Introduction

The French overseas departments and territories in which the study takes place is an exception in its geographical area with an incidence of Mycobacterium ulcerans of 4.29 / 100,000 inhabitants. Third cause of mycobacterial infections in the world, it is predominant in sub-Saharan Africa and Australia. The major handicap it causes confers it in 1998 via the Yamoussoukro conference the status of neglected tropical disease. The treatment recommended in the 1980s and 1990s is surgical; it changed in 2004, with the WHO recommending first-line antibiotic therapy combining rifampicin and streptomycin. In 2013, clarithromycin replaced streptomycin in the DOM TOM studied and in Australia.

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Materials and methods

The objective of this study was to describe the course of treatment for M. ulcerans in the geographical area studied and assess the efficacy and tolerance of antibiotic therapy. We conducted a retrospective single-center study using the cohort of patients followed in the dermatology department from 1971 to 2015.

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Results

Two hundred and thirty patients were treated, of which 153 were definite diagnoses. One hundred and forty three patients were treated by surgery, 143 by antibiotic therapy, all lines combined. Apart from 69 (28.2%) lost to follow-up, all the cases treated were cured. 114/143 (79.7%) patients were treated with rifampicin, 48 (33.5%) with clarithromycin, 18 (12.6%) with aminoglycosides. Surgical treatment declined in 2005, giving way to antibiotic therapy (p < 0.001). The relapse rates after a first line of surgery alone or antibiotic therapy recommended by the WHO are similar (9.5% vs 10.7%; p = 1). Under antibiotic therapy, 7 side effects (6.4%) and 4 paradoxical reactions (14.3%) were noted.

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Conclusion

International recommendations have changed the treatment of M. ulcerans within the DOM TOM studied, which has become an effective, well-tolerated bi-antibiotic therapy.

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