Buruli Ulcer
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This 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 transmission remains unclear. However, trauma, insect bite and inhalation have been suggested.
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.
Cause
- Mycobacterium ulcerans
Symptoms
- 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 AFBs, bacterial cultures and sensitivity
- Skin biopsy for histopathology
TreatmentTreatment Objectives
- 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 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 to centres with expertise for managing buruli ulcer.