Volume 200 - Issue 2
Risk factors for recurrent Mycobacterium ulcerans disease after exclusive surgical treatment in an Australian cohort
Authors: Daniel P O’Brien, Anthony McDonald and Peter Callan
Med J Aust 2014; 200 (2): 86. || doi: 10.5694/mja13.10963
Published online: 3 February 2014
Published online: 3 February 2014
In reply: We thank Steffen for reporting her and her colleagues’ experience with surgical management of Mycobacterium ulcerans disease in the Daintree region of far north Queensland. We note she reports lower recurrence rates after surgical treatment alone than in our study from Victoria’s Bellarine Peninsula (8%-11% v 32%).1,2
As older age may increase recurrence risk, this difference in rates may be influenced by the higher ...
In reply: We thank Steffen for reporting her and her colleagues’ experience with surgical management of Mycobacterium ulcerans disease in the Daintree region of far north Queensland. We note she reports lower recurrence rates after surgical treatment alone than in our study from Victoria’s Bellarine Peninsula (8%–11% v 32%).1,2
As older age may increase recurrence risk, this difference in rates may be influenced by the higher median patient age in our cohort (65 v 42 years).1,2 Other factors that may increase recurrence risk, such as positive histological margins, patient immunosuppression, proximal location of lesions and the duration of symptoms before diagnosis, were not detailed in the experiences of Steffen and colleagues.2 Our practice aims to minimise morbidity through minimally invasive surgery,3 potentially resulting in higher rates of positive histological margins.
We agree that surgery alone remains an important option in the treatment of M. ulcerans disease. Additionally, assessment of factors that may increase recurrence risk with surgery alone can be useful in determining the potential benefits of adjunctive antibiotics.
Competing interests
No relevant disclosures.
References
- O’Brien DP, Walton A, Hughes AJ, et al. Risk factors for recurrent Mycobacterium ulcerans disease after exclusive surgical treatment in an Australian cohort. Med J Aust 2013; 198: 436-439. 0_CHDBEAGA
- Steffen CM, Smith M, McBride WJ. Mycobacterium ulcerans infection in North Queensland: the “Daintree ulcer”. ANZ J Surg 2010; 80: 732-736. 0_i1142871
- Simpson C, O’Brien DP, McDonald A, Callan P. Mycobacterium ulcerans infection: evolution in clinical management. ANZ J Surg 2013; 83: 523-526. 0_CBBFEJGF