Buruli ulcer is a neglected tropical disease caused by the bacterium Mycobacterium ulcerans. It primarily affects the skin, though it can also involve subcutaneous tissues and, in severe cases, bones. The disease is characterized by progressive, painless skin lesions that can develop into large ulcers, typically on the limbs. The toxin produced by M. ulcerans, known as mycolactone, is responsible for tissue destruction and suppression of the immune response, contributing to the lack of pain in early stages.
The exact mode of transmission remains unclear, but it is believed that environmental exposure plays a role, particularly in tropical, subtropical, and temperate regions with slow-moving water bodies. The disease is endemic in West and Central Africa, with additional reported cases in Australia, Southeast Asia, and parts of South America.
Diagnosis is based on clinical presentation, polymerase chain reaction (PCR) testing, microscopy, and histopathological examination. Early detection can lead to non-surgical treatment with antibiotics, typically a combination of rifampicin and streptomycin, or alternative regimens where streptomycin is not feasible. In advanced cases, surgical intervention and wound care may be required.
Prevention strategies focus on community awareness, early treatment, and protective clothing to reduce skin exposure in endemic areas. The World Health Organization (WHO) includes Buruli ulcer in its list of neglected tropical diseases and supports surveillance and control programs in affected countries.
There is no licensed vaccine specifically for Buruli ulcer, though the Bacillus Calmette–Guérin (BCG) vaccine may offer temporary, partial protection.