Buruli Ulcer (M. ulcerans Infection) New Insights, New Hope for Disease Control 英文参考文献.docVIP

Open access, freely available online Neglected Diseases Buruli Ulcer (M. ulcerans Infection): New Insights, New Hope for Disease Control Paul D. R. Johnson*, Timothy Stinear, Pamela L. C. Small, Gerd Plushke, Richard W. Merritt, Francoise Portaels, Kris Huygen, John A. Hayman, Kingsley Asiedu B uruli ulcer is a disease of skin and soft tissue with the potential to leave sufferers scarred and disabled. It is caused by an environmental pathogen, Mycobacterium ulcerans, that produces a destructive toxin. The exact mode of transmission is unclear. The main burden of disease falls on children living in sub-Saharan Africa, but healthy people of all ages, races, and socioeconomic classes are susceptible. In Australia, the disease remains uncommon, but there have been increases in both incidence and the number of endemic areas in the last 15 years [13,14]. Causative Organism and Pathology Mycobacterium ulcerans is a slow-growing environmental mycobacterium that can be cultured from human lesions on mycobacterial medium at 30–32 °C [15]. Histological specimens typically show large clumps of extracellular acid- fast organisms surrounded by areas of necrosis and a poor or absent in?ammatory response [16]. Subcutaneous fat is particularly affected, but underlying bone may also become involved in advanced cases [15]. The pathogenesis and histological appearance is explained by a recently identi?ed diffusible lipid toxin, mycolactone [17]. Later in the natural history of the disease, the immunosuppressive effect of the toxin is somehow overcome by the host, immunity develops, and healing commences. History and Epidemiology M. ulcerans is the third most common mycobacterial pathogen of humans, after M. tuberculosis and M. leprae (which cause tuberculosis and leprosy, respectively). The de?nitive description of M. ulcerans was published in 1948, when MacCallum and others in Australia reported six cases of an unusual skin infection caused by a mycobacterium that could only be