Imported Tropical Infectious Ulcers in Travelers

Abstract

Skin ulcers are a commonly encountered problem at departments of tropical dermatology in the Western world. Furthermore, the general dermatologist is likely to be consulted more often for imported chronic skin ulcers because of the ever-increasing travel to and from tropical countries. The most common cause of chronic ulceration throughout the world is probably pyoderma. However, in some parts of the world, cutaneous leishmaniasis is one of the most prevalent causes. Mycobacterium ulcerans is an important cause of chronic ulcers in West Africa. Bacterial infections include pyoderma, mycobacterial infections, diphtheria, and anthrax. Pyoderma is caused by Staphylococcus aureus and/or beta-hemolytic streptococci group A. This condition is a common cause of ulcerative skin lesions in tropical countries and is often encountered as a secondary infection in travelers. The diagnosis is often made on clinical grounds. Antibacterial treatment for pyoderma should preferably be based on culture outcome. Floxacillin is generally active against S. aureus and beta-hemolytic streptococci. Infection with Mycobacterium ulcerans, M. marinum, and M. tuberculosis may cause ulcers. Buruli ulcers, which are caused by M. ulcerans, are endemic in foci in West Africa and have been reported as an imported disease in the Western world. Treatment is generally surgical, although a combination of rifampin (rifampicin) and streptomycin may be effective in the early stage. M. marinum causes occasional ulcerating lesions in humans. Treatment regimens consist of combinations containing clarithromycin, rifampin, or ethambutol. Cutaneous tuberculosis is rare in travelers but may be encountered in immigrants from developing countries. Treatment is with multiple drug regimens consisting of isoniazid, ethambutol, pyrazinamide, and rifampin. Cutaneous diphtheria is still endemic in many tropical countries. Cutaneous diphtheria ulcers are nonspecific and erythromycin and penicillin are both effective antibacterials. Antitoxin should be administered intramuscularly in suspected cases. Anthrax is caused by spore-forming Bacillus anthracis. This infection is still endemic in many tropical countries. Eschar formation, which sloughs and leaves behind a shallow ulcer at the site of inoculation, characterizes cutaneous anthrax. Penicillin and doxycycline are effective antibacterials. Cutaneous leishmaniasis is caused by different species belonging to the genus Leishmania. The disorder is one of the ten most frequent causes of skin diseases in travelers returning from (sub)tropical countries. The clinical picture is diverse, ranging from a painless papule or nodule to an ulcer with or without a scab. Treatment depends on the clinical manifestations and the species involved.Sporotrichosis, chromo(blasto)mycosis, and mycetoma are the most common mycoses that may be accompanied by ulceration. Infections are restricted to certain regions and often result from direct penetration of the fungus into the skin. Anti-mycotic treatment depends on the microorganism involve...

Corynebacterium diphtheriae and the Returned Tropical Traveler

“…19 Infected lesions may persist for weeks to months. 22 While immunization is generally associated with reduced severity of disease and reduced colonization with toxigenic C. diphtheriae, 17,23 it may not prevent cutaneous infection. 5 The finding of frequent coinfection with S. pyogenes, S. aureus, and Arcanobacterium haemolyticum was consistent with previous reports in the literature.…”

Kutane Diphtherie nach Bagatellverletzung in Sri Lanka

“…B. Polyneuritis, Myokarditis) auftreten [1,4]. Andere Autoren sprechen sich für eine rasche Gabe schon bei Verdacht auf toxinbildende Stämme aus [6,7]. In unserer Literaturrecherche konnten wir keinen Fall einer rein kutanen Diphtherie mit systemischer Toxinwirkung finden, jedoch kann die kutane Diphtherie als Reservoir für Infektionen des Respirationstraktes dienen, die häufig mit systemischer Toxinwirkung assoziiert sind [1,2].…”

“…Obwohl die Meldepflicht nach dem Infektionsschutzgesetz nur toxinbildende Stämme einschließt, sollte eine Meldung dennoch frühzei-tig erfolgen, um entsprechende Maßnah-men zeitnah einleiten zu können. Meist tritt die kutane Diphtherie in Industrieländern bei Patienten mit Reiseanamnese auf [1,3,6,7]. Durch den weltweiten Reiseverkehr kommt es in Deutschland immer wieder zu sporadischen Erkrankungen [4][5][6].…”

Úlcera de Buruli

“…18 A few cases reported in North America and Europe were associated with international travelers. 19 Some cases have been reported in China, but the extension of the disease is unknown. In the Americas, the disease appears to be more common in the French Guiana …”

“…Infection by Mycobacterium ulcerans is among the main ulcers diagnosed in travelers to West Africa, Central America and other Western countries, together with leishmaniasis, diphtheria, and profound mycoses. 19,21 Despite advanced knowledge about the clinical symptoms of BU in endemic countries, in other areas this diagnosis may be overlooked. Therefore, physicians should be aware of its symptoms, since early diagnosis and proper treatment help prevent functional disabilities resulting from the infection.…”