All-Oral Antibiotic Treatment for Buruli Ulcer A Report of Four Patients 英文参考文献.docVIP

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All-Oral Antibiotic Treatment for Buruli Ulcer A Report of Four Patients 英文参考文献.doc

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All-Oral Antibiotic Treatment for Buruli Ulcer A Report of Four Patients 英文参考文献

Symposium All-OralAntibioticTreatmentforBuruliUlcer:AReportof FourPatients ClaireL.Gordon1,JohnA.Buntine2,3,JohnA.Hayman4,CarolineJ.Lavender5,JanetA.M.Fyfe5 ,Patrick Hosking6,MikeStarr7,PaulD.R.Johnson1,5* 1Department of Infectious Diseases, Austin Health, Melbourne, Australia, 2Department of Surgery, Box Hill Hospital, Melbourne, Australia, 3Department of Surgery, MonashUniversity,Melbourne,Australia,4DepartmentofAnatomyandDevelopmentalBiology,MonashUniversity,Melbourne,Australia,5WHOCollaboratingCentre for Mycobacterium ulcerans (Western Pacific Region) and Victorian Infectious Diseases Reference Laboratory, Melbourne, Australia, 6Department of Anatomical Pathology,BoxHillHospital,Melbourne,Australia,7DepartmentofInfectiousDiseases,RoyalChildren’sHospital,Melbourne,Australia TheCases resolving inflammation and no acid-fast bacilli (AFB) by Ziehl-Neelsen staining. Incase3,aZiehl-Neelsen stainedsection showed persistent AFB but culture was negative.Hehadreceivedareduceddose of rifampicin due to gastrointestinal and neurological side effects and underwent earlier excision than planned at 4weeks. Inflammation of surrounding skin and the size of the lesion reduced during antibiotic therapy in all four patients (Figures 1–4). PCR was not performed on surgical excision specimens (cases 1– 3). Excision and primary closure, rather thangrafting, wasachieved incase2and Discussion Buruli ulcer (BU) was treated primar- ily with wide surgical excision until recent studies confirmed the efficacy of oral rifampicin combined with intra- muscular streptomycin. Whether all- oral antibiotic regimens will be equally effective is unknown. This report de- scribes four patients with Mycobacterium ulcerans infection, all of whom received rifampicin-based oral antibiotic therapy followed by surgical resection (three patients) or oral antibiotics alone (one patient). Following oral antibiotics for between 4 and 8 weeks, viable M. ulcerans was not detectable by culture i