Buruli Ulcer: Review of a Neglected Skin Mycobacterial Disease

J Clin Microbiol. 2018 Mar 26;56(4):e01507-17. doi: 10.1128/JCM.01507-17. Print 2018 Apr.

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.

Publication types

  • Review

MeSH terms

  • Africa, Western / epidemiology
  • Anti-Bacterial Agents / therapeutic use
  • Buruli Ulcer / drug therapy*
  • Buruli Ulcer / epidemiology
  • Buruli Ulcer / microbiology*
  • Clarithromycin / therapeutic use
  • Humans
  • Macrolides / metabolism
  • Mycobacterium Infections / drug therapy
  • Mycobacterium Infections / epidemiology
  • Mycobacterium Infections / microbiology
  • Mycobacterium ulcerans / drug effects
  • Mycobacterium ulcerans / genetics
  • Neglected Diseases / drug therapy
  • Neglected Diseases / epidemiology
  • Neglected Diseases / microbiology*
  • Polymerase Chain Reaction
  • Rifampin / therapeutic use
  • Skin Diseases, Bacterial / drug therapy
  • Skin Diseases, Bacterial / microbiology*
  • Streptomycin / therapeutic use

Substances

  • Anti-Bacterial Agents
  • Macrolides
  • mycolactone
  • Clarithromycin
  • Rifampin
  • Streptomycin