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Nutritional status and wound healing in patients with Mycobacterium ulcerans disease (Buruli ulcer): a pilot study from rural Côte d’Ivoire Volume 32, issue 2, March-April 2022

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Authors
1 School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, 852-8523, Japan
2 National Buruli Ulcer Control Program, Abidjan, Côte d’Ivoire
3 Centre Suisse de Recherches Scientifiques, Abidjan, Côte d’Ivoire
4 Eco Epidemiology Unit, Pasteur Institute of Côte d’Ivoire, Abidjan, Côte d’Ivoire
5 Hope Commission International Inc., Abidjan, Côte d’Ivoire
6 Tulane School of Public Health & Tropical Medicine, New Orleans, Louisiana, 70112, USA
7 Department of Dermatology, National Center for Global Health and Medicine, Shinjuku, Tokyo, 162-8655, Japan
Reprints: Kazuko Ugai

Background

Buruli ulcer (BU) is a neglected tropical disease caused by Mycobacterium ulcerans which manifests as deep ulceration of the skin. Wounds from any cause heal slowly if individuals are malnourished.

Objectives

To assess the impact of nutritional status on wound healing, we carried out a nutritional assessment of 11 patients diagnosed with BU in rural Côte d’Ivoire, and followed them longitudinally through the wound healing process.

Materials & Methods

We conducted patient interviews to collect data on their socioeconomic characteristics, food intake and perception of nutrition. We then prospectively carried out clinical observations to assess their wound healing until complete healing or the end of the study period (median follow-up period: 19 weeks).

Results

The age of the patients ranged from 6 to 66 years (median: 24; interquartile range: 20.5-52). Nine patients had normal nutritional status, one had mild malnutrition and one had moderate malnutrition as assessed by their body mass index and/or mid-upper arm circumference. Three (60%) of the five patients with adequate caloric intake, but only 1/6 (17%) of the patients with an inadequate caloric intake achieved complete healing during follow-up. Low food intake from appetite loss primarily due to wound pain and odour was reported by seven patients after developing wounds.

Conclusion

Our study is the first of its kind, and the findings highlight the importance of integrating nutritional interventions into wound management protocols, and properly assessing and controlling wound pain in patients with BU.