1921
Volume 82, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

We report a case of under treated necrotizing fasciitis (NF) in a 65-year-old woman with diabetes misdiagnosed as infection. She came to the Institut Médical Evangélique (IME) with an extensive painful edematous ulcerated lesion on the dorsum of the right foot and ankle. The diagnosis of Buruli ulcer (BU) was based initially on clinical findings and place of residence (Songololo Territory, the largest known focus of BU in Bas-Congo province). Tissue specimens gave negative results for acid-fast bacilli (AFB), culture, and polymerase chain reaction (PCR) for Histopathologic analysis revealed marked necrosis of the lower dermis and subcutaneous tissue. No AFB was found. Later, scattered foci of intracellular gram-positive cocci typical of streptococci were seen. Clinicopathologic correlation of these findings strongly supported the diagnosis of NF. This patient shows the difficulties that may be encountered even in known endemic areas in recognizing BU cases purely on clinical findings.

Loading

Article metrics loading...

/content/journals/10.4269/ajtmh.2010.09-0256
2010-03-01
2017-09-25
Loading full text...

Full text loading...

/deliver/fulltext/14761645/82/3/478.html?itemId=/content/journals/10.4269/ajtmh.2010.09-0256&mimeType=html&fmt=ahah

References

  1. World Health Organization Asiedu K, Scherpbier R, Raviglione M, , 2000. Buruli ulcer: Mycobacterium ulcerans infection. , eds. Geneva: World Health Organization.
  2. Walsh DS, Portaels F, Meyers WM, , 2008. Review: Buruli ulcer (Mycobacterium ulcerans infection). Trans R Soc Trop Med Hyg 102: 969978.[Crossref]
  3. Aiga H, Amano T, Cairncross S, Domako JA, Nanas OK, Coleman S, , 2004. Assessing water-related risk factors for Buruli ulcer: a case-control study in Ghana. Am J Trop Med Hyg 71: 387392.
  4. Debacker M, Zinsou C, Aguiar J, Meyers WM, Portaels F, , 2003. First case of Mycobacterium ulcerans disease (Buruli ulcer) following a human bite. Clin Infect Dis 36: e67e68.[Crossref]
  5. Meyers WM, Shelly WM, Connor DH, Meyers EK, , 1974. Mycobacterium ulcerans infections developing at sites of trauma to skin. Am J Trop Med Hyg 23: 919923.
  6. Abalos FM, Aguiar J, Guédénon A, Portaels F, Meyers WM, , 2000. Mycobacterium ulcerans infection (Buruli ulcer): a case report of the disseminated nonulcerative form. Ann Diagn Pathol 4: 386390.[Crossref]
  7. Portaels F, Silva MT, Meyers WM, , 2009. Buruli ulcer. Clin Dermatol 27: 291305.[Crossref]
  8. Meyers WM, Connor DH, McCullough B, Bourland J, Moris R, Proos L, , 1974. Distribution of Mycobacterium ulcerans infection in Zaïre, including the report of new foci. Ann Soc Belg Med Trop 54: 147157.
  9. World Health Organization Portaels F, Johnson P, Meyers WM, , 2001. Buruli Ulcer: Diagnosis of Mycobacterium ulcerans disease. , eds. Geneva: World Health Organization. WHO/CDS/CPE/BBUI/2001.4.
  10. Braunwald E, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL, , 2001. 15th Edition Harrison's Manual of Medicine. New York: McGraw-Hill, 176, 180, 378.
  11. Dahl PR, Perniciaro C, Holmkvist KA, O'Connor MI, Gibson LE, , 2002. Fulminant group A streptococcal necrotizing fasciitis: clinical and pathological findings in 7 patients. J Am Acad Dermatol 47: 489492.[Crossref]
  12. Hasham S, Matteucci P, Stanley PR, Hart NB, , 2005. Necrotising fasciitis. Br Med J 330: 830833.[Crossref]
  13. Smeets L, Bous A, Heymans O, , 2007. Necrotizing fasciitis: case report and review of literature. Acta Chir Belg 107: 2936.[Crossref]
  14. Angoules AG, Kontakis G, Drakoulakis E, Vrentzos G, Granick MS, Giannoudis PV, , 2007. Necrotising fasciitis of upper and lower limb: a systematic review. Injury 38S: S18S25.[Crossref]
  15. Fleming RA, , 1962. The causes, pathologic aspects and treatment of phagedenic ulcer in West Africa. J Int Coll Surg 38: 120128.
  16. Robinson DC, Adriaans B, Hay RJ, Yesudian P, , 1988. The clinical and epidemiologic features of tropical ulcer (tropical phagedenic ulcer). Int J Derm 27: 4953.[Crossref]
  17. Janssens P, Pattyn S, Meyers WM, Portaels F, , 2005. Buruli ulcer: an historical overview with updating to 2005. Bull Seances Acad R Sci Outre Mer 51: 265299.
  18. Bulto T, Maskel FH, Fisseha G, , 1993. Skin lesions in resettled and indigenous populations in Gambela, with special emphasis on the epidemiology of tropical ulcer. Ethiop Med J 31: 7582.
  19. Tumwine JK, Dungare PS, Tswana SA, Maoneke WR, , 1989. Tropical ulcers in a remote area in Zimbabwe. Cent Afr J Med 35: 413416.
  20. Van Deun A, Hamid Salim A, Cooreman E, Daru P, Das AP, Aung KJ, Rieder HL, , 2004. Scanty AFB smears: what's in a name? Int J Tuberc Lung Dis 8: 816823.
  21. Phanzu MD, Bafende AE, Imposo BB, Dunda KB, Nsiangana ZS, Kibadi KA, Singa NJ, Meyers WM, Portaels F, , 2006. Mycobacterium ulcerans disease (Buruli ulcer) in a rural hospital in Bas-Congo, Democratic Republic of Congo, 2002–2004. Am J Trop Med Hyg 75: 311314.
  22. Debacker M, Aguiar J, Steunou C, Zinsou C, Meyers WM, Guédénon A, Scott JT, Dramaix M, Portaels F, , 2004. Mycobacterium ulcerans disease (Buruli ulcer) in a rural hospital, Southern Benin, 1997–2001. Emerg Infect Dis 10: 13911398.[Crossref]
  23. van der Werf TS, van der Graaf WTA, Tappero JW, Asiedu K, , 1999. Mycobacterium ulcerans infection. Lancet 354: 10131018.[Crossref]
  24. Ogundiran TO, Akute OO, Oluwatosin OM, , 2004. Necrotising fasciitis. Trop Doct 34: 175178.[Crossref]
  25. Cox NH, , 1999. Streptococcal necrotizing fasciitis and the dermatologist. Br J Dermatol 141: 613614.[Crossref]
  26. Siegmund V, Adjei O, Nitschke J, Thompson W, Klutse E, Herbinger KH, Thompson R, van Vloten F, Racz P, Fleischer B, Loescher T, Bretzel G, , 2007. Dry reagent-based polymerase chain reaction compared with other laboratory methods available for the diagnosis of Buruli ulcer disease. Clin Infect Dis 45: 6875.[Crossref]
  27. World Health Organization, 2004. Provisional guidance on the role of specific antibiotics in the management of Mycobacterium ulcerans disease (Buruli ulcer). WHO/CDS/CPE/GBUI/2004.10. Geneva: World Health Organization.
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.2010.09-0256
Loading
/content/journals/10.4269/ajtmh.2010.09-0256
Loading

Data & Media loading...

  • Received : 12 May 2009
  • Accepted : 26 Oct 2009

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error