Buruli ulcer, mostly in tropical countries, is caused by Mycobacterium ulcerans. It appears as a chronic, painless skin ulcer usually on the legs. In the early stages, it is treatable with combined antibiotics.
CASES/YEAR
0 (US); 5,500 (Global)
OTHER NAMES
Mycobacterium ulcerans infection;
INCUBATION
About 2-3 months; Could be longer periods of latency; [CCDM, p. 83]
INITIAL SYMPTOMS
Buruli ulcers usually start on the lower extremities of children as painless papules or nodules that ulcerate. Ulcers have a white or yellow base and "cotton wool" appearance. [CCDM]
PRECAUTIONS
"Human-to-human transmission of Buruli ulcer in the field is exceptional; cases have rarely developed in caregivers of patients." [CCDM, p. 83]
COMMENTS
Other presentations include plaques, edematous lesions, osteomyelitis, and disabling contractures. An increasingly recognized disease in recent decades, especially in western Africa, the disease occurs in rural people living near wetlands. Insect bites may transmit the infection. Other naturally infected hosts of M. ulcerans are insects, snails and fish. M. ulcerans can infect koala, possums, potoroo, and domesticated alpaca. [CCDM, p. 81-3] Systemic symptoms and regional lymphadenopathy are absent; [ID, p. 1404] Local and regional lymphadenopathy is not common. Water bugs may transmit infection. [Guerrant, p. 250]
DIAGNOSTIC
Usually diagnosed clinically; Ziel-Neelsen stain for AFB; culture; PCR; histopathology; [CCDM]
SCOPE
Reported in more than 30 countries, mostly tropical; [CCDM] Endemic in tropical, rural wetlands; [Guerrant, p. 248] See maps at http://www.who.int/buruli/country/
SIGNS & SYMPTOMS
-
H lymphadenopathy
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S entry wound with lymph nodes
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S papules or plaques
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S pustule
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S skin or subcutaneous nodule
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S ulcer of skin
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*arthritis
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*osteomyelitis
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*sepsis
ENTRY
Skin or Mucous Membranes (Includes Conjunctiva)
SOURCE
Waterborne (Ingesting, Inhaling, or Swimming)
RESERVOIR
Fish and Shellfish, Wild Animals
TREATMENT
"Combined antibiotic therapy has been shown to be effective in treating early, limited disease. For more advanced disease, surgical excision and skin graft may be required." [CCDM, p. 84]
REFERENCES FOR CASES/YEAR
1.
2. (Global) 5000-6000 cases reported annually (most in sub-Saharan Africa); [Fact sheets from WHO]