Buruli Ulcer treatment; more than wound healing alone?

Loth, S. (Susanne) (2013) Buruli Ulcer treatment; more than wound healing alone? thesis, Medicine.

Text LothS.pdf Restricted to Registered users only Download (1MB)

Abstract

Buruli Ulcer (BU) is an infectious, necrotizing, skin disease caused by Mycobacterium ulcerans. The prevalence of BU is highest in West-Africa. At the moment the standard treatment for BU is eight weeks of streptomycin and rifampicin, wound care, and, when necessary, surgery. Clinical observations suggest that during treatment patients are in pain, and that they experience problems like stigma, disabilities, and various side effects. For this reason the aim of this study was to provide a better view of three different aspects of the treatment; pain, Quality of Life and toxicity. The aspect of pain was assessed in three ways; by examining the current prescribing behaviour, by interviewing health workers, by pain measurements in BU patients. Current prescribing behaviour was determined by reviewing 40 patient files of patient with BU admitted to the Agogo Presbyterian Hospital in the period January 2008 - December 2012. For 32 patients ten different pain medications had been prescribed 169 times, of which diclofenac was prescribed most often (34.9%). In 39.6% of the cases that pain medication was prescribed the indication was missing. In cases that the indications were known, wound debridement or excision was noted most frequently (15.4%). Additionally, seven health workers who were actively involved in the treatment of BU participated in a semi-structured interview on BU treatment and pain experienced by the patients. All the health workers stated that pain medication was given depending on the severity of the pain, but that the main restrictions for prescribing pain medication according to the health workers are shortage of financial means and doubts about the safety of the drugs or their side-effects. Pain measurements with pain rating scales were done for three patients of ages five and seven years who received regular wound treatment for their BU infection at Agogo Presbyterian Hospital. One out of three patients reported severe pain. For the assessment of Quality of Life 70 former BU patients from the BURULICO trial, and 82 healthy controls were interviewed using the WHOQOL-BREF questionnaire. Former patients scored a higher Quality of Life than the healthy controls in all the domains, but this difference is only significant (p<0.01) in the domains of Physical health and Environment. To measure toxicity of the treatment 127 former BU patients older than four years, and who had participated in the BURULICO trial and had scars less than 10 cm, were included. Blood was taken and audiometry was done. In adults (≥16 years) the treatment arm of SR8 has a significant (p<0.05) higher serum creatinine concentration than the SR4/CR4 treatment arm after eight weeks of treatment. At follow-up there is still a difference but this is not significant any more. For children under 16 years old there is no significant difference in serum creatinine between the two groups at all measure moments. The hearing levels of adult patients from the SR8 treatment arm are significantly (p<-.05) lower for all measured frequencies compared to the SR4/CR4 treatment arm, especially the highest frequencies (6000 Hz and 8000 Hz with p<0.01). The outcomes of both treatment arms are within the speech area. For children no significant difference was found between the two treatment groups at any frequency, with the outcomes of the measurements of both treatment arms within the speech area. In conclusion pain is an important aspect during the treatment of BU, as is mentioned by patients and health workers and recorded in patient files. There is need for standardized protocols for pain assessment and prescription of pain medication during the treatment of BU. The Quality of Life for patients with small lesions (≤ 10cm) seems to be high at follow-up, which gives a good prospective for the future. Quality of Life should, however, still be assessed in patients with bigger lesions (> 10cm). Besides that long term effects of the treatment are lower when 4 weeks streptomycin and rifampicin followed by 4 weeks clarithromycin and rifampicin is used instead of the current standard of 8 weeks streptomycin and rifampicin. In other words there is a lot more to BU treatment than only the wound healing and there is room for improvement of the treatment of BU, but there is still need for more research on all the aspects of the treatment.

Item Type:	Thesis (Thesis)
Supervisor name:	Stienstra, Y. MD
Supervisor name:	Abass, Mr. K.M. and Thomson, Dr. W.N.A. and Agogo Presbyterian Hospital and Ashanti-Akyem, Ghana
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:06
Last Modified:	25 Jun 2020 11:06
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2557

Actions (login required)

View Item