Skip to main content
SpringerLink
Log in

Nutritional status and wound healing in patients with Mycobacterium ulcerans disease (Buruli ulcer): a pilot study from rural Côte d’Ivoire

  • Clinical Report
  • Published:
European Journal of Dermatology

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Mitjà O, Marks M, Bertran L, et al. Integrated control and management of neglected tropical skin diseases. PLoS Negl Trop Dis 2017; 11: 1–13.

    Article  Google Scholar 

  2. Yotsu RR, Suzuki K, Simmonds RE, et al. Buruli Ulcer: a review of the current knowledge. Curr Trop Med Rep 2018; 5: 247–56.

    Article  Google Scholar 

  3. World Health Organization (WHO). Number of new reported cases of Buruli ulcer. WHO, 2021. Available at: https://www.who.int/data/gho/data/indicators/indicator-details/GHO/number-of-new-reported-cases-of-buruli-ulcer.(accessed on 29/04/2021).

  4. Yotsu RR, Murase C, Sugawara M, et al. Revisiting buruli ulcer. J Dermatol 2015; 42: 1033–41.

    Article  Google Scholar 

  5. WHO. Wound and lymphoedema management. Geneva, Switzerland: WHO, 2010.

    Google Scholar 

  6. Barchitta M, Maugeri A, Favara G, et al. Nutrition and wound healing: an overview focusing on the beneficial effects of curcumin. Int J Mol Sci 2019; 20(5): 1119.

    Article  CAS  Google Scholar 

  7. Black RE, Victora CG, Walker SP, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 2013; 382: 427–51.

    Article  Google Scholar 

  8. UNICEF. Malnutrition in children — UNICEF DATA. UNICEF, 2021. Available at: https://data.unicef.org/topic/nutrition/malnutrition/ (accessed on 10/10/2020).

  9. NCD Risk Factor Collaboration. Country Profile. Available at: https://ncdrisc.org/country-profile.html (accessed on 19/06/2021).

  10. WHO. The global health observatory, Côte d’Ivoire. Available at: https://www.who.int/data/gho/data/countries/country-details/GHO/côte-d-ivoire?countryProfileId=b776120c-2843-4429-b454-67ec1b23b887 (accessed 13/10/2020).

  11. National Institute of Statistics (INS) ICF International. Demographic and health survey and multiple indicators of Côte d’Ivoire 2011–2012. Calverton, Maryland, USA: INS and ICF International, 2012.

    Google Scholar 

  12. WHO. Physical status: the use and interpretation of anthropometry. Geneva, Switzerland: WHO, 1995.

    Google Scholar 

  13. Benítez Brito N, Suárez Llanos JP, Fuentes Ferrer M, et al. Relationship between mid-upper arm circumference and body mass index in inpatients. PLoS One 2016; 11: e0160480.

    Article  Google Scholar 

  14. WHO. Management of severe malnutrition: a manual for physicians and other senior health workers. Geneva, Switzerland: WHO, 1999.

    Google Scholar 

  15. Lazarus M, Moses N, Martha M, et al. A growth reference for mid upper arm circumference for age among school age children and adolescents, and validation for mortality: growth curve construction and longitudinal cohort study. BMJ 2017; 358: j3423.

    Google Scholar 

  16. The Food and Nutrition Technical Assistance III Project (FANTA). Global MUAC cutoffs for adults: a technical consultation. Glob MUAC cutoffs adults A Tech Consult. FANTA, 2018. Available at: https://www.fantaproject.org/sites/default/files/resources/FANTA-MUAC-Cutoffs-Consultation-Jun2018.pdf (accessed on 10/05/2020).

  17. National Cancer Institute. 24-hour dietary recall (24HR) at a glance ∣ dietary assessment primer. Available at: https://dietassessmentprimer.cancer.gov/profiles/recall/ (accessed on 31/10/2020).

  18. Harris JA, Benedict FG. Recently Ingested. Nutr Lab Stn Exp Evol Carneige Inst Washingt 1918: 370–3.

  19. National Research Council. Recommended dietary allowances, tenth edition. Washington, DC, USA: The National Academies Press, 1989.

