title: Etiology and incidence of chronic ulcers in Blantyre, Malawi.
abstract: BACKGROUND
  Little information is available on the incidence and etiology of chronic ulcers in the tropics. Therefore, the incidence and etiology of chronic skin ulcers were assessed in out-patients at the Department of Dermatology and in in-patients at the Departments of Dermatology, Surgery, Medicine, and Pediatrics, Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi.
  
  
  METHODS
  In a 10-week study period, 44 patients (31 males, 70%) with chronic skin ulcers were diagnosed from 6292 patients seen by the departments involved.
  
  
  RESULTS
  The mean age of patients with ulcers was 38 years (range, 9 months to 82 years). The most frequent cause of ulcers was bacterial infection (n=22), followed by malignancy (n=11) and trauma (n=7).
  
  
  CONCLUSIONS
  In contrast with developed countries, venous and diabetic ulcers were uncommon. In addition to bacterial infections, a surprisingly large number of malignancies were found in this study. We speculate that human immunodeficiency virus (HIV) infection, which is seen with a high prevalence at QECH, is a contributing factor. Because of the large number of malignancies, we recommend early histopathologic investigation of chronic ulcers in this part of Africa.
authors.affiliation: Department of Dermatology, Academic Medical Centre, Amsterdam, The Netherlands, and Department of Microbiology, College of Medicine, Blantyre, Malawi. j.e.zeegelaar@amc.uva.nl
authors.forename: Jim E
authors.initials: JE
authors.lastname: Zeegelaar
authors.forename: Aimee C
authors.initials: AC
authors.lastname: Stroïnk
authors.forename: Willemyn H
authors.initials: WH
authors.lastname: Steketee
authors.forename: William R
authors.initials: WR
authors.lastname: Faber
authors.forename: Allard C
authors.initials: AC
authors.lastname: van der Wal
authors.forename: Isaac O O
authors.initials: IO
authors.lastname: Komolafe
authors.forename: Charles
authors.initials: C
authors.lastname: Dzamalala
authors.forename: Cecilia
authors.initials: C
authors.lastname: Chibwana
authors.forename: Johannes F
authors.initials: JF
authors.lastname: Wendte
authors.forename: Eduard E
authors.initials: EE
authors.lastname: Zijlstra
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011711:Pyoderma / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D017192:Skin Diseases, Bacterial / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D012883:Skin Ulcer / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology* / Q000382:microbiology