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:

  1. Painless subcutaneous nodule
  2. Painless swelling of the legs, arms or face
  3. 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:

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

Non-pharmacological treatment

  1. Complete excision of nodules, preferably with primary closure if possible
  2. 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]
Rifampicin, oral, 10 mg/kg daily for 8 weeks

And

Clarithromycin, oral, 7.5 mg/kg 12 hourly for 8 weeks

Referral Criteria

Refer patients with Buruli ulcer to health facilities with expertise for managing buruli ulcer.