Response to treatment in a prospective cohort of patients with large ulcerated lesions suspected to be Buruli Ulcer (Mycobacterium ulcerans disease)

BACKGROUND: The World Health Organization (WHO) advises treatment of Mycobacterium ulcerans disease, also called "Buruli ulcer" (BU), with a combination of the antibiotics rifampicin and streptomycin (R+S), whether followed by surgery or not. In endemic areas, a clinical case definition is recommended. We evaluated the effectiveness of this strategy in a series of patients with large ulcers of > or =10 cm in longest diameter in a rural health zone of the Democratic Republic of Congo (DRC). METHODS: A cohort of 92 patients with large ulcerated lesions suspected to be BU was enrolled between October 2006 and September 2007 and treated according to WHO recommendations. The following microbiologic data were obtained: Ziehl-Neelsen (ZN) stained smear, culture and PCR. Histopathology was performed on a sub-sample. Directly observed treatment with R+S was administered daily for 12 weeks and surgery was performed after 4 weeks. Patients were followed up for two years after treatment. FINDINGS: Out of 92 treated patients, 61 tested positive for M. ulcerans by PCR. PCR negative patients had better clinical improvement than PCR positive patients after 4 weeks of antibiotics (54.8% versus 14.8%). For PCR positive patients, the outcome after 4 weeks of antibiotic treatment was related to the ZN positivity at the start. Deterioration of the ulcers was observed in 87.8% (36/41) of the ZN positive and in 12.2% (5/41) of the ZN negative patients. Deterioration due to paradoxical reaction seemed unlikely. After surgery and an additional 8 weeks of antibiotics, 98.4% of PCR positive patients and 83.3% of PCR negative patients were considered cured. The overall recurrence rate was very low (1.1%). INTERPRETATION: Positive predictive value of the WHO clinical case definition was low. Low relapse rate confirms the efficacy of antibiotics. However, the need for and the best time for surgery for large Buruli ulcers requires clarification. We recommend confirmation by ZN stain at the rural health centers, since surgical intervention without delay may be necessary on the ZN positive cases to avoid progression of the disease. PCR negative patients were most likely not BU cases. Correct diagnosis and specific management of these non-BU ulcers cases are urgently needed.This study was supported by the Directorate-General for Development and Cooperation (DGDC), Brussels, Belgium, the European Commission (International Science and Technology Cooperation Development Program) (project no. INCO-CT-2005-051476-BURULICO), and by a grant from the Health Services of Fundacao Calouste Gulbenkian. K.K. was supported by a grant from DGDC. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Tetraphenylphosphonium octahydrotriborate

The structure of the title salt, C(24)H(20)P(+)center dot H(8)B(3)(-) , at 120 (2) K has triclinic (P1) symmetry with an unusual Z = 5, although there is pseudosymmetry observedwith the tetraphenylphosphonium cations exhibiting I (4) over bar symmetry. One of the anions is disordered over two sets of sites with refined occupancies of 0.478 (11) and 0.522 (11

Mycobacterium ulcerans disease: role of age and gender in incidence and morbidity

During the 5-year period, 1997-2001, 1700 patients with a clinical diagnosis of Mycobacterium ulcerans disease [Buruli ulcer (BU)] were treated at the Centre Sanitaire et Nutritionnel Gbemoten, Zagnanado, Benin. The patients lived in the four regions of southern Benin: Atlantique, Mono, Oueme and Zou, with the largest number coming from the Zou Region where the centre is located. The median age of BU patients was 15 years (q1 = 7, q3 = 30). Lower limbs are involved 3.2 times more frequently than upper limbs in older patients and younger patients have the highest prevalence of multiple lesions. The latter are frequently associated with bone lesions. Specific detection rates for age and gender showed a distribution with maximum peaks in the 10-14 years group and among adults between 75 and 79 years. Over 59 years, males are more at risk of developing M. ulcerans disease than females. Children under 15 years represent the largest part of the BU disease burden and of the general population. The highest detection rates (per 100 000 population) were in the 75-79-year-old patients. The most likely explanation of this was reactivation of disease from a latent infection of M. ulcerans. Educational programmes should target especially these two groups of population at risk.SCOPUS: ar.jFLWINinfo:eu-repo/semantics/publishe

Surgical treatment of spondylodiscitis in the cervical spine: a minimum 2-year follow-up

Cervical spine spondylodiscitis is a rare, but serious manifestation of spinal infection. We present a retrospective study of 20 consecutive patients between 01/1994 and 12/1999 treated because of cervical spondylodiscitis. Mean age at the time of treatment was 59.7 (range 34–81) years, nine of them female. In all cases, diagnosis had been established with a delay. All patients in this series underwent surgery such as radical debridement, decompression if necessary, autologous bone grafting and instrumentation. Surgery was indicated if a neurological deficit, symptoms of sepsis, epidural abscess formation with consecutive stenosis, instability or severe deformity were present. Postoperative antibiotic therapy was carried out for 8–12 weeks. Follow-up examinations were performed a mean of 37 (range 24–63) months after surgery. Healing of the inflammation was confirmed in all cases by laboratory, clinical and radiological parameters. Spondylodesis was controlled radiologically and could be achieved in all cases. One case showed a 15°kyphotic angle in the proximal adjacent segment. Spontaneous bony bridging of the proximal adjacent segment was observed in one patient. In the other cases the adjacent segments radiologically showed neither fusion nor infection related changes. Preoperative neurological deficits improved in all cases. Residual neurological deficits persisted in three of eight cases. The results indicate that spondylodiscitis in cervical spine should be treated early and aggressive to avoid local and systemic complications