Buruli ulcer treatment: Rate of surgical intervention differs highly between treatment centers in West Africa.
BACKGROUND:Antibiotic treatment proved itself as the mainstay of treatment for Buruli ulcer disease. This neglected tropical disease is caused by Mycobacterium ulcerans. Surgery persists as an adjunct therapy intended to reduce the mycobacterial load. In an earlier clinical trial, patients benefited...
Published in: | PLOS Neglected Tropical Diseases |
---|---|
Main Authors: | , , , , , , , , , , , , , |
Format: | Article in Journal/Newspaper |
Language: | English |
Published: |
Public Library of Science (PLoS)
2019
|
Subjects: | |
Online Access: | https://doi.org/10.1371/journal.pntd.0007866 https://doaj.org/article/e3c3a9ee257c44288126597e3476e4d5 |
id |
ftdoajarticles:oai:doaj.org/article:e3c3a9ee257c44288126597e3476e4d5 |
---|---|
record_format |
openpolar |
spelling |
ftdoajarticles:oai:doaj.org/article:e3c3a9ee257c44288126597e3476e4d5 2023-05-15T15:16:25+02:00 Buruli ulcer treatment: Rate of surgical intervention differs highly between treatment centers in West Africa. Anita C Wadagni Jonathan Steinhorst Yves T Barogui P M Catraye Ronald Gnimavo Kabiru M Abass George Amofa Michael Frimpong Francisca N Sarpong Tjip S van der Werf Richard Phillips Ghislain E Sopoh Christian R Johnson Ymkje Stienstra 2019-10-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0007866 https://doaj.org/article/e3c3a9ee257c44288126597e3476e4d5 EN eng Public Library of Science (PLoS) https://doi.org/10.1371/journal.pntd.0007866 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0007866 https://doaj.org/article/e3c3a9ee257c44288126597e3476e4d5 PLoS Neglected Tropical Diseases, Vol 13, Iss 10, p e0007866 (2019) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2019 ftdoajarticles https://doi.org/10.1371/journal.pntd.0007866 2022-12-31T10:07:33Z BACKGROUND:Antibiotic treatment proved itself as the mainstay of treatment for Buruli ulcer disease. This neglected tropical disease is caused by Mycobacterium ulcerans. Surgery persists as an adjunct therapy intended to reduce the mycobacterial load. In an earlier clinical trial, patients benefited from delaying the decision to operate. Nevertheless, the rate of surgical interventions differs highly per clinic. METHODS:A retrospective study was conducted in six different Buruli ulcer (BU) treatment centers in Benin and Ghana. BU patients clinically diagnosed between January 2012 and December 2016 were included and surgical interventions during the follow-up period, at least one year after diagnosis, were recorded. Logistic regression analysis was carried out to estimate the effect of the treatment center on the decision to perform surgery, while controlling for interaction and confounders. RESULTS:A total of 1193 patients, 612 from Benin and 581 from Ghana, were included. In Benin, lesions were most frequently (42%) categorized as the most severe lesions (WHO criteria, category III), whereas in Ghana lesions were most frequently (44%) categorized as small lesions (WHO criteria, category I). In total 344 (29%) patients received surgical intervention. The percentage of patients receiving surgical intervention varied between hospitals from 1.5% to 72%. Patients treated in one of the centers in Benin were much more likely to have surgery compared to the clinic in Ghana with the lowest rate of surgical intervention (RR = 46.7 CI 95% [17.5-124.8]). Even after adjusting for confounders (severity of disease, age, sex, limitation of movement at joint at time of diagnosis, ulcer and critical sites), rates of surgical interventions varied highly. CONCLUSION:The decision to perform surgery to reduce the mycobacterial load in BU varies highly per clinic. Evidence based guidelines are needed to guide the role of surgery in the treatment of BU. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic PLOS Neglected Tropical Diseases 13 10 e0007866 |
institution |
Open Polar |
collection |
Directory of Open Access Journals: DOAJ Articles |
op_collection_id |
ftdoajarticles |
language |
English |
topic |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
