A large, destructive ulcer on my leg? My, hand me the kitchen knife!

The Buruli Ulcer (named after the place in Uganda where it was first described) is a spreading, highly destructive ulcerative disease caused by the bacterium Mycobacterium ulcerans and, according to the WHO, the third most common mycobacterial infection of humans after tuberculosis and leprosy. It is endemic in 32 tropical countries in Asia, Africa and South America and seems to affect mostly children and women who live in rural areas near rivers or wetlands.

Deforestation and increased basic agricultural activities may significantly contribute to the recent marked increases in incidences of M. ulcerans infections, especially in West Africa, where the disease is rapidly emerging. There doesn't seem to be any racial predisposition

Mode of transmission is still unknown, but it is believed that trauma to the skin with subsequent infection through soil is the most likely cause. The disease presents first with a firm, painless nodule which grows and then breaks down into an painless ulcer which rapidly spreads in all directions. Bizarrely, satellite ulcers often communicate with the primary one by subcutaneous tunnels, making the damage much larger than it appears. Important structures such as the eye, breast, or genitalia are sometimes lost or severely damaged and there is regular bone involvement in form of osteomyelitis.

Treatment is by wide excision and skinflap, as non treatment would result in large, heavily scarred areas with functional limitations. Apparently Rifampicin has a role in the treatment of early presentations, but once established, surgery is the only option.

Prevention seems to be impossible, but early detection and treatment is vital. The best way to avoid the disease seems to stay clear of the often sharply geographically defined areas where the disease is endemic.


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