Buruli ulcer

Last Updated: 2020-08-13

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 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
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.