Buruli Ulcer

Question 1

Key characteristics of Buruli ulcer

Answer 1

Undermined border, painless, necrotic trough

Papule -> nodule -> plaque -> ulcer

Large amounts of bacilli and necrosis on microscopy

Question 2

Reservoir for mycobacterium ulcers

Answer 2

Stagnant water

Question 3

What is the organism for Buruli ulcer?

Answer 3

Mycobacterium ulcerans

Question 4

Risk factors for a B.ulcer?

Answer 4

Genetics
Young age
Mosquito bites

Question 5

Pathogenesis for a B.ulcer?

Answer 5

polyketide toxin mycolactone

Cytotoxicity, Immunosuppression and analgesia

Question 6

What investigations for a buruli ulcer?

Answer 6

Direct swab - necrosis, lots of bacilli

Serology
PCR
Biopsy

Question 7

Name the diagnosis

Answer 7

Buruli ulcer

Question 8

Treatment of B.ulcer?

Answer 8

Rifampicin plus streptomycin/clarithromycin/moxifloxacin

Clarithromycin best - oral treatment

Question 9

Name the diagnosis and why?

Answer 9

Buruli ulcer, undermined borders, central necrosis

Question 10

Characteristic features of tuberculin on Bx

Answer 10

Large immune response, no bacilli seen on Bx (different to primary cutaneous from direct inoculation

Question 11

What is the pathogenesis of tuberculosis chancre?

Answer 11

Direct inoculation

Multibacilliary on Bx

Question 12

What is a scorfuloderma?

Answer 12

Fistulae formation draining to skin from lymph node/bone/joint/lung

Question 13

What is a gumma?

Answer 13

Granulomatous ulcer, necrosis, haematogenous spread

Question 14

What cutaneous TB is paucibaciliary?

Answer 14

Lupus vulgaris
- Haematogenous or scrofula spread
- plaque

Question 15

What is the diagnosis?

Answer 15

TB verrucosa cutis

Question 16

Causes of paniculitis?

Answer 16

Erythema nodosum
Erythema induratum of Bazin (posterior legs, ulcerate)

Question 17

What is the diagnosis?

Answer 17

Papulo necrotic tubercullid

Question 18

What is the diagnosis?

Answer 18

Lichen scrofulosorum

Papular lesions

Commonly associated with scrofuloderma and tuberculous adenopathy

Question 19

Diagnosis of cutaenous TB?

Answer 19

Granuloma formation on skin scrape microscopy

Culture often negative
Consider PPD/IGRA/PCR or pulmonary testing

Question 20

How do you Rx cutaneous TB, how likely is it to be resistant?

Answer 20

RPZE - 6months as pulmonary
Unlikely to be resistant

Question 21

What is the diagnosis?

Answer 21

Many plasma cells, Russell bodies, Large histiocytes , containing bacteria, in the form of rods

Nasal and oral mucosa

Rhinoscleroderma from Klebsiella pneumonia

Rx: 6 wks to 6 months

Question 22

What is the cause of painful palpation of muscle on trunk?

Answer 22

Tropical pyomyositis

• Abrupt onset of local tenderness
• Fever
• High WBC and high sedimentation rate
• Blood cultures are positive in 30% of patients
• Most likely isolation is Staphylococcus aureus , non-MRSA

Question 23

Trauma causing painful rapidly growing large ulcer on leg?

Answer 23

Tropical phagedenic ulcer

DDX: leishmaniasis, Buruli ulcer , pyoderma gangrenosum, stasis
ulcers

Question 24

What is the diagnosis?

Answer 24

Noma
Oral infection rapidly progressing to skin ulceration -> gangrene

Fusiform bacillus, combined with non-hemolytic Streptococcus ,
Staphylococcus aureus

Question 25

What are the causes of a mycetoma?

Answer 25

Eumycetoma :true fungi Actinomycetoma: actinomyces (nocardia) Botriomycosis (staph aureus)

Question 26

A man spent time on safari in South Africa, lesion with eschar and surrounding lymphangitis and papular haemorrhagic rash

Answer 26

Rickettsia africae infection African Tick Bite Fever