Buruli Ulcer: Review of a Neglected Skin Mycobacterial Disease

Abstract

Buruli ulcer is caused by Mycobacterium ulcerans This neglected disease occurs in scattered foci around the world, with a higher concentration of cases in West Africa. The mycobacteria produce mycolactones that cause tissue necrosis. The disease presents as a painless skin nodule that ulcerates as necrosis expands. Finding acid-fast bacilli in smears or histopathology, culturing the mycobacteria, and performing M. ulcerans PCR in presumptive cases confirm the diagnosis. Medical treatment with oral rifampin and intramuscular streptomycin or oral treatment with rifampin plus clarithromycin for 8 weeks is supported by the World Health Organization. This review summarizes the epidemiology, pathogenesis, clinical presentation, diagnostic tests, and advances in treatment.

Keywords: Buruli ulcer; Mycobacterium ulcerans; neglected disease; skin mycobacteria.

Copyright © 2018 American Society for Microbiology.

Figures

FIG 1

(A) Category 3 ulcer in the upper extremity, revealing the patient's tendons and muscle. (B) Ziehl-Neelsen stain demonstrating abundant clusters of acid-fast bacilli in the necrotic adipose tissue. This was a tissue sample from a nodule. The photograph was taken under oil immersion. (C) Histopathology of an ulcer, showing hyperplastic epidermis (arrow), necrosis (*), and inflammation (i). The photograph was taken at low magnification (4× objective). (All photographs were obtained while the author worked for the Centers for Disease Control and Prevention.)