RESUMO
Mycobacterium ulcerans [MU] produces mycolactone toxin when infected with a plasmid. Toxin is cytotoxic and immunosuppressive, causing extensive destruction of tissues, leading to large ulcers on exposed parts of the body. Spontaneous healing by secondary intention leads to contractures, subluxation of joints, disuse atrophy, distal lymphedema and other complications. The disease is endemic in some communities within the middle belt of Ghana. To document the clinical and epidemiological features of MU disease in the middle belt of Ghana and the outcome of treatment. Patients with lesions suspected to MU disease were screened by community workers. Lesions were confirmed by any of the following: direct smear examination, culture, polymerase chain reaction [PCR], or histopathology. Patients were treated with rifampicin [10 mg/kg orally] and streptomycin [15 mg/kg IM] combination for eight weeks. Patients selected for surgical treatment included cases where medical treatment had failed, cases where medical treatment is contraindicated, cases presenting late with complications and recurrent cases. 258 patients were seen in the Ahafo Ano, Amansie Central, Amansie West, Asunafo, Asutifi, and Upper Denkyira districts of Ghana between 2005 and 2012. Their ages ranged from 1 year 3 months to 98 years, with a mean age of 29.8 [SD 20.4]. The clinical forms of MU disease seen were: papule [0.5%], nodule [1.5%], chronic osteomyelitis [1.5%], contracture [1.5%], edematous lesion [3%], and ulcer [92%]. Uncommon complications include subluxation of knee joint, salivary gland fistula and Marjolin's ulcer. The lesions were distributed as follows: head and neck [6.8%], upper limb [20.3%], trunk [1.7%], and lower limb [71.2%]. MU disease in the middle belt of Ghana can be controlled by early case detection and adequate curative treatment
RESUMO
Infection with Mycobacterium ulcerans [MU] causes extensive destruction of tissues with the formation of large ulcers on exposed parts of the body. Healing leads to extensive scarring and other complications which may impair function. To document the complications of MU disease and the reconstructive surgery performed to correct them. Prospective from January 2010 to December 2012. Ahafo Ano, Amansie West, Asunafo, and Upper Denkyira districts of Ghana. Patients with unhealed lesions after completing 8 weeks of rifampicin and streptomycin treatment, and patients with complications of MU disease were selected and prepared for surgical treatment. 61 patients were treated successfully with rifampicin and streptomycin without complications. 65 patients presented with complications; they comprised 34 males and 31 females. Their ages ranged from 1 year 3 months to 80 years with mean age of 29.7 [S.D. 20.1]. The types of lesions seen were ulcers [54], contractures [7], chronic osteomyelitis [one], subluxation of knee joint [one], salivary gland fistula [one] and Marjolin's ulcer [one]. The lesions were distributed as follows: 69.2% on the lower, and 23.1% on the upper limbs, 6.2% on the head and neck and 1.5% on the trunk. Wound excision with or without skin grafting was done in 84.6% of patients, surgery for contractures in10.8%, and sequestrectomy, exploration and ligation of fistula, groin dissection and above knee amputation in 4.6%. Whilst ulcers, the commonest MU lesions, are being controlled with antibiotics, rare complications of the disease are also emerging