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.