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| | '''For patient information, click [[Buruli ulcer (patient information)|here]]''' |
| {{Buruli ulcer}} | | {{Buruli ulcer}} |
| {{CMG}} | | {{CMG}} |
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| The '''Buruli ulcer''' (also known as the '''Bairnsdale ulcer''') is an [[infectious disease]] caused by ''[[Mycobacterium ulcerans]]'', from the [[Mycobacterium|same family of bacteria]] which causes [[tuberculosis]] and [[leprosy]]. The infection causes painless swelling, with [[lesion]]s developing in the skin later on. Further progression of this bacteria produces toxins that [[Immune suppression|suppress]] the [[immune system]] and destroy skin, underlying tissue and bone, causing severe deformities. It predominantly affects the limbs.
| | {{SK}} Bairnsdale ulcer; Searls ulcer |
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| ==Identification and naming== | | ==[[Buruli ulcer overview|Overview]]== |
| It was first described in 1948 from the Bairnsdale district in south-east [[Australia]]. The disease was well known in Africa before this time but the mycobacterium had never been identified. James Augustus Grant, in his book ''A Walk across Africa'', describes how his leg became grossly swollen and stiff with later a copious discharge. This was almost certainly the severe oedematous form of the disease, and is the first known description of the infection. The name "Buruli ulcer" comes from an area in Uganda where the disease was once most prevalent, especially during the 1960s.
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| Just recently, an international team of researchers led by Monash University scientist Dr Tim Stinear has unlocked the entire genomic makeup of this mysterious disease hoping it could provide researchers with the knowledge of creating a treatment or even a vaccine.
| | ==[[Buruli ulcer historical perspective|Historical Perspective]]== |
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| ==Infection== | | ==[[Buruli ulcer pathophysiology|Pathophysiology]]== |
| Being one of the less known diseases caused by [[mycobacteria]], means of infection are not completely clear. However, the mycobacterium has been identified in stagnant or slowly moving water sources in [[Endemic (epidemiology)|endemic areas]] and in aquatic insects (''Naucoridiae''). [[Transmission (medicine)|Transmission]] to man may be by means of insects or by a contaminated aerosol generated from decaying vegetation in the water source. Infection in Australia has occurred in an alpaca, in koalas, possums and other marsupials.
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| ==Symptoms== | | ==[[Buruli ulcer causes|Causes]]== |
| The infection in most instances presents as a [[wikt:subcutaneous|subcutaneous]] [[Nodule (medicine)|nodule]], which is characteristically painless. In southern Australia the presentation is more often as a [[papule]] (or pimple), which is in the [[skin]] (dermis) rather than subcutaneous. The infection is mostly on the limbs, most often on exposed areas but not on the hands or feet. In children all areas may be involved, including the face or abdomen. A more severe form of infection produces diffuse swelling of a limb, which, unlike the papule or nodule, can be painful and accompanied by [[fever]]. Infection may frequently follow [[physical trauma]], often minor trauma such as a small scratch.
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| ==Pathology== | | ==[[Buruli ulcer differential diagnosis|Differentiating Buruli ulcer from other Diseases]]== |
| The disease is primarily an infection of subcutaneous fat, resulting in a focus of necrotic (dead) fat containing myriads of the mycobacteria in characteristic spherules formed within the dead fat cells. [[Ulcer#Skin ulcers|Skin ulceration]] is a secondary event. The mycobacterium produces a toxin, named mycolactone, which causes this fat necrosis and inhibits an immune response. Healing may occur spontaneously but more often the disease is slowly progressive with further ulceration, granulation, scarring, and contractures. Secondary infection may occur with other nodules developing and infection may occur into bone. Although seldom fatal, the disease results in considerable morbidity and hideous deformity.
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| Th1-mediated [[Immune system|immune responses]] are protective against ''M. ulcerans'' infection, whereas Th2-mediated responses are not.
| | ==[[Buruli ulcer epidemiology and demographics|Epidemiology and Demographics]]== |
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| ==Diagnosis== | | ==[[Buruli ulcer risk factors|Risk Factors]]== |
| The diagnosis of Buruli ulcer is usually based on the characteristic appearance of the ulcer in an endemic area. If there is any doubt about the diagnosis, then [[polymerase chain reaction|PCR]] using the IS2404 target is helpful, but this is not specific for ''M. ulcerans''. The [[Ziehl-Neelsen stain]] is only 40–80% sensitive, and culture is 20–60% sensitive.
