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Africa
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Infection
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Tropical ulcer, though the name sounds vague and non-specific, is a distinct entity that is seen frequently in tropical and subtropical regions, particularly in parts of Africa, where people walk bare-legged through rough terrain or long grass. It almost always occurs on the leg and men make up the majority of patients. The initial lesion is a small split in the skin (a cut, thorn-scratch, insect bite or other minor abrasion), which is then contaminated with all kinds of dirt or stagnant water. The most likely infecting organisms are Fusiformis fusiformis and Borrelia vincentii (both common in faeces). This results in an indolent ulcer which defies most forms of topical treatment (and certainly traditional remedies native to those parts of the world) (Figure 2.11). The ulcer may eventually bore its way into the soft tissues and the underlying bone; occasionally, after many years, it gives rise to a locally invasive squamous-cell carcinoma.
History of public health in Pacific Island countries
Published in Milton J. Lewis, Kerrie L. MacPherson, Public Health in Asia and the Pacific, 2007
Of endemic infections, yaws and hepatitis B were probable companions. Yaws, a bacterial treponemal infection (related to syphilis), is transmitted by direct contact between children, or adults and children, with open sores from the infection, usually on the legs. The infection can progress to disfigurement. Significant proportions of skeletal lesions in prehistoric samples of bones from the Solomon Islands and the Marianas are considered to be consequent to yaws (Buckley and Tayles 2003: 303–324; Pietrusewsky, Douglas and Ikehara-Quebral 1997: 315–342). Those infected with yaws are immune to venereal syphilis, a phenomenon that is initially advantageous, but leads to problems following yaws eradication. Tropical ulcers (non-yaws) due to infection of minor scratches or insect bites are likely to have been a major source of morbidity since this was the case following contact, especially in PNG (Spencer 1998: 261–267).
Pharmacologic management of Mycobacterium ulcerans infection
Published in Expert Review of Clinical Pharmacology, 2020
Tjip S Van Der Werf, Yves T Barogui, Paul J Converse, Richard O Phillips, Ymkje Stienstra
Simple questions, e.g., the optimal number of dressing changes per week, might also be addressed in formal studies; some of these questions might be answered by enrolling a variety of different wounds (e.g., Buruli ulcer, tropical ulcer, venous and diabetic ulcers), as much of current wound care science is expert opinion-based, without a strong scientific evidence base. In summary, we believe that wound management [168,169] would be an important area of future research to improve outcomes for patients with Buruli ulcer. The role of debridement surgery, extent of removal of the necrotic slough, or timing or type of skin grafting has also been little studied [160], there is a striking variability in surgical practice that is not explained by differences in patient populations, or clinical presentations of wounds, but rather by individual doctors caring for these patients [170]. As resection surgery does not generally bring a clear benefit to patients, this practice should best be discouraged, especially in poor-resourced settings where surgery is much more of a concern than in affluent settings where specialist care is widely available – but even there, the benefit of resection surgery is probably over-rated.