RESUMO
We report a case of a four-year-old Angolan boy with the edematous form of Buruli ulcer on the face and scalp, who was treated at a rural hospital in the Bas-Congo Province, Democratic Republic of Congo. Treatment consisted of a series of surgical interventions and antimycobacterial chemotherapy (rifampin and ciprofloxacin) for two months. This case demonstrates the diagnostic and management difficulties of an edematous lesion of BU on the face and suggests an enhancement of healing and limitation of extent of excision by specific antibiotherapy. The outcome in this patient also underscores the importance of prompt referral of suspected cases and training of health professionals in the early diagnosis of BU.
Assuntos
Úlcera de Buruli/diagnóstico , Úlcera de Buruli/terapia , Edema/diagnóstico , Edema/terapia , Mycobacterium ulcerans/isolamento & purificação , Angola , Antibacterianos/uso terapêutico , Úlcera de Buruli/microbiologia , Pré-Escolar , Ciprofloxacina/uso terapêutico , Edema/microbiologia , Humanos , Masculino , Necrose/microbiologia , Necrose/cirurgia , Necrose/terapia , Rifampina/uso terapêutico , Resultado do TratamentoRESUMO
Buruli ulcer (BU), which is caused by Mycobacterium ulcerans, is an important disabling skin disease. Its prevalence is highest in west and central Africa. We report an apparent resurgence of BU in the Bas-Congo Province, Democratic Republic of Congo. During a 28-month period in 2002-2004, the rural hospital of the Institut Médical Evangélique at Kimpese admitted 51 patients suspected of having BU. Bacteriologic, molecular biologic, and histopathologic studies confirmed BU in 36 of these patients. Extensive clinical data, treatment outcomes, and socioeconomic correlations are summarized. Osteomyelitis was an important complication. A multidisciplinary approach to BU control in the Bas-Congo is proposed, aimed primarily at active case detection.