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Phase change material for thermotherapy of Buruli ulcer: a prospective observational single centre proof-of-principle trial.

Junghanss T, Um Boock A, Vogel M, Schuette D, Weinlaeder H, Pluschke G - PLoS Negl Trop Dis (2009)

Bottom Line: Patients with large defects had skin grafting after successful heat treatment.Heat treatment was not associated with marked increases in local inflammation or the development of ectopic lymphoid tissue.Our reusable PCM-based heat application device appears perfectly suited to treat BU in endemic countries with limited resources and infrastructure.

View Article: PubMed Central - PubMed

Affiliation: Section Clinical Tropical Medicine, University Hospital, Heidelberg, Germany. thomas.junghanss@urz.uni-heidelberg.de

ABSTRACT

Background: Buruli ulcer (BU) is an infection of the subcutaneous tissue leading to chronic necrotizing skin ulcers. The causative pathogen, Mycobacterium ulcerans, grows best at 30 degrees C-33 degrees C and not above 37 degrees C. We explored the safety, tolerability and efficacy of phase change material (PCM), a novel heat application system for thermotherapy of BU.

Methodology/principal findings: In a prospective observational single centre proof-of-principle trial in Ayos/Cameroon, six laboratory reconfirmed patients with ulcerative Buruli lesions received 28-31 (ulcers < or = 2 cm) or 50-55 (ulcers > 2 cm) days of thermotherapy with the PCM sodium acetate trihydrate as heat application system. This PCM is widely used in commercial pocket heat pads, it is easy to apply, rechargeable in hot water, non-toxic and non-hazardous to the environment. All patients enrolled in the trial completed treatment. Being completely mobile during the well-tolerated heat application, acceptability of the PCM bandages was very high. In patients with smaller ulcers, wounds healed completely without further intervention. Patients with large defects had skin grafting after successful heat treatment. Heat treatment was not associated with marked increases in local inflammation or the development of ectopic lymphoid tissue. One and a half years after completion of treatment, all patients are relapse-free.

Conclusions/significance: Our reusable PCM-based heat application device appears perfectly suited to treat BU in endemic countries with limited resources and infrastructure.

Trial registration: Controlled-Trials.com ISRCTN88392614.

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Related in: MedlinePlus

Healing of Buruli ulcers under PCM-based heat treatment and long term results.(A) Patient 2, (B) patient 5: Progress of healing during heat treatment. Note in particular early onset of epithelialisation. Far right follow-up 12 months after completion of heat treatment. Patient 5 (B) after skin grafting.
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pntd-0000380-g003: Healing of Buruli ulcers under PCM-based heat treatment and long term results.(A) Patient 2, (B) patient 5: Progress of healing during heat treatment. Note in particular early onset of epithelialisation. Far right follow-up 12 months after completion of heat treatment. Patient 5 (B) after skin grafting.

Mentions: All patients enrolled into the trial completed treatment. In all patients temperatures at the lesion and over a wide margin of healthy looking skin were maintained above ≥39°C for between 8.4 and 13.2 hours and ≥40°C for between 4.4 and 9.3 hours per day (Fig. 2). Undermined margins collapsed between day 1 and day 3. Epithelialization started in all patients between 4 and 11 days after the start and was almost completed in patients 1, 2, and 3 at the end of heat treatment (Fig. 2 and Fig. 3). In particular in patients with oedematous lesions (patients 4, 5) white discharge from ulcers was observed during initial treatment for various lengths of time. The two patients with large defects (patients 5 and 6) had skin grafting after completion of heat treatment (Fig. 3B).


Phase change material for thermotherapy of Buruli ulcer: a prospective observational single centre proof-of-principle trial.

Junghanss T, Um Boock A, Vogel M, Schuette D, Weinlaeder H, Pluschke G - PLoS Negl Trop Dis (2009)

Healing of Buruli ulcers under PCM-based heat treatment and long term results.(A) Patient 2, (B) patient 5: Progress of healing during heat treatment. Note in particular early onset of epithelialisation. Far right follow-up 12 months after completion of heat treatment. Patient 5 (B) after skin grafting.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2637542&req=5

pntd-0000380-g003: Healing of Buruli ulcers under PCM-based heat treatment and long term results.(A) Patient 2, (B) patient 5: Progress of healing during heat treatment. Note in particular early onset of epithelialisation. Far right follow-up 12 months after completion of heat treatment. Patient 5 (B) after skin grafting.
Mentions: All patients enrolled into the trial completed treatment. In all patients temperatures at the lesion and over a wide margin of healthy looking skin were maintained above ≥39°C for between 8.4 and 13.2 hours and ≥40°C for between 4.4 and 9.3 hours per day (Fig. 2). Undermined margins collapsed between day 1 and day 3. Epithelialization started in all patients between 4 and 11 days after the start and was almost completed in patients 1, 2, and 3 at the end of heat treatment (Fig. 2 and Fig. 3). In particular in patients with oedematous lesions (patients 4, 5) white discharge from ulcers was observed during initial treatment for various lengths of time. The two patients with large defects (patients 5 and 6) had skin grafting after completion of heat treatment (Fig. 3B).

Bottom Line: Patients with large defects had skin grafting after successful heat treatment.Heat treatment was not associated with marked increases in local inflammation or the development of ectopic lymphoid tissue.Our reusable PCM-based heat application device appears perfectly suited to treat BU in endemic countries with limited resources and infrastructure.

View Article: PubMed Central - PubMed

Affiliation: Section Clinical Tropical Medicine, University Hospital, Heidelberg, Germany. thomas.junghanss@urz.uni-heidelberg.de

ABSTRACT

Background: Buruli ulcer (BU) is an infection of the subcutaneous tissue leading to chronic necrotizing skin ulcers. The causative pathogen, Mycobacterium ulcerans, grows best at 30 degrees C-33 degrees C and not above 37 degrees C. We explored the safety, tolerability and efficacy of phase change material (PCM), a novel heat application system for thermotherapy of BU.

Methodology/principal findings: In a prospective observational single centre proof-of-principle trial in Ayos/Cameroon, six laboratory reconfirmed patients with ulcerative Buruli lesions received 28-31 (ulcers < or = 2 cm) or 50-55 (ulcers > 2 cm) days of thermotherapy with the PCM sodium acetate trihydrate as heat application system. This PCM is widely used in commercial pocket heat pads, it is easy to apply, rechargeable in hot water, non-toxic and non-hazardous to the environment. All patients enrolled in the trial completed treatment. Being completely mobile during the well-tolerated heat application, acceptability of the PCM bandages was very high. In patients with smaller ulcers, wounds healed completely without further intervention. Patients with large defects had skin grafting after successful heat treatment. Heat treatment was not associated with marked increases in local inflammation or the development of ectopic lymphoid tissue. One and a half years after completion of treatment, all patients are relapse-free.

Conclusions/significance: Our reusable PCM-based heat application device appears perfectly suited to treat BU in endemic countries with limited resources and infrastructure.

Trial registration: Controlled-Trials.com ISRCTN88392614.

Show MeSH
Related in: MedlinePlus