Diagnósticos de enfermagem em clientes com afecções cutâneas / Nursing diagnoses in patients with cutaneous affections

Objetivo: descrever os diagnósticos de enfermagem, fatores de risco/relacionados e características definidoras apresentados pelos clientes com afecções cutâneas. Método: trata-se de estudo bibliográfico, tipo revisão integrativa de estudos indexados de 1998 a 2018, em português, inglês e espanhol, nas bases LILACS, MEDLINE e Biblioteca Virtual SciELO. Interpretaram-se os dados com base na comparação das teorias, conclusões e implicações dos estudos, apresentando-os em figuras. Resultados: observa-se precariedade de artigos publicados: apenas três, com nível de evidência 4. Abordaram-se, no primeiro, os diagnósticos de Enfermagem em clientes com diversas afecções cutâneas; o segundo identificou apenas os diagnósticos de Enfermagem em clientes com hanseníase e o terceiro, nos clientes com dermatoses imunobolhosas. Conclusão: verifica-se a escassez de estudos. Encontrou-se o risco de infecção, definido pela "vulnerabilidade à invasão e multiplicação de organismos patogênicos, que pode comprometer a "saúde", como diagnóstico de enfermagem, em todos os pacientes, em todos os estudos.(AU)

Objective: to describe the nursing diagnoses, risk/related factors and defining characteristics presented by customers with cutaneous affections. Method: this is a bibliographical study, integrative-review-type of studies indexed from 1998 to 2018, in Portuguese, English and Spanish, on LILACS, MEDLINE and SciELO Virtual Library databases. The data were interpreted based on a comparison of theories, conclusions and implications of the study, presenting them in figures. Results: there was precariousness of published articles: only three, with level of evidence 4. The first one addressed nursing diagnoses in clients with various cutaneous affections; the second identified only nursing diagnoses in customers with leprosy and the third, in clients with autoimmune bullous dermatoses. Conclusion: there is a paucity of studies. All studies identified risk for infection, defined as the "vulnerability to invasion and multiplication of pathogenic organisms", which can harm the "health", as nursing diagnosis in all patients.(AU)

Objetivo: describir los diagnósticos de enfermería, los factores de riesgo/relacionados y definir las características presentadas por clientes con afecciones cutáneas. Método: este es un estudio bibliográfico, tipo revisión integradora de estudios indexados desde 1998 a 2018, en portugués, inglés y español, en las bases de datos MEDLINE, LILACS y Biblioteca Virtual SciELO. Los datos fueron interpretados con base en una comparación de teorías, conclusiones e implicaciones del estudio, presentándolos en cifras. Resultados: se observó la precariedad de los artículos publicados: sólo tres, con nivel de evidencia 4. El primero artigo discute los diagnósticos de enfermería en clientes con diversas afecciones cutáneas; el segundo identifica sólo diagnósticos de enfermería en clientes con la lepra y el tercero, en clientes con dermatosis imunobolhosas. Conclusión: existe una escasez de estudios. Se encontró el riesgo de infección, definido por la "vulnerabilidad a la invasión y multiplicación de microorganismos patógenos", que pueden perjudicar la "salud", como diagnóstico de enfermería en todos los pacientes, en todos los estudios.(AU)

Estrutura física e recursos materiais das salas de curativos das policlínicas regionais / Physical structure and material resources of the healing halls of regional polyclinics

Objetivo: identificar a estrutura física e os recursos materiais das salas de curativos de Policlínicas Regionais de Niterói para o atendimento ao cliente com feridas. Método: trata-se de estudo qualitativo, descritivo, observacional e transversal. Elaboraram-se checklists para a coleta de dados e os analisaram por meio de estatística descritiva simples, utilizando o programa Excel. Apresentaram-se os resultados em forma de figuras. Resultados: encontraram quatro policlínicas com dimensão mínima adequada e duas inadequadas. Observou-se que, dos 22 materiais preconizados na literatura, apenas oito foram encontrados em todas as policlínicas. Conclusão: verificou-se a inexistência de uma unidade em consonância com o preconizado na literatura, uma vez que todas as policlínicas pesquisadas apresentaram algum tipo de carência, seja na estrutura, seja nos recursos materiais.(AU)

