Buruli ulcer: Difference between revisions

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{{Infobox medical condition (new)
{{Short description|A chronic debilitating skin and soft tissue infection}}
| name           = Buruli ulcer
{{DiseaseDisorder infobox
| synonyms        = Bairnsdale ulcers, Searls ulcer, Daintree ulcer<ref name="Andrews"/><ref name="Lavender CJ, Senanayake SN, Fyfe JA, et al. 62–3"/>
| name = Buruli ulcer
| image           = Buruli ulcer left ankle EID.jpg
| image = Buruli ulcer.jpg
| caption         = Buruli ulcer on the ankle of a person from Ghana.
| caption = A patient with Buruli ulcer on the leg
| field          = [[Infectious disease (medical specialty)|Infectious disease]]
| symptoms        = Area of swelling that becomes an [[Ulcer (dermatology)|ulcer]]<ref name=WHO2013/>
| complications  =
| onset          =
| duration        =
| causes          = ''[[Mycobacterium ulcerans]]''<ref name=WHO2013/>
| risks          =
| diagnosis      =
| differential    =
| prevention      =
| treatment      = [[Rifampicin]] and [[streptomycin]]<ref name=WHO2013/>
| medication      =
| prognosis      =
| frequency      = ~ 2,000 cases reported (2015)<ref name=WHO2013/>
| deaths          =
}}
}}
<!-- Definition and symptoms -->
'''Buruli ulcer''' is an [[infectious disease]] caused by ''[[Mycobacterium ulcerans]]''.<ref name=WHO2013>{{cite web|title=Buruli ulcer (''Mycobacterium ulcerans'' infection) Fact sheet N°199|url=http://www.who.int/mediacentre/factsheets/fs199/en/|work=World Health Organization|accessdate=23 February 2014|date=June 2013|url-status=live|archiveurl=https://web.archive.org/web/20140227115058/http://www.who.int/mediacentre/factsheets/fs199/en/|archivedate=27 February 2014}}</ref> The early stage of the infection is characterised by a painless [[nodule (medicine)|nodule]] or area of swelling.<ref name=WHO2013/> This nodule can turn into an [[Ulcer (dermatology)|ulcer]].<ref name=WHO2013/> The ulcer may be larger inside than at the surface of the skin,<ref name=Nak2013>{{cite journal|last=Nakanaga|first=K|author2=Yotsu, RR|author3=Hoshino, Y|author4=Suzuki, K|author5=Makino, M|author6=Ishii, N|year=2013|title=Buruli ulcer and mycolactone-producing mycobacteria.|journal=Japanese Journal of Infectious Diseases|volume=66|issue=2|pages=83–8|doi=10.7883/yoken.66.83|pmid=23514902|doi-access=free}}</ref> and can be surrounded by swelling.<ref name=Nak2013/> As the disease worsens, [[Osteomyelitis|bone can be infected]].<ref name=WHO2013/> Buruli ulcers most commonly affect the arms or legs;<ref name=WHO2013/> fever is uncommon.<ref name=WHO2013/>


<!-- Cause -->
'''Buruli ulcer''' is a chronic, debilitating skin and soft tissue infection caused by the bacterium ''[[Mycobacterium ulcerans]]''. It is characterized by the development of large ulcers, primarily on the limbs, and can lead to significant morbidity if not treated appropriately.
''M. ulcerans'' releases a toxin known as [[mycolactone]], which decreases [[immune suppression|immune system function]] and results in tissue [[apoptosis|death]].<ref name=WHO2013/> Bacteria from the same group also cause [[tuberculosis]] and [[leprosy]] (''[[Mycobacterium tuberculosis|M. tuberculosis]]'' and ''[[Mycobacterium leprae|M. leprae]]'', respectively).<ref name=WHO2013/> How the disease is spread is not known.<ref name=WHO2013/> Sources of water may be involved in the spread.<ref name=Nak2013/> As of 2018, there is no effective vaccine.<ref name=WHO2018/><ref name=Ein2011/> The [[BCG vaccine|Bacillus Calmette–Guérin (BCG) vaccine]] has demonstrated limited protection.<ref name=WHO2013/>


