Page 116 - 2020 JSOM Winter

surgical equipment and meticulous postoperative care; there-
fore, these logistical requirements must be considered in aus-
tere environments. 15

Rehabilitation Considerations
The patient’s guardian indicated that the patient was totally
dependent for community-level ambulation and that in the
home, he would scoot to move from one area to another. His FIGURE 4
social interactions with family and friends were restricted to Patient learning
inside the home or sitting nearby as they played outside. Ini- to use his new
tial physical therapy guidance was provided to help improve wheelchair.
passive and active range of motion in the right upper and bilat-
eral lower extremities, with particular attention to the shoul-
der, elbow, and knees (Figure 3). He was to repeat this 3–4
times per day, each day. Shoulder and elbow exercises were
recommended supine and then seated. After a follow-up exam-
ination showed no improvement, the exercises were again dis-
cussed and emphasized, but the medical team began to discuss
additional options. The patient was unable to tolerate quality
home exercises due to pain from the severity of his contrac-
tures. The level of comprehensive rehabilitation therapy re- References
quired to restore optimal functionality was inaccessible as a 1. Yotsu RR, Suzuki K, Simmonds RE, et al. Buruli ulcer: a review of
the current knowledge. Curr Trop Med Rep. 2018;5(4):247–256.
result of the poor medical infrastructure in the patient’s home 2. Marsollier L, Robert R, Aubry J, et al. Aquatic insects as a vector
country. A wheelchair was secured to promote independence for Mycobacterium ulcerans. Appl Environ Microbiol. 2002;68
and social engagement with his peers as a more suitable long- (9):4623–4628.
term solution to his mobility deficits (Figure 4). His long-term 3. Guarner J. Buruli ulcer: review of a neglected skin mycobacterial
mobility prognosis was similar to that of a patient with lower disease. J Clin Microbiol. 2018;56(4):e01507-17.
extremity paraplegia. Our team presented him with a wheel- 4. Alferink M, de Zeeuw J, Sopoh G, et al. Pain associated with
chair at the 8-week rehabilitation follow-up. Wheelchair oper- wound care treatment among Buruli ulcer patients from Ghana
and Benin. PLoS ONE. 2015;10(6):e0119926.
ation, safety, and its role in community ambulation and social 5. de Zeeuw J, Alferink M, Barogui YT, et al. Assessment and treat-
engagement were reiterated to his family. His community-level ment of pain during treatment of Buruli ulcer. PLoS Negl Trop
mobility improved to modified independent, and he was now Dis. 2015;9(9):e0004076.
able to socialize with his family and friends directly. 6. Velink A, Woolley RJ, Phillips RO, et al. Former Buruli ulcer pa-
tients’ experiences and wishes may serve as a guide to further
improve Buruli ulcer management. PLoS Negl Trop Dis. 2016;10
FIGURE 3 Patient prone attempting to extend both knees, with (12):e0005261.
lesions dressed and wrapped.
7. 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(5):1011–1015.
8. O’Brien DP, Globan M, Fyfe JM, et al. Diagnosis of Mycobacte-
rium ulcerans disease: be alert to the possibility of negative initial
PCR results. Med J Aust. 2019;210(9):416.
9. Schunk M, Thompson W, Klutse E, et al. Outcome of patients
with Buruli ulcer after surgical treatment with or without anti-
mycobacterial treatment in Ghana. Am J Trop Med Hyg. 2009;
81:75–81.
10. Barogui Y, Johnson RC, van der Werf TS, et al. Functional lim-
itations after surgical or antibiotic treatment for Buruli ulcer in
Benin. Am J Trop Med Hyg. 2009;81(1):82–87.
11. Pak J, O’Brien DP, Quek T, Athan E. Treatment costs of Myco-
bacterium ulcerans in the antibiotic era. Int Health. 2012;4(2):
123–127.
12. Stienstra Y, Dijkstra PU, Guédénon A, et al. Development of a
questionnaire assessing Buruli ulcer-induced functional limita-
Conclusion tion. Am J Trop Med Hyg. 2004;70(3):318–322.
13. Beeres DT, Horstman J, van der Tak P, et al. The paediatric
As medical elements support Special Operations Forces (SOF) participation scale measuring participation restrictions among
in increasingly austere settings, the likelihood of encountering former Buruli Ulcer patients under the age of 15 in Ghana and
unusual infectious diseases such as Buruli ulcers increases. In Benin: development and first validation results. PLoS Negl Trop
many instances, SOF medics may be the most advanced medi- Dis. 2019;13(3):e0007273.
cal capability in the area and, depending on the mission, may 14. Effah A, Ersser SJ, Hemingway A. Support needs of people living
be presented with patients from the local populace seeking with Mycobacterium ulcerans (Buruli ulcer) disease in a Ghana
treatment. Through electronic teleconsultation, a definitive rural community: a grounded theory study. Int J Dermatol. 2017;
56(12):1432–1437.
multidisciplinary plan can be implemented. Optimized man- 15. Adu E, Ampadu E, Acheampong D. Surgical management of
agement decreases morbidity and improves quality of life and Buruli ulcer disease: a four-year experience from four endemic
functionality, even in the resource-limited austere setting. districts in Ghana. Ghana Med J. 2011;45(1):4–9.

114 | JSOM Volume 20, Edition 4 / Winter 2020