Mapping biopsy for Buruli ulcer self‐medicated with occlusive dressing

Abstract

Buruli ulcer is the third most common mycobacterial infection next to tuberculosis and leprosy caused by Mycobacterium ulcerans. Although it affects the skin, subcutaneous tissues, muscles and sometimes bones, there is no reliable evidence to determine the extent of debridement. We present here a case of Buruli ulcer treated successfully with a preoperative mapping biopsy procedure, which had been self-medicated with occlusive dressing. Because Buruli ulcer is accompanied by subtle pain, patients and clinicians tend to initially treat the ulcer with occlusive dressing therapy, which leads to the misdiagnosis of Buruli ulcer as a common bacterial infection only judging from bacterial culture of the surface of the ulcer. We propose the efficacy of mapping biopsy for treating Buruli ulcer.

Histological and quantitative polymerase chain reaction-based analysis of Buruli ulcer using mapping biopsy method

“…Our mapping biopsy, in other words, intends to find the location of the infiltration belt and to resect the necrotic core. Therefore, we think that our method corresponds to the findings of another previous study [3,4,9].…”

“…In our previous studies [ 3 , 4 , 9 ], we have tried to examine the relationship between mycobacteria and histological changes in Buruli ulcer lesions based on only whether IS 2404 amplification was detected by conventional PCR. In the present study, we performed quantitative PCR for IS 2404 using DNA extracted from skin samples taken in our mapping biopsies.…”

“…This histological type is often accompanied with necrosis and granuloma formation. As for the histological examination to avoid unnecessary radical surgical resection, we have proposed performing the mapping biopsy procedure before debridement, especially for cases with affected exposed area and joint sites where performing extensive debridement is difficult [ 3 , 4 , 9 ]. As pointed out in our previous study [ 9 ], the center of the lesions showed massive necrosis, and adjacent to it, dense inflammatory cell infiltration was observed.…”

“…The diagnosis of Buruli ulcer was based on the compatible cutaneous manifestations, compatible histological findings, and positive IS 2404 amplification by PCR using DNA extracted from their skin tissue. Details of these cases were reported previously [ 3 , 4 , 9 ]. The clinical appearances of the cases are shown in Fig 1A to 1C .…”

“…We have proposed a mapping biopsy procedure to perform adequate debridement for severe cases [3,4,9]. In these previous reports, multiple punch biopsies were performed from various sites around the Buruli ulcer lesions for mapping biopsy.…”