<!-- Treatment -->
==Epidemiology==
If people are treated early, [[antibiotic]]s for eight weeks are effective in 80% of cases.<ref name=WHO2013/><ref name=Guidance2012>{{cite web|url=http://apps.who.int/iris/bitstream/handle/10665/77771/9789241503402_eng.pdf;jsessionid=B3009652B80BE1D7A4F5261248CCD27D?sequence=1|title=Treatment of Mycobacterium ulcerans disease (Buruli ulcer): guidance for health workers.|last=|first=|date=2012|website=World Health Organization|access-date=17 April 2018}}</ref> The treatment often includes the medications [[rifampicin]] and [[streptomycin]].<ref name=WHO2013/> [[Clarithromycin]] or [[moxifloxacin]] are sometimes used instead of streptomycin.<ref name=WHO2013/> Other treatments may include [[Surgery|cutting out]] the ulcer.<ref name=WHO2013/><ref name=Siz2006>{{cite journal |vauthors=Sizaire V, Nackers F, Comte E, Portaels F | title=''Mycobacterium ulcerans'' infection: control, diagnosis, and treatment | journal=Lancet Infect Dis |year=2006 | volume=6 | issue=5 | pages=288–296 | pmid=16631549 | doi=10.1016/S1473-3099(06)70464-9 | hdl=10144/17727 | url=https://fieldresearch.msf.org/bitstream/10144/17727/1/lancet%20sizaire%20M.%20ulcerans%5b1%5d.pdf }}</ref> After the infection heals, the area typically has a scar.<ref name=Ein2011>{{cite journal |vauthors=Einarsdottir T, Huygen K |title=Buruli ulcer |journal=Hum Vaccin |volume=7 |issue=11 |pages=1198–203 |date=November 2011 |pmid=22048117 |doi=10.4161/hv.7.11.17751 |url=http://www.landesbioscience.com/journals/hv/abstract.php?id=17751}}</ref>
Buruli ulcer is most commonly found in rural areas of [[West Africa]], [[Central Africa]], and some parts of [[Australia]]. It is considered a neglected tropical disease and primarily affects children and young adults. The exact mode of transmission is not well understood, but it is believed to be associated with environmental factors, particularly aquatic environments.
 
<!-- Epidemiology and culture -->
About 2,000 cases are reported a year.<ref name=WHO2018>{{cite web|url=http://www.who.int/mediacentre/factsheets/fs199/en/|title=Buruli ulcer (''Mycobacterium ulcerans'' infection) Fact sheet N°199|date=April 2018|work=World Health Organization|accessdate=17 April 2018}}</ref> Buruli ulcers occur most commonly in rural [[sub-Saharan Africa]] and Australia with fewer cases in South America and the [[Western Pacific Ocean|Western Pacific]].<ref name=WHO2018/> Children are most commonly infected in Africa, while adults are most commonly affected in Australia.<ref name=WHO2018/> Cases have been reported in 33 countries.<ref name=WHO2018/> The disease also occurs in animals other than humans, though no link between animal and human infection has been established.<ref>{{cite web|url=https://www.cdc.gov/buruli-ulcer/transmission.html|title=Buruli Ulcer: Transmission|last=|first=|date=26 January 2015|website=Centers for Disease Control and Prevention|access-date=17 April 2018}}</ref> [[Albert Ruskin Cook]] was the first to describe buruli ulcers in 1897.<ref name=Nak2013/> It is classified as a [[neglected tropical disease]].<ref name=NTD2017>{{cite web|title=Neglected Tropical Diseases|url=https://www.cdc.gov/globalhealth/ntd/diseases/index.html|website=cdc.gov|accessdate=28 November 2014|date=June 6, 2011|url-status=live|archiveurl=https://web.archive.org/web/20141204084219/http://www.cdc.gov/globalhealth/ntd/diseases/index.html|archivedate=4 December 2014}}</ref>
 
==Signs and symptoms==
[[Image:Buruli ulcer hand Peru.png|thumb|Development of Buruli ulcer on the hand of a person from [[Peru]]. A) Swollen patch on the middle finger B) about 4 weeks later, ulcers form on the middle finger C) 5.5 weeks after first seen, a large ulcer covers the finger D) cured lesion 5 months after first seen, 1 month after [[autologous]] [[skin graft]]]]
 
