Tropical ulcers and mycotic infections in the tropics

Abstract

The prevalence of diseases in any environment often reflects the interplay of climate, customs, and racial and nutritional factors of that community. Even so, it is now necessary to establish a clearer understanding and a unified management approach for such exotic lesions as tropical ulcers and deep mycotic infections in this era of increasing international travel. Over a 10-year period (June 1979 to May 1989), we reviewed the cases of “phagedenic” tropical ulcers and deep mycotic infections of surgical relevance in children admitted to the University of Nigeria Teaching Hospital, Enugu, Nigeria, a tertiary health care center. “Phagedenic” tropical ulcers accounted for 126 cases (0.35%), mycetoma (“Madura foot”) for 18 (0.05%), phycomycosis for 108 (0.3%), and African histoplasmosis for 27 (0.08%) of the 36,000 admissions in the Pediatric Department during the 10-year period. Early recognition of these clinical entities arises from an intense suspicion in children in the tropics with any ulcers, swellings, nodules, papules, abscesses, or sinuses. Also, there is need for a novel or at least improved modality of drug treatment, especially for the deep mycotic infections. Finally, intense collaboration between the front-line physician (in the rural areas) and a bacteriologist cum mycologist, pathologist, radiologist, and surgeon is clearly necessary for early specific diagnosis and appropriate treatment in these challenging lesions.