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Verfasst von:Addison, Naa Okaikor [VerfasserIn]   i
 Pfau, Stefanie [VerfasserIn]   i
 Junghanss, Thomas [VerfasserIn]   i
Titel:Assessing and managing wounds of Buruli ulcer patients at the primary and secondary health care levels in Ghana
Verf.angabe:Naa Okaikor Addison, Stefanie Pfau, Eric Koka, Samuel Yaw Aboagye, Grace Kpeli, Gerd Pluschke, Dorothy Yeboah-Manu, Thomas Junghanss
E-Jahr:2017
Jahr:February 28, 2017
Umfang:20 S.
Fussnoten:Gesehen am 02.11.2018
Titel Quelle:Enthalten in: Public Library of SciencePLoS neglected tropical diseases
Ort Quelle:Lawrence, Kan. : PLoS, 2007
Jahr Quelle:2017
Band/Heft Quelle:11(2017,2) Artikel-Nummer e0005331, 20 Seiten
ISSN Quelle:1935-2735
Abstract:Background Beyond Mycobacterium ulcerans—specific therapy, sound general wound management is required for successful management of Buruli ulcer (BU) patients which places them among the large and diverse group of patients in poor countries with a broken skin barrier. Methods Clinically BU suspicious patients were enrolled between October 2013 and August 2015 at a primary health care (PHC) center and a municipal hospital, secondary health care (SHC) center in Ghana. All patients were IS2404 PCR tested and divided into IS2404 PCR positive and negative groups. The course of wound healing was prospectively investigated including predictors of wound closure and assessment of infrastructure, supply and health staff performance. Results 53 IS2404 PCR positive patients—31 at the PHC center and 22 at the SHC center were enrolled—and additionally, 80 clinically BU suspicious, IS2404 PCR negative patients at the PHC center. The majority of the skin ulcers at the PHC center closed, without the need for surgical intervention (86.7%) compared to 40% at the SHC center, where the majority required split-skin grafting (75%) or excision (12.5%). Only 9% of wounds at the PHC center, but 50% at the SHC center were complicated by bacterial infection. The majority of patients, 54.8% at the PHC center and 68.4% at the SHC center, experienced wound pain, mostly severe and associated with wound dressing. Failure of ulcers to heal was reliably predicted by wound area reduction between week 2 and 4 after initiation of treatment in 75% at the PHC center, and 90% at the SHC center. Obvious reasons for arrested wound healing or deterioration of wound were missed additional severe pathology; at the PHC center (chronic osteomyelitis, chronic lymphedema, squamous cell carcinoma) and at the SHC center (malignant ulceration, chronic lymphedema) in addition to hygiene and wound care deficiencies. When clinically suspicious, but IS2404 PCR negative patients were recaptured in the community, 76/77 (98.7%) of analyzed wounds were either completely closed (85.7%) or almost closed (13%). Five percent were found to have important missed severe pathology (chronic osteomyelitis, ossified fibroma and suspected malignancy). Conclusion The wounds of most BU patients attending the primary health care level can be adequately managed. Additionally, the patients are closer to their families and means of livelihood. Non-healing wounds can be predicted by wound area reduction between 2 to 4 weeks after initiation of treatment. Patients with clinically BU suspicious, but PCR negative ulcers need to be followed up to capture missed diagnoses.
DOI:doi:10.1371/journal.pntd.0005331
URL:Bitte beachten Sie: Dies ist ein Bibliographieeintrag. Ein Volltextzugriff für Mitglieder der Universität besteht hier nur, falls für die entsprechende Zeitschrift/den entsprechenden Sammelband ein Abonnement besteht oder es sich um einen OpenAccess-Titel handelt.

Kostenfrei: Volltext ; Verlag: http://dx.doi.org/10.1371/journal.pntd.0005331
 Kostenfrei: Volltext: http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0005331
 DOI: https://doi.org/10.1371/journal.pntd.0005331
Datenträger:Online-Ressource
Sprache:eng
Sach-SW:Analgesics
 Buruli ulcer
 Lesions
 Mycobacterium ulcerans
 Osteomyelitis
 Tissue repair
 Ulcers
 Wound healing
K10plus-PPN:1572239832
Verknüpfungen:→ Zeitschrift

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