Tropical ulcer, more commonly known as jungle rot, is a chronic ulcerative skin

lesion A lesion is any damage or abnormal change in the tissue of an organism, usually caused by disease or trauma. ''Lesion'' is derived from the Latin "injury". Lesions may occur in plants as well as animals. Types There is no designated classif ...

thought to be caused by polymicrobial infection with a variety of

microorganism A microorganism, or microbe,, ''mikros'', "small") and ''organism'' from the el, ὀργανισμός, ''organismós'', "organism"). It is usually written as a single word but is sometimes hyphenated (''micro-organism''), especially in olde ...

s, including

mycobacteria ''Mycobacterium'' is a genus of over 190 species in the phylum Actinomycetota, assigned its own family, Mycobacteriaceae. This genus includes pathogens known to cause serious diseases in mammals, including tuberculosis (''M. tuberculosis'') and ...

. It is common in tropical climates. Ulcers occur on exposed parts of the body, primarily on anterolateral aspect of the lower limbs and may erode

muscle Skeletal muscles (commonly referred to as muscles) are Organ (biology), organs of the vertebrate muscular system and typically are attached by tendons to bones of a skeleton. The muscle cells of skeletal muscles are much longer than in the other ...

s and

tendon A tendon or sinew is a tough, high-tensile-strength band of dense fibrous connective tissue that connects muscle to bone. It is able to transmit the mechanical forces of muscle contraction to the skeletal system without sacrificing its ability ...

s, and sometimes, the

bone A bone is a rigid organ that constitutes part of the skeleton in most vertebrate animals. Bones protect the various other organs of the body, produce red and white blood cells, store minerals, provide structure and support for the body, an ...

s.Medcyclopedia-Tropical ulcer These lesions may frequently develop on preexisting abrasions or sores sometimes beginning from a mere scratch.

Signs and symptoms

The vast majority of the tropical ulcers occur below the

knee In humans and other primates, the knee joins the thigh with the human leg, leg and consists of two joints: one between the femur and tibia (tibiofemoral joint), and one between the femur and patella (patellofemoral joint). It is the largest join ...

, usually around the

ankle The ankle, or the talocrural region, or the jumping bone (informal) is the area where the foot and the leg meet. The ankle includes three joints: the ankle joint proper or talocrural joint, the subtalar joint, and the inferior tibiofibular ...

. They may also occur on arms. They are often initiated by minor trauma, and subjects with poor nutrition are at higher risk. Once developed, the ulcer may become chronic and stable, but also it can run a destructive course with deep tissue invasion,

osteitis Osteitis is inflammation of bone. More specifically, it can refer to one of the following conditions: * Osteomyelitis, or ''infectious osteitis'', mainly ''bacterial osteitis'' * Alveolar osteitis or "dry socket" * Condensing osteitis (or Osteit ...

, and risk of

amputation Amputation is the removal of a limb by trauma, medical illness, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on ind ...

. Unlike

Buruli ulcer Buruli ulcer () is an infectious disease characterized by the development of painless open wounds. The disease is limited to certain areas of the world, most cases occurring in Sub-Saharan Africa and Australia. The first sign of infection is a s ...

, tropical ulcers are very painful. Lesions begin with inflammatory

papule A papule is a small, well-defined bump in the skin. It may have a rounded, pointed or flat top, and may have a dip. It can appear with a stalk, be thread-like or look warty. It can be soft or firm and its surface may be rough or smooth. Some ha ...

s that progress into vesicles and rupture with the formation of an

ulcer An ulcer is a discontinuity or break in a bodily membrane that impedes normal function of the affected organ. According to Robbins's pathology, "ulcer is the breach of the continuity of skin, epithelium or mucous membrane caused by sloughing o ...

. Chronic ulcers involve larger area and may eventually develop into squamous epithelioma after 10 years or more.

Complications

* Skin color: Rarely, Jungle rot will result in complications with skin pigmentation. It has been known to leave the victim with different colors such as bright red, blue, green, and a rare color change of orange. * Deep tissue invasion - Infection may spread deep to the subcutaneous tissue, but rarely involve the bone * Chronic ulceration - characterised by thick rim of fibrous tissue around the ulcer edges * Recurrent ulceration - most commonly in children *

Squamous cell carcinoma Squamous-cell carcinomas (SCCs), also known as epidermoid carcinomas, comprise a number of different types of cancer that begin in squamous cells. These cells form on the surface of the skin, on the lining of hollow organs in the body, and on th ...

