Makindo Medical Notes

📖 About

• Tropical ulcer is a necrotising skin infection occurring in hot, humid climates.
• Fusobacterium species are almost always present, though other mixed anaerobes may contribute.
• Common in barefoot populations and in areas with poor hygiene or minor skin trauma.

🧬 Aetiology

• Initiated by minor trauma or insect bites → secondary infection with Fusobacteria and other anaerobes.
• Malnutrition and poor living conditions increase susceptibility.
• May coexist with spirochaetes or other tropical pathogens.

🩺 Clinical Features

• Intensely painful, rapidly enlarging shallow ulcer.
• Typically found on the lower limb (ankle, shin, foot).
• More common in children and young adults in tropical regions.
• If untreated → chronicity, deep tissue destruction, and risk of secondary osteomyelitis.

🔍 Differentials

• Cutaneous leishmaniasis.
• Atypical mycobacterial infection.
• Pyoderma gangrenosum.
• Venous or arterial leg ulcers.
• Yaws (Treponema pallidum pertenue).

🧪 Investigations

• Swabs and cultures from ulcer base and edges → bacterial identification.
• Biopsy if diagnosis uncertain (to exclude atypical infections or malignancy).
• Blood tests: FBC, CRP if systemic infection suspected.

💊 Management

• Antibiotics: Tetracycline and/or Metronidazole (targeting anaerobes).
• Local care: wound cleaning, dressings, and limb elevation.
• Surgical debridement to remove necrotic tissue.
• Skin grafting may be required in extensive cases.
• Nutritional support and public health interventions (footwear, hygiene) help prevention.

📚 References

• Cook GC, Zumla AI. Manson’s Tropical Diseases.
• WHO guidelines on neglected tropical skin diseases.
• NCBI StatPearls – Tropical Ulcer