Buruli ulcer, which is caused by Mycobacterium ulcerans, is a chronic, necrotizing disease of the skin and soft tissues. It is an emerging infectious disease and is the third most common mycobacterial disease of the immunocompetent host, after tuberculosis and leprosy.
2. SCIENTIFIC CLASSIFICATION
• KINGDOM : BACTERIA
• PHYLUM : ACTINOBACTERIA
• ORDER : ACTINOMYCETALES
• SUB ORDER : CORNEYBACTERINAE
• FAMILY : MYCOBACTERIACEAE
• GENUS : MYCOBACTERIUM
• SPECIES : ULCERANS
3. BURULI ULCER
• DEVASTATING SKIN DISEASE.
• NAMED AFTER REGION NAMED BURULI,NEAR NILE RIVER WHERE THE
FIRST CASE WAS REPORTED IN 1961.
• INFECTION LEADS TO EXTENSIVE DESTRUCTION OF SKIN AND SOFT
TISSUE.
• FORMS LARGE ULCERS MOSTLY ON LEGS AND ARMS.
• LEADS TO PERMANENT DISFIGUREMENT AND LONG TERM DISABILITY.
4.
5. EPIDEMIOLOGY
• MOSTLY SEEN IN AFRICA AND AUSTRALIA.
• PEOPLE LIVING OR WORKING ON THE RIVER SIDES AND MOVING
WATERS.
• ALL AGE PEOPLE ARE AFFECTED, MOSTLY UNDER 15 YEARS.
• AFFECTS ANY PART OF BODY BUT 90% IN LIMBS.
• NO EVIDENCE OF HUMAN TO HUMAN TRANSMISSION.
6. THE ORGANISM
• ROD SHAPED BACTERIA.
• STAINING REACTIONS : GRAM POSITIVE AND ACID FAST ORGANISM
• ENVIRONMENTAL Mycobacterium
• FORMERLY KNOWN AS Mycobacterium marinum.
• COLONY MORPHOLOGY: SLOW GROWER.
• FORMS SMALL, TRANSPARENT COLONIES AFTRER FOUR WEEKS.
7. THE ORGANISM
• TRANSMISSION – UNKNOWN.
• GROWS BEST AT 29-33 DEGREE CELSIUS.
• NEEDDS LOW OXYGEN CONCENTRATION.
• UNIQUE TOXIN – MYCOLACTONE.
• TOXIN IS USED TO DESTROY TISSUES AND INHIBITS IMMUNE
RESPONSE.
8. PATHOGENESIS
• INCUBATION PERIOD: WEEKS TO MONTHS.
• MODE OF TRANSMISSION : EXPOSURE TO UNCLEAR STAGNANT
WATER,SOIL OR VEGETATION AREAS.
• THE BACTERIA ENTERS THROUGH A BREAK IN THE SKIN.
• TWO HYPOTHESIS : ONE IS OF ACQURING CONTAMINATED AEROSOLS
AND SECOND ONE IS GETTING INFECTED THROUGH INSECTS THAT
LIVE IN THE WATER AREAS WHICH CONTAINS THIS ORGANISM.
9. • THREE CATEGORIES OF SEVERITY:
• CLASS 1 – SMALL LEISONS, NODULE FORMATION
• CLASS II – NON ULCERATIVE AND ULCERATIVE PLAQUE FORMS AND
ODEMATOUS FORMS
• CLASS III – DISSEMINATED AND MIXED FORMS SUCH AS
OSTEOMYELITIS AND OSTITIS.
10. CLASS - I
• PAINLESS STAGE
• FIRM LEISONS OF 1-2 cm
• OR LESS THAN 5 cm.
• SITUTAION – SUB-CUTANEOUS TISSUES
• GETS ATTACHED TO SKIN.
• COMPLETELY HEALS WITH ANTIBIOTIC TREATMENT.
12. CLASS - II
PLAQUE STAGE
• PAINLESS STAGE
• DEMARCATION IS OBSERVED.
• INDURATED AND ELEVATED
LEISON.
• SIZE OF LEISON- MORE THAN
2cm.
ODEMATOUS STAGE
• DIFFUSE SWELLING.
• ILL DEFINED MARGINS IN THE
LIMBS.
• PAINLESS AND FIRM LEISONS.
• COLOR CHANGES IN AFFECTED
AREA.
• ACCOMAPNY OF FEVER.
13. CLASS - II
• SIZE OF LEISON – 5 TO 15 cm
• SOMETYPES OF CLASS II LEISONS MAY HEAL COMPLETELY WITH
ANTIBIOTIC TREATMENT.
14. CLASS - III
OSTEOMYELITIS
• MULTIPLE LEISONS
• SIZE- MORE THAN 15cm.
• LEISONS OCCURS AT CRITICAL SITES (BREAST, GENITAL AREAS)
• IN ADDITION TO ANTIBIOTICS, SURGERY MAY BE REQUIRED TO TREAT
THE AREAS AFFECTED.
