0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Observation |

Buruli Ulcer Successfully Treated With Negative-Pressure Wound Therapy

Chiaki Murase, MD1; Michihiro Kono, MD, PhD1; Kazue Nakanaga, PhD2; Norihisa Ishii, MD, PhD2; Masashi Akiyama, MD, PhD1
[+] Author Affiliations
1Department of Dermatology, Nagoya University Graduate School of Medicine, Aichi, Japan
2Leprosy Research Center, National Institute of Infectious Diseases, Tokyo, Japan
JAMA Dermatol. 2015;151(10):1137-1139. doi:10.1001/jamadermatol.2015.1567.
Text Size: A A A
Published online

Extract

This case report details successful use of negative-pressure wound therapy for treatment of an advanced Buruli ulcer and suggests that such treatment might be effective in similar future cases.

Buruli ulcer (BU) is a slowly progressive lesion with local necrosis caused by Mycobacterium ulcerans.1 It is mostly seen in tropical areas,2,3 and the lack of awareness of BU in nonendemic areas sometimes leads to diagnostic delay. Significant delay places patients at risk of more extensive disease. Negative-pressure wound therapy (NPWT) is considered to be a great alternative because it accelerates wound healing. Herein, we report an advanced case of BU successfully treated with NPWT.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview

Figures

Place holder to copy figure label and caption
Figure 1.
Genetic Analysis by Polymerase Chain Reaction (PCR) Targeting IS2404 and Virulence Plasmid pMUM001

A, Under PCR analysis of IS2404, the biopsy specimen was found to be strongly positive for the 154-bp product, which raised the possibility of Mycobacterium ulcerans or M ulcerans subspecies shinshuense as the causative organism. Lane M represents a 100–base pair (bp) ladder marker; lane NC, a negative control; lane PC, a positive control; lane S1, a DNA sample extracted from paraffin-embedded skin (patient) before antibiotic use; lane S2, a DNA sample extracted from paraffin-embedded skin (patient) after antibiotic use. B, Under PCR analysis of virulence plasmid pMUM001, only lane 3 was found to be negative. These results clearly indicate the diagnosis of Buruli ulcer caused by M ulcerans subspecies shinshuense. Lane M represents a 100-bp ladder marker; lane 1, repA (413 bp); lane 2, parA (501 bp); lane 3, the serine/threonine protein kinase gene MUP011 (479 bp); lane 4, a loading domain of mls (560 bp); lane 5, an acyltransferase domain of mls (504 bp); lane 6, the rep type II thioesterase gene (500 bp); lane 7, the rep type III ketosynthase gene (496 bp); and lane 8, the repP450 hydroxylase gene (500 bp).

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Time Series of the Clinical Features of Buruli Ulcer (BU)

A, Painful ulceration with necrotic tissue surrounded by erythema on the right ankle on day 1 of BU-specific antibiotic treatment. B, The ulcer after radical debridement on day 20. The Achilles tendon and the calcaneal bone are exposed, and the articular capsule of the ankle joint has been destroyed. C, After negative-pressure wound therapy treatment, red granulation tissue covers the ulcer bed on day 69. D, The well-preserved skin graft completely encloses the lesion on day 127.

Graphic Jump Location

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

353 Views
0 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Jobs
JAMAevidence.com

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Laboratory Diagnosis of Pertussis

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Supplemental Appendix Methods: Study Selection

brightcove.createExperiences();