Department of Infectious Diseases, Barwon Health, Geelong, Victoria, Australia.
Department of Medicine and Infectious Diseases, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia.
PLoS Negl Trop Dis. 2019 Feb 19;13(2):e0007178. doi: 10.1371/journal.pntd.0007178. eCollection 2019 Feb.
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.
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.
溃疡分枝杆菌引起皮肤和软组织的坏死性感染，由聚酮外毒素分枝杆菌内酯介导，导致细胞凋亡和免疫抑制。有人假设在出现临床病变之前可以消除感染，但很少有自发缓解临床病变的描述。
方法/主要发现：我们报告了五例澳大利亚患者的病例系列，这些患者在没有使用抗生素或手术的情况下治愈了小的溃疡分枝杆菌病变。患者的中位年龄为 47 岁（IQR 30-68 岁），所有患者均有小的溃疡性病变（中位大小为 144mm2，IQR 121-324mm2）。从诊断到治愈的中位时间为 68 天（IQR 63-105 天），没有患者在症状出现后 16.6 个月（IQR 16.6-17.9 个月）的中位随访时间内复发，也没有患者因该疾病而长期残疾。
我们已经表明，未经特定治疗即可治愈小的溃疡性溃疡分枝杆菌病变，这表明在某些情况下，强大的免疫反应本身就可以治愈病变。需要进一步研究确定哪些病变和宿主因素与自发愈合有关，以及单独观察是否是治疗选定的小溃疡分枝杆菌病变的有效和安全方法。