    Google Scholar 

  20. Flanagan M. Improving accuracy of wound measurement in clinical practice. Ostomy Wound Manage 2003; 49(10): 28–40.

    PubMed  Google Scholar 

  21. Oe M, Yotsu RR, Arisandi D, et al. Validity of DMIST for monitoring healing of diabetic foot ulcers. Wound Repair Regen 2020; 28: 539–46.

    Article  Google Scholar 

  22. Haefeli M, Elfering A. Pain assessment. Eur Spine J 2006; 15: 17–24.

    Article  Google Scholar 

  23. Boog B. Qualitative research practice. J Soc Interv Theory Pract 2005; 14: 47.

    Article  Google Scholar 

  24. WHO. Ending the neglect to attain the Sustainable Development Goals: a road map for neglected tropical diseases 2021–2030. WHO, 2021. Available at: https://www.who.int/publications/i/item/9789240010352 (accessed on 23/02/2021).

  25. Collins N. Calculating your patients’ caloric needs wound management & prevention. World Management and Prevention. 2009. Available at: https://www.o-wm.com/article/nutrition-411-calculating-your-patients-caloric-needs (accessed 23/03/2021).

  26. Dorner B, Posthauer ME, Thomas D. The role of nutrition in pressure ulcer prevention and treatment. Adv Skin Wound Care 2009; 22: 212–21.

    Article  Google Scholar 

  27. Thompson C, Fuhrman MP. Nutrients and wound healing: still searching for the magic bullet. Nutr Clin Pract 2005; 20: 331–47.

    Article  Google Scholar 

  28. Wright JA, Richards T, Srai SKS. The role of iron in the skin and cutaneous wound healing. Front Pharmacol 2014; 5: 1–8.

    Article  CAS  Google Scholar 

  29. Quain AM, Khardori NM. Nutrition in wound care management: a comprehensive overview. Wounds 2015; 27(12): 327–35.

    PubMed  Google Scholar 

  30. Stechmiller J. Wound healing. In: Mueller CM, editor. A.S.P.E.N. Adult Nutrition Support Core Curriculum. Silver Spring, MD: American Society for Parenteral and Enteral Nutrition, 2012.

    Google Scholar 

  31. Doughty DB, Sparks-DeFriese B. Wound-healing physiology. In: Bryant RAND, editor. Acute and chronic wounds: current management concepts. St. Louis, MO: Elsevier, 2012.

    Google Scholar 

  32. Food Standards Agency (FSA). FSA nutrient and food based guidelines for UK institutions. FSA, 2007 Available at: http://www.food.gov.uk/sites/default/files/multimedia/pdfs/nutrientinstitution.pdf.(accessed on 01/03/2021).

  33. Tanaka H, Molnar J. Vitamin C and wound healing. In: Molnar J, editor. Nutrition and wound healing. Boca Raton, FL: CRC Press, 2007.

    Google Scholar 

  34. Momen-Heravi M, Barahimi E, Razzaghi R, et al. The effects of zinc supplementation on wound healing and metabolic status in patients with diabetic foot ulcer: A randomized, double-blind, placebo-controlled trial. Wound Repair Regen 2017; 25: 512–20.

    Article  Google Scholar 

  35. Kogan S, Sood A, Granick MS. Zinc and wound healing: a review of zinc physiology and clinical applications. Wounds 2017; 29: 102–6.

    PubMed  Google Scholar 

  36. Zhang Z, Pereira SL, Luo M, et al. Evaluation of blood biomarkers associated with risk of malnutrition in older adults: a systematic review and meta-analysis. Nutrients 2017; 9: 829.

    Article  Google Scholar 

  37. Marcos A, Nova E, Montero A. Changes in the immune system are conditioned by nutrition. Eur J Clin Nutr 2003; 57: S66–9.

    Article  CAS  Google Scholar 

  38. Russell L. The importance of patients’ nutritional status in wound healing. Br J Nurs 2001; 10: S44–9.

    Article  Google Scholar 

  39. Breslow RA, Hallfrisch J, Guy DG, et al. The importance of dietary protein in healing pressure ulcers. J Am Geriatr Soc 1993; 41: 357–62.