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| ==Treatment== | | ==[[Buruli ulcer natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| Treatment is by [[Surgery|surgical excision]] (removal) of the lesion, which may be only a minor operation and very successful if undertaken early. Advanced disease may require prolonged treatment with extensive skin grafting. Surgical practice can be dangerous and scarcely available in affected third world countries.
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| Antibiotics currently play little part in the treatment of Buruli ulcer. The [[World Health Organisation|WHO]] currently recommend [[rifampicin]] and [[streptomycin]] for eight weeks in the hope of reducing the need for surgery. The combination of rifampicin and [[clarithromycin]] has been used for many years in Australia. Rifampicin must never be used alone because the bacterium quickly becomes resistant.
| | == Diagnosis == |
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| There are a number of experimental treatments currently being investigated:
| | [[Buruli ulcer history and symptoms| History and Symptoms]] | [[Buruli ulcer physical examination | Physical Examination]] | [[Buruli ulcer laboratory findings | Laboratory Findings]] | [[Buruli ulcer chest x ray|Chest X Ray]] | [[Buruli ulcer other diagnostic studies|Other Diagnostic Studies]] |
| * [[Sitafloxacin]] and [[rifampicin]] is a synergistic combination that only been trialled in mice.
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| * Rifalazil is a [[rifamycin]] antibiotic that appears to be more potent than [[rifampicin]] that has only been trialled in mice.
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| * Epiroprim and [[dapsone]] are synergistic when used in combination (''in vitro'' studies only at present)
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| * Diarylquinoline shows high potency ''in vitro''
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| In a small series of eight patients, local heat at 40°C led to complete healing without surgery (except the initial removal of dead tissue).<ref>{{cite journal | author=Meyers WM, Shelly WM, Connor DH | title=Heat treatment of ''Mycobacterium ulcerans'' infections without surgical excision | journal=Am J Trop Med Hyg | year=1974 | volume=23 | pages=924–29 }}</ref>
| | ==Treatment== |
| | [[Buruli ulcer medical therapy|Medical Therapy]] | [[Buruli ulcer surgery|Surgery]] | [[Buruli ulcer primary prevention|Primary Prevention]] | [[Buruli ulcer secondary prevention|Secondary Prevention]] | [[Buruli ulcer cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Buruli ulcer future or investigational therapies|Future or Investigational Therapies]] |
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| ==Global spread== | | ==Case Studies== |
| The infection occurs in well defined areas throughout the world, mostly tropical areas - in several areas in Australia, in Uganda, in several countries in West Africa, in Central and South America, in Southeast Asia and New Guinea. It is steadily rising as a serious disease, especially in West Africa and underdeveloped countries, where it is the third leading cause of mycobacterial infection in healthy people, after tuberculosis and leprosy. In East Africa, thousands of cases occur annually and in these areas the disease has displaced leprosy to become the second most important mycobacterial disease of man (after tuberculosis).
| | [[Buruli ulcer case study one|Case #1]] |
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| The disease is more likely to occur where there have been environmental changes such as the development of water storages, sand mining and irrigation.
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| == References ==
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| MacCallum P, Tolhurst JC, Buckle G, Sissons HA (1948). A New Mycobacterial Infection in Man. ''J Pathol Bacteriol'' '''60''' (1): 93–122.
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| *[http://www.who.int/mediacentre/factsheets/fs199/en/ World Health Organization buruli ulcer page]
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| *[http://www.burulibusters.com/ Buruli Action Page] (Warning: Graphic Images)
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| *{{cite journal | author=Sizaire V, Nackers F, Comte E, Portaels F | title=Mycobacterium ulcerans infection: control, diagnosis, and treatment | journal=Lancet Infect Dis | year=2006 | volume=6 | issue=5 | pages=288–296 | id=PMID 16631549 | doi=10.1016/S1473-3099(06)70464-9 | url=http://linkinghub.elsevier.com/retrieve/pii/S1473-3099(06)70464-9 }}
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| <references/>
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| {{Bacterial diseases}} | | {{Bacterial diseases}} |
| [[de:Buruli-Ulkus]] | | [[de:Buruli-Ulkus]] |
| [[es:Úlcera de Buruli]] | | [[es:Úlcera de Buruli]] |
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| [[Category:Infectious disease]] | | [[Category:Disease]] |
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| [[Category:Bacterial diseases]] | | [[Category:Bacterial diseases]] |
| [[Category:Neglected diseases]] | | [[Category:Neglected diseases]] |
| [[Category:Tropical disease]] | | [[Category:Tropical disease]] |
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