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| Tropical ulcer | |
|---|---|
| Other names | Aden ulcer, Jungle rot, Malabar ulcer, Tropical phagedena[1] |
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| The left foot of a person with acute tropical ulcer upon his admission to Toborra Goroka Hospital, inGoroka,Papua New Guinea. | |
| Specialty | Dermatology  |
Tropical ulcer, more commonly known asjungle rot, is a chronic ulcerative skinlesion thought to be caused by polymicrobial infection with a variety ofmicroorganisms, includingmycobacteria. It is common intropical climates.[2]
Ulcers occur on exposed parts of the body, primarily on anterolateral aspect of the lower limbs and may erodemuscles andtendons, and sometimes, thebones.[3] These lesions may frequently develop on preexisting abrasions or sores sometimes beginning from a mere scratch.[1]
The vast majority of the tropical ulcers occur below theknee, usually around theankle. They may also occur on arms. 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 ofamputation. UnlikeBuruli ulcer, tropical ulcers are very painful.[4] Lesions begin with inflammatorypapules that progress intovesicles and rupture with the formation of anulcer.[1] Chronic ulcers involve larger areas and may eventually develop intosquamous epithelioma after 10 years or more.[5]
There is now considerable evidence to suggest that this disease is an infection.Mycobacterium ulcerans has recently been isolated from lesions and is unique to tropical ulcers.[5] Early lesions may be colonized or infected by,Bacillus fusiformis (Vincent's organism),anaerobes andspirochaetes. Later, tropical ulcer may become infected with a variety of organisms, notably,staphylococci and/orstreptococci.[4] The condition has been shown to be transmissible by inoculation of material from affected patients.[5]
Adequatefootwear 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]
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 a 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 inTanzania 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, andpyogenic infections.[1] Males are more commonly infected than females.[5]
Tropical ulcer is seen throughout the tropics and subtropics. In some of these countries, such as northern Papua New Guinea, it is the most common skin disease.[citation needed]
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