Problematic Management of Buruli Ulcer and HIV Co-infection in Tropical Regions

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].