Spontaneous healing of Mycobacterium ulcerans disease in Australian patients

O'Brien, Daniel P, Murrie, Adrian, Meggyesy, Peter, Priestley, Jonathan, Rajcoomar, Avinash and Athan, Eugene 2019, Spontaneous healing of Mycobacterium ulcerans disease in Australian patients, PLoS neglected tropical diseases, vol. 13, no. 2, pp. 1-8, doi: 10.1371/journal.pntd.0007178.

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Title Spontaneous healing of Mycobacterium ulcerans disease in Australian patients
Author(s) O'Brien, Daniel P
Murrie, Adrian
Meggyesy, Peter
Priestley, Jonathan
Rajcoomar, Avinash
Athan, EugeneORCID iD for Athan, Eugene orcid.org/0000-0001-9838-6471
Journal name PLoS neglected tropical diseases
Volume number 13
Issue number 2
Article ID e0007178
Start page 1
End page 8
Total pages 8
Publisher Public Library of Science
Place of publication San Francisco, Calif.
Publication date 2019-02-19
ISSN 1935-2727
Keyword(s) Lesions
Mycobacterium ulcerans
Tissue repair
Surgical and invasive medical procedures
Immune response
Diagnostic medicine
Skin infections
Summary BACKGROUND: Mycobacterium ulcerans causes necrotising infections of skin and soft tissue mediated by the polyketide exotoxin mycolactone that causes cell apoptosis and immune suppression. It has been postulated that infection can be eradicated before the development of clinical lesions but spontaneous resolution of clinical lesions has been rarely described. METHODOLOGY/PRINCIPAL FINDINGS: We report a case series of five Australian patients who achieved healing of small M. ulcerans lesions without antibiotics or surgery. The median age of patients was 47 years (IQR 30-68 years) and all patients had small ulcerative lesions (median size 144mm2, IQR 121-324mm2). The median duration of symptoms prior to diagnosis was 90 days (IQR 90-100 days) and the median time to heal from diagnosis without treatment was 68 days (IQR 63-105 days). No patients recurred after a median follow-up of 16.6 months (IQR 16.6-17.9 months) from the development of symptoms and no patients suffered long-term disability from the disease. CONCLUSIONS: We have shown that healing without specific treatment can occur for small ulcerated M. ulcerans lesions suggesting that in selected cases a robust immune response alone can cure lesions. Further research is required to determine what lesion and host factors are associated with spontaneous healing, and whether observation alone is an effective and safe form of management for selected small M. ulcerans lesions.
Language eng
DOI 10.1371/journal.pntd.0007178
Field of Research 06 Biological Sciences
11 Medical and Health Sciences
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2019, O’Brien et al
Persistent URL http://hdl.handle.net/10536/DRO/DU:30120690

Document type: Journal Article
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