Buruli Ulcer - Another NTD - Third Most Common Mycobacterial Infection.

imhotep

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  • Mar 29, 2017
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    In a recent post about Buruli ulcers, many raised questions and this post is to offer a brief clarification on the issues raised. The disease itself was discovered in 1897 in Buruli (Now Nakasongola District - Uganda) and hence the name.
    Buruli ulcer is a skin infection that kills the cells and tissue in an affected area and creates ulcers on the skin. It is caused by a bacteria and is the third most common bacterial disease after TB and leprosy.

    All three conditons are due to a bacteria in the Mycobacterium family. TB is caused by Mycobacterium tuberculosis, Leprosy is caused by Mycobacterium Leprae and Buruli ulcer is caused by Mycobacterium Ulcerans.

    Even though about 125 years have gone by, there isn't a vaccination available. Of course there are antibiotics to treat. The method of transmission to humans is unclear yet. The organism produces a unique toxin – Mycolactone – that causes the damage to the skin. Early diagnosis and treatment are crucial to minimizing morbidity, costs and prevent long-term disability.
    It can manifest as an ulcer or as a non-ulcerated skin lesion, such as a plaque, nodule or oedema.

    Buruli has been reported in over 33 countries around the world, the greatest burden of disease is in the tropical regions of West and Central Africa, Australia, and Japan.

    Disease can be confirmed by a PCR but a negative PCR doesn't exclude the disease as false negatives occur if the swab is taken on early onset of disease. Also swabs on non-ulcerated disease have a high false negative rate.

    Treatment regime is usually several antibiotics in a combination (to minimise Anti Microbial Resistance and also higher efficacy) like Rifampicin in combination with clarithromycin/ciprofloxacin/moxifloxacin upto a period of 8 weeks.

    Typical presentation-


    Right calf Buruli ulcer.




    Right buttock Buruli ulcer.



    Oedematous form of Buruli ulcer with suspected superimposed bacterial infection.