Nonspecific tropical ulcers

Organism No specific organism is normally detected, but initial infection is often accompanied by cellulitis, probably caused by a Streptococcus.

Transmission Flies are responsible for contaminating small wounds and scratches or occasionally biting insects transmit infecting organisms directly. Scratching of the wound by the host can be a potent method of instilling organisms into the skin.

Clinical features The initial wound becomes red and indurated, with cellulitis spreading to the regional lymph nodes, and systemic fever. An ulcer that refuses to heal then develops at the initial point of infection, producing increasing tissue loss.

Incubation period Uncertain but probably between 1 and 5 days.

Period of communicability Unknown, but probably as long as there are moist lesions.

Occurrence and distribution Tropical ulcers are found in the warm, moist areas of the world, where the temperature and humidity are fairly constant. All ages and both sexes are susceptible.

Control and prevention Tropical ulcers can be prevented by taking scrupulous care over minor cuts and abrasions. As soon as any break in the skin surface occurs, it should be cleaned, an antiseptic applied and covered with a dressing. Where dressings are in short supply, certain kinds of leaves can be used. Flies should be controlled by the provision of sanitation (Section 3.3.4) and the disposal of garbage.

Treatment During the invasive stage, antibiotics should be given both systemically and locally, and the limb rested. Once the ulcer has formed, antibiotics have no effect and a cleaning solution, such as Eusol, should be applied. In coastal areas, soaking the affected limb in seawater is a cost-free method of cleaning out the ulcer. Skin grafting may be necessary.

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