The first signs of Buruli ulcer can vary, but usually involve the appearance of a painless swollen area on the arm or leg. This most commonly takes the form of a small bump, similar in appearance to an insect bite.<ref name=Yotsu2015/><ref name=WHO2019/> However, sometimes the first sign is a patch of firm, raised, skin about three centimeters across called a "plaque"; or a more widespread swelling under the skin.<ref name=Yotsu2015/><ref name=WHO2019/> Over the course of a few weeks, the original swollen area may expand, forming an irregularly shaped patch of swollen skin.<ref name=Yotsu2015>{{cite journal|title=Revisiting Buruli Ulcer |journal=The Journal of Dermatology |vauthors=Yotsu RR, Murase C, Sugawara M, Suzuki K, Nakanaga K, Ishii N, Asiedu K |date=September 2015 |doi=10.1111/1346-8138.13049 |volume=42 |issue=11 |pages=1033-41}}</ref><ref name=Guarner2018>{{cite journal|title=Buruli Ulcer: Review of a Neglected Skin Mycobacterial Disease |journal=Journal of Clinical Microbiology |date=April 2018 |volume=56 |issue=4 |pages=e01507-17 |doi=10.1128/JCM.01507-17 |pmc=5869816 |author=Guarner J}}</ref> After about four weeks, the affected skin sloughs off, leaving a large painless ulcer.<ref name=WHO2019>{{cite web|url=https://www.who.int/news-room/fact-sheets/detail/buruli-ulcer-(mycobacterium-ulcerans-infection) |title=Buruli ulcer (Mycobacterium ulcerans infection) |date=21 May 2019 |publisher=World Health Organization}}</ref> The ulcer continues to grow wider and sometimes deeper, with skin at the margin [[necrosis|dying]] and sloughing off, and underlying muscle, tendon, and bone sometimes exposed.<ref name=Guarner2018/> Oftentimes, these large exposed ulcers are infected by other bacteria, causing the wound to smell foul.<ref name=Guarner2018/>
 
Buruli ulcers can appear anywhere on the body, but are far more common on the limbs than elsewhere. Ulcers are most common on the lower limbs (62%) and upper limbs (24%), but can also be found on the trunk (9%), head/neck (3%), or genitals (less than 1%).<ref name=Zingue2018>{{cite journal|title=Buruli Ulcer, a Prototype for Ecosystem-Related Infection, Caused by ''Mycobacterium ulcerans'' |journal=Clinical Microbiology Reviews |date=January 2018 |volume=31 |issue=1 |pages=e0004-17 |doi=10.1128/CMR.00045-17 |pmc=5740976 |vauthors=Zingue D, Bouam A, Tian RB, Drancourt M}}</ref> The World Health Organization classifies Buruli ulcer cases into three categories depending on the severity of their symptoms. A single small (less than five centimeters) ulcer is category I. Larger ulcers (up to 15 centimeters) are category II. Ulcers that are larger, disseminated across the body, or include particularly sensitive sites (e.g. the eyes, bones, joints, or genitals) are called category III.<ref name=Guarner2018/>
 
<gallery>
Image:Buruli_ulcer_hand_Nigeria.png|A typical Buruli ulcer on the left hand of a 17-year-old boy in [[Nigeria]]
Image:Buruli_ulcer_ear_infant_Australia.png|Ear of an 18-month-old with confirmed Buruli ulcer
Image:Buruli_ulcer_traveler.png|Buruli ulcer in a long-term traveler to [[Senegal]]
</gallery>
 
==Cause==
Buruli ulcer is caused by infection of the skin with the [[bacterium]] ''[[Mycobacterium ulcerans]]''.<ref name=WHO2019/> ''M. ulcerans'' infections typically occur near slow-moving or stagnant bodies of water, where ''M. ulcerans'' can be found in aquatic insects, mollusks, fish, and the water itself.<ref name=Guarner2018/> How ''M. ulcerans'' is transmitted to humans remains unclear, but somehow bacteria enter the skin and begin to grow. Disease is primarily caused by a toxin produced by the bacteria, [[mycolactone]].<ref name=Yotsu2018>{{cite journal|title=Buruli Ulcer: a Review of the Current Knowledge |journal=Current Tropical Medicine Reports |date=September 2018 |volume=5 |issue=4 |pages=247-256 |doi=10.1007/s40475-018-0166-2 |pmc=6223704 |vauthors=Yotsu RR, Suzuki K, Simmonds RE, Bedimo R, Ablordey A, Yeboah-Manu D, Phillips R, Asiedu K}}</ref> As the bacteria grow, they release mycolactone, which diffuses into host cells and blocks the action of [[Sec61]], the core translocation protein that serves as the gateway to the [[endoplasmic reticulum]].<ref name=Yotsu2018/> When Sec61 is blocked, proteins that would normally enter the endoplasmic reticulum are instead translated into the [[cytosol]], causing a pathological stress response that results in [[cell death]] by [[apoptosis]].<ref name=Yotsu2018/> This cell death results in large-scale tissue death at the site of infection, causing the large open ulcer characteristic of disease.<ref name=Yotsu2018/> At the same time, Sec61 inhibition prevents cells from signalling to activate the [[immune system]], resulting in ulcers that lack infiltrating immune cells.<ref name=Yotsu2018/>
 
