secondary buruli ulcer skin lesions emerging several months after completion of chemotherapy paradoxical reaction or evidence for immune protection二级布鲁里溃疡皮肤损伤新兴几个月后完成化疗矛盾或证据的免疫保护反应.pdfVIP

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secondary buruli ulcer skin lesions emerging several months after completion of chemotherapy paradoxical reaction or evidence for immune protection二级布鲁里溃疡皮肤损伤新兴几个月后完成化疗矛盾或证据的免疫保护反应.pdf

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secondary buruli ulcer skin lesions emerging several months after completion of chemotherapy paradoxical reaction or evidence for immune protection二级布鲁里溃疡皮肤损伤新兴几个月后完成化疗矛盾或证据的免疫保护反应

Secondary Buruli Ulcer Skin Lesions Emerging Several Months after Completion of Chemotherapy: Paradoxical Reaction or Evidence for Immune Protection? ´ ` 1,2 3,4 3,4 3,4 Marie-Therese Ruf , Annick Chauty , Ambroise Adeye , Marie-Franc¸oise Ardant , Hugues 3,4 4 1,2 Koussemou , Roch Christian Johnson , Gerd Pluschke * ` ` 1 Swiss Tropical and Public Health Institute, Basel, Switzerland, 2 University of Basel, Basel, Switzerland, 3 Centre de Diagnostic et de Traitement de l’Ulcere de Buruli, Pobe, Benin, 4 Fondation Raoul Follereau, Cotonou, Benin Abstract Background: The neglected tropical disease Buruli ulcer (BU) caused by Mycobacterium ulcerans is an infection of the subcutaneous tissue leading to chronic ulcerative skin lesions. Histopathological features are progressive tissue necrosis, extracellular clusters of acid fast bacilli (AFB) and poor inflammatory responses at the site of infection. After the recommended eight weeks standard treatment with rifampicin and streptomycin, a reversal of the local immunosuppres- sion caused by the macrolide toxin mycolactone of M. ulcerans is observed. Methodology/Principal Findings: We have conducted a detailed histopathological and immunohistochemical analysis of tissue specimens from two patients developing multiple new skin lesions 12 to 409 days after completion of antibiotic treatment. Lesions exhibited