Diagnosis
Differential diagnoses of Buruli ulcer include tropical phagedenic ulcers, chronic lower leg ulcers due to arterial and venous insufficiency (often in elderly populations), diabetic ulcers, cutaneous leishmaniasis, extensive ulcerative yaws and ulcers caused by Haemophilus ducreyi.
Early nodular and papular lesions may be confused with insect bite, boils, lipomas, ganglions, lymph node tuberculosis, onchocerciasis nodules or deep fungal subcutaneous infections. Cellulitis may look like oedema caused by Mycobacterium ulceransinfection but in the case of cellulitis, there is pain and fever. Four standard laboratory methods can be used to confirm Buruli ulcer: IS2404 polymerase chain reaction (PCR), direct microscopy, histopathology and culture. The bacterium grows best at temperatures between 29–33 °C (Mycobacterium tuberculosis grows at 37 °C) and needs a low (2.5%) oxygen concentration.
In 2019, WHO established the Buruli ulcer Laboratory Network for Africa to help strengthen PCR confirmation in 9 endemic countries in Africa. Thirteen laboratories participate in this network, supported by the American Leprosy Missions, Anesvad, Raoul Follereau Foundation and coordinated by the Pasteur Center of Cameroon.
In 2021, WHO completed an online consultation for a draft document on Target Product Profiles to develop rapid test for the diagnosis of Buruli ulcer. With the availability of simple oral treatment for Buruli ulcer, a rapid test to allow early confirmation of diagnosis can facilitate the timely treatment of the disease. The current turnaround time of a PCR test is too long to guide early treatment decisions.
Treatment
Treatment consists of a combination of antibiotics and complementary treatments. A combination of rifampicin (10 mg/kg once daily) and clarithromycin (7.5 mg/kg twice daily) is now the recommended treatment. Interventions such as wound and lymphoedema management and surgery (mainly debridement and skin grafting) are used to speed up healing, thereby shortening the duration of hospitalization. Physiotherapy is needed in severe cases to prevent disability. Those left with disability require long-term rehabilitation. These same interventions are applicable to other neglected tropical diseases, such as leprosy and lymphatic filariasis.
The WHO has developed a treatment guidance for health workers.
HIV infection complicates the management of the patient, making clinical progression more aggressive and resulting in poor treatment outcomes. WHO has published a technical guide to help clinicians in the management of co-infection.