Objective: to identify the physical structure and material resources of the healing rooms of Regional Polyclinics of Niteroi to customer with wounds. Method: this is a qualitative study, descriptive, observational and cross-sectional. It drafted checklists for data collection and analyzed by means of simple descriptive statistics, using the Excel program. The results are presented in the form of figures. Results: we found four polyclinics with appropriate minimum dimension and two inadequate. It was observed that, of the 22 materials recommended in the literature, only eight were found in all the polyclinics. Conclusion: it was verified that the absence of a unit in line with the recommendations in the literature, since all the clinics surveyed had some kind of grace, be in the structure, either in material resources. (AU)

Objetivo: identificar la estructura física y los recursos materiales de las salas de curación de Policlínicas Regionales de Niterói para clientes con heridas. Método: este es un estudio cualitativo, descriptivo, observacional y transversal. Se redactaron listas de comprobación para la recopilación de datos y analizados por medio de la estadística descriptiva simple, utilizando el programa Excel. Los resultados se presentan en forma de cifras. Resultados: se encontraron cuatro policlínicas con dimensión mínima adecuada y dos insuficientes. Se observó que, de los 22 materiales recomendados en la literatura, sólo ocho fueron encontrados en todas las policlínicas. Conclusión: se comprobó que la ausencia de una unidad en línea con las recomendaciones en la literatura, ya que todas las clínicas encuestadas tenían algún tipo de gracia, sea en la estructura, ya sea en los recursos materiales.(AU)

Subcutaneous Granulomatous Inflammation due to Basidiobolomycosis: Case Reports of 3 Patients in Buruli Ulcer Endemic Areas in Benin.

BACKGROUND: Basidiobolomycosis is a rare subcutaneous mycosis, which can be mistaken for several other diseases, such as soft tissue tumors, lymphoma, or Buruli ulcer in the preulcerative stage. Microbiological confirmation by PCR for Basidiobolus ranarum and culture yield the most specific diagnosis, yet they are not widely available in endemic areas and with varying sensitivity. A combination of histopathological findings, namely, granulomatous inflammation with giant cells, septate hyphal fragments, and the Splendore-Hoeppli phenomenon, can confirm basidiobolomycosis in patients presenting with painless, hard induration of soft tissue. CASE PRESENTATIONS: We report on three patients misdiagnosed as suffering from Buruli ulcer, who did not respond to Buruli treatment. Histopathological review of the tissue sections from these patients suggests basidiobolomycosis. All patients had been lost to follow-up, and none received antifungal therapy. On visiting the patients at their homes, two were reported to have died of unknown causes. The third patient was found alive and well and had experienced local spontaneous healing. CONCLUSION: Basidiobolomycosis is a rare subcutaneous fungal disease mimicking preulcerative Buruli ulcer. We stress the importance of the early recognition by clinicians and pathologists of this treatable disease, so patients can timely receive antifungal therapy.

Report of a series of 82 cases of Buruli ulcer from Nigeria treated in Benin, from 2006 to 2016.

BACKGROUND: Nigeria is one of the countries endemic for Buruli ulcer (BU) in West Africa but did not have a control programme until recently. As a result, BU patients often access treatment services in neighbouring Benin where dedicated health facilities have been established to provide treatment free of charge for BU patients. This study aimed to describe the epidemiological, clinical, biological and therapeutic characteristics of cases from Nigeria treated in three of the four treatment centers in Benin. METHODOLOGY/PRINCIPAL FINDINGS: A series of 82 BU cases from Nigeria were treated in three centres in Benin during 2006-2016 and are retrospectively described. The majority of these patients came from Ogun and Lagos States which border Benin. Most of the cases were diagnosed with ulcerative lesions (80.5%) and WHO category III lesions (82.9%); 97.5% were healed after a median hospital stay of 46 days (interquartile range [IQR]: 32-176 days). CONCLUSIONS/SIGNIFICANCE: This report adds to the epidemiological understanding of BU in Nigeria in the hope that the programme will intensify efforts aimed at early case detection and treatment.

A Genomic Approach to Resolving Relapse versus Reinfection among Four Cases of Buruli Ulcer.

