<i>Mycobacterium ulcerans</i> disease management in Australian patients: the re‐emergence of surgery as an important treatment modality

O’Brien, D. P.; Callan, Peter; Friedman, N. Deborah; Athan, Eugene; Hughes, Andrew; McDonald, Anthony

doi:10.1111/ans.14829

Cited by 15 publications

(28 citation statements)

References 28 publications

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“…In contrast, our paediatric cohort demonstrates the effectiveness of antibiotic therapy alone. The contemporary backbone of BU treatment is rifampicin‐based antibiotic therapy, with surgical intervention reserved to promote healing by removal of necrotic tissue . Aggressive surgical resection of lesions is no longer recommended.…”

Section: Discussionmentioning

confidence: 99%

“…The important role of surgery lies in improving the rate of wound healing, and preventing further tissue loss associated with severe paradoxical reactions. Surgery without antibiotics may be an effective option for selected small lesions; however, aggressive surgical resection is no longer required for most cases . Globally, this change in therapeutic strategy towards medical or combined therapy has resulted in reduced rates of invasive surgery and general anaesthesia, as well as reduced incidence of disability, disfigurement and disease recurrence .…”

Section: Discussionmentioning

confidence: 99%

“…Definitions of surgical methods were as previously described . Treatment success was defined as complete healing of the lesion without the occurrence of a culture positive M. ulcerans lesion within 12 months of commencing antibiotic treatment.…”

Section: Methodsmentioning

confidence: 99%

“…Treatment success was defined as complete healing of the lesion without the occurrence of a culture positive M. ulcerans lesion within 12 months of commencing antibiotic treatment. Paradoxical reactions were defined by the presence of one or both of the following features: (i) clinical: an initial improvement with antibiotic treatment in the clinical appearance of a M. ulcerans lesion followed by a clinically significant deterioration of the lesion or its surrounding tissues in terms of oedema or tissue necrosis, or the appearance of a new lesion(s); and (ii) histopathology: examination of excised tissue from the clinical lesion showing evidence of an intense inflammatory reaction consistent with a paradoxical reaction …”

Section: Methodsmentioning

confidence: 99%

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Paediatric Buruli ulcer in Australia

Walker

Friedman

O'Brien

et al. 2019

J Paediatrics Child Health

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Aim: This study describes an Australian cohort of paediatric Buruli ulcer (BU) patients and compares them with adult BU patients. Methods: Analysis of a prospective cohort of all BU cases managed at Barwon Health, Victoria, from 1 January 1998 to 31 May 2018 was performed. Children were defined as ≤15 years of age. Results: A total of 565 patients were included: 52 (9.2%) children, 289 (51.2%) adults aged 16-64 years and 224 (39.6%) adults aged ≥65 years. Among children, half were female and the median age was 8.0 years (interquartile range 4.8-12.3 years). Six (11.5%) cases were diagnosed from 2001 to 2006, 14 (26.9%) from 2007 to 2012 and 32 (61.5%) from 2013 to 2018. Compared to adults, children had a significantly higher proportion of non-ulcerative lesions (32.7%, P < 0.001) and a higher proportion of severe lesions (26.9%, P < 0.01). The median duration of symptoms prior to diagnosis was shorter for children compared with adults aged 16-64 years (42 vs. 56 days, P = 0.04). Children were significantly less likely to experience antibiotic complications (6.1%) compared with adults (20.6%, P < 0.001), but had a significantly higher rate of paradoxical reactions (38.8%) compared with adults aged 16-64 (19.2%) (P < 0.001). Paradoxical reactions in children occurred significantly earlier than in adults (median 17 vs. 56 days, P < 0.01). Cure rates were similarly high for children compared to adults treated with antibiotics alone or with antibiotics and surgery. Conclusions: Paediatric BU cases in Australia are increasing and represent an important but stable proportion of Australian BU cohorts. Compared with adults, there are significant differences in clinical presentation and treatment outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Paediatric Buruli ulcer in Australia

Walker

Friedman

O'Brien

et al. 2019

J Paediatrics Child Health

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“…In most patients, wound healing commences irrespective of the massive local leukocyte infiltration and stimulation, which can thus be regarded as a sign of the success of antimycobacterial treatment. In patients showing severe paradoxical reactions, the use of corticosteroids and/or adjunct surgical procedures has been proposed to prevent further tissue loss [50,51].…”

Section: Diagnosis In Reference Laboratories and At The Point Of Carementioning

confidence: 99%

The immunology of other mycobacteria: M. ulcerans, M. leprae

et al. 2020

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Mycobacterial pathogens can be categorized into three broad groups: Mycobacterium tuberculosis complex causing tuberculosis, M. leprae and M. lepromatosis causing leprosy, and atypical mycobacteria, or non-tuberculous mycobacteria (NTM), responsible for a wide range of diseases. Among the NTMs, M. ulcerans is responsible for the neglected tropical skin disease Buruli ulcer (BU). Most pathogenic mycobacteria, including M. leprae, evade effector mechanisms of the humoral immune system by hiding and replicating inside host cells and are furthermore excellent modulators of host immune responses. In contrast, M. ulcerans replicates predominantly extracellularly, sheltered from host immune responses through the cytotoxic and immunosuppressive effects of mycolactone, a macrolide produced by the bacteria. In the year 2018, 208,613 new cases of leprosy and 2713 new cases of BU were reported to WHO, figures which are notoriously skewed by vast underreporting of these diseases.

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Buruli ulcer – A neglected tropical disease in the Barwon region of Victoria, Australia: An emerging public health threat with local and national ramifications

Bartley

O’Brien

2023

Emerg Medicine Australasia

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Mycobacterium ulcerans (MU) is known to be endemic in heavily touristed coastal regions of Victoria and is the cause of Buruli ulcer (BU) disease. The incidence, severity and geographic spread of MU infection/BU disease is increasing, including metropolitan Victorian suburbs. While the specifics of disease transmission and effective prevention strategies remain uncertain, severe complications can be mitigated by health systems that provide vigilant population surveillance to underpin early recognition, early specialist involvement and definitive treatment for the individual. Current theories regarding disease transmission and 'best practice' (or best guess) prevention and mitigation measures are presented herein. Opportunities to improve the health system response to this emerging public health threat are identified. It is incumbent upon all healthcare providers, including ED clinicians, to contribute by familiarising themselves with the established and emerging areas of endemicity of MU infection and the array of BU clinical presentations.

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Mycobacterium ulcerans disease management in Australian patients: the re‐emergence of surgery as an important treatment modality

Abstract: With the demonstration of the effectiveness of antibiotic treatment,

Cited by 15 publications

References 28 publications

Paediatric Buruli ulcer in Australia

Paediatric Buruli ulcer in Australia

The immunology of other mycobacteria: M. ulcerans, M. leprae

Buruli ulcer – A neglected tropical disease in the Barwon region of Victoria, Australia: An emerging public health threat with local and national ramifications

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