Buruli ulcer

Last Updated: 2023-07-07

Author(s): Anzengruber F., Navarini A.

ICD11: 1B21.20

  • Cook 1897
  • Kleinschmidt 1935
  • McCallum 1948

Buruli ulcer.

  • Atypical mycobacteriosis caused by Mycobacterium ulcerans
  • Infection with the atypical mycobacterium, Mycobacterium ulcerans, an obligate pathogen
  • 3rd most common mycobacteriosis in immunocompetent individuals
  • Most common in tropical and subtropical areas
  • Pathogen: Mycobacterium ulcerans
  • Inoculation period: 2-14 weeks
  • The route of infection is not clear. Possibly via contaminated soil, plants, possibly insects or from person to person
  • S.c., painless, slightly scaly, centrally draining, partly oedematous nodules appear on legs or trunk, which in the course of time transform into a size-progressive ulcer (up to 15% of the KOF)
  • In rare cases, there is involvement of the fascia, muscles and bones
  • Clinic
  • Bact. smear

Granulomas with Langerhans giant cells, acanthosis, hyperkeratosis.

The occurrence of widespread necrosis and seeding of mycobacteria on the bones are possible. Spontaneous remission with scarring is possible.

  • If the disease is diagnosed early, wide excision is indicated
  • Systemic therapy is not very promising so far
Therapy according to Lebwohl Evidence level
Rifampin p.o. 10 mg/kg bw and streptomycin i.m. 15 mg/kg bw daily for-412 weeks B
Operative removal alone B
Operative removal and rifampin p.o. 10 mg/kg bw daily and ciprofloxacin p.o. 250-500 mg 2x daily for 3-6 months B
Rifampicin p.o. 10 mg/kg bw/d and clarithromycin p.o. 12-15 mg/kg bw for 2-6 months and surgical measures B
Rifampin p.o. 10 mg/kg bw/d and moxifloxacin p.o. 400 mg 1x daily for 3-6 months C
Ciprofloxacin p.o. 500 mg 2x tgl. and clarithromycin p.o. 500 mg 2x tgl. for 3-6 months and surgical removal. C
Rifampicin 10 mg/kg bw 1x tgl. and moxifloxacin p.o. 400 mg 2x tgl. for 3-6 months and surgical removal. C
Hyperthermia (40°C) C
  1. Meyers, W.M. and F. Portaels, Mycobacterium ulcerans Infection (Buruli Ulcer), in Tropical Infectious Diseases. 2006, Elsevier BV. p. 428-435.
  2. Phillips, R., et al., Sensitivity of PCR Targeting the IS2404 Insertion Sequence of Mycobacterium ulcerans in an Assay Using Punch Biopsy Specimens for Diagnosis of Buruli Ulcer. Journal of Clinical Microbiology, 2005. 43(8): p. 3650-3656.

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