5th WHO Advisory Group Meeting on Buruli Ulcer

Study Group Report

on Buruli Ulcer Treatment with Clay

presented by Prof Carbonnelle

laboratory of Bacteriology, CHU Angers, France

OMS/WHO – Geneva, March 14, 2002

As you have noticed in the presentation given by Mrs. Brunet de Courssou, the results obtained by the treatment with clay in Zouan-Hounien are impressive. 

The question that comes to mind is to determine what is due:

§         On the one hand to the quality of the nursing care given with much devotion and faith by Mrs. de Courssou and her team, and we know that the quality of the nursing care is absolutely essential in the débridement of the lesions in Buruli ulcer,

§         And on the other hand, what is due to the physico-chemical properties of the clay which obviously brings "great benefits" that we must appreciate.

So first of all, let us try to assess the advantages of the use of clay compared to the conventional method of care (that is, surgical débridement):

1.       The method is non-invasive and makes it possible to avoid in the reported experiment the recourse to surgical débridement, therefore:

-              no anesthesia,

-              no hemorrhage,

-              no blood transfusions,

-              a lesser amount of pain for the patients.

2.       No surgery, therefore not need for an operating room; the method can thus apply everywhere.

3.       Cost evaluated to 0.50 euro per day and per patient; therefore lower than the use of the conventional bandages.

4.       Fast resorption of edemas (less than 3 days).

5.       Respect living/healthy tissues.

6.       Effectiveness on the totality of the clinical forms, even the most advanced.

7.       Substantially reduced pain when changing the dressings.

Then, let us setout objective criteria of effectiveness:

1.       Applied since patient’s admission, the clay treatment allowed:

§         For small and medium size lesions, to obtain the complete scarring of lesions and the recovery of 22 patients.  After one year, none of the lesions healed without skin grafts gave any infection recurrence.

§         For the more significant lesions requiring the recourse to a skin graft, débridement with clay made it possible to offer a perfectly deterged ground ready for skin grafting.  Out of a total of 20 skin grafts, 19 succeeded perfectly and one failed for an external cause.

2.       In the current state of the observations, we have observed neither keloids nor retractions in vicious position.

The results given above are drawn up over one year experience with the débridement of 42 ulcers using clay.

It is now necessary to proceed further in order to confirm or refute the benefits offered by the clay treatment.

For that we propose 2 things:

1.       Engage in a comparative study:

on a side:

§         in the center in Zouan-Hounien - all débridements without any exception will be done with clay

§         the commencement of the study can be immediate; all material, educated and experienced personnel are already in place

on the other side:

§         with another center whose recruitment is similar; the center would change nothing in its methods and uses customary débridement

Each case is documented with detailed observations and photographs.

After one year, the results of the treatments will be compared:

§         average time for scarring

§         time between patient’s admission and when skin graft is performed

§         skin graft results:

-       failures

-       recurrences

-       keloids

2.       Other centers in Côte d'Ivoire and in other countries may volunteer to introduce the clay treatment.

Issues Added By The Participants

at the time of the Presentation

of the Study Group Report

1.       Ensure immunization against tetanus by vaccination

2.       Ensure quality of clays used and check their microbiological harmlessness

3.       The protocol set up is randomized

4.       To undertake in vitro studies and to look further into the relations between clay and mycotoxin, and clay and bacteria