BACKGROUND: Increased availability of Next Generation Sequencing (NGS) techniques allows, for the first time, to distinguish relapses from reinfections in patients with multiple Buruli ulcer (BU) episodes. METHODOLOGY: We compared the number and location of single nucleotide polymorphisms (SNPs) identified by genomic screening between four pairs of Mycobacterium ulcerans isolates collected at the time of first diagnosis and at recurrence, derived from a collection of almost 5000 well characterized clinical samples from one BU treatment center in Benin. PRINCIPAL FINDINGS: The findings suggest that after surgical treatment-without antibiotics-the second episodes were due to relapse rather than reinfection. Since specific antibiotics were introduced for the treatment of BU, the one patient with a culture available from both disease episodes had M. ulcerans isolates with a genomic distance of 20 SNPs, suggesting the patient was most likely reinfected rather than having a relapse. CONCLUSIONS: To our knowledge, this study is the first to study recurrences in M. ulcerans using NGS, and to identify exogenous reinfection as causing a recurrence of BU. The occurrence of reinfection highlights the contribution of ongoing exposure to M. ulcerans to disease recurrence, and has implications for vaccine development.

Contribution of the community health volunteers in the control of Buruli ulcer in Bénin.

BACKGROUND: Buruli ulcer (BU) is a neglected tropical disease caused by Mycobacterium ulcerans. Usually BU begins as a painless nodule, plaque or edema, ultimately developing into an ulcer. The high number of patients presenting with ulcers in an advanced stage is striking. Such late presentation will complicate treatment and have long-term disabilities as a consequence. The disease is mainly endemic in West Africa. The primary strategy for control of this disease is early detection using community village volunteers. METHODOLOGY/PRINCIPAL FINDINGS: In this retrospective, observational study, information regarding Buruli ulcer patients that reported to one of the four BU centers in Bénin between January 2008 and December 2010 was collected using the WHO/BU01 forms. Information used from these forms included general characteristics of the patient, the results of diagnostic tests, the presence of functional limitations at start of treatment, lesion size, patient delay and the referral system. The role of the different referral systems on the stage of disease at presentation in the hospital was analyzed by a logistic regression analysis. About a quarter of the patients (26.5%) were referred to the hospital by the community health volunteers. In our data set, patients referred to the hospital by community health volunteers appeared to be in an earlier stage of disease than patients referred by other methods, but after adjustment by the regression analysis for the health center, this effect could no longer be seen. The Polymerase Chain Reaction (PCR) for IS2404 positivity rate among patients referred by the community health volunteers was not systematically lower than in patients referred by other systems. CONCLUSIONS/SIGNIFICANCE: This study clarifies the role played by community health volunteers in Bénin, and shows that they play an important role in the control of BU.

Insertion sequence element single nucleotide polymorphism typing provides insights into the population structure and evolution of Mycobacterium ulcerans across Africa.

Buruli ulcer is an indolent, slowly progressing necrotizing disease of the skin caused by infection with Mycobacterium ulcerans. In the present study, we applied a redesigned technique to a vast panel of M. ulcerans disease isolates and clinical samples originating from multiple African disease foci in order to (i) gain fundamental insights into the population structure and evolutionary history of the pathogen and (ii) disentangle the phylogeographic relationships within the genetically conserved cluster of African M. ulcerans. Our analyses identified 23 different African insertion sequence element single nucleotide polymorphism (ISE-SNP) types that dominate in different areas where Buruli ulcer is endemic. These ISE-SNP types appear to be the initial stages of clonal diversification from a common, possibly ancestral ISE-SNP type. ISE-SNP types were found unevenly distributed over the greater West African hydrological drainage basins. Our findings suggest that geographical barriers bordering the basins to some extent prevented bacterial gene flow between basins and that this resulted in independent focal transmission clusters associated with the hydrological drainage areas. Different phylogenetic methods yielded two well-supported sister clades within the African ISE-SNP types. The ISE-SNP types from the "pan-African clade" were found to be widespread throughout Africa, while the ISE-SNP types of the "Gabonese/Cameroonian clade" were much rarer and found in a more restricted area, which suggested that the latter clade evolved more recently. Additionally, the Gabonese/Cameroonian clade was found to form a strongly supported monophyletic group with Papua New Guinean ISE-SNP type 8, which is unrelated to other Southeast Asian ISE-SNP types.