===Transmission===
It is not known how ''M. ulcerans'' is introduced to humans.<ref name=WHO2019/> Human-to-human transmission is extremely rare, and Buruli ulcer is not considered contagious.<ref name=Guarner2018/> In areas [[Endemic (epidemiology)|endemic]] for Buruli ulcer, cases tend to be found near stagnant bodies of water, leading to the long-standing hypothesis that ''M. ulcerans'' is somehow transmitted to humans from aquatic environments.<ref name=Yotsu2018/> Supporting this model, ''M. ulcerans'' is widespread in aquatic environments, where it can survive as free-living or associated with other aquatic organisms.<ref name=Zingue2018/> Live ''M. ulcerans'' has been isolated from aquatic insects, mosses, and animal feces; and its DNA has been found in water, soil, [[biofilm|mats of bacteria and algae]], fish, crayfish, aquatic insects, and other animals that live in or near water.<ref name=Yotsu2018/> A role for biting insects in transmission has long been investigated, with particular focus on mosquitoes, [[Belostomatidae|giant water bugs]], and [[Naucoridae]]. ''M. ulcerans'' is occasionally found in these insects, and they can sometimes transmit the bacteria in certain laboratory settings.<ref name=Zingue2018/> However, whether these insects are regularly involved in transmission remains unclear.<ref name=Guarner2018/><ref name=Yotsu2018/> Pre-existing wounds have also been implicated in disease transmission, and poor wound care is associated with a higher risk of acquiring Buruli ulcer.<ref name=Jacobsen2010>{{cite journal|title=Risk factors for ''Mycobacterium ulcerans'' infection |journal=International Journal of Infectious Diseases |volume=14 |issue=8 |date=August 2010 |pages=e677-e681 |vauthors=Jacobsen KH, Padgett JJ |doi=10.1016/j.ijid.2009.11.013}}</ref> Consistent with this, wearing long pants and long-sleeved shirts is associated with a lower risk of Buruli ulcer, possibly by preventing insect bites or protecting wounds.<ref name=Guarner2018/><ref name=Jacobsen2010/>
 
Other mammals are also susceptible to ulcers caused by ''M. ulcerans'', and could serve as [[Natural reservoir|environmental reservoirs]] of ''M. ulcerans''.<ref name=Guarner2018/>


In Australia, animals such as koalas and possums are naturally infected.<ref>{{cite journal |vauthors=Mitchell PJ, Jerrett IV, Slee KJ |year= 1984| title= Skin ulcers caused by ''Mycobacterium ulcerans'' in koalas near Bairnsdale, Australia | journal= Pathology | volume=16|pages=256–260 | pmid = 6514393  | doi = 10.3109/00313028409068533 | issue=3}}</ref><ref>{{cite journal |vauthors=Flood P, Street A, O'Brien P, Hayman J |title=''Mycobacterium ulcerans'' infection on Phillip Island, Victoria |journal=Med. J. Aust. |volume=160 |issue=3 |page=160 |date=February 1994 |pmid=8295586 |doi=10.5694/j.1326-5377.1994.tb126569.x }}</ref> Epidemiological evidence has not clearly supported person-to-person transmission. However, Muelder & Nourou found that 10 out of 28 patients had relatives who had also had the disease, and cautioned against the dismissal of person-to-person transmission.<ref>{{cite journal |author1=Muelder, K.  |author2=A. Nourou| year= 1990|title= Buruli ulcer in Benin. |journal=Lancet| volume= 336|pages=1109–1111 | pmid = 1977990  |doi = 10.1016/0140-6736(90)92581-2 | issue=8723}}</ref> Given the number of patients who shed large numbers of bacilli from their wounds and live in very close contact with relatives, more cases should have been observed. The cases reported by Muelder & Nourou could perhaps have been exposed to a common source of infection, and there might also be genetic component to sensitivity to the disease.
==Pathophysiology==
The disease is caused by ''Mycobacterium ulcerans'', which produces a toxin known as [[mycolactone]]. This toxin is responsible for the tissue necrosis and immunosuppression observed in Buruli ulcer. The infection typically begins as a painless nodule or papule, which can progress to a large ulcer with undermined edges.


''Mycobacterium ulcerans'' was first cultivated and characterized from the environment in 2008.<ref name=Portaels08>{{cite journal |vauthors=Portaels F, Meyers WM, Ablordey A, Castro AG, Chemlal K, de Rijk P, Elsen P, Fissette K, Fraga AG, Lee R, Mahrous E, Small PL, Stragier P, Torrado E, Van Aerde A, Silva MT, Pedrosa J | title= First Cultivation and Characterization of ''Mycobacterium ulcerans'' from the Environment |journal= PLoS Negl Trop Dis |volume=2 |pages=e178 | pmid = 18365032 | doi=10.1371/journal.pntd.0000178 | issue=3 |pmc=2268003 | year=2008 |laydate=2008-03-25 |layurl =http://www.eurekalert.org/pub_releases/2008-03/plos-afs031908.php# |laysource=EurekAlert!}} {{open access}}
==Clinical Presentation==
</ref>
The initial presentation of Buruli ulcer is often a painless, firm nodule or plaque. Over time, this lesion can ulcerate, leading to the characteristic large, necrotic ulcer with undermined edges. The ulcers are typically painless, but secondary bacterial infections can cause pain and further complications. The disease primarily affects the skin and soft tissues, but in severe cases, it can involve bones.


