cited by 257 publications

References 30 publications

Challenges Associated with Management of Buruli Ulcer/Human Immunodeficiency Virus Coinfection in a Treatment Center in Ghana: A Case Series Study

Challenges Associated with Management of Buruli Ulcer/Human Immunodeficiency Virus Coinfection in a Treatment Center in Ghana: A Case Series Study

The Application of Modern Dressings to Buruli Ulcers: Results from a Pilot Implementation Project in Ghana

Building Sustainable Capacity for Disease Diagnosis in Sub-Saharan Africa: Case Studies of Cooperation in Diagnostic Pathology

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