Abalos F M, Aguiar J, Guédénon A, Portaels F, Meyers W M
Department of Infectious and Parasitic Disease Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA.
Ann Diagn Pathol. 2000 Dec;4(6):386-90. doi: 10.1053/adpa.2000.19372.
The World Health Organization recognizes Mycobacterium ulcerans infection (Buruli ulcer) as a reemerging disease. Classically, lesions are indolent, undermined ulcers of the skin. The characteristic histopathologic changes are provoked by a soluble toxin of M ulcerans that is necrotizing and immunosuppressive. After tuberculosis and leprosy, Buruli ulcer is the third most common mycobacterial disease in humans. We report Buruli ulcer in a patient in Benin, West Africa, with widespread edema and diffuse induration of approximately one half of the skin of the trunk. There was no ulceration. The tissue studied was a 16-cm portion excised from the center of the large surgical specimen. Histopathologic analysis showed massive contiguous necrosis of the dermis and subcutis in sections of biopsy specimens from the center, at 2-cm intervals in two radii from the center to the periphery, and at 5-cm intervals around the margin. Acid-fast bacilli infiltrated all specimens except at one peripheral site. Samples of the entire surgical specimen taken from seven sites before fixation were polymerase chain reaction and culture positive for M ulcerans. The disseminated nonulcerative form of M ulcerans infection is well known, but is now increasingly frequent in some highly endemic areas, especially in West Africa. This patient died within 48 hours postsurgery, but cause of death was not established. The only regularly effective treatment for advanced lesions is surgical excision of all infected tissue. Estimation of the lateral limits of invasion by M ulcerans may help the surgeon establish the optimal extent of excision. Refinement of the basic concept we used and adaptation to preoperative assessment of the limit of bacterial invasion are urgently needed, especially for massive lesions.
世界卫生组织将溃疡分枝杆菌感染（布氏溃疡）认定为一种再度出现的疾病。典型情况下，病变表现为皮肤的无痛性、潜行性溃疡。特征性组织病理学变化是由溃疡分枝杆菌的一种可溶性毒素引发的，该毒素具有坏死性和免疫抑制性。在结核病和麻风病之后，布氏溃疡是人类第三常见的分枝杆菌病。我们报告了西非贝宁一名患有布氏溃疡的患者，其躯干约一半皮肤出现广泛水肿和弥漫性硬结，无溃疡形成。所研究的组织是从大手术标本中心切除的一段16厘米的组织。组织病理学分析显示，在活检标本切片中，从中心到周边以两个半径方向每隔2厘米，以及在边缘周围每隔5厘米处，真皮和皮下组织出现大片连续性坏死。除一个周边部位外，所有标本均有抗酸杆菌浸润。在固定前从七个部位采集的整个手术标本样本经聚合酶链反应检测和培养，结果显示溃疡分枝杆菌呈阳性。溃疡分枝杆菌感染的播散性非溃疡性形式广为人知，但目前在一些高流行地区越来越常见，尤其是在西非。该患者在手术后48小时内死亡，但死因未明确。对于晚期病变，唯一常规有效的治疗方法是手术切除所有感染组织。评估溃疡分枝杆菌的侧向侵袭范围可能有助于外科医生确定最佳切除范围。迫切需要完善我们所采用的基本概念，并使其适用于术前对细菌侵袭范围的评估，尤其是对于大面积病变。
