[Mycobacterium ulcerans disease (Buruli ulcer): surgical treatment of 102 cases in the Democratic Republic of Congo]. / Ulcère à Mycobacterium ulcerans: prise en charge chirurgicale dans 102 observations en Republique Démocratique du Congo.

ABSTRACT

This report describes the preliminary results of surgical treatment of 102 patients presenting Buruli ulcer (BU) over the 5-year period from January 1, 2000 to January 1, 2005. The overall purpose is to improve therapeutic management of BU in the Democratic Republic of Congo. The main disease features were the same as those described in the literature. Diffuse mixed ulcerative forms were the most common in the hospital and at the health care center. Infection by Mycobacterium ulcerans was confirmed by microbacteriological analysis and histological study. Surgical removal of the BU was performed with primary suture, protective dressing, or skin grafting. Local care consisted of application of an aqueous solution of chloramine-metronidazole-nitrofurandoine daily after debridement. Skin grafting was performed with or without protective dressing. Preliminary results with a follow-up of 12 months showed healing in 62 cases, recurrece in 22, and unknown outcome in 18. Although surgical treatment was feasible in poor rural facilities, the cost depending on clinical form is high and recurrence is frequent. These findings undersscore the importance of early detection and treatment with antimycobacterials.