Buruli ulcer

Role of specific antibiotics in Mycobacterium ulcerans (Buruli ulcer) management

Provisional guidelines

When to suspect M. ulcerans disease

In a known endemic area, an experienced health worker can usually diagnose M. ulcerans disease on clinical grounds. The following clinico-epidemiological features are important diagnostic clues:

  • most patients live in or have travelled to a known endemic area;
  • most patients are children under 15 years of age;
  • about 85% of lesions are on the limbs;
  • lower-limb lesions are twice as common as upper-limb lesions;
  • non-ulcerative lesions are almost painless or minimally painful (although ulcers may be painful in the presence of secondary bacterial infection);
  • in the absence of secondary bacterial infections or other coinfections in ulcerative lesions, there are often no constitutional symptoms (such as fever);
  • enlarged lymph nodes are not a feature of M. ulcerans disease.