==Diagnosis==
==Diagnosis==
The diagnosis of Buruli ulcer is usually based on the characteristic appearance of the ulcer in an endemic area. If there is any doubt about the diagnosis, then [[polymerase chain reaction|PCR]] using the IS2404 target is helpful, but this is not specific for ''M. ulcerans''. The [[Ziehl-Neelsen stain]] is only 40–80% sensitive, and culture is 20–60% sensitive. Simultaneous use of multiple methods may be necessary to make the diagnosis.<ref>{{cite journal|author1=Herbinger K-H |author2=Adjei O |author3=Awua‐Boateng N-Y |title=Comparative study of the sensitivity of different diagnostic methods for the laboratory diagnosis of Buruli ulcer disease|journal=Clin Infect Dis|year=2009|volume=48|pages=1055–64|doi=10.1086/597398|pmid=19275499|issue=8|display-authors=etal|doi-access=free}}</ref>
Diagnosis of Buruli ulcer is primarily clinical, supported by laboratory tests. [[Polymerase chain reaction]] (PCR) testing for ''Mycobacterium ulcerans'' DNA is the most sensitive method. Other diagnostic methods include [[microscopy]], [[culture]], and [[histopathology]]. Early diagnosis is crucial for effective treatment and to prevent complications.
 
==Prevention==
There is no specific vaccine for ''Myocobacterium ulcerans''.<ref name=Ein2011/> The [[Bacillus Calmette-Guérin]] vaccine may offer temporary protection.<ref name=WHO2013/>


==Treatment==
==Treatment==
[[Image:Healed Buruli ulcer lesions.jpg|thumb|Healed Buruli ulcer lesions in a [[Ghana]]ian woman]]
The mainstay of treatment for Buruli ulcer is a combination of antibiotics, typically [[rifampicin]] and [[clarithromycin]] or [[streptomycin]]. Surgical intervention may be necessary for extensive lesions, including debridement and skin grafting. Early treatment is essential to prevent severe tissue damage and disability.
If treated early, antibiotics for eight weeks are effective in 80% of people.<ref name=WHO2013/> This often includes the medications [[rifampicin]] and [[streptomycin]].<ref name=WHO2013/> [[Clarithromycin]] or [[moxifloxacin]] are sometimes used instead of streptomycin.<ref name=WHO2013/>


Treatment may also include [[Surgery|cutting out]] the ulcer.<ref name=Siz2006/> This may be a minor operation and very successful if undertaken early. Advanced disease may require prolonged treatment with extensive skin grafting. Surgical practice can be dangerous in the developing countries where the disease is common.
==Prevention==
 
Preventive measures for Buruli ulcer are not well established due to the unclear mode of transmission. However, efforts to reduce exposure to potential environmental sources, such as stagnant water, may help reduce the risk. Community education and early case detection are important components of prevention strategies.
==Epidemiology==
[[File:Buruli ulcer map 2009.png|thumb|left|upright=1.4|Map with number of reported cases of Buruli ulcer in 2009.]]
The infection occurs in well-defined areas throughout the world, mostly tropical areas — in several areas in Australia, in Uganda, in several countries in [[West Africa]], in [[Central America|Central]] and [[South America]], in [[southeast Asia]] and [[New Guinea]]. It is steadily rising as a serious disease, especially in West Africa and underdeveloped countries, where it is the third leading cause of mycobacterial infection in healthy people, after tuberculosis and leprosy.
 
The disease is more likely to occur where there have been environmental changes such as the development of water storages, sand mining, and irrigation.
 
Buruli ulcer is currently endemic in Benin, Côte d'Ivoire, Ghana, Guinea, Liberia, Nigeria, Sierra Leone and Togo.<ref name="statistics1">WHO, (2000) Buruli ulcer: Mycobacterium ulcerans infection. Geneva</ref> In Ghana, 1999 data indicated that the prevalence rate of the disease in the Ga West District was 87.7 per 100,000, higher than the estimated national prevalence rate at 20.7 per 100,000 generally, and 150.8 per 100,000 in the most disease-endemic districts.<ref name="statistics2">{{cite journal |vauthors=Amofah G, Bonsu F, Tetteh C |title=Buruli ulcer in Ghana: results of a national case search |journal=Emerging Infect. Dis. |volume=8 |issue=2 |pages=167–70 |date=February 2002 |pmid=11897068 |pmc=2732443 |doi=10.3201/eid0802.010119 |display-authors=etal |df= }}</ref>
 
