Tropical ulcer
Encyclopedia
Tropical ulcer is a lesion
occurring in cutaneous leishmaniasis
. It is caused by a variety of microorganism
s, including mycobacteria. It is common in tropical climates.
Ulcers occur on exposed parts of the body, primarily on anterolateral aspect of the lower limbs and may erode muscle
s and tendon
s, and sometimes, the bone
s. These lesions may frequently develop on preexisting abrasions or sores sometimes beginning from a mere scratch.
, usually around the ankle
. They are often initiated by minor trauma, and subjects with poor nutrition are at higher risk. Once developed, the ulcer may become chronic and stable, but also it can run a destructive course with deep tissue invasion, osteitis
, and risk of amputation
. Unlike Buruli ulcer
, tropical ulcers are very painful. Lesions begin with inflammatory papule
s that progress into vesicles and rupture with the formation of an ulcer.
(Vincent's organism), anaerobes and spirochaete
s. Later, tropical ulcer may become infected with a variety of organisms, notably, staphylococci and/or streptococci.
in sugarcane workers cutting the crops while barefoot. Tropical ulcers can also occur to the visitors of tropics. The disease is most common in native laborers and in schoolchildren of the tropics and subtropics during the rainy season and is caused in many instances by the bites of insects, poor hygiene, and pyogenic infections.
is important to prevent trauma. General good health and nutrition also reduce ulcer risk. Adequate and prompt cleansing and treatment of ankle and leg skin breaks is also important. Improving hygiene and nutrition may help to prevent tropical ulcers.
Lesion
A lesion is any abnormality in the tissue of an organism , usually caused by disease or trauma. Lesion is derived from the Latin word laesio which means injury.- Types :...
occurring in cutaneous leishmaniasis
Cutaneous leishmaniasis
Cutaneous leishmaniasis is the most common form of leishmaniasis. It is a skin infection caused by a single-celled parasite that is transmitted by sandfly bites...
. It is caused by a variety of microorganism
Microorganism
A microorganism or microbe is a microscopic organism that comprises either a single cell , cell clusters, or no cell at all...
s, including mycobacteria. It is common in tropical climates.
Ulcers occur on exposed parts of the body, primarily on anterolateral aspect of the lower limbs and may erode muscle
Muscle
Muscle is a contractile tissue of animals and is derived from the mesodermal layer of embryonic germ cells. Muscle cells contain contractile filaments that move past each other and change the size of the cell. They are classified as skeletal, cardiac, or smooth muscles. Their function is to...
s and tendon
Tendon
A tendon is a tough band of fibrous connective tissue that usually connects muscle to bone and is capable of withstanding tension. Tendons are similar to ligaments and fasciae as they are all made of collagen except that ligaments join one bone to another bone, and fasciae connect muscles to other...
s, and sometimes, the bone
Bone
Bones are rigid organs that constitute part of the endoskeleton of vertebrates. They support, and protect the various organs of the body, produce red and white blood cells and store minerals. Bone tissue is a type of dense connective tissue...
s. These lesions may frequently develop on preexisting abrasions or sores sometimes beginning from a mere scratch.
Clinical features
The vast majority of the tropical ulcers occur below the kneeKnee
The knee joint joins the thigh with the leg and consists of two articulations: one between the fibula and tibia, and one between the femur and patella. It is the largest joint in the human body and is very complicated. The knee is a mobile trocho-ginglymus , which permits flexion and extension as...
, usually around the ankle
Ankle
The ankle joint is formed where the foot and the leg meet. The ankle, or talocrural joint, is a synovial hinge joint that connects the distal ends of the tibia and fibula in the lower limb with the proximal end of the talus bone in the foot...
. They are often initiated by minor trauma, and subjects with poor nutrition are at higher risk. Once developed, the ulcer may become chronic and stable, but also it can run a destructive course with deep tissue invasion, osteitis
Osteitis
Osteitis is a general term for inflammation of bone. More specifically, it can refer to one of the following conditions:* Alveolar osteitis or "dry socket"* Condensing osteitis * Osteitis deformans...
, and risk of amputation
Amputation
Amputation is the removal of a body extremity by trauma, prolonged constriction, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on individuals as a preventative surgery for...
. Unlike Buruli ulcer
Buruli ulcer
The Buruli ulcer is an infectious disease caused by Mycobacterium ulcerans. The genus also includes the causative agents of tuberculosis and leprosy...
