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Thermotherapy effectively treats Buruli ulcer
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Local thermotherapy appeared to be a safe, effective and inexpensive treatment option for Buruli ulcer and could potentially be a home remedy for suspected lesions, according to recent findings.
“This is encouraging for regions with limited access to laboratory confirmation and where quality assurance, in particular of PCR in reference labs, remains a problem,” researchers wrote in Clinical Infectious Diseases.
In the phase 2, open-label clinical trial, the researchers evaluated 63 patients, including 53 with confirmed Buruli ulcer (BU), a necrotizing skin disease, who were treated at the Ayos District Hospital in Cameroon from February 2009 to November 2012. Sixty-two percent of patients with laboratory confirmed cases (n = 33) were designated as WHO category II, 19% were category 1 and 19% were category 3. The average lesion size was 45 cm2.
Participants underwent up to 8 weeks of heat treatment, consisting of heat applied to lesions through silicone bags filled with 800 g sodium acetate trihydrate. The primary endpoints were absence of BU features based on WHO guidelines or wound closure within 6 months of completing treatment (“primary cure”) and no recurrence of BU up to 23 months after treatment (“definite cure”). The secondary endpoints included withdrawal for low compliance, consent withdrawal and adverse events. After clinical BU features resolved, patients were followed monthly until wound closure; all patients were followed at months 6, 12, and 24.
A primary cure rate of 92.4% (95% CI, 81.8%-98%) was achieved within 6 months, according to researchers. Fifteen patients achieved wound closure within 1 month of treatment conclusion, five patients met the endpoint within 2 months, 15 patients within 4 months, and 6 patients within 6 months.
Of the 49 patients with cured primary lesions, 36 continued to be free of new lesions for 24 months (83.7%; 95% CI, 70.3-92.7%). Thirteen patients developed new lesions; five of these patients later healed. Treatment failure occurred in eight patients who later received WHO-recommended chemotherapy. In the 10 unconfirmed cases, all lesions healed with heat treatment.
Overall, the treatment was well-tolerated. Adverse events related to therapy included mild, local skin reactions at the treatment site.
“Thermotherapy should be considered an alternative to chemotherapy as primary treatment for BU across all age classes for several reasons: it is highly effective, is easy to apply, cheap, well tolerated, free of relevant side effects, has nonspecific positive effects on wound healing and does not compromise wound healing in non-BU lesions in cases of misclassification,” the researchers wrote. “This is an undebatable advantage in settings where treatment decisions need to rely primarily on clinical diagnosis.” – by Jen Byrne
Disclosure: The researchers report no relevant financial disclosures.
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