Buruli ulcer

Organism Mycobacterium ulcerans is found in the exudate of the ulcer.

Clinical features There is at first just a small papule surrounded by shiny skin, but this soon breaks down to reveal a large necrotic ulcer with undermined edges. Tissue damage may be extensive involving bone and other structures.

Diagnosis is made on clinical grounds and a stained smear of the exudate.

Transmission The method of transmission has not been elucidated, but there are presumed to be environmental factors due to the relationship with rivers and wetlands. The role of aquatic insects has recently been suggested as M. ulcerans has been found in the salivary glands of insects. Focal outbreaks have followed migrations and movements of people, for example due to floods or dam construction. In Australia, koalas and opossums are found naturally infected.

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