spellingShingle |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Anita C Wadagni Jonathan Steinhorst Yves T Barogui P M Catraye Ronald Gnimavo Kabiru M Abass George Amofa Michael Frimpong Francisca N Sarpong Tjip S van der Werf Richard Phillips Ghislain E Sopoh Christian R Johnson Ymkje Stienstra Buruli ulcer treatment: Rate of surgical intervention differs highly between treatment centers in West Africa. |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
BACKGROUND:Antibiotic treatment proved itself as the mainstay of treatment for Buruli ulcer disease. This neglected tropical disease is caused by Mycobacterium ulcerans. Surgery persists as an adjunct therapy intended to reduce the mycobacterial load. In an earlier clinical trial, patients benefited from delaying the decision to operate. Nevertheless, the rate of surgical interventions differs highly per clinic. METHODS:A retrospective study was conducted in six different Buruli ulcer (BU) treatment centers in Benin and Ghana. BU patients clinically diagnosed between January 2012 and December 2016 were included and surgical interventions during the follow-up period, at least one year after diagnosis, were recorded. Logistic regression analysis was carried out to estimate the effect of the treatment center on the decision to perform surgery, while controlling for interaction and confounders. RESULTS:A total of 1193 patients, 612 from Benin and 581 from Ghana, were included. In Benin, lesions were most frequently (42%) categorized as the most severe lesions (WHO criteria, category III), whereas in Ghana lesions were most frequently (44%) categorized as small lesions (WHO criteria, category I). In total 344 (29%) patients received surgical intervention. The percentage of patients receiving surgical intervention varied between hospitals from 1.5% to 72%. Patients treated in one of the centers in Benin were much more likely to have surgery compared to the clinic in Ghana with the lowest rate of surgical intervention (RR = 46.7 CI 95% [17.5-124.8]). Even after adjusting for confounders (severity of disease, age, sex, limitation of movement at joint at time of diagnosis, ulcer and critical sites), rates of surgical interventions varied highly. CONCLUSION:The decision to perform surgery to reduce the mycobacterial load in BU varies highly per clinic. Evidence based guidelines are needed to guide the role of surgery in the treatment of BU. |
format |
Article in Journal/Newspaper |
author |
Anita C Wadagni Jonathan Steinhorst Yves T Barogui P M Catraye Ronald Gnimavo Kabiru M Abass George Amofa Michael Frimpong Francisca N Sarpong Tjip S van der Werf Richard Phillips Ghislain E Sopoh Christian R Johnson Ymkje Stienstra |
author_facet |
Anita C Wadagni Jonathan Steinhorst Yves T Barogui P M Catraye Ronald Gnimavo Kabiru M Abass George Amofa Michael Frimpong Francisca N Sarpong Tjip S van der Werf Richard Phillips Ghislain E Sopoh Christian R Johnson Ymkje Stienstra |
author_sort |
Anita C Wadagni |
title |
Buruli ulcer treatment: Rate of surgical intervention differs highly between treatment centers in West Africa. |
title_short |
Buruli ulcer treatment: Rate of surgical intervention differs highly between treatment centers in West Africa. |
title_full |
Buruli ulcer treatment: Rate of surgical intervention differs highly between treatment centers in West Africa. |
title_fullStr |
Buruli ulcer treatment: Rate of surgical intervention differs highly between treatment centers in West Africa. |
title_full_unstemmed |
Buruli ulcer treatment: Rate of surgical intervention differs highly between treatment centers in West Africa. |
title_sort |
buruli ulcer treatment: rate of surgical intervention differs highly between treatment centers in west africa. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2019 |
url |
https://doi.org/10.1371/journal.pntd.0007866 https://doaj.org/article/e3c3a9ee257c44288126597e3476e4d5 |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
PLoS Neglected Tropical Diseases, Vol 13, Iss 10, p e0007866 (2019) |
op_relation |
https://doi.org/10.1371/journal.pntd.0007866 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0007866 https://doaj.org/article/e3c3a9ee257c44288126597e3476e4d5 |
op_doi |
https://doi.org/10.1371/journal.pntd.0007866 |
container_title |
PLOS Neglected Tropical Diseases |
container_volume |
13 |
container_issue |
10 |
container_start_page |
e0007866 |
_version_ |
1766346714134872064 |