Outcome of Patients with Buruli Ulcer after Surgical Treatment with or without Antimycobacterial Treatment in Ghana

Abstract

This study assesses the frequency of recurrences and treatment outcome after surgery of buruli ulcer disease (BUD) with or without concomitant antimycobacterial treatment. Of 129 laboratory-confirmed BUD patients who underwent surgery in two treatment centers in Ghana, 79 (61%) were retrieved for follow-up 4-29 months after the initial treatment. Among 7 (9%) recurrent cases no significant association was found between recurrences and clinical or treatment specific factors including antimycobacterial treatment. In 21 (27%) patients, a reduced range of motion (ROM) of one or more joints was detected. Lesions other than nodules, joint involvement, and skin grafting were identified as independent risk factors. Functional limitations hampering daily activities were perceived by 22% of the patients. Compared with other studies the recurrence rate was relatively low, functional limitations were, however, frequent. This emphasizes the need for improvement of pre- and post-treatment wound care as well as rehabilitation programs.

Nontuberculous Mycobacteria

“…Early diagnosis and treatment are the only ways to minimize morbidity. 60,61 The current recommended antibiotic therapy per WHO guidelines is an 8-week course of rifampin and streptomycin. Surgical intervention should be reserved only for lesions that continue to enlarge despite 4 weeks of antibiotic therapy, for debridement of superimposed bacterial infection, or for skin grafting to accelerate healing of large ulcers.…”

Buruli ulcer: wound care and rehabilitation

“…72,115 Poor implementation of such programs results in patients developing physical disabilities such as scarring, contractures, deformities, and sometimes requiring amputation 116 or are otherwise left with functional limitations. 106,107,110 The WHO advocates for increased public education through outreach programs and early treatment for improvement in disease outcome. …”

“…Reduced range of movement of one or more joints hampering daily activities affected 27% of patients in one study. 110 A BU functional limitation scoring system has been developed to assess the nature and severity of limitation, 111 which is helpful in clinical trials of treatment. 112 The BU functional limitation scoring system comprises a list of daily activities that were investigated in patients with BU in Benin and Ghana following treatment.…”

A Genotypic Approach for Detection, Identification, and Characterization of Drug Resistance in Mycobacterium ulcerans in Clinical Samples and Isolates from Ghana

“…However, non-standardized regimens of RMP and/or SM were also used as concomitant treatment before or after surgical interventions before 2006. [3][4][5] Although effective and in many aspects advantageous over surgery, introduction of antimycobacterial treatment poses new challenges for the management of BUD. 1 As is well-known from tuberculosis and leprosy, antimycobacterial treatment is prone to the development of drug resistance.…”