Buruli ulcer
You don't need to be Editor-In-Chief to add or edit content to WikiDoc. You can begin to add to or edit text on this WikiDoc page by clicking on the edit button at the top of this page. Next enter or edit the information that you would like to appear here. Once you are done editing, scroll down and click the Save page button at the bottom of the page.
| Buruli ulcer Classification and external resources | |
| ICD-10 | A31.1 |
|---|---|
| ICD-9 | 031.1 |
| DiseasesDB | 8568 |
| MeSH | D009165 |
|
WikiDoc Resources for Buruli ulcer | |
|
Articles | |
|---|---|
|
Most recent articles on Buruli ulcer Most cited articles on Buruli ulcer | |
|
Media | |
|
Powerpoint slides on Buruli ulcer | |
|
Evidence Based Medicine | |
|
Clinical Trials | |
|
Ongoing Trials on Buruli ulcer at Clinical Trials.gov Clinical Trials on Buruli ulcer at Google
| |
|
Guidelines / Policies / Govt | |
|
US National Guidelines Clearinghouse on Buruli ulcer
| |
|
Books | |
|
News | |
|
Commentary | |
|
Definitions | |
|
Patient Resources / Community | |
|
Patient resources on Buruli ulcer Discussion groups on Buruli ulcer Patient Handouts on Buruli ulcer Directions to Hospitals Treating Buruli ulcer Risk calculators and risk factors for Buruli ulcer
| |
|
Healthcare Provider Resources | |
|
Causes & Risk Factors for Buruli ulcer | |
|
Continuing Medical Education (CME) | |
|
International | |
|
| |
|
Businness | |
|
Experimental / Informatics | |
Please Take Over This Page and Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [1] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.
The Buruli ulcer (also known as the Bairnsdale ulcer) is an infectious disease caused by Mycobacterium ulcerans, from the same family of bacteria which causes tuberculosis and leprosy. The infection causes painless swelling, with lesions developing in the skin later on. Further progression of this bacteria produces toxins that suppress the immune system and destroy skin, underlying tissue and bone, causing severe deformities. It predominantly affects the limbs.
Identification and naming
It was first described in 1948 from the Bairnsdale district in south-east Australia. The disease was well known in Africa before this time but the mycobacterium had never been identified. James Augustus Grant, in his book A Walk across Africa, describes how his leg became grossly swollen and stiff with later a copious discharge. This was almost certainly the severe oedematous form of the disease, and is the first known description of the infection. The name "Buruli ulcer" comes from an area in Uganda where the disease was once most prevalent, especially during the 1960s.
Just recently, an international team of researchers led by Monash University scientist Dr Tim Stinear has unlocked the entire genomic makeup of this mysterious disease hoping it could provide researchers with the knowledge of creating a treatment or even a vaccine.
Infection
Being one of the less known diseases caused by mycobacteria, means of infection are not completely clear. However, the mycobacterium has been identified in stagnant or slowly moving water sources in endemic areas and in aquatic insects (Naucoridiae). Transmission to man may be by means of insects or by a contaminated aerosol generated from decaying vegetation in the water source. Infection in Australia has occurred in an alpaca, in koalas, possums and other marsupials.
Symptoms
The infection in most instances presents as a subcutaneous nodule, which is characteristically painless. In southern Australia the presentation is more often as a papule (or pimple), which is in the skin (dermis) rather than subcutaneous. The infection is mostly on the limbs, most often on exposed areas but not on the hands or feet. In children all areas may be involved, including the face or abdomen. A more severe form of infection produces diffuse swelling of a limb, which, unlike the papule or nodule, can be painful and accompanied by fever. Infection may frequently follow physical trauma, often minor trauma such as a small scratch.
Pathology
The disease is primarily an infection of subcutaneous fat, resulting in a focus of necrotic (dead) fat containing myriads of the mycobacteria in characteristic spherules formed within the dead fat cells. Skin ulceration is a secondary event. The mycobacterium produces a toxin, named mycolactone, which causes this fat necrosis and inhibits an immune response. Healing may occur spontaneously but more often the disease is slowly progressive with further ulceration, granulation, scarring, and contractures. Secondary infection may occur with other nodules developing and infection may occur into bone. Although seldom fatal, the disease results in considerable morbidity and hideous deformity.
Th1-mediated immune responses are protective against M. ulcerans infection, whereas Th2-mediated responses are not.
Diagnosis
The diagnosis of Buruli ulcer is usually based on the characteristic appearance of the ulcer in an endemic area. If there is any doubt about the diagnosis, then PCR using the IS2404 target is helpful, but this is not specific for M. ulcerans. The Ziehl-Neelsen stain is only 40–80% sensitive, and culture is 20–60% sensitive.
Treatment
Treatment is by surgical excision (removal) of the lesion, which may be only a minor operation and very successful if undertaken early. Advanced disease may require prolonged treatment with extensive skin grafting. Surgical practice can be dangerous and scarcely available in affected third world countries.
