Mycobacterium ulcerans (MU) produces mycolactone toxin when infected with a plasmid. Toxin is cytotoxic and immunosuppressive, causing extensive destruction of tissue, leading to large ulcers on exposed parts of the body. Spontaneous healing by secondary intention leads to contractures, subluxation of joints, disuse atrophy or distal lymphedema.
The disease is endemic in some communities within the middle belt of Ghana.
To document the clinical and epidemiological features of MU disease in the middle belt of Ghana and the outcome of treatment.
Patients and Methods
Patients with lesions suspected to be MU disease were screened by community workers. Lesions were confirmed by any of direct smear examination, culture, polymerase chain reaction (PCR) or histopathology. The patients were treated with rifampicin (10mg/kg orally) and streptomycin (15mg/kg im) combination for eight weeks. Patients selected for surgical treatment included cases where medical treatment had failed, cases where medical treatment is contraindicated, cases presenting late with complications and recurrent cases.
258 patients were seen in Ahafo Ano, Amansie Central, Amansie West, Asunafo, Asutifi and Upper Denkyira districts of Ghana between 2005 and 2012. Their ages ranged from one year three months to 98 years with mean age of 29.8 (SD 20.4)
Clinical forms of MU disease seen were: papule (0.5%), nodule (1.5%), chronic osteomyelitis (1.5%), contracture (1.5%), edematous lesion (3%) and ulcer (92%).
Uncommon complications included subluxation of knee joint, salivary gland fistula, and Marjolin’s ulcer
MU lesions were distributed as follows: head and neck (6.8%), upper limb (20.3%), trunk (1.7%), and lower limb (91.2%)
MU disease in the middle belt of Ghana can be controlled by early case detection and adequate curative treatment
Emmanuel J.K. Adu is a senior lecturer in the Department of Surgery of the School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. He is a Consultant Plastic and Reconstructive Surgeon at Komfo Anokye Teaching Hospital in Kumasi. He obtained his BSc (Human Biology) and MB ChB from the School of Medical Sciences (1984), and his Fellowship of the West African College of Surgeons in Plastic and Reconstructive Surgery from the University of Ghana Medical School in 2002. He was elected a Foundation Fellow of the Ghana College of Physicians and Surgeons in the faculty of surgery in 2005.
His areas of expertise include: management of soft tissue injuries; congenital anomalies of the limbs, head and neck, including polydactyly, syndactyly, macrodactyly, constriction rings, cleft lip and palate; soft tissue infections like Buruli ulcer and cancrum oris; skin cancers, especially basal cell carcinoma, squamous cell carcinoma and malignant melanoma
He is the vice-president of the Ghana Burn Association (2006); patron of Ghana Burn Survivors Foundation(2008); visiting lecturer in surgery (plastic and reconstructive) to the School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana.
He is an examiner in Plastic and Reconstructive Surgery for the West African College of Surgeons (since 2013); he is a reviewer for several local and international medical journals including Ghana Medical Journal, Nigerian Journal of Plastic Surgery, and International Journal of Mycobacteriology. He has spoken at several local and international conferences.
He has 17 publications to his credit in areas pertaining to his specialty.