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Risk factors for recurrent Mycobacterium ulcerans disease after exclusive surgical treatment in an Australian cohort
Author(s) -
O'Brien Daniel P,
Walton Aaron,
Hughes Andrew J,
Friedman N Deborah,
McDonald Anthony,
Callan Peter,
Rhadon Richard,
Holten Ian,
Athan Eugene
Publication year - 2013
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/mja12.11708
Subject(s) - mycobacterium ulcerans , cohort , medicine , disease , buruli ulcer , surgery
Objective: To describe risk factors for recurrence after exclusive surgical treatment of Mycobacterium ulcerans infection. Design, setting and participants: Prospective observational cohort study of all M. ulcerans cases managed with surgery alone at Barwon Health, a tertiary referral hospital, from 1 January 1998 to 31 December 2011. A random‐effects Poisson regression model was used to assess rates and associations of treatment failure. Main outcome measures: Rates of treatment failure and rate ratios (RRs) for factors associated with treatment failure. Results: Of 192 patients with M. ulcerans infection, 50 (26%) had exclusive surgical treatment. Median age was 65.0 years (interquartile range [IQR], 45.5–77.7 years), and median duration of symptoms was 46 days (IQR, 26–90 days). There were 20 recurrences in 16 patients. For first lesions, the recurrence incidence rate was 41.8 (95% CI, 25.6–68.2) per 100 person‐years, and median time to recurrence was 50 days (IQR, 30–171 days). Recurrence occurred ≤ 3 cm from the original lesion in 13 cases, and > 3 cm in nine. On univariable analysis, age ≥ 60 years (RR 13.84; 95% CI, 2.21–86.68; P < 0.01), distal lesions (RR, 20.43; 95% CI, 1.97–212.22; P < 0.01), positive histological margins (RR, 21.02; 95% CI, 5.51–80.26; P < 0.001), immunosuppression (RR, 17.97; 95% CI, 4.17–77.47; P < 0.01) and duration of symptoms > 75 days (RR, 10.13; 95% CI, 1.76–58.23; P = 0.02) were associated with treatment failure. On multivariable analysis, positive margins (RR, 7.72; 95% CI, 2.71–22.01; P < 0.001) and immunosuppression (RR, 6.45; 95% CI, 2.42–17.20; P = 0.01) remained associated with treatment failure. Conclusions: Recurrence rates after exclusive surgical treatment of M. ulcerans disease in an Australian cohort are high, with increased rates associated with immunosuppression or positive histological margins.