Multifocal Buruli Ulcer Associated with Secondary Infection in HIV Positive Patient

Abstract

Buruli ulcer is a chronic and infectious skin disease, caused by Mycobacterium ulcerans. It leads to large skin ulceration and sometimes bone infection which is responsible for deformities. Here, we report a case of multifocal form of Buruli ulcer associated with secondary infection in a 46-year-old human immunodeficiency virus (HIV) positive woman. The antimycobacterial drugs combined to surgery allowed curing this multifocal case and rose up two relevant issues: the susceptibility of immune reconstitution inflammatory syndrome (IRIS) occurrence and Mycobacterium dissemination. The deep immune depression, the underline biological, and clinical disorders of the patient might contribute to IRIS occurrence and Buruli ulcer dissemination. Future investigations have to be conducted on the mechanism of IRIS on set and on Mycobacterium ulcerans dissemination after ARV drugs initiation and the patient related underline clinical or biological disorders.

Management of BU–HIV co‐infection

“…HIV may affect the clinical presentation and severity of BU disease with a reported increased incidence of multiple, larger and ulcerated BU lesions in HIV-infected individuals (Johnson et al 2002;Toll et al 2005;Kibadi et al 2010;Komenan et al 2013;Christinet et al 2014). It also appears that the presence and severity of BU may reflect the level of underlying immune suppression in an HIV-infected person.…”

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

“…A retrospective study conducted in Cameroon revealed that human immunodeficiency virus (HIV) infection may affect the clinical presentation and severity of BU disease with a reported increased incidence of multiple, larger, and ulcerated BU lesions. [16][17][18] Data available on the absorption of antituberculosis medications in tuberculosis (TB)/HIV coinfection compared with HIV-negative patients showed conflicting results. 19,20 Therefore, whether antimycobacterial combination treatment is less efficacious in persons with HIV infection is unknown and needs to be systematically studied.…”

Problematic Management of Buruli Ulcer and HIV Co-infection in Tropical Regions

“…Moreover, in TB/HIV co-infection, the incidence of IRIS occurrence is increased in patients who start ART within 30 days of TB treatment initiation [7]. Comparing to the case report recently described in Côte d'Ivoire with multifocal BU lesions developing in a HIV patient with severe immunodepression (baseline CD4 cell counts of 51 cell/ mm3), on month after both BU and HIV treatment initiation [2].…”

“…In Côte d'Ivoire, the most sub-Saharan Africa country affected by Buruli ulcer, more than 2000 new cases per year are diagnosed, and HIV and Mycobacterium ulcerans co-infection [2] become more and more frequent.…”