Kotrajaras R, Tagami H
Int J Dermatol. 1987 Jan-Feb;26(1):45-50. doi: 10.1111/j.1365-4362.1987.tb04575.x.
There is a yearly outbreak of endemic leg ulcers in Thailand. Corynebacterium pyogenes, a pathogen to animals, is frequently isolated from the fresh lesions in addition to common pyogenic bacteria such as beta-hemolytic streptococci, mostly group A, and Staphylococcus aureus and Staphylococcus epidermidis. Although circulating titers of IgG and IgM anti-C. pyogenes antibodies were found to be very low in studied cases, intradermal skin test with C. pyogenes vaccine containing nonviable 10(5) microorganisms induced an erythematous reaction with maximum intensity at 6 hours; direct immunofluorescence showed granular deposition of C3 along the dermoepidermal junction at this time. Unexpectedly, the sites of such a skin test that subsequently underwent biopsy presented tender erythematosus induration 1 week later and developed granulomatous ulcerative lesions after 10 days in 11 of 15 patients. Radioimmunoassay for C5a and C5a of arginine demonstrated that C. pyogenes activated complement even in the absence of specific antibodies. These findings suggest that importance of skin injury followed by infection with C. pyogenes in the development of endemic leg ulcers, supporting our hypothesis that the infection of accidentally traumatized skin by C. pyogenes, which is carried by Oriental-eye flies, induces the granulomatous lesions of endemic leg ulcers.
泰国每年都会爆发地方性腿部溃疡。化脓棒状杆菌是一种动物病原体，除了常见的化脓性细菌，如主要为A组的β-溶血性链球菌、金黄色葡萄球菌和表皮葡萄球菌外，还经常从新鲜病灶中分离出来。尽管在所研究的病例中发现抗化脓棒状杆菌IgG和IgM抗体的循环滴度非常低，但用含有10(5)个无活力微生物的化脓棒状杆菌疫苗进行皮内皮肤试验，在6小时时诱导出最大强度红斑反应；此时直接免疫荧光显示C3沿真皮表皮交界处呈颗粒状沉积。出乎意料的是，15名患者中有11名在进行活检的此类皮肤试验部位，1周后出现压痛性红斑硬结，10天后出现肉芽肿性溃疡性病变。对C5a和精氨酸C5a的放射免疫分析表明，即使在没有特异性抗体的情况下，化脓棒状杆菌也能激活补体。这些发现表明，化脓棒状杆菌感染继发皮肤损伤在地方性腿部溃疡的发生中具有重要意义，支持了我们的假设，即东方眼蝇携带的化脓棒状杆菌感染意外受伤的皮肤会诱发地方性腿部溃疡的肉芽肿性病变。
