溃疡分支杆菌引发Buruli溃疡的诊断与治疗（附6例报告并文献复习）（英文）

目的 描述Buruli溃疡的病理、病原体的形态特征以及治疗特点，以提高对本病的认识。方法 复习有关文献，根据临床和病理分析6例下肢及上肢慢性溃疡病人，按照WHO诊断标准作出临床诊断，并皆经病理和PCR检测证实。溃疡采用切除加植皮术治疗。结果 5例单发溃疡中左下肢4例，右下肢1例。1例为多发溃疡，病变位于左右下肢及左食指。溃疡直径2．5—6．5cm，平均3，2cm。其特点是皮肤及皮下组织坏死，边缘呈潜行性，底部有黄色坏死物覆盖。溃疡周围皮肤水肿和色素沉着。显微镜下见到细胞外有散在或成团的抗酸杆菌和坏死脂肪细胞一“鬼影细胞”。抗结核药物和抗生素对本组Buruli溃疡无较，5例行手术切除溃疡加植皮术或清创术，除1例复发外，4例治疗效果良好。另1例行清创术换药后溃疡愈合。结论 Buruli溃疡可以在我国的亚热带地区发生，因此当遇到久经不愈的慢性皮肤溃疡时，要考虑患有Buruli溃疡的可能性。外科手术仍然是目前治疗Bundi溃疡的主要方法。

Mycobacterium ulcerans infection (Buruli ulcer) First report of six cases in China with literature review.

Objective To report the six Mycobacterium ulcerans infections (Buruli ulcer) in China which is the third most common mycobacterial infection in West Africa after tuberculosis and leprosy, with literterature review and to provide sciertific information for diagnosis and treal ment of the disease. Methods Six patients with chronic ulcers in lower or upper extremities were diagnosed clinically, and confirmed either by histopathologically, or by PCR or both, then managed by surgical approach of the six caoes. Results One case was male, one male and five were females, with an averaged age of 69 years (47 - 83 years) . The clinical manifestations of the patients were deep, indolent, chronic ulcer with undermined margin in their legs in five cases, and in the legs and left finger in one case. Left side outnumbered right one. The diameter of the ulcer was 2.5 -6.5 cm, averaged 3.2 cm. The microscopic findings in the lesion showed extra - cellular anti - fast bacilli and ghost cells. Anti - tuberculosis drugs and antibiotics have no effectiveness to the patients. Six cases had a satisfactory result except one whe had recurrent ulcer after surgical intervention. Conclusion Chronic unusual skin lesions. occurred in this country should consider Mycobacterium ulcerans infection Surgery remains the mainstay of potentially curative treatment.