[Multifocal forms of Buruli ulcer: clinical aspects and management difficulties in 11 cases]

A certain number of authors have in literature pointed out multifocal forms of Buruli ulcer but no study was ever dedicated to them. The purpose of this study is to be more specific about the clinical aspects and to show how difficult it is for those multifocal forms of Buruli ulcer to be operated on.

The 11 patients who were accepted for the study were subjected to an interrogation, a thorough clinical examination, research of BAAR in ulcers and operative pieces with a direct examination after Ziehl-Neelsen colouring. Each of these patients underwent a surgical treatment under general anaesthesia or spinal anaesthesia depending on the seat of the lesions under cover of pre and post operative therapy by antibiotics.

Initial lesions preferentially were located at limbs level; new foci appeared within an average period of 3 months, ranging from 1 to 15 months in some cases. All body parts could be the seats of secondary foci. Depending on the patients, the number of foci varied from 3 to 7. Furthermore, amputation has been necessary for the complete healing of four patients. The average operation was 2.4 by patient ranged from 2 to 5. We observed the healing of all the patients within an average hospitalisation time of 6.3 months running sometimes from 4 to 13 months. In addition to amputations, 4 patients presented after-effects as articular stiffness, retractions of the hand's dorsal face and knee's retraction.

Those multifocal forms can, with good reason, be considered as malignant form of Buruli ulcer.