Abstract
The HIV infection in Buruli ulcer patients worsens their disease clinical course that leads to bad prognosis and sometimes to treatment failure or to immune reconstitution Inflammatory Syndrome (IRIS). The latest is poorly understood, but well documented [3]. IRIS occurs in the setting of Anti-retroviral treatment (ART) initiation and it is considered as a deregulated immunologic response to a previously existing pathogen such as mycobacterium ulcerans in Buruli ulcer. Clinically, we have two types of IRIS as follows, the unmasking IRIS in which a previously unrecognized infection becomes clinically apparent as immune reconstitution occurs, and the paradoxical IRIS which causes clinical deterioration of previously recognized and sometimes treated infections [4].
Highlights
In Côte d’Ivoire, the most sub-Saharan Africa country affected by Buruli ulcer, more than 2000 new cases per year are diagnosed, and Humain immunodeficiency virus (HIV) and Mycobacterium ulcerans co-infection [2] become more and more frequent
Among the factor known to predispose to immune reconstitution Inflammatory Syndrome (IRIS), there are: a very low CD4 cell counts at the initiation of Anti-retroviral treatment (ART) and a preexisting infectious disease like Buruli ulcer [4]
Concerning BU, this paradoxical reactions are proposed to result from reversal of the mycolactone toxin induced immune-inhibitory state via the antibiotic mediated killing of mycobacterium ulcerans organisms allowing intense immunological reaction to develop against the persisting mycobacterial agents [5,6 ]
Summary
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. ; IRIS occurs mostly in the first weeks or months after Highly Active Antiretroviral therapy (HAART) initiation. Among the factor known to predispose to IRIS, there are: a very low CD4 cell counts at the initiation of ART and a preexisting infectious disease like Buruli ulcer [4].
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