Puesta en marcha de un centro hospitalario en un área rural de Benín. Estudio comparativo con el centro público existente / Implementing a dispensary in a rural area in Benin. Comparison between the new private centre and the old public centre’s consultation

We present an example of a busy dispensary that provides nutritional care, outpatient services for all ages, treatment for medical emergencies, surgery and long term hospitalisation in a rural area of western Africa already covered by local tertiary care centres. We compare the different diagnoses in our dispensary in Zagnanado (Benin) and the public centres of the region. The main change observed is the success of the integration of a new private health centre that is fully equipped and ready to assist the population. The increasing demand and sustained investments have brought the patients to consider this dispensary as a reference for all health problems. We can see that private health care is essential to accurately estimate the burden of disease in developing countries not only in preventive and curative care but also in health education, which is essential in such settings and often not taken into consideration (AU)

Puesta en marcha de un centro hospitalario en un área rural de Benín. Estudio comparativo con el centro público existente Mostramos un ejemplo de implantación de un centro hospitalario con gran presión asistencial en una zona rural de África Occidental, donde ya existían centros de salud locales, que desarrolla actividades programadas y urgentes, tanto en las áreas de hospitalización como en las consultas externas, y proporciona desde actividad quirúrgica cuidados nutricionales de la población a cualquier edad. A continuación comparamos los diferentes diagnósticos realizados en las consultas de nuestro dispensario en Zagnanado (Benín) y aquellos realizados en los centros públicos de la región. Los resultados obtenidos muestran el éxito de la integración del nuevo centro que está completamente equipado y listo para atender a la población. La demanda de los pacientes y la aportación continua de recursos han permitido que el centro disponga de una infraestructura y un equipamiento adecuado y hoy está considerado como punto de referencia para los problemas de salud de la región. Podemos observar que los centros de salud privados son esenciales para estimar fielmente la carga de enfermedad en los países en vías de desarrollo, algo necesario no sólo con fines curativos y preventivos sino también para las labores de educación en salud que a menudo no se tienen en cuenta en estos escenarios (AU)

Fine-needle aspiration, an efficient sampling technique for bacteriological diagnosis of nonulcerative Buruli ulcer.

Invasive punch or incisional skin biopsy specimens are currently employed for the bacteriological confirmation of the clinical diagnosis of Buruli ulcer (BU), a cutaneous infectious disease caused by Mycobacterium ulcerans. The efficacy of fine-needle aspirates (FNA) using fine-gauge needles (23G by 25 mm) for the laboratory confirmation of BU was compared with that of skin tissue fragments obtained in parallel by excision or punch biopsy. In three BU treatment centers in Benin, both types of diagnostic material were obtained from 33 clinically suspected cases of BU and subjected to the same laboratory analyses: i.e., direct smear examination, IS2404 PCR, and in vitro culture. Twenty-three patients, demonstrating 17 ulcerative and 6 nonulcerative lesions, were positive by at least two tests and were therefore confirmed to have active BU. A total of 68 aspirates and 68 parallel tissue specimens were available from these confirmed patients. When comparing the sensitivities of the three confirmation tests between FNA and tissue specimens, the latter yielded more positive results, but only for PCR was this significant. When only nonulcerative BU lesions were considered, however, the sensitivities of the confirmation tests using FNA and tissue specimens were not significantly different. Our results show that the minimally invasive FNA technique offers enough sensitivity to be used for the diagnosis of BU in nonulcerative lesions.

Association of HIV infection and Mycobacterium ulcerans disease in Benin.

We investigated the association between Buruli ulcer and HIV by comparing the HIV-1/2 seroprevalence in a series of 426 Buruli ulcer patients and a sample of 613 residents of southern Benin. The overall HIV prevalence was 2.6% (11/426) among patients and 0.3% among controls (2/613), giving an odds ratio for the association between HIV and Buruli ulcer of 8.1 (95% confidence interval = 1.8-75; P = 0.003).

Effects of grinding surgical tissue specimens and smear staining methods on Buruli ulcer microscopic diagnosis.

To optimize Buruli ulcer (BU) microscopic diagnosis, we compared two smear preparation methods from tissue specimens: smears made with tissue suspension after grinding and smears made directly with unground tissue. We also compared two smear staining methods: auramine and Ziehl-Neelsen (ZN). IS 2404-PCR was used as reference method. One hundred and thirty-one surgical tissue specimens from patients suspected of having BU were analyzed. Both smear preparation methods and both staining methods were equivalent in any combination. Thus we recommend ZN stained smears of unground tissue for peripheral treatment centres.

Primary culture of Mycobacterium ulcerans from human tissue specimens after storage in semisolid transport medium.

