Abstract:
Mycobacterium ulcerans (MU) disease
causes extensive destruction of tissues leaving large
ulcers on the body. Management which consisted of
surgical excision of the lesions is gradually being
replaced with chemotherapy.
Objective: To study the impact on surgery of prior
treatment of MU disease with rifampicin and streptomycin.
Study Design: Retrospective, from September 2004
to September 2009.
Setting: Asunafo, Amansie West, Ahafo Ano and
Amansie Central districts of Ghana.
Methods: Patients who have completed 8 weeks or a
minimum of 4 weeks treatment with rifampicin and
streptomycin but have unhealed lesions were selected
for surgery.
Results: 132 patients had surgery for MU disease; 51
at Tepa (Ahafo Ano); 36 at Agroyesum (Amansie
West); 16 from Jacobu (Amansie Central); 29 from
Goaso (Asunafo) districts. Their ages ranged from 4
to 98 years, with mean age of 29.90 years, standard
deviation of 20.74. Sites involved were: head and
neck 1 (0.74%), upper limb 40 (29.63%), lower limb
92 (68.15%), trunk 2 (1.48%) (N=135). The clinical
forms were: papule 1 (0.74%), nodule 2 (1.48%),
oedematous lesion 4 (2.96%), osteomyelitis 2
(1.48%), ulcers 124 (91.85%), contractures 2
(1.48%). 139 surgical procedures were performed:
excision 25 (18.11), skin grafting 36 (26.1%), excision
and skin grafting 54 (39.1%), debridem net 10
(7.2%), sequestrectomy 2 (1.4%), regrafting 10
(7.2%), release of contractures 2 (1.4%).
Conclusion: Treatment of MU disease with rifampicin
and streptomycin improved the condition and
minimised the extent of surgery. Combination of surgery
and antibiotics is necessary to prevent the development
contractures.
