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Mycobacterium ulcerans disease, Peru.

Guerra H, Palomino JC, Falconí E, Bravo F, Donaires N, Van Marck E, Portaels F - Emerging Infect. Dis. (2008)

Bottom Line: Diverse treatments (antituberculous drugs, World Health Organization [WHO] recommended antimicrobial drug treatment for BU, and for 3 patients, excision surgery) were successful.BU is endemic in Peru, although apparently infrequent.Education of populations and training of health workers are first needed to evaluate and understand the full extent of BU in Peru.

View Article: PubMed Central - PubMed

Affiliation: Universidad Peruana Cayetano Heredia, Lima, Perú.

ABSTRACT
Eight adult patients (ages 18-58, 5 women) with Buruli ulcer (BU) confirmed by at least 2 diagnostic methods were seen in a 10-year period. Attempts to culture Mycobacterium ulcerans failed. Five patients came from jungle areas, and 3 from the swampy northern coast of Peru. The patients had 1-5 lesions, most of which were on the lower extremities. One patient had 5 clustered gluteal lesions; another patient had 2 lesions on a finger. Three patients were lost to follow-up. All 5 remaining patients had moderate disease. Diverse treatments (antituberculous drugs, World Health Organization [WHO] recommended antimicrobial drug treatment for BU, and for 3 patients, excision surgery) were successful. Only 1 patient (patient 7) received the specific drug treatment recommended by WHO. BU is endemic in Peru, although apparently infrequent. Education of populations and training of health workers are first needed to evaluate and understand the full extent of BU in Peru.

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Patient 8. A) Nonulcerative edematous lesion on the right middle finger as first seen; B) ulcerated lesions on the right middle finger ≈4 weeks later; C) extensive debridement, 5.5 weeks after first seen; D) cured lesion 5 months after first seen, 1 month after autologous skin graft.
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Figure 2: Patient 8. A) Nonulcerative edematous lesion on the right middle finger as first seen; B) ulcerated lesions on the right middle finger ≈4 weeks later; C) extensive debridement, 5.5 weeks after first seen; D) cured lesion 5 months after first seen, 1 month after autologous skin graft.

Mentions: Patient 6 was treated by excision surgery and later received antituberculosis treatment (regimen 1) for 6 months. Patient 7 was pregnant when first seen. After tissue specimens were taken and BU was diagnosed, she was treated conservatively with topical disinfectants until delivery. She then received the WHO-recommended rifampin and streptomycin treatment (12) for 31 days and had excision surgery of the largest lesions. Later, all lesions were excised. Patient 8 had lesions on the right middle finger (Figure 2, panel A) that ulcerated after treatment for 1 month with ciprofloxacin, clindamycin, and dexametasone (Figure 2, panel B). Diagnosis was made on the basis of material obtained at the first extensive debridement (Figure 2, panel C). He received 5 weeks of regimen 1 treatment for tuberculosis, to which streptomycin was added for the last 3 weeks before surgical debridement and autologous skin graft. Antituberculous regimen 1 was continued for 2 more weeks. Figure 2, panel D shows the lesion 1 month after surgery. The patient then received 4 months of treatment with minocycline, ciprofloxacin, and trimethoprim-sulfamethoxazole and undertook rehabilitation including exercises. He recovered very good use of his right hand.


Mycobacterium ulcerans disease, Peru.

Guerra H, Palomino JC, Falconí E, Bravo F, Donaires N, Van Marck E, Portaels F - Emerging Infect. Dis. (2008)

Patient 8. A) Nonulcerative edematous lesion on the right middle finger as first seen; B) ulcerated lesions on the right middle finger ≈4 weeks later; C) extensive debridement, 5.5 weeks after first seen; D) cured lesion 5 months after first seen, 1 month after autologous skin graft.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2570831&req=5

Figure 2: Patient 8. A) Nonulcerative edematous lesion on the right middle finger as first seen; B) ulcerated lesions on the right middle finger ≈4 weeks later; C) extensive debridement, 5.5 weeks after first seen; D) cured lesion 5 months after first seen, 1 month after autologous skin graft.
Mentions: Patient 6 was treated by excision surgery and later received antituberculosis treatment (regimen 1) for 6 months. Patient 7 was pregnant when first seen. After tissue specimens were taken and BU was diagnosed, she was treated conservatively with topical disinfectants until delivery. She then received the WHO-recommended rifampin and streptomycin treatment (12) for 31 days and had excision surgery of the largest lesions. Later, all lesions were excised. Patient 8 had lesions on the right middle finger (Figure 2, panel A) that ulcerated after treatment for 1 month with ciprofloxacin, clindamycin, and dexametasone (Figure 2, panel B). Diagnosis was made on the basis of material obtained at the first extensive debridement (Figure 2, panel C). He received 5 weeks of regimen 1 treatment for tuberculosis, to which streptomycin was added for the last 3 weeks before surgical debridement and autologous skin graft. Antituberculous regimen 1 was continued for 2 more weeks. Figure 2, panel D shows the lesion 1 month after surgery. The patient then received 4 months of treatment with minocycline, ciprofloxacin, and trimethoprim-sulfamethoxazole and undertook rehabilitation including exercises. He recovered very good use of his right hand.

Bottom Line: Diverse treatments (antituberculous drugs, World Health Organization [WHO] recommended antimicrobial drug treatment for BU, and for 3 patients, excision surgery) were successful.BU is endemic in Peru, although apparently infrequent.Education of populations and training of health workers are first needed to evaluate and understand the full extent of BU in Peru.

View Article: PubMed Central - PubMed

Affiliation: Universidad Peruana Cayetano Heredia, Lima, Perú.

ABSTRACT
Eight adult patients (ages 18-58, 5 women) with Buruli ulcer (BU) confirmed by at least 2 diagnostic methods were seen in a 10-year period. Attempts to culture Mycobacterium ulcerans failed. Five patients came from jungle areas, and 3 from the swampy northern coast of Peru. The patients had 1-5 lesions, most of which were on the lower extremities. One patient had 5 clustered gluteal lesions; another patient had 2 lesions on a finger. Three patients were lost to follow-up. All 5 remaining patients had moderate disease. Diverse treatments (antituberculous drugs, World Health Organization [WHO] recommended antimicrobial drug treatment for BU, and for 3 patients, excision surgery) were successful. Only 1 patient (patient 7) received the specific drug treatment recommended by WHO. BU is endemic in Peru, although apparently infrequent. Education of populations and training of health workers are first needed to evaluate and understand the full extent of BU in Peru.

Show MeSH
Related in: MedlinePlus