Tissue specimens collected from patients with clinically suspected Buruli ulcer treated in two Buruli ulcer treatment centers in Benin between 1998 and 2004 were placed in semisolid transport medium and transported at ambient temperature for microbiological analysis at the Institute of Tropical Medicine in Antwerp, Belgium. The impact of the delay before microbiological analysis on primary culture of Mycobacterium ulcerans was investigated. The length of storage in semisolid transport medium varied from 6 days to 26 weeks. Of the 1,273 tissue fragments positive for M. ulcerans DNA by an IS2404-specific PCR, 576 (45.2%) yielded positive culture results. The sensitivity of direct smear examination was 64.6% (822/1,273 tissue fragments). The median time required to obtain a positive culture result was 11 weeks. Positive cultures were obtained even from samples kept for more than 2 months at ambient temperatures. Moreover, there was no reduction in the viability of M. ulcerans, as detected by culture, when specimens remained in semisolid transport medium for long periods of time (up to 26 weeks). We can conclude that the method with semisolid transport medium is very robust for clinical specimens from patients with Buruli ulcer that, due to circumstances, cannot be analyzed in a timely manner. This transport medium is thus very useful for the confirmation of a diagnosis of Buruli ulcer with specimens collected in the field.

Buruli ulcer surveillance, Benin, 2003-2005.

We reviewed Buruli ulcer (BU) surveillance in Benin, using the World Health Organization BU02 form. We report results of reliable routine data collected on 2,598 new and recurrent cases from 2003 through 2005.

Risk factors for Buruli ulcer, Benin.

We identified risk factors for Buruli ulcer (BU) in Benin in an unmatched case-control study at the Centre Sanitaire et Nutritionnel Gbemoten in southern Benin. A total of 2,399 persons admitted from 1997 through 2003 and 1,444 unmatched patients with other conditions in 2002 were recruited. Adjusted odds ratios were determined for age, sex, place of residence, Mycobacterium bovis BCG vaccination at birth, type of water for domestic use, and occupation. Children <15 years of age and adults >49 years of age had a higher risk for BU. Use of unprotected water from swamps was associated with increased risk for BU; this association was strongest in adults >49 years of age. Sex was not a risk factor for BU. Our data showed that BU was mainly associated with age, place of residence, and water sources in all age groups. Risk for BU was higher in BCG-vaccinated patients > or =5 years of age.

Buruli ulcer recurrence, Benin.

Buruli ulcer is a recognized public health problem in West Africa. In Benin, from 1989 to 2001, the Centre Sanitaire et Nutritionnel Gbemoten (CSNG) treated >2,500 Buruli ulcer patients. From March 2000 to February 2001, field trips were conducted in the Zou and Atlantique regions. The choice of the 2 regions was based on the distance from CSNG and on villages with the highest number of patients treated at CSNG. A total of 66 (44.0%) of 150 former patients treated at CSNG were located in the visited villages. The recurrence rate of CSNG-treated patients after a follow-up period of up to 7 years was low (6.1%, 95% confidence interval [CI] 2.0-15.6). We attribute this low rate to the high quality of Buruli ulcer treatment at an accessible regional center (CSNG). The World Health Organization definition of a Buruli ulcer recurrent case should be revised to include a follow-up period >1 year.

Mycobacterium ulcerans disease (Buruli ulcer) in rural hospital, Southern Benin, 1997-2001.

Data from 1,700 patients living in southern Benin were collected at the Centre Sanitaire et Nutritionnel Gbemoten, Zagnanado, Benin, from 1997 through 2001. In the Zou region in 1999, Buruli ulcer (BU) had a higher detection rate (21.5/100,000) than leprosy (13.4/100,000) and tuberculosis (20.0/100,000). More than 13% of the patients had osteomyelitis. Delay in seeking treatment declined from 4 months in 1989 to 1 month in 2001, and median hospitalization time decreased from 9 months in 1989 to 1 month in 2001. This reduction is attributed, in part, to implementing an international cooperation program, creating a national BU program, and making advances in patient care.

First case of Mycobacterium ulcerans disease (Buruli ulcer) following a human bite.

Mycobacterium ulcerans disease (MUD) is rapidly reemerging in many countries, especially in West African countries. Antecedent trauma has often been related to the lesions that characterize this frequently crippling disease. We report here the first case of MUD that followed a human bite at the site where the lesion later occurred.