CSIRO, Australian Animal Health Laboratory, Geelong, Victoria, Australia.
Department of Microbiology and Immunology, University of Melbourne, Melbourne, Victoria, Australia.
PLoS Negl Trop Dis. 2018 Aug 13;12(8):e0006724. doi: 10.1371/journal.pntd.0006724. eCollection 2018 Aug.
We examined recurrent Buruli ulcer cases following treatment and assumed cure in a large cohort of Australian patients living in an endemic area. We report that while the recurrence rate was low (2.81 cases/year/1000 population), it remained similar to the estimated risk of primary infection within the general population of the endemic area (0.85-4.04 cases/year/1,000 population). The majority of recurrent lesions occurred in different regions of the body and were separated by a median time interval of 44 months. Clinical, treatment and epidemiological factors combined with whole genome sequencing of primary and recurrent isolates suggests that in most recurrent cases a re-infection was more likely as opposed to a relapse of the initial infection. Additionally, all cases occurring more than 12 months after commencement of treatment were likely re-infections. Our study provides important prognostic information for patients and their health care providers concerning the nature and risks associated with recurrent cases of Buruli ulcer in Australia.
我们对在一个流行地区生活的大量澳大利亚患者进行了治疗并假定治愈后的复发性溃疡病例进行了检查。我们报告称，尽管复发率较低（2.81 例/年/1000 人），但与流行地区普通人群中估计的原发性感染风险（0.85-4.04 例/年/1000 人）相似。大多数复发性病变发生在身体的不同部位，两次发病的时间间隔中位数为 44 个月。临床、治疗和流行病学因素以及原发性和复发性分离株的全基因组测序表明，在大多数复发性病例中，再次感染的可能性大于初始感染的复发。此外，所有在治疗开始后 12 个月以上发生的病例都可能是再次感染。我们的研究为患者及其医疗保健提供者提供了有关澳大利亚复发性溃疡病例性质和相关风险的重要预后信息。