    Article  CAS  Google Scholar 

  40. Addison NO, Pfau S, Koka E, et al. Assessing and managing wounds of Buruli ulcer patients at the primary and secondary health care levels in Ghana. PLoS Negl Trop Dis 2017; 11: 1–20.

    Article  Google Scholar 

  41. Marion E, Song OR, Christophe T, et al. Mycobacterial toxin induces analgesia in Buruli ulcer by targeting the angiotensin pathways. Cell 2014; 157: 1565–76.

    Article  CAS  Google Scholar 

  42. Alferink M, De Zeeuw J, Sopoh G, et al. Pain associated with wound care treatment among Buruli ulcer patients from Ghana and Benin. PLoS One 2015; 10: 1–13.

    Article  Google Scholar 

  43. Woolley RJ, Velink A, Phillips RO, et al. Experiences of pain and expectations for its treatment among former buruli ulcer patients. Am J Trop Med Hyg 2016; 95: 1011–5.

    Article  Google Scholar 

  44. de Zeeuw J, Alferink M, Barogui YT, et al. Assessment and treatment of pain during treatment of buruli ulcer. PLoS Negl Trop Dis 2015; 9: 1–10.

    Article  Google Scholar 

  45. Sheehan P, Jones P, Caselli A, Giurini JM, Veves A. Percent change in wound area of diabetic foot ulcers over a 4-week period is a robust predictor of complete healing in a 12-week prospective trial. Diabetes Care 2003; 26: 1879–82.

    Article  Google Scholar 

  46. van Rijswijk L, Polansky M. Predictors of time to healing deep pressure ulcers. Ostomy Wound Manage 1994; 40: 40–2.

    CAS  PubMed  Google Scholar 

  47. Eddyani M, Sopoh GE, Ayelo G, et al. Diagnostic accuracy of clinical and microbiological signs in patients with skin lesions resembling buruli ulcer in an endemic region. Clin Infect Dis 2018; 67: 827–34.

    Article  Google Scholar 

Download references

Acknowledgments

We sincerely thank the nurses and staff at the four Primary Health Centres in Oumé Health District of Côte d’Ivoire for their contributions to our study. Furthermore, we are grateful to all the participants of this study. This research was funded by the International Collaborative Research Program for Tackling NTDs (Neglected Tropical Diseases) and Challenges in African countries by the Japan Agency for Medical Research and Development (AMED), Japan (https://www.amed.go.jp/en/), grant number: 21jm0510004h0204.

Author information

Authors and Affiliations

  1. School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, 852-8523, Japan

    Kazuko Ugai & Rie R. Yotsu

  2. National Buruli Ulcer Control Program, Abidjan, Côte d’Ivoire

    Didier Y. Koffi

  3. Centre Suisse de Recherches Scientifiques, Abidjan, Côte d’Ivoire

    Didier Y. Koffi

  4. Eco Epidemiology Unit, Pasteur Institute of Côte d’Ivoire, Abidjan, Côte d’Ivoire

    Kouamé Kouadio

  5. Hope Commission International Inc., Abidjan, Côte d’Ivoire

    Aubin Yao

  6. Tulane School of Public Health & Tropical Medicine, New Orleans, Louisiana, 70112, USA

    Rie R. Yotsu

  7. Department of Dermatology, National Center for Global Health and Medicine, Shinjuku, Tokyo, 162-8655, Japan

    Rie R. Yotsu

Authors
  1. Kazuko Ugai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Didier Y. Koffi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kouamé Kouadio
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Aubin Yao
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rie R. Yotsu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kazuko Ugai.

Additional information

Conflicts of interest

The authors declare no conflicts of interest. The funders had no role in the design of the study; in the collection, analysis, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Supplementary data

40699_2022_4225_MOESM1_ESM.pdf

Nutritional status and wound healing in patients with Mycobacterium ulcerans disease (Buruli ulcer): a pilot study from rural Côte d’Ivoire

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ugai, K., Koffi, D.Y., Kouadio, K. et al. Nutritional status and wound healing in patients with Mycobacterium ulcerans disease (Buruli ulcer): a pilot study from rural Côte d’Ivoire. Eur J Dermatol 32, 227–236 (2022). https://doi.org/10.1684/ejd.2022.4225

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1684/ejd.2022.4225

Key words

Search

Navigation