Buruli Ulcer

What is Buruli ulcer?

Buruli Ulcer is a chronic painless necrotising ulcer with undermined edges, which can lead to debilitating skin and soft tissue infection and permanent disfigurement.

While it is known that this ulcer is caused by a bacterium, the mode of its transmission remains unclear.

However, trauma, insect bite and inhalation have been suggested as its mode of transmission.

When detected early, the majority can be cured with a combination of antibiotics.

Thus, early identification and appropriate management reduce morbidity and disability from this condition.

Causes

Buruli Ulcer is caused by Mycobacterium ulcerans

Symptoms of Buruli Ulcer

The symptoms of Buruli Ulcer include the following:

Painless subcutaneous nodule
Painless swelling of the legs, arms or face
Extensive skin ulceration

Signs

Nodule: Painless firm lesion 1-2 cm in diameter situated in the subcutaneous tissue and attached to the skin
Diffuse painless swelling of the legs, arms or face
Large painless area of induration
Extensive skin ulceration.

Investigations

Wound swab for Acid- Fast Bacilli (AFB) smear and culture, bacterial cultures and sensitivity
Skin biopsy for histopathology

Treatment for Buruli Ulcer

Treatment objectives

The treatment objectives of this disease condition are:

To limit the extent of tissue destruction
To prevent disability
To treat both primary and secondary bacterial infection

Non-pharmacological treatment

Complete excision of nodules, preferably with primary closure if possible
Skin grafting of ulcers if facilities for this procedure are available

Pharmacological treatment

1st Line Treatment

Evidence Rating: [A]

Rifampicin, oral, 10 mg/kg daily for 8 weeks

And

Streptomycin, IM, 15 mg/kg daily for 8 weeks

2nd Line Treatment

Evidence Rating: [C]