Localized Treatment of Chronic Buruli Ulcer with Hyperoil™: An Unexpected Outcome

Case Report

Austin J Clin Case Rep. 2014;1(7): 1035.

Localized Treatment of Chronic Buruli Ulcer with Hyperoil™: An Unexpected Outcome

Iabichella ML1,4*, Topolinska M2, Amaku Anzako C2, Pediliggieri C1,4, Izzo A3, Bertolotti A3 and Lugli M4

1Helios Med Onlus, Italy

2Ariwara Hospital, Central Africa

3Inter Med Onlus, Italy

4Department of Cardiovascular, Deep Venous Surgery and Tissue Repair International Centre, Italy

*Corresponding author: Iabichella ML, Helios Med Onlus, International Health Organization, 97016 Pozzallo (RG), Italy

Received: July 10, 2014; Accepted: Aug 05, 2014; Published: Aug 08, 2014


The successful sustained outcome of this patient with chronic Buruli Ulcer treated with Hyperoil™, suggests its use for local treatment of infected ulcers with bone exposition. Hyperoil™ use could be particularly effective in endemic areas, far from specialized centers, where African populations living in poor rural areas are more difficult to be treated.

Keywords: Chronic Buruli ulcer; Buruli ulcer local treatment; Osteomyelitis; Infected utaneous ulcer


Buruli Ulcer (BU) is an extensive tissue necrosis resulting from an initial skin infection caused by a diffusible lipid toxin (mycolactone) produced by Mycobacterium ulcerans, a bacterium prevalent in humid, rural tropical areas. Several thousand people are infected each year, especially in tropical Africa, where BUs are often a source of major disability, especially linked with super-infections [1]. As little is known about disease transmission, prevention is difficult. Furthermore, even if several studies are in progress, to date, there is no vaccine[1]. A combination of oral rifampicin and injectable streptomycin is the treatment recommended by World Health Organization [2,3], in early, limited disease [4], but in a few cases in the deep and remote lands, because of the lack medicines, it is not possible use antibiotics [5]. As not all patients with M. ulcerans infection have BU, the synergistic anti-mycobacterial action of antibiotics and immune defense mechanisms may be required to treat the infection efficiently [6]. The differential diagnosis of BU due to M. ulcerans, based on clinical and epidemiologic basis only, is difficult [3],, so the BU diagnosis needs to be confirmed by IS2404 polymerase chain reaction (PCR) [7].

Surgical treatment and functional rehabilitation are often necessary but their use and the best time for surgery for large BUs needs clarification3. High relapse rates [8], prohibitive cost and limited access to surgery in endemic areas in Africa (far from National reference centers for BU treatment) led to search new therapeutic options being easily used by local health care providers in these poorly assisted areas. Some BUs can become chronic as not fully recovered because of inappropriate treatment, or even using reference treatments, that led to infection [9].

Members of the no-profit organization Helios Med periodically go to Ariwara (Congo Democratic Republic, Africa), for training missions to local health care providers working in the surgical clinic. Chronic BU is an endemic pathology in Congo DR, especially in younger population of the most isolated zones. The presence of M. ulcerans was confirmed with Zihel Nielsen method performed in the laboratory equipped by Inter Med Onlus.

Trainings include the antiseptic treatment of the wounds with ozone therapy, being the standard protocol applied for the treatment of BU [9]. During our last mission, on July 2013, the ozone production unit stopped working and, thus, we were obliged to find an alternative wounds local treatment.

The only available antiseptic we had was Hyperoil™, a mixture of hypericum flowers extract (Hypericum perforatum) and nimh oil (Azadirachta indica) produced by RIMOS S.r.L. Mirandola (MO) - Italy (Medical Device Class IIB CE0476), available as oil, gel, cream and gauze gel, that was recently tested to be used in complicated diabetic foot ulcers [10].

Case Presentation

We used Hyperoil™ on 13 years old boy with a chronic BU on the bottom right leg and osteomyelitis. Chronic BU was located on the lateral bottom middle third of the right leg and on the upper pole (at about 4 cm from the perilesional cephalic margin), and appeared about 15 months before. The patient refers the lesion started as a painful nodule on the leg that becomes edematous. Then, the skin above the nodule ulcerated with white-yellow material in the middle of the lesion, having cotton appearance. The lesion becomes largerand deeper in the next days. This patient was previously treated with an unknown antibiotic therapy and his ulcer had a surgical toilette, with temporary improvement of symptoms. Then, because of the lack of money to continue treatments, UB worsened in the following year.

On September 19th 2012, when the boy was visited by us for the first time, a chronic UB (13.5x5 cm, Figure 1A) appeared localized, exuding and smelly, with focal exposed bone necrosis on two sites (depth, respectively, 0.3 mm and 1 cm) in a limited area healed, with slight scar retraction, in the third distal area of the right leg (approximately 4 cm from the cephalic peri-lesional margin). The ulcer was delimited by partially regular and undermined edges, skin being scarcely elastic and edematous in the area around the lesion.