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제목 |
Microbiological studies of plantar ulcers in leprosy patient |
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저자 |
Woe Jong Sohn, Tae Kyung Choi, Joon Lew |
소속 |
Dept. of Microbiology, Yonsei University College of Medicine, Seoul, Korea |
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년도 |
1975 |
권 |
9 |
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호 |
1 |
번호 |
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시작페이지 |
17 |
끝페이지 |
35 |
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첨부 |
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요약 |
Chronic ulcers which develop on the sole of the feet or the lower legs constitute one
of the most common complications in leprosy patients. Medical professions and
paramedical personnels, whether directly involved in the treatment of leprosy cases or
not, have become familiar with this troublesome and distressing complication. At the
same time it has been a general experience that violent infection, general sepsis and
tetanus resulting from the chronic ulcers are extremely rare in spite of long persistence
and intractability of the ulcers.
In 1959, Price first introduced the term “plantar ulcer” and defined it as a chronic
ulceration of the anesthetic sole of the foot, situated in well-defined areas overlaying a
bony prominence, resistant to local or systemic therapy and characterized by a marked
tendency to recurrence. Price’s definition (1959a) of plantar ulcers was the result of
careful empiric studies. In recent years, application of the knowledge gained in the
diseases vita neural damage, and careful studios of the static and dynamic forces in the
normal and diseased foot have resulted in great advances in our understanding of the
etiology and natural history of plantar ulcers in leprosy(Price, 1959a; 1959b; 1959c; 1960a;
1960b; 1961; 1962; 1963; 1964a: 1964b, ; Anderson, 1961: Ross, 1962; Anderson, 1964)
Although the incidence of plantar ulecrs among leprosy patients shows some variation
with differences in the locality, country and the investigator, it is generally accepted that
a considerable fraction of leprosy patients suffers from such chronic ulcers. Price (1964a)
observed plyntar ulcers in ratios varying from 6 to 16 per 100 feet in leprosy patients
under treatment. Furthermore, Price’s observation in Nigeria indicated that incidence of
plantar ulcers in leprosy patients was 8 to 12 times grealer than the incidence in case
of foot drop which resulted from other causes than leprosy, and 20 to 40 times greater
the incidence of plantar ulcers in the patients with Charcot’s progressive neuropathic
muscular atrophy.
In spite of the fact that following the development of plantar ulcers microbial invaders
from the unclean surrounding environment have free access of the lesions and there is
likelihood that sooner or later the ulcers should become infected. surprisingly the
occurrence of violent secondary infections of such ulcers is rather rare and so far no
satisfactory explanation has been put forward for such an unusual host-parasite
relationship.
The rarity of pyogenic infections of plantar ulcers might be a possible explanation for
the low occurrence of generalized secondary infections in leprosy. Anderson (1961)
pointed out that the relative absence of infection in these open ulcer lesions exposed to
dust and dirt was remarkable and that it might be taken as a negative proof of the
traumatic origin of plantar ulceration in leprosy patients.
In the past only a few reports have been made on the microbiological study of plantar
ulcers in leprosy patients. Murata (1912) observed a remarkable effect with
antistreptococcal serum therapy for patients with streptococcal infections of the ulcers, of
which precise location was not indicated. Bashima (1943) carried out mouse toxicity
tests with staphylococci isolated from “leprous” ulcer. Later, Kojima (1953) introduced
the term “perforating ulcer” in reference the deep penetrating leprous ulcers and found
Mycobacterium leprae present in the lesions accompanied by sequestered formation of
bone. Price (1964a, b) reported that the extent of secondary infections of plantar ulcers
with pyogenic organisms could influence the duration of ulcer healing. Recently,
Goodwin and Wood (1970) conducted a bacteriological study of plantar ulcers of
Ethiopian leprosy patients and showed that the range of pathogens isolated was what
would be expected from infected wounds.
In attempts to elucidate the natural history of secondary infections of plantar ulcers in
leprosy patients and to provide possible explanations about the rarity of such secondary
infection of plantar ulcers in leprosy patients in the absence of chemotherapeutic drugs,
studies were made with plantar ulcers in leprose patients on 1) identification and
characterization of microbial infections in the ulcer lesions, 2) effects of wide use of
chemotherapeutic agents, particularly of antibiotics on the microbial organisms in the
ulcers of leprosy patients who had been under prolonged medication with sulfone drugs
such as DDS, 3) histopathological and biochemical characteristics of the ulcer lesion, and
4) possible toxic effect of the ulcer tissues on the microbial organisms. |
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