===Geographical distribution===
Buruli ulcer has been reported from at least 32 countries around the world, mostly in tropical areas:
* West Africa: [[Benin]], [[Burkina Faso]], [[Côte d'Ivoire]], [[Ghana]], [[Liberia]], [[Nigeria]], [[Togo]], [[Guinea]], [[Sierra Leone]].
* Other African Countries: [[Angola]], [[Cameroon]], [[Republic of the Congo|Congo]], [[Democratic Republic of Congo]], [[Equatorial Guinea]], [[Gabon]], [[Sudan]], [[Uganda]].
* Western Pacific: [[Australia]], [[Papua New Guinea]], [[Kiribati]].
* Americas: [[French Guiana]], [[Mexico]], [[Peru]], [[Suriname]].
* Asia: [[China]], [[Malaysia]], [[Japan]].
 
In several of these countries, the disease is not considered to be a [[public health]] problem, hence the current distribution and the number of cases are not known. Possible reasons include:
* the distribution of the disease is often localized in certain parts of endemic countries;
* Buruli ulcer is not a notifiable disease
* In most places where the disease occurs, patients receive care from private sources such as voluntary mission hospitals and traditional healers. Hence the existence of the disease may not come to the attention of the ministries of health.
 
It most commonly occurs in Africa: Congo and Cameroon in Central Africa, Côte d'Ivoire, Ghana and Benin in West Africa. Some Southeast Asian countries (Papua New Guinea) and Australia have major foci, and there have been a few patients reported from South America (French Guyana and Surinam) and Mexico. Focal outbreaks have followed flooding, human migrations,<ref name=Group1971>{{cite journal  | author=Uganda Buruli Group | year= 1971| title= Epidemiology of Mycobacterium ulcerans infection (Buruli ulcer) at Kinyara, Uganda | journal=Trans R Soc Trop Med Hyg | volume=65 | pages=763–775 | pmid = 5157438  |doi = 10.1016/0035-9203(71)90090-3 | issue=6}}</ref> and man-made topographic modifications such as dams and resorts. Deforestation and increased basic agricultural activities may significantly contribute to the recent marked increases in the incidence of ''M. ulcerans'' infections, especially in West Africa, where the disease is rapidly emerging.
 
===Race, age and sex===
Buruli ulcer commonly affects poor people in remote rural areas with limited access to health care. The disease can affect all age groups, although children under the age of 15 years (range 2–14 years) are predominantly affected. There are no sex differences in the distribution of cases among children. Among adults, some studies have reported higher rates among women than males (Debacker ''et al.'' accepted for publication). No racial or socio-economic group is exempt from the disease. Most ulcers occur on the extremities; lesions on the lower extremities are almost twice as common as those on the upper extremities. Ulcers on the head and trunk accounted for less than 8% of cases in one large series.<ref name=Marston1995>{{cite journal |author1=Marston, B.J. |author2=Diallo, M.O. |author3=Horsburgh jr., C.R. |author4=Diomande, I. |author5=Saki, M.Z. |author6=Kanga, J.M. |author7=Patrice, G. |author8=Lipman, H.B. |author9=Ostroff, S.M. |author10=Good, R.C. | year= 1995 | title= Emergence of Buruli Ulcer disease in the Daloa region of Côte d'Ivoire | journal= Am J Trop Med Hyg | volume=52| pages=219–224 | pmid = 7694962 |issue=3|doi=10.4269/ajtmh.1995.52.219 }}</ref>
 
==History==
[[James Augustus Grant]], in his book ''A Walk across Africa'' (1864), describes how his leg became grossly swollen and stiff with later a copious discharge. This was almost certainly the severe [[edema]]tous form of the disease, and is the first known description of the infection{{Citation needed|date=November 2009}}. Buruli ulcer disease was identified in 1897 by [[Albert Ruskin Cook|Sir Albert Cook]], a British physician, at [[Mengo Hospital]] in [[Kampala]], [[Uganda]]. The disease was named after Buruli County in [[Uganda]] (now called [[Nakasongola District]]), because of the many cases that occurred there in the 1960s.<ref>{{cite web |url=http://www.allcountries.org/health/buruli_ulcer_disease.html |title=Buruli ulcer disease -Mycobacterium ulcerans infection |work=Health Topics A TO Z |accessdate=2010-12-24 |url-status=live |archiveurl=https://web.archive.org/web/20101204100827/http://www.allcountries.org/health/buruli_ulcer_disease.html |archivedate=2010-12-04 }}</ref> The incidence of the disease has recently been rising in tropical Africa and in certain parts of Australia.
 
