Tropical ulcer L98.44

Probably a special form of ecthyma. The chronic infectious disease occurs mainly in tropical regions among troops or among workers in plantations.

Local trivial injury, probably mixed infection with streptococci, staphylococci, also Gram-negative germs in general malnutrition and weakening of the immune system.

Fusoborreliosis is also being discussed.

Especially adults in tropical, warm and humid areas. The Ulcus tropicum is endemic in the Apsokok nomads in Papua New Guinea (Prescott TAK et al. (2017). Rarely occurring in children.

Formation of single or multiple, rapidly bursting blisters with necrotic bladder base. Ecthyma-like aspect. Spread of necrosis to subcutis, fascia, muscles and periosteum. Scarred healing with hyperpigmented rim, possibly severe contractures that make amputations necessary.

Notice! If the ulcer does not heal under penicillin or metronidazole, cutaneous leishmaniasis or tuberculosis must be considered!

Depending on the severity, systemic antibiosis, e.g. with benzylpenicillin (e.g. penicillin Grünenthal) once/day 5 million IU i.v. or penicillin V (e.g. megacillin) 3 times/day 1 million IU p.o.

Alterrnatively: broad-spectrum antibiotics such as tetracyclines, erythromycin, cephalosproins, ciprofloxacin.

Alternative: Metronidazole (e.g. Clont) 2-3 times/day 400 mg p.o.

1. Adriaans B et al (1989) Cytotoxicity of Fusobacterums ulcerans. J Med Microbiol 29: 177-180
2. Adriaans B et al (1987) The infectious aetiology of tropical ulcer - a study of the role of anaerobic bacteria. Br J Dermatol 116: 31-37
3. MacDonald P (2003) Tropical ulcers: a condition still hidden from the western world. J Wound Care 12: 85-90
4. Morris GE et al (1989) The diagnosis and management of tropical ulcer in east Sepik Province of Papua New Guinea. J Trop Med Hyg 92: 15-20
5. Prescott TAK et al (2017) Tropical ulcer plant treatments used by Papua New Guinea's Apsokok nomads.
   J Ethnopharmacol 205:240-245.