||Genetic Susceptibility and Predictors of Paradoxical Reactions in Buruli Ulcer
JOHNSON ROCH CHRISTIAN ,
Barogui Yves Thierry ,
Klis Sandor-Adrian ,
||PLOS Neglected Tropical Diseases
Buruli ulcer (BU) is the third most frequent mycobacterial disease in immunocompetent persons
after tuberculosis and leprosy. During the last decade, eight weeks of antimicrobial
treatment has become the standard of care. This treatment may be accompanied by transient
clinical deterioration, known as paradoxical reaction. We investigate the incidence and
the risks factors associated with paradoxical reaction in BU.
The lesion size of participants was assessed by careful palpation and recorded by serial
acetate sheet tracings. For every time point, surface area was compared with the previous
assessment. All patients received antimicrobial treatment for 8 weeks. Serum concentration
of 25-hydroxyvitamin D, the primary indicator of vitamin D status, was determined in duplex
for blood samples at baseline by a radioimmunoassay. We genotyped four polymorphisms
in the SLC11A1 gene, previously associated with susceptibility to BU. For testing the association
of genetic variants with paradoxical responses, we used a binary logistic regression
analysis with the occurrence of a paradoxical response as the dependent variable.
Paradoxical reaction occurred in 22% of the patients; the reaction was significantly associated
with trunk localization (p = .039 by Χ2), larger lesions (p = .021 by Χ2) and genetic factors.
The polymorphisms 3’UTR TGTG ins/ins (OR 7.19, p < .001) had a higher risk for
developing paradoxical reaction compared to ins/del or del/del polymorphisms.
Paradoxical reactions are common in BU. They are associated with trunk localization, larger
lesions and polymorphisms in the SLC11A1 gene.
||Buruli ulcer, genetic susceptibility, predictors
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