Buruli ulcer

A chronic debilitating skin and soft tissue infection

Buruli ulcer
Synonyms	Bairnsdale ulcer, Daintree ulcer, Mossman ulcer, Kumasi ulcer, Searls ulcer
Pronounce	N/A
Field	Infectious disease
Symptoms	Painless area of swelling under the skin, which becomes a necrotic ulcer
Complications	Permanent disfigurement, secondary infections, restricted movement of limbs
Onset	Gradual; may take weeks to months for ulcer to develop
Duration	Weeks to months, depending on treatment
Types	N/A
Causes	Mycobacterium ulcerans
Risks	Exposure to contaminated environments, especially in tropical and subtropical regions; proximity to wetlands
Diagnosis	Clinical examination, PCR test, acid-fast bacilli smear, histopathology, culture
Differential diagnosis	Cutaneous leishmaniasis, tropical ulcer, diabetic ulcer, pyoderma gangrenosum
Prevention	Avoiding insect bites and contact with contaminated water in endemic areas; wound care
Treatment	Combination antibiotic therapy with rifampicin and clarithromycin or streptomycin
Medication	Rifampicin, clarithromycin, streptomycin
Prognosis	Good with early treatment; delayed treatment may result in severe scarring and disability
Frequency	Endemic in West and Central Africa, parts of Australia, and Southeast Asia
Deaths	Rare with proper treatment, but can occur in severe untreated cases

Early signs of Buruli ulcer in Cameroon. Top, painless swollen bumps. Bottom-left, a "plaque". Bottom-right, widespread swelling of the lower arm.

Buruli ulcer 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 appropriately.

Epidemiology

Buruli ulcer is most commonly found in rural areas of West Africa, Central Africa, and some parts of Australia. It is considered a neglected tropical disease and primarily affects children and young adults. The exact mode of transmission is not well understood, but it is believed to be associated with environmental factors, particularly aquatic environments.

Pathophysiology

The disease is caused by Mycobacterium ulcerans, which produces a toxin known as mycolactone. This toxin is responsible for the tissue necrosis and immunosuppression observed in Buruli ulcer. The infection typically begins as a painless nodule or papule, which can progress to a large ulcer with undermined edges.

Clinical Presentation

The initial presentation of Buruli ulcer is often a painless, firm nodule or plaque. Over time, this lesion can ulcerate, leading to the characteristic large, necrotic ulcer with undermined edges. The ulcers are typically painless, but secondary bacterial infections can cause pain and further complications. The disease primarily affects the skin and soft tissues, but in severe cases, it can involve bones.

Diagnosis

Diagnosis of Buruli ulcer is primarily clinical, supported by laboratory tests. Polymerase chain reaction (PCR) testing for Mycobacterium ulcerans DNA is the most sensitive method. Other diagnostic methods include microscopy, culture, and histopathology. Early diagnosis is crucial for effective treatment and to prevent complications.

Treatment

The mainstay of treatment for Buruli ulcer is a combination of antibiotics, typically rifampicin and clarithromycin or streptomycin. Surgical intervention may be necessary for extensive lesions, including debridement and skin grafting. Early treatment is essential to prevent severe tissue damage and disability.

Prevention

Preventive measures for Buruli ulcer are not well established due to the unclear mode of transmission. However, efforts to reduce exposure to potential environmental sources, such as stagnant water, may help reduce the risk. Community education and early case detection are important components of prevention strategies.

Related pages

• Mycobacterium ulcerans
• Neglected tropical diseases
• Skin infections

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