, tropical ulcers are very painful. Lesions begin with inflammatory papule
Papule
A papule is a circumscribed, solid elevation of skin with no visible fluid, varying in size from a pinhead to 1 cm.With regard to the quote "...varying in size from a pinhead to 1cm," depending on which text is referenced, some authors state the cutoff between a papule and a plaque as 0.5cm,...
s that progress into vesicles and rupture with the formation of an ulcer.
Microbiology
There is no single agreed causative organism for tropical ulcer, although early lesions may be colonized or infected by Bacillus fusiformisBacillus fusiformis
Bacillus fusiformis is a gram-positive bacterium of the genus Bacillus....
(Vincent's organism), anaerobes and spirochaete
Spirochaete
Spirochaetes belong to a phylum of distinctive Gram-negative bacteria, which have long, helically coiled cells...
s. Later, tropical ulcer may become infected with a variety of organisms, notably, staphylococci and/or streptococci.
Epidemiology
Tropical ulcer is seen throughout the tropics and subtropics. No figures are available for its prevalence, but, recently, it has not been seen as frequently as it was previously . Tropical ulcer has been described as a disease of the 'poor and hungry'; it may be that slowly improving socioeconomic conditions and nutrition account for its decline. Urbanization of populations could be another factor, as tropical ulcer is usually a rural problem. More widespread use of shoes and socks also provides protection from initiating trauma. Despite this, susceptible individuals still develop tropical ulcers. Sometimes outbreaks can occur; one was recorded in TanzaniaTanzania
The United Republic of Tanzania is a country in East Africa bordered by Kenya and Uganda to the north, Rwanda, Burundi, and the Democratic Republic of the Congo to the west, and Zambia, Malawi, and Mozambique to the south. The country's eastern borders lie on the Indian Ocean.Tanzania is a state...
in sugarcane workers cutting the crops while barefoot. Tropical ulcers can also occur to the visitors of tropics. The disease is most common in native laborers and in schoolchildren of the tropics and subtropics during the rainy season and is caused in many instances by the bites of insects, poor hygiene, and pyogenic infections.
Treatment
- AntibioticAntibioticAn antibacterial is a compound or substance that kills or slows down the growth of bacteria.The term is often used synonymously with the term antibiotic; today, however, with increased knowledge of the causative agents of various infectious diseases, antibiotic has come to denote a broader range of...
s: In early stages, penicillinPenicillinPenicillin is a group of antibiotics derived from Penicillium fungi. They include penicillin G, procaine penicillin, benzathine penicillin, and penicillin V....
is usually sufficient. Broad spectrum antibiotics may be needed in later stages. - Improved nutrition and vitamins.
- Non-adherent dressings.
- Large infected ulcers may require debridementDebridementDebridement is the medical removal of a patient's dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue...
under anesthesiaAnesthesiaAnesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...
. - Skin graftingSkin graftingSkin grafting is a type of graft surgery involving the transplantation of skin. The transplanted tissue is called a skin graft.Skin grafting is often used to treat:*Extensive wounding or trauma*Burns...
may be helpful. - In extreme cases, amputationAmputationAmputation is the removal of a body extremity by trauma, prolonged constriction, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on individuals as a preventative surgery for...
is necessary.
Prevention
Adequate footwearFootwear
Footwear consists of garments worn on the feet, for fashion, protection against the environment, and adornment. Being barefoot is commonly associated with poverty, but some cultures chose not to wear footwear at least in some situations....
is important to prevent trauma. General good health and nutrition also reduce ulcer risk. Adequate and prompt cleansing and treatment of ankle and leg skin breaks is also important. Improving hygiene and nutrition may help to prevent tropical ulcers.
Complications
- Skin color: Rarely, Jungle rot will result in complications with skin pigmentation. It has been known to leave the victim with different colors such as bright red, blue, green, and a rare color change of orange.
- Deep tissue invasion: Often with bone involvement, and potentially leading to amputation.
- Chronic ulceration.
- Recurrent ulceration.
- Squamous cell carcinomaSquamous cell carcinomaSquamous cell carcinoma , occasionally rendered as "squamous-cell carcinoma", is a histologically distinct form of cancer. It arises from the uncontrolled multiplication of malignant cells deriving from epithelium, or showing particular cytological or tissue architectural characteristics of...
may occasionally develop, usually in chronic cases, and at the edge of ulcer. - TetanusTetanusTetanus is a medical condition characterized by a prolonged contraction of skeletal muscle fibers. The primary symptoms are caused by tetanospasmin, a neurotoxin produced by the Gram-positive, rod-shaped, obligate anaerobic bacterium Clostridium tetani...
: by entry of tetanus bacilli through the ulcer.