Department of Dermatology, Fukushima Medical University School of Medicine, Fukushima, Japan.
Department of Microbiology, Fukushima Medical University School of Medicine, Fukushima, Japan.
JAMA Dermatol. 2014 Jan;150(1):64-7. doi: 10.1001/jamadermatol.2013.6816.
Buruli ulcer, a severe skin infectious disease caused by Mycobacterium ulcerans, is prevalent in tropical and subtropical areas. Recently, cases of Buruli ulcer have been increasing in Japan. All cases have been sporadic, and to date the pathogenic organism has not been detected in materials from the environment.
Three members of the same family were seen with large indurated plaques on their face and extremities in the winter of 2010. Skin biopsy specimens of their lesions showed extensive necrosis of deep dermis and subcutaneous fat. Acid-fast bacilli were detected in each biopsy specimen by Ziehl-Neelsen stain, and bacteriological analysis of cultured microorganisms revealed the strains to be M ulcerans subsp shinshuense. The patients were treated with a combination of antibiotics and surgical debridement. Insertion sequence 2404 was detected from a crayfish captured in a stagnant water channel in the backyard of the family's house.
We report a rare instance of familial occurrence of Buruli ulcer in Japan. Detection of insertion sequence 2404 from a crayfish suggests that the pathogenic organism may reside in an aquatic environment in Japan, as in other endemic areas. To prevent this serious infectious disease, further investigation is needed to clarify the transmission pathway.
由溃疡分枝杆菌引起的严重皮肤传染病—— 布鲁里溃疡，流行于热带和亚热带地区。最近，日本的布鲁里溃疡病例一直在增加。所有病例均为散发病例，迄今为止，尚未从环境材料中检测到病原体。
2010 年冬季，同一家庭的 3 名成员面部和四肢出现大的硬结斑块。对其病变的皮肤活检标本显示深部真皮和皮下脂肪广泛坏死。Ziehl-Neelsen 染色在每个活检标本中均检测到抗酸杆菌，培养的微生物的细菌学分析显示菌株为申舒溃疡分枝杆菌亚种。患者接受抗生素联合手术清创治疗。在家中后院的死水渠道中捕获的一只小龙虾中检测到插入序列 2404。
我们报告了日本罕见的家族性布鲁里溃疡病例。从一只小龙虾中检测到插入序列 2404 表明，病原体可能存在于日本的水生环境中，就像在其他流行地区一样。为了预防这种严重的传染病，需要进一步调查以阐明传播途径。
