Last Updated: 2020-08-13
- Cook 1897.
- Kleinschmidt 1935.
- McCallum 1948.
- Atypical mycobacteriosis caused by Mycobacterium ulcerans.
- Infection with the atypical mycobacterium, Mycobacterium ulcerans, an obligatory pathogen
- 3. most frequent mycobacteriosis in immunocompetent persons
- Mainly found in the tropics and subtropical regions
- Pathogen: Mycobacterium ulcerans.
- Incubation time: 2-14 weeks.
- The path of infection is not clear. Possibly via contaminated soil, plants, possibly insects or from person to person.
- Painless, slightly scaly, centrally draining, partly oedematous nodules on the legs or trunk, which in the course of time develop into a size-progressive ulcer (up to 15% of KOF)
- In rare cases there is involvement of the fascia, muscles and bones
- Clinical features.
- Bact. smear
Granulomas with giant Langerhans cells, acanthosis, hyperkeratosis.
The occurrence of widespread necroses and the sowing of mycobacteria on the bones is possible. Spontaneous remission with scarring is possible.
- If the disease is detected early, a widespread excision is indicated.
- Systemic therapy has so far shown little promise of success.
Therapy after Lebwohl
Level of evidence
|Rifampin p.o. 10 mg/kg bw and Streptomycin i.m. 15 mg/kg bw daily for- 412 weeks||B|
|Surgical removal alone||B|
|Surgical 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 daily and Clarithromycin p.o. 500 mg 2x daily for 3-6 months and surgical removal.||C|
|Rifampicin 10 mg/kg bw 1x daily and Moxifloxacin p.o. 400 mg 2x daily for 3-6 months and surgical removal.||C|
- Meyers, W.M. and F. Portaels, Mycobacterium ulcerans Infection (Buruli Ulcer), in Tropical Infectious Diseases. 2006, Elsevier BV. p. 428-435.
- 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.