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Spontaneous healing of mycobacterium ulcerans disease in australian patients

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Version 3 2024-06-18, 14:10
Version 2 2024-06-03, 15:33
Version 1 2019-04-11, 15:26
journal contribution
posted on 2024-06-18, 14:10 authored by DP O’Brien, A Murrie, P Meggyesy, J Priestley, A Rajcoomar, Eugene AthanEugene Athan
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.

History

Journal

PLoS Neglected Tropical Diseases

Volume

13

Article number

ARTN e0007178

Pagination

1 - 8

Location

United States

Open access

  • Yes

ISSN

1935-2727

eISSN

1935-2735

Language

English

Publication classification

C1 Refereed article in a scholarly journal

Copyright notice

2019, O’Brien et al

Issue

2

Publisher

PUBLIC LIBRARY SCIENCE