Etiology and incidence of chronic ulcers in Blantyre, Malawi.
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.
Zeegelaar
Jim E
JE
Department of Dermatology, Academic Medical Centre, Amsterdam, The Netherlands, and Department of Microbiology, College of Medicine, Blantyre, Malawi. j.e.zeegelaar@amc.uva.nl
Stroïnk
Aimee C
AC
Steketee
Willemyn H
WH
Faber
William R
WR
van der Wal
Allard C
AC
Komolafe
Isaac O O
IO
Dzamalala
Charles
C
Chibwana
Cecilia
C
Wendte
Johannes F
JF
Zijlstra
Eduard E
EE
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