Tropical ulcer

jkljklal ulcer
Classification and external resources
ICD-10	L98.4 (ILDS L98.440)

Tropical ulcer (also known as "Aden ulcer," "Jungle rot," "Malabar ulcer," and "Tropical phagedena")^[1] is a lesion occurring in cutaneous leishmaniasis. It is caused by a variety of microorganisms, including mycobacteria. It is common in tropical climates.^[2]

Ulcers occur on exposed parts of the body, primarily on anterolateral aspect of the lower limbs and may erode muscles and tendons, and sometimes, the bones.^[3] These lesions may frequently develop on preexisting abrasions or sores sometimes beginning from a mere scratch.^[1]

Clinical features

This image depicted the left foot of a patient, which displayed this acute tropical ulcer upon his admission to toborra Goroka Hospital, in Goroka, New Guinea.

The vast majority of the tropical ulcers occur below the knee, 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.^[4] Lesions begin with inflammatory papules that progress into vesicles and rupture with the formation of an ulcer.^[1]

Microbiology

There is no single agreed causative organism for tropical ulcer, although early lesions may be colonized or infected by Bacillus fusiformis (Vincent's organism), anaerobes and spirochaetes. Later, tropical ulcer may become infected with a variety of organisms, notably, staphylococci and/or streptococci.^[4]

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^{[citation needed]} . 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^{[citation needed]}. 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^{[citation needed]}. Despite this, susceptible individuals still develop tropical ulcers. Sometimes outbreaks can occur; one was recorded in Tanzania in sugarcane workers cutting the crops while barefoot. Tropical ulcers can also occur to the visitors of tropics.^[4] 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.^[1]

Treatment

• Antibiotics: In early stages, penicillin is usually sufficient. Broad spectrum antibiotics may be needed in later stages.^{[citation needed]}
• Improved nutrition and vitamins.^{[citation needed]}
• Non-adherent dressings.^{[citation needed]}
• Large infected ulcers may require debridement under anesthesia.^{[citation needed]}
• Skin grafting may be helpful.^{[citation needed]}
• In extreme cases, amputation is necessary.^{[citation needed]}

Prevention

Adequate footwear 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.^{[citation needed]} Improving hygiene and nutrition may help to prevent tropical ulcers.^[1]

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.^{[citation needed]}
• Chronic ulceration.^{[citation needed]}
• Recurrent ulceration.^{[citation needed]}
• Squamous cell carcinoma may occasionally develop, usually in chronic cases, and at the edge of ulcer.^{[citation needed]}
• Tetanus: by entry of tetanus bacilli through the ulcer.^{[citation needed]}

See also

• Skin lesion

References

1. ^ ^{a b c d e} Odom, Richard B.; Davidsohn, Israel; James, William D.; Henry, John Bernard; Berger, Timothy G.; Clinical diagnosis by laboratory methods; Dirk M. Elston (2006). Andrews' diseases of the skin: clinical dermatology. Saunders Elsevier. pp. 276–267. ISBN 0-7216-2921-0. 
2. ^ Stedman's Electronic Medical Dictionary
3. ^ Medcyclopedia-Tropical ulcer
4. ^ ^{a b c} Gill, Geoffrey V.; Geoff Gill; Beeching, N. (2004). Lecture notes on tropical medicine. Oxford: Blackwell Science. ISBN 0-632-06496-X. 

Sources

• Adriaans B, Hay R, Drasar B, Robinson D (January 1987). "The infectious aetiology of tropical ulcer--a study of the role of anaerobic bacteria". Br. J. Dermatol. 116 (1): 31–7. doi:10.1111/j.1365-2133.1987.tb05788.x. PMID 3814513. 
• Aribi M, Poirriez J, Breuillard F (June 1999). "Guess what! Tropical phagedenic ulcer". Eur J Dermatol 9 (4): 321–2. PMID 10465620. http://www.john-libbey-eurotext.fr/en/revues/medecine/ejd/e-docs/00/01/87/08/article.phtml. 
• MacDonald P (March 2003). "Tropical ulcers: a condition still hidden from the western world". J Wound Care 12 (3): 85–90. PMID 12677870.