Antibiotics currently play little part in the treatment of Buruli ulcer. The WHO currently recommend rifampicin and streptomycin for eight weeks in the hope of reducing the need for surgery. The combination of rifampicin and clarithromycin has been used for many years in Australia. Rifampicin must never be used alone because the bacterium quickly becomes resistant.
There are a number of experimental treatments currently being investigated:
- Sitafloxacin and rifampicin is a synergistic combination that only been trialled in mice.
- Rifalazil is a rifamycin antibiotic that appears to be more potent than rifampicin that has only been trialled in mice.
- Epiroprim and dapsone are synergistic when used in combination (in vitro studies only at present)
- Diarylquinoline shows high potency in vitro
In a small series of eight patients, local heat at 40°C led to complete healing without surgery (except the initial removal of dead tissue).[1]
Global spread
The infection occurs in well defined areas throughout the world, mostly tropical areas - in several areas in Australia, in Uganda, in several countries in West Africa, in Central and South America, in Southeast Asia and New Guinea. It is steadily rising as a serious disease, especially in West Africa and underdeveloped countries, where it is the third leading cause of mycobacterial infection in healthy people, after tuberculosis and leprosy. In East Africa, thousands of cases occur annually and in these areas the disease has displaced leprosy to become the second most important mycobacterial disease of man (after tuberculosis).
The disease is more likely to occur where there have been environmental changes such as the development of water storages, sand mining and irrigation.
References
MacCallum P, Tolhurst JC, Buckle G, Sissons HA (1948). A New Mycobacterial Infection in Man. J Pathol Bacteriol 60 (1): 93–122.
- World Health Organization buruli ulcer page
- Buruli Action Page (Warning: Graphic Images)
- Sizaire V, Nackers F, Comte E, Portaels F (2006). "Mycobacterium ulcerans infection: control, diagnosis, and treatment". Lancet Infect Dis 6 (5): 288–296. doi:10.1016/S1473-3099(06)70464-9. PMID 16631549.
WikiDoc Research Resources for Buruli ulcer | |
|---|---|
| Articles on Buruli ulcer | Most recent articles on Buruli ulcer • Most cited articles on Buruli ulcer • Review articles on Buruli ulcer • Articles on Buruli ulcer in N Eng J Med, Lancet, BMJ |
| Media (Slides, Video, Images, MP3) on Buruli ulcer | Powerpoint slides on Buruli ulcer • Images of Buruli ulcer • Photos of Buruli ulcer • Podcasts & MP3s on Buruli ulcer • Videos on Buruli ulcer |
| Evidence Based Medicine Regarding Buruli ulcer | Cochrane Collaboration on Buruli ulcer • Bandolier on Buruli ulcer • TRIP on Buruli ulcer |
| Cost Effectiveness of Buruli ulcer | Cost Effectiveness of Buruli ulcer |
| Clinical Trials Involving Buruli ulcer | Ongoing Trials on Buruli ulcer at Clinical Trials.gov • Trial results on Buruli ulcer • Clinical Trials on Buruli ulcer at Google |
| Guidelines / Policies / Government Resources (FDA/CDC) Regarding Buruli ulcer | US National Guidelines Clearinghouse on Buruli ulcer • NICE Guidance on Buruli ulcer • NHS PRODIGY Guidance • FDA on Buruli ulcer • CDC on Buruli ulcer |
| Textbook Information on Buruli ulcer | Books and Textbook Information on Buruli ulcer |
| Pharmacology Resources on Buruli ulcer | Dosing of Buruli ulcer • Drug interactions with Buruli ulcer • Side effects of Buruli ulcer • Allergic reactions to Buruli ulcer • Overdose information on Buruli ulcer • Carcinogenicity information on Buruli ulcer • Buruli ulcer in pregnancy • Pharmacokinetics of Buruli ulcer • |
| Genetics, Pharmacogenomics, and Proteinomics of Buruli ulcer | Genetics of Buruli ulcer • Pharmacogenomics of Buruli ulcer • Proteomics of Buruli ulcer |
| Newstories on Buruli ulcer | Buruli ulcer in the news • Be alerted to news on Buruli ulcer • News trends on Buruli ulcer |
| Commentary on Buruli ulcer | Blogs on Buruli ulcer |
| Patient Resources on Buruli ulcer | Patient resources on Buruli ulcer • Discussion groups on Buruli ulcer • Patient Handouts on Buruli ulcer • Directions to Hospitals Treating Buruli ulcer • Risk calculators and risk factors for Buruli ulcer |
| Healthcare Provider Resources on Buruli ulcer | Symptoms of Buruli ulcer • Causes & Risk Factors for Buruli ulcer • Diagnostic studies for Buruli ulcer • Treatment of Buruli ulcer |
| Continuing Medical Education (CME) Programs on Buruli ulcer | CME Programs on Buruli ulcer |
| International Resources on Buruli ulcer | Buruli ulcer en Espanol • Buruli ulcer en Francais |
| Business Resources on Buruli ulcer | Buruli ulcer in the Marketplace • Patents on Buruli ulcer |
| Informatics Resources on Buruli ulcer | List of terms related to Buruli ulcer |
| ||||
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