- may develop at the rate of 2 to 15% of the chronic ulcers that persists for more than three years *

Tetanus Tetanus, also known as lockjaw, is a bacterial infection caused by '' Clostridium tetani'', and is characterized by muscle spasms. In the most common type, the spasms begin in the jaw and then progress to the rest of the body. Each spasm usuall ...

: by entry of tetanus bacilli through the ulcer.

Microbiology

There is now considerable evidence to suggest that this disease is an infection. ''

Mycobacterium ulcerans ''Mycobacterium ulcerans'' is a species of bacteria found in various aquatic environments. The bacteria can infect humans and some other animals, causing persistent open wounds called Buruli ulcer. ''M. ulcerans'' is closely related to ''Mycoba ...

'' has recently been isolated from lesions and is unique to tropical ulcers. Early lesions may be colonized or infected by, '' Bacillus fusiformis'' (Vincent's organism),

anaerobe An anaerobic organism or anaerobe is any organism that does not require molecular oxygen for growth. It may react negatively or even die if free oxygen is present. In contrast, an aerobic organism (aerobe) is an organism that requires an oxygena ...

s and

spirochaete A spirochaete () or spirochete is a member of the phylum Spirochaetota (), (synonym Spirochaetes) which contains distinctive diderm (double-membrane) gram-negative bacteria, most of which have long, helically coiled (corkscrew-shaped or ...

s. Later, tropical ulcer may become infected with a variety of organisms, notably,

staphylococci ''Staphylococcus'' is a genus of Gram-positive bacteria in the family Staphylococcaceae from the order Bacillales. Under the microscope, they appear spherical ( cocci), and form in grape-like clusters. ''Staphylococcus'' species are facultativ ...

and/or

streptococci ''Streptococcus'' is a genus of gram-positive ' (plural ) or spherical bacteria that belongs to the family Streptococcaceae, within the order Lactobacillales (lactic acid bacteria), in the phylum Bacillota. Cell division in streptococci ...

. The condition has been shown to be transmissible by inoculation of material from affected patients.

Prevention

Adequate footwear is important to prevent trauma. General good health and nutrition also reduce ulcer risk. Adequate and prompt cleansing and treatment of ankle and leg skin breaks is also important. Improving hygiene and nutrition may help to prevent tropical ulcers.

Treatment

Antibiotic An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting pathogenic bacteria, bacterial infections, and antibiotic medications are widely used in the therapy, ...

s: In early stages,

penicillin Penicillins (P, PCN or PEN) are a group of β-lactam antibiotics originally obtained from ''Penicillium'' moulds, principally '' P. chrysogenum'' and '' P. rubens''. Most penicillins in clinical use are synthesised by P. chrysogenum using ...

or metronidazole are used in combination with topical antiseptic. * Improved nutrition and vitamins. * Non-adherent dressings and elevation of limbs. * Large infected ulcers may require

debridement Debridement is the medical removal of dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue. Removal may be surgical, mechanical, chemical, autolytic (self-digestion), and by maggot therapy. ...

under

anesthesia Anesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prevention of pain), paralysis (muscle relaxation), a ...

. *

Skin grafting Skin grafting, a type of graft surgery, involves the transplantation of skin. The transplanted tissue is called a skin graft. Surgeons may use skin grafting to treat: * extensive wounding or trauma * burns * areas of extensive skin loss d ...

may be helpful in advanced cases to ensure the lesion does not progress to chronic stage. * In extreme cases,

is necessary.

Epidemiology

Tropical ulcer has been described as a disease of the 'poor and hungry'; it may be that slowly improving socioeconomic conditions and nutrition account for its decline. Urbanization of populations could be another factor, as a tropical ulcer is usually a rural problem. More widespread use of shoes and socks also provides protection from initiating trauma. Despite this, susceptible individuals still develop tropical ulcers. Sometimes outbreaks can occur; one was recorded in

Tanzania Tanzania (; ), officially the United Republic of Tanzania ( sw, Jamhuri ya Muungano wa Tanzania), is a country in East Africa within the African Great Lakes region. It borders Uganda to the north; Kenya to the northeast; Comoro Islands ...

in sugarcane workers cutting the crops while barefoot. Tropical ulcers can also occur to the visitors of tropics. The disease is most common in native laborers and in schoolchildren of the tropics and subtropics during the rainy season and is caused in many instances by the bites of insects, poor hygiene, and pyogenic infections. Males are more commonly infected than females.

Geographic distribution

Tropical ulcer is seen throughout the tropics and subtropics. In some of these countries, such as northern Papua New Guinea, it is the most common skin disease.

References

Sources

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External links

{{Bacterial cutaneous infections Infectious diseases Bacterial diseases Tropical diseases Bacterium-related cutaneous conditions