Under Treated Necrotizing Fasciitis Masquerading as Ulcerated Edematous Mycobacterium ulcerans Infection (Buruli Ulcer)

Phanzu, Mavinga D.; Bafende, Aombe E.; Imposo, Bofunga B. D.; Meyers, Wayne M.; Portaels, Françoise

doi:10.4269/ajtmh.2010.09-0256

Cited by 7 publications

(3 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We observed that 86.8% of these cases wounds were completely healed and 13.2% were partially healed without any antimycobacterial treatment [ 27 ]. Similarly, there have been reports of lesions clinically diagnosed as BU but were later confirmed as tropical phagedenic ulcer, deep fungal infection, cellulitis and diabetic ulcer [ 15 – 17 , 28 ]. It has previously been thought that diagnosis of ulcerative lesions is very straightforward due to readily recognized indolent, undermined edges lesions.…”

Section: Discussionmentioning

confidence: 94%

“…The introduction of antimycobacterial therapy made laboratory confirmation of presumptive cases very critical to avoid misdiagnosis and unnecessary antibiotics administration, albeit several studies have previously reported cases that were treated on clinical grounds only but later found not to be BU but other conditions [ 15 – 17 ]. Nevertheless, the infrastructure and technical expertise for the gold standard method, which is polymerase chain reaction (PCR) detection of the insertion sequence IS 2404 , is nonexistent within the Ghana Health Service (GHS) facilities.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Laboratory confirmation of Buruli ulcer cases in Ghana, 2008-2016

et al. 2018

View full text Add to dashboard Cite

BackgroundBuruli ulcer (BU), a necrotizing skin infection caused by Mycobacterium ulcerans is the third most important mycobacterial disease globally after tuberculosis and leprosy in immune competent individuals. This study reports on the retrospective analyses of microbiologically confirmed Buruli ulcer (BU) cases in seventy-five health facilities in Ghana.Method/Principal findingsPathological samples were collected from BU lesions and transported either through courier services or by car directly to the laboratory. Samples were processed and analysed by IS2404 PCR, culture and Ziehl-Neelsen staining for detection of acid-fast bacilli. From 2008 to 2016, we analysed by PCR, 2,287 samples of 2,203 cases from seventy-five health facilities in seven regions of Ghana (Ashanti, Brong Ahafo, Central, Eastern, Greater Accra, Northern and Volta). The mean annual positivity rate was 46.2% and ranged between 14.6% and 76.2%. The yearly positivity rates from 2008 to 2016 were 52.3%, 76.2%, 56.7%, 53.8%, 41.2%, 41.5%, 22.9%, 28.5% and 14.6% respectively. Of the 1,020 confirmed cases, the ratio of female to male was 518 and 502 respectively. Patients who were 15 years of age and below accounted for 39.8% of all cases. The median age was 20 years (IQR = 10–43). Ulcerative lesions were 69.2%, nodule (9.6%), plaque (2.9%), oedema (2.5%), osteomyelitis (1.1%), ulcer/oedema (9.5%) and ulcer/plaque (5.2%). Lesions frequently occurred on the lower limbs (57%) followed by the upper limbs (38%), the neck and head (3%) and the least found on the abdomen (2%).Conclusions/SignificanceOur findings show a decline in microbiological confirmed rates over the years and therefore call for intensive education on case recognition to prevent over-diagnosis as BU cases decline.

show abstract

Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Laboratory confirmation of Buruli ulcer cases in Ghana, 2008-2016

et al. 2018

View full text Add to dashboard Cite

show abstract

“…This may account for certain non-BU cases included in this study. In endemic regions, depending on the clinical stage of the disease, BU may be confused with many other conditions such as nodular onchocerciasis, cyst, lipoma, lymphadenitis, phagedenic tropical ulcer, pyomyositis, necrotizing fasciitis [20] , [21] , to name a few. Our study showed that 72 out of the 241 (30%) patients who were tested, were confirmed in the laboratory.…”

Section: Discussionmentioning

confidence: 99%

Burden of Mycobacterium ulcerans Disease (Buruli Ulcer) and the Underreporting Ratio in the Territory of Songololo, Democratic Republic of Congo

et al. 2013

Self Cite

View full text Add to dashboard Cite

BackgroundCutaneous infection by Mycobacterium ulcerans, also known as Buruli ulcer (BU), represents the third most common mycobacterial disease in the world after tuberculosis and leprosy. Data on the burden of BU disease in the Democratic Republic of Congo are scanty. This study aimed to estimate the prevalence rate and the distribution of BU in the Songololo Territory, and to assess the coverage of the existing hospital-based reporting system.MethodsWe conducted a cross-sectional survey (July–August 2008) using the door-to-door method simultaneously in the two rural health zones (RHZ) of the Songololo Territory (RHZ of Kimpese and Nsona-Mpangu), each containing twenty health areas. Cases were defined clinically as active BU and inactive BU in accordance with WHO-case definitions.ResultsWe detected 775 BU patients (259 active and 516 inactive) in a total population of 237,418 inhabitants. The overall prevalence of BU in Songololo Territory was 3.3/1000 inhabitants, varying from 0 to 27.5/1000 between health areas. Of the 259 patients with active BU, 18 (7%) had been reported in the hospital-based reporting system at Kimpese in the 6–8 months prior to the survey.ConclusionThe survey demonstrated a huge variation of prevalence between health areas in Songololo Territory and gross underreporting of BU cases in the hospital-based reporting system. Data obtained may contribute to better targeted and improved BU control interventions, and serve as a baseline for future assessments of the control program.

show abstract