Buruli Ulcer

Question 1

What causes buruli ulcer?

Answer 1

Mycobacterium ulcerans

Question 2

Where in the world do you get buruli ulcer?

Answer 2

West Africa
Australia

Tropical/subtropical countries

Question 3

What are the features of Mycobacterium ulcerans?

Answer 3

Acid fast bacilli

Associated with stagnant water

Question 4

What is the pathophysiology of buruli ulcer?

Answer 4

M. Ulcerans produces mycolactone which

• interacts with nerves to reduce pain
• causes apoptosis
• reduces immune cell signalling

Question 5

What are the features of buruli ulcer?

Answer 5

Painless nodule or plaque or SC swelling

4wks later: painless ulcer that can either last years or spontaneously heal in months

Question 6

What are the categories of buruli ulcer?

Answer 6

Cat 1 <5cm
Cat 2 5-15cm
Cat 3 >15cm or spread past skin

Question 7

What are the sequelae of buruli ulcer?

Answer 7

Osteomyelitis
Muscle/bone permanent damage leading to disability
Secondary infections

Question 8

How do you diagnose buruli ulcer?

Answer 8

Clinical
Ziehl neelson staining
PCR- WHO has increased number of reference labs in West Africa

Question 9

How do you treat buruli ulcer?

Answer 9

Rifampicin and clarithromycin 8weeks
Debride +- skin graft
20% have paradoxical reaction 3-12wks later

Question 10

Where are buruli ulcers mainly found on the body?

Answer 10

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