Corticosteroid Use for Paradoxical Reactions during Antibiotic Treatment for Mycobacterium ulcerans

N Deborah Friedman,Daniel P O'Brien,Anthony H Mcdonald,Michael E Robson,Richard O Phillips

doi:10.1371/journal.pntd.0001767

N Deborah Friedman, Daniel P O'Brien + Show 3 more

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https://doi.org/10.1371/journal.pntd.0001767

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Abstract

Buruli or Bairnsdale Ulcer (BU) is a neglected infectious disease caused by Mycobacterium ulcerans and is characterized by necrotic cutaneous lesions. Infection is challenging to treat, and the ideal combination of surgery and antimicrobial therapy continues to evolve. M. ulcerans has been endemic to the Bellarine peninsula in Victoria, Australia, since 1998, with more than 250 cases of infection. Studies have illustrated the safety and efficacy of antimicrobial therapy [1]–[5], and our standard treatment practice has evolved over the last 15 years to comprise limited surgical debridement with combination antimicrobial therapy.

Highlights

Immune reconstitution inflammatory syndrome (IRIS) is a paradoxical reaction occurring during treatment of an infection, recognized clinically by deterioration after initial improvement
In our group’s description of paradoxical reactions during therapy for Bairnsdale Ulcer (BU), we proposed that adjunctive corticosteroid therapy may improve healing and prevent the need for further surgical intervention [10]
In the last 2 years our group has acquired an early experience with the use of steroid therapy to treat severe IRIS in patients with M. ulcerans infection

Summary

Introduction

Immune reconstitution inflammatory syndrome (IRIS) is a paradoxical reaction occurring during treatment of an infection, recognized clinically by deterioration after initial improvement. These reactions are well described in tuberculosis and leprosy, where effective antimicrobial killing may be accompanied by (transient) clinical deterioration during treatment [6,7], predominantly in HIV-infected patients after the introduction of antiretroviral therapy [8]. Our group and others have described paradoxical reactions occurring during the treatment of M. ulcerans infection with antimicrobials [10,11].

Results

Conclusion