A detailed description of the disease was written in 1948 by Professor [[Peter MacCallum]] and his colleagues, who were treating patients from the [[Bairnsdale, Victoria|Bairnsdale district]], in the [[Gippsland]] region in eastern [[Victoria, Australia]]. MacCallum and his team were the first to identify ''[[Mycobacterium ulcerans]]'' as the [[pathogen]] causing the condition. In Australia it is also known as Bairnsdale or [[Daintree Rainforest|Daintree]] ulcer.
 
In March 2008, researchers announced the first isolation of ''M. ulcerans'' from the environment.<ref name=Portaels08/> This suggested that the disease might be transmitted via contact with the environment rather than person to person.<ref name=Portaels08/> The entire genome of ''M. ulcerans'' has been sequenced.<ref name="pmid27688344">{{cite journal |vauthors = Yoshida M, Nakanaga K, Ogura Y, Toyoda A, Ooka T, Kazumi Y, Mitarai S, Ishii N, Hayashi T, Hoshino Y |title=Complete Genome Sequence of Mycobacterium ulcerans subsp. shinshuense |journal=Genome Announc |volume=4 |issue=5 |pages= |year=2016 |pmid=27688344 |pmc=5043562 |doi=10.1128/genomeA.01050-16 }}</ref>
 
Certain types of clay have historically been used in an attempt to treat the condition.<ref>{{cite web|title=New answer to MRSA, other 'superbug' infections: clay minerals? {{!}} NSF - National Science Foundation|url=https://www.nsf.gov/discoveries/disc_summ.jsp?cntn_id=132052&org=NSF|website=www.nsf.gov|accessdate=18 April 2018|language=en}}</ref>
 
===Other names===
Other names include [[Bairnsdale]] ulcer, Searls ulcer, Daintree ulcer,<ref name="Andrews">{{cite book |author1=James, William D. |author2=Berger, Timothy G. |title=Andrews' Diseases of the Skin: clinical Dermatology |publisher=Saunders Elsevier |location= |year=2006 |page=340 |isbn=978-0-7216-2921-6 |display-authors=etal}}</ref><ref name="Bolognia">{{cite book |author1=Rapini, Ronald P. |author2=Bolognia, Jean L. |author3=Jorizzo, Joseph L. |title=Dermatology: 2-Volume Set |publisher=Mosby |location=St. Louis |year=2007 |at=Chapter 74 |isbn=978-1-4160-2999-1 }}</ref><ref name="Lavender CJ, Senanayake SN, Fyfe JA, et al. 62–3">{{cite journal |vauthors=Lavender CJ, Senanayake SN, Fyfe JA |title=First case of ''Mycobacterium ulcerans'' disease (Bairnsdale or Buruli ulcer) acquired in New South Wales |journal=Med. J. Aust. |volume=186 |issue=2 |pages=62–3 |date=January 2007 |pmid=17223764 |url=http://www.mja.com.au/public/issues/186_02_150107/lav10784_fm.html |display-authors=etal |url-status=live |archiveurl=https://web.archive.org/web/20110405073417/http://www.mja.com.au/public/issues/186_02_150107/lav10784_fm.html |archivedate=2011-04-05 |doi=10.5694/j.1326-5377.2007.tb00801.x }}</ref><ref name="Bolognia"/> [[Kumusi River|Kumusi]] ulcer,<ref>{{cite book|last1=Rudolf|first1=Zdenek Hubálek, Ivo|title=Microbial zoonoses and sapronoses|date=2011|publisher=Springer|location=Dordrecht|isbn=9789048196579|page=258|url=https://books.google.com/books?id=UPjo6_FQI-EC&pg=PA258|url-status=live|archiveurl=https://web.archive.org/web/20170908213545/https://books.google.com/books?id=UPjo6_FQI-EC&pg=PA258|archivedate=2017-09-08}}</ref> and mycoburuli ulcers.<ref>{{cite book|author=Yann A. Meunier|others=Contributions from Michael Hole, Takudzwa Shumba & B.J. Swanner|title=Tropical diseases : a practical guide for medical practitioners and students|date=2014|publisher=Oxford University Press|location=Oxford|isbn=9780199997909|page=167|url=https://books.google.com/books?id=ZWcGAQAAQBAJ&pg=PT167|url-status=live|archiveurl=https://web.archive.org/web/20170908213545/https://books.google.com/books?id=ZWcGAQAAQBAJ&pg=PT167|archivedate=2017-09-08}}</ref> Searls was one of the first physicians to describe it.<ref>{{cite book|title=Medical Journal of Australia|url=https://books.google.com/books?id=5UBRAQAAIAAJ|volume=2|issue=14–26|page=926|year=1966|publisher=Australasian Medical Publishing Company}}</ref>
 
