FN Archimer Export Format PT J TI Réponses et réactions paradoxales au cours du traitement médicamenteux de l’infection à Mycobacterium ulcerans (ulcère de Buruli). Quatre observations en Guyane française OT Paradoxical reactions and responses during antibiotic treatment for Mycobacterium ulcerans infection (Buruli ulcer). Four cases from French Guiana BT AF SAMBOURG, E. DUFOUR, J EDOUARD, S. MORRIS, A. MOSNIER, E. REYNAUD, Yann SAINTE-MARIE, D. NACHER, M. GUEGAN, J. -F. COUPPIE, P. AS 1:1;2:1,2;3:1;4:3;5:1;6:4;7:1,2;8:2,5;9:6,7;10:1,2; FF 1:;2:;3:;4:;5:;6:;7:;8:;9:;10:; C1 Ctr Hosp Cayenne, Serv Dermatol, Cayenne 97300, French Guiana. Univ Antilles Guyane, Ctr Hosp Cayenne, EA EPaT 3593, Cayenne 97300, French Guiana. Bournemouth Univ, Sch Appl Sci, Poole BH12 5BB, Dorset, England. Inst Pasteur Guyane, Cayenne 97300, French Guiana. Ctr Hosp Cayenne, INSERM, CIE 802, CIC EC Antilles Guyane, Cayenne 97300, French Guiana. Univ Montpellier I, Ctr IRD Montpellier, CNRS, UMR MIVEGEC,IRD, F-34000 Montpellier, France. Univ Montpellier 2, Ctr IRD Montpellier, CNRS, UMR MIVEGEC,IRD, F-34000 Montpellier, France. C2 CHU CAYENNE, FRANCE UNIV ANTILLES GUYANE, FRANCE UNIV BOURNEMOUTH, UK INST PASTEUR GUYANE, FRANCE CHU CAYENNE, FRANCE UNIV MONTPELLIER, FRANCE UNIV MONTPELLIER, FRANCE IF 0.919 TC 4 UR https://archimer.ifremer.fr/doc/00771/88288/93953.pdf LA French DT Article DE ;Mycobacterium ulcerans;Buruli ulcer;Paradoxical reaction;Tropical disease;French Guiana AB Background. In recent years, first-line therapy for Mycobacterium ulcerans infection in French Guiana has consisted of antibiotics active against this organism. Two regimens are used comprising rifampicin associated with clarithromycin or amikacin. Patients and methods. We describe four patients presenting apparent worsening of their lesions during treatment: ulceration of a nodular lesion in a 32-year-old woman and worsening of an ulcerated lesion in three patients aged 16, 27 and 79 years. Discussion. In these 4 patients, we concluded that the symptoms were caused by a paradoxical response or a reaction, a phenomenon already described in tuberculosis and leprosy. Such worsening is transient and must not be misinterpreted as failure to respond to treatment. The most plausible pathophysiological hypothesis involves the re-emergence of potentially necrotizing cellular immunity secondary to the loss of mycolactone, a necrotizing and immunosuppressive toxin produced by M. ulcerans, resulting from the action of the antibiotics. (C) 2014 Elsevier Masson SAS. All rights reserved. PY 2014 PD JUL SO Annales De Dermatologie Et De Venereologie SN 0151-9638 PU Masson Editeur VL 141 IS 6-7 UT 000338757800002 BP 413 EP 418 DI 10.1016/j.annder.2014.01.010 ID 88288 ER EF