Heat Treatment of Mycobacterium Ulcerans Infections without Surgical Excision *

Meyers, Wayne M.; Shelly, Walter M.; Connor, Daniel H.

doi:10.4269/ajtmh.1974.23.924

Cited by 91 publications

(46 citation statements)

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“…The role of antimycobacterial drugs is being investigated under the auspices of the World Health Organization. Many different topical treatments have been tried (2,15), but the only topical treatment shown to increase the rate of healing in a double-blind controlled trial is acidified nitrite creams, which generate nitric oxide and other oxides of nitrogen (16a).…”

mentioning

confidence: 99%

In Vitro Killing ofMycobacterium ulceransby Acidified Nitrite

Phillips

Kuijper

Benjamin

et al. 2004

Antimicrob Agents Chemother

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mentioning

confidence: 99%

In Vitro Killing ofMycobacterium ulceransby Acidified Nitrite

Phillips

Kuijper

Benjamin

et al. 2004

Antimicrob Agents Chemother

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“…However, cure rates are generally low. [14][15][16][17][18][19] Understanding the pathogenesis of human M. ulcerans infections has been slowed by the lack of an animal model that develops features resembling human disease. Rats, mice, and guinea pigs are used as animal models for M. ulcerans infections, but each is limited in replicating the spectrum of features found in human disease.…”

mentioning

confidence: 99%

Transmission of Mycobacterium ulcerans to the nine-banded armadillo.

Walsh¹,

Meyers²,

Krieg³

et al. 1999

The American Journal of Tropical Medicine and Hygiene

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Abstract. Animal models for Mycobacterium ulcerans infections (Buruli ulcer) include guinea pigs, rats, and mice, but each has limitations in replicating the spectrum of human disease. Here, 19 adult nine-banded armadillos were inoculated intradermally with M. ulcerans. Injection sites were examined and skin samples obtained for histologic and microbiology studies. Necropsies were conducted to assess systemic involvement. In group 1 (n ϭ 4), 2 animals developed progressive skin ulcers with undermined borders at the injection sites within 6-10 weeks. Biopsies showed features similar to human disease including extensive necrosis in the deep dermis and subcutaneous fat, mixed cellular infiltrates, and acid-fast bacilli (AFB). In group 2 (n ϭ 15), 5 animals developed progressive skin ulcers, 3 had evanescent papulo-nodules, 3 died shortly after inoculation of unknown causes, and 4 showed no signs of infection. Lesion samples from 3 animals with progressive ulcers were culture positive for AFB. Our findings indicate that nine-banded armadillos are susceptible to M. ulcerans and may develop cutaneous lesions that closely mimic Buruli ulcer.In tropical countries, skin ulcers caused by infectious agents are common. Mycobacterium ulcerans, the causative organism of Buruli ulcer first isolated in Australia, is considered a public health threat, especially in Africa. [1][2][3][4][5][6][7][8][9][10] Recent observations suggest that environmental sources of M. ulcerans include swamps, with subsequent transmission by insects. 11 The clinical features of Buruli ulcer are variable. In uncomplicated disease, painless skin ulcers, typically on the extremities, develop without fever or malaise. 12,13 However, progressive lesions may result in large areas of ulceration, necrosis, and osteomyelitis. Many lesions tend to heal, but this may take years without medical intervention. Advanced disease requires surgical excision and skin grafts or amputation. Crippling contractures and lymphedema may accompany healing. Medical therapies include clofazimine, dapsone, rifampicin, phenytoin, cotrimoxazole, macrolide compounds, and heat. However, cure rates are generally low. [14][15][16][17][18][19] Understanding the pathogenesis of human M. ulcerans infections has been slowed by the lack of an animal model that develops features resembling human disease. Rats, mice, and guinea pigs are used as animal models for M. ulcerans infections, but each is limited in replicating the spectrum of features found in human disease. Rats and mice develop lesions after cutaneous inoculation with M. ulcerans, but lack the extensive ulceration characteristic of human disease. In the mouse footpad, the organisms multiply but necrosis without ulceration destroys the limb and causes death. 20,21 Guinea pigs develop inflammatory lesions at the inoculation sites that usually resolve without ulcer formation. 21,22 The nine-banded armadillo is highly susceptible to M. leprae and has been a useful animal model for leprosy. 23 Here, we report that armadillos are also s...

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“…Bacteriologic confirmation may be obtained using liquid media supplemented with enrichment substrates, but definitive therapy should not be delayed until such confirmation is available. Early surgical excision 25,26 and local heat 18,26 may be the best combination therapy for these unusual infections. The role of antimycobacterial drug therapy remains to be defined.…”

Section: Discussionmentioning

confidence: 99%

“…Treatment with clarithromycin and rifampin was continued for a total course of 18 months ( Figure 2). In week 44, local heat with a thermometer-controlled heating pad (40ЊC; 1 hr twice a day) was added to the treatment regimen 18 and continued for 6 months. At present, he remains well after 4 years of followup with no evidence of local recurrence.…”

Section: Case Reportmentioning

confidence: 99%

Mycobacterium ulcerans infection (Buruli ulcer): first reported case in a traveler.

Semret

Koromihis²,

MacLean³

et al. 1999

The American Journal of Tropical Medicine and Hygiene

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Abstract. A chronic, painless sore developed over a 2-month period on the left calf of a Canadian man traveling for 8 months in Africa. A presumptive diagnosis of a Mycobacterium spp. infection was made despite initially negative biopsy and culture results, after failure of several courses of anti-bacterial antibiotics. Mycobacterium ulcerans was eventually isolated and the lesion progressed despite treatment with multiple anti-mycobacterial agents. The lesion finally responded to wide and repeated excision, aggressive treatment with anti-mycobacterial antibiotics, and splitthickness skin grafting. The isolation and treatment of this unusual organism are discussed.In 1897, Sir Albert Cook described a range of unusual and chronic necrotizing skin ulcers in Africans.

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Heat Treatment of Mycobacterium Ulcerans Infections without Surgical Excision *

Cited by 91 publications

References 0 publications

In Vitro Killing ofMycobacterium ulceransby Acidified Nitrite

In Vitro Killing ofMycobacterium ulceransby Acidified Nitrite

Transmission of Mycobacterium ulcerans to the nine-banded armadillo.

Mycobacterium ulcerans infection (Buruli ulcer): first reported case in a traveler.

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