== References ==
{{reflist}}
 
==External links==
{{Medical condition classification and resources
| DiseasesDB      = 8568
| ICD10          = {{ICD10|A|31|1|a|30}} ([[ILDS]] A31.120)
| ICD9            = {{ICD9|031.1}}
| ICDO            =
| OMIM            =
| MedlinePlus    =
| eMedicineSubj  =
| eMedicineTopic  =
| MeshID          = D054312
}}
*[http://www.who.int/mediacentre/factsheets/fs199/en/ World Health Organization buruli ulcer page]
*{{cite web |title=''Mycobacterium ulcerans'' |work=NCBI Taxonomy Browser |url=https://www.ncbi.nlm.nih.gov/Taxonomy/Browser/wwwtax.cgi?mode=Info&id=1809 |id=1809}}
* {{Cite journal | last1 = Merritt | first1 = R. W. | last2 = Walker | first2 = E. D. | last3 = Small | first3 = P. L. C. | last4 = Wallace | first4 = J. R. | last5 = Johnson | first5 = P. D. R. | last6 = Benbow | first6 = M. E. | last7 = Boakye | first7 = D. A. | editor1-last = Phillips | editor1-first = Richard O | title = Ecology and Transmission of Buruli Ulcer Disease: A Systematic Review | doi = 10.1371/journal.pntd.0000911 | journal = PLoS Neglected Tropical Diseases | volume = 4 | issue = 12 | pages = e911 | year = 2010 | pmid =  21179505| pmc =3001905 }} {{open access}}


{{Gram-positive actinobacteria diseases}}
==Related pages==
* [[Mycobacterium ulcerans]]
* [[Neglected tropical diseases]]
* [[Skin infections]]


{{DEFAULTSORT:Buruli Ulcer}}
[[Category:Infectious diseases]]
[[Category:Bacterial diseases]]
[[Category:Neglected tropical diseases]]
[[Category:Neglected diseases]]
[[Category:Skin conditions]]
[[Category:Tropical diseases]]
[[Category:Mycobacterium-related cutaneous conditions]]
[[Category:RTT]]
[[Category:RTTID]]

Revision as of 19:07, 22 March 2025

A chronic debilitating skin and soft tissue infection


Buruli ulcer
Buruli ulcer.jpg
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Symptoms N/A
Complications N/A
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Risks N/A
Diagnosis N/A
Differential diagnosis N/A
Prevention N/A
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Medication N/A
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Deaths N/A


Buruli ulcer is a chronic, debilitating skin and soft tissue infection caused by the bacterium Mycobacterium ulcerans. It is characterized by the development of large ulcers, primarily on the limbs, and can lead to significant morbidity if not treated appropriately.

Epidemiology

Buruli ulcer is most commonly found in rural areas of West Africa, Central Africa, and some parts of Australia. It is considered a neglected tropical disease and primarily affects children and young adults. The exact mode of transmission is not well understood, but it is believed to be associated with environmental factors, particularly aquatic environments.

Pathophysiology

The disease is caused by Mycobacterium ulcerans, which produces a toxin known as mycolactone. This toxin is responsible for the tissue necrosis and immunosuppression observed in Buruli ulcer. The infection typically begins as a painless nodule or papule, which can progress to a large ulcer with undermined edges.

Clinical Presentation

The initial presentation of Buruli ulcer is often a painless, firm nodule or plaque. Over time, this lesion can ulcerate, leading to the characteristic large, necrotic ulcer with undermined edges. The ulcers are typically painless, but secondary bacterial infections can cause pain and further complications. The disease primarily affects the skin and soft tissues, but in severe cases, it can involve bones.

Diagnosis

Diagnosis of Buruli ulcer is primarily clinical, supported by laboratory tests. Polymerase chain reaction (PCR) testing for Mycobacterium ulcerans DNA is the most sensitive method. Other diagnostic methods include microscopy, culture, and histopathology. Early diagnosis is crucial for effective treatment and to prevent complications.

Treatment

The mainstay of treatment for Buruli ulcer is a combination of antibiotics, typically rifampicin and clarithromycin or streptomycin. Surgical intervention may be necessary for extensive lesions, including debridement and skin grafting. Early treatment is essential to prevent severe tissue damage and disability.

Prevention

Preventive measures for Buruli ulcer are not well established due to the unclear mode of transmission. However, efforts to reduce exposure to potential environmental sources, such as stagnant water, may help reduce the risk. Community education and early case detection are important components of prevention strategies.

Related pages

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