BURULI ULCER

Buruli ulcer caused by Mycobacterium ulcerans is the third most common
mycobacterial disease after tuberculosis and leprosy in non-HIV-infected
patients. The disease first described in Uganda is now endemic in
swampy areas in West Africa, but may be seen elsewhere. It is
transmitted by mild injuries, the bacillus probably residing in muddy
water. Patients are usually children.
Two different forms of the disease are seen.
1. A slow form which develops in 2-3 months. A hard indurated plaque
with surrounding severely constricting oedema forms and compromises
the circulation in the affected limb, leading to ischaemia and necrosis.
2. A fast form which develops in 2-4 weeks. A painless papule or nodule
forms and ulcerates, extending rapidly. The typical ulcer has undermined
edges. The patient is not sick and there is no oedema.
Very extensive ulceration and secondary infection may occur and lead to
sepsis, tetanus and death. Besides the skin and subcutis deeper
structures may be involved. Particularly osteomyelitis may be seen.
The lesions may heal spontaneously with severe scarring and
contractures.
Management of Buruli ulcer
- Prevent secondary infections.
- There is only one effective treatment: Surgery as soon as possible, wide excision
with skin grafting. There is no effective medical treatment!