Buruli ulcer disease

Buruli Ulcer Disease Buruli ulcer disease is a chronic, debilitating skin and soft tissue infection caused by the bacterium *Mycobacterium ulcerans*. It is characterized by the development of large ulcers, primarily on the limbs, and can lead to significant morbidity if not treated promptly.

Overview

Buruli ulcer is considered a neglected tropical disease and primarily affects people in rural areas of West and Central Africa, although cases have been reported in other regions, including Australia and Southeast Asia. The disease is named after the Buruli County in Uganda, where it was first described in the 1890s.

Etiology

The causative agent, *Mycobacterium ulcerans*, is a slow-growing mycobacterium that produces a toxin known as mycolactone. This toxin is responsible for the tissue damage and immunosuppression observed in Buruli ulcer disease.

Transmission

The exact mode of transmission of *M. ulcerans* is not fully understood. However, it is believed to be associated with aquatic environments, and transmission may occur through direct contact with contaminated water or soil. There is no evidence of person-to-person transmission.

Clinical Presentation

Buruli ulcer typically begins as a painless nodule or papule, which can progress to a large ulcer with undermined edges. The disease primarily affects the skin and subcutaneous tissues, but in severe cases, it can involve deeper structures such as bones.

Stages of Disease

1. ]]Pre-ulcerative stage]]: Characterized by a painless nodule, papule, or plaque. 2. ]]Ulcerative stage]]: The nodule breaks down to form a painless ulcer with undermined edges. 3. ]]Healing stage]]: With appropriate treatment, the ulcer heals, often leaving a scar.

Diagnosis

Diagnosis of Buruli ulcer is based on clinical presentation and can be confirmed by laboratory tests such as: - Polymerase chain reaction (PCR) to detect *M. ulcerans* DNA. - Microscopy of stained smears. - Culture of the organism, although this is technically challenging.

Treatment

The World Health Organization recommends a combination of antibiotics for the treatment of Buruli ulcer. The standard regimen includes: - Rifampicin - Clarithromycin or streptomycin Surgical intervention may be necessary for extensive lesions or to correct deformities.

Prevention

Preventive measures are not well established due to the unclear mode of transmission. However, avoiding contact with potentially contaminated water and soil may reduce the risk of infection.

Epidemiology

Buruli ulcer is most prevalent in rural areas of West and Central Africa, with C te d'Ivoire, Ghana, and Benin reporting the highest number of cases. The disease affects all age groups but is more common in children under 15 years of age.

Research and Challenges

Research is ongoing to better understand the transmission dynamics of *M. ulcerans* and to develop more effective prevention and treatment strategies. Challenges include the lack of awareness and resources in endemic regions, which can delay diagnosis and treatment.

See Also

• Neglected tropical diseases
• Mycobacterium infections

External Links

- [World Health Organization - Buruli Ulcer](https://www.who.int/news-room/fact-sheets/detail/buruli-ulcer-(mycobacterium-ulcerans-infection))

NIH genetic and rare disease info

• NIH info on Buruli ulcer disease

Buruli ulcer disease is a rare disease.