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Buruli Ulcer:Transmission, Diagnosis, Signs, and Treatment

21 September, 2020 Riya Vaja

Buruli ulcer is a chronic paralyzing disease that occurs in scattered foci around the world. It is caused by Mycobacterium ulcerans, a bacterial species found in aquatic environments. This bacteria can affect both humans and animals, causing tenacious open wounds called Buruli ulcer.

It is one of the most frequent skin mycobacterial infections having prevalence worldwide. Although it has affected many people all around the world, the greatest burden of this disease lies in the tropical regions of the west and central Africa, Japan, and Australia.

This condition generally starts with a small painless nodule or an area of swelling that undergoes necrosis, producing an ulcer that keeps growing painlessly without any systematic symptoms. The early acknowledgment and diagnosis are vital for minimizing morbidity, costs, and preventing any further health complications.


This type of skin ulcer has many names (Buruli ulcer, Bairnsdale ulcer, Daintree ulcer, Searl ulcer, Mossman ulcer), primarily depending on the geographical area where it is found. By far 33 countries from around the world have been reporting fluctuating cases of Buruli ulcer skin infection, in which most cases occurred in the tropical and subtropical regions of China, Asia, Japan, and Australia. 

However, treating and preventing Buruli ulcers is not easy. This is mainly because not all countries have access to appropriate health care systems that can detect and diagnose the disease. The occurrence of this ulcerans infection is equal in both males and females. The disease can cluster in families but is not a contagious infection.


No evidence proves Buruli ulcer to be a human-to-human transmitted disease. The most common form by which a person gets infected with Mycobacterium ulcerans is through stagnant water bodies. The disease-causing bacteria (M. ulcerans) grows at temperatures between 29-33 °C and produces a unique toxin called mycolactone that damages body tissues and inhibits the immune response. 

M. ulcerans can survive with other aquatic organisms as well as insects, mosses, giant water bugs, and animal feces. The DNA of this bacterium can be found in water, soil, mats of bacteria and algae, fish, crayfish, and other animals that live in or around water bodies. Poor wound care is frequently associated with acquiring Buruli ulcer.

Signs & Symptoms of Buruli Ulcer

  • The first sign of this ulcerans infection is a swollen bump that may look similar to an insect bite.
  • It can also appear to be a swollen skin area or a patch of the firm, raised skin about 3 centimeters long across called plague, or a wider swelling under the skin.
  • Potential growth of open wounds.
  • You may experience a diffused painless swelling in the legs, arms, or face (oedema).
  • Bone infection and deformities.
  • Although they can happen anywhere in the body, ulcers are more frequent on the lower limbs (62%), upper limbs (24%), and on the trunk (9%).

Diagnosis of Buruli Ulcer

According to 3MEDS, the best healthcare provider in India, the diagnosis and treatment for Buruli ulcer should be conducted only by experienced health professionals based on the signs and symptoms alone and must exclude other conditions like tropical phagedenic ulcers, chronic lower level ulcers, diabetic ulcers, cutaneous leishmaniasis, and so on from the diagnosis to gain more accurate results. Doctors may confirm the diagnosis by polymerase chain reaction (real-time PCR test), that spots a DNA sequence termed IS2404, highly specific to M. ulcerans in 54-84% of cases.

Other similar methods used to confirm Buruli ulcer includes direct microscopy, histopathology, and culture that have their own advantages and disadvantages. Therefore, it is advisable to disclose all your underlying medical conditions to your healthcare provider so that they can make an apt choice for the diagnosis procedure.

Treatment & Prevention

Treatment of Buruli Ulcer

  • Treatment for Buruli ulcer includes a fusion of antibiotics and complementary treatments.

  • A combination of rifampicin (10 mg/kg once per day) and clarithromycin (7.5 mg/kg twice daily) is recommended.
  • Several other antibiotics can be used to partner with rifampicin, such as amikacin, ciprofloxacin, moxifloxacin, and levofloxacin. 
  • Wound and lymphedema management and surgery are used to speed up the healing process, thereby shortening the hospital stay for the patient.
  • Various physiotherapies may be used to treat and prevent patients with/from functional disability.

Prevention of Buruli Ulcer

  • Avoid any contact with aquatic environments in endemic areas.

  • Choose wearing long sleeves and pants.
  • Use insect repellent, and cleaning and covering your wounds as a major prevention step.
  • BCG vaccine that offers temporary protection from the disease.


Researchers have always been curious to know more about Buruli ulcer since the description of M. ulcerans in 1948. As a result, more developments in the treatment and diagnosis are seen to cure Buruli ulcer. Currently, the recommended medications that can be availed from the best online pharmacy in India, work effectively in patients with such disorders. Improvements in the treatment can be expected in the near future!