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Buruli Ulcer Mycobacterium ulcerans Infection. Prepared by: A. Elkader Y. Elottol Supervisor: Prof M. Shubir. Disease caused by Mycobacterium ulcerans. First described by MacCallum in 1948, but the name came from Buruli country in Uganda.
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Buruli UlcerMycobacterium ulcerans Infection Prepared by: A. Elkader Y. Elottol Supervisor: Prof M. Shubir
Disease caused by Mycobacterium ulcerans. • First described by MacCallum in 1948, but the name came from Buruli country in Uganda. • The third most common Mycobacterium , that affected more than 30 countries .
Mode of transmission • Mode of transmission is not entirely known evidence suggest that insects are aquatic bugs belong to the genus Noucaris and Diplonychus may transmit the microbe. • Person to person transmission are not clearly supported . • Trauma during swimming.
Pathogenesis • Once inoculated into the subcutaneous tissue the organisms proliferates and elaborates a toxin that has affinity for fat cells. • The toxin called Mycolactone which cause local immunosuppression in infected tissue. • The most affected are children under the age of 15 years, mortality is low but disability is high(66%) affected region mostly the upper extremities. • The resulting necrosis then provides a favorable milieu for further proliferation of the organisms. • Clinically the disease manifests as Papules, Nodules, Plaques, Odematous Forms and Ulcers.
Diagnosis • Clinical: depending on the clinical ground • Laboratory: any two of the following finding are required: • Acid fast bacilli in a smear stained with Ziehl Neelsen . • Positive culture of M.ulcerans ( required 6-8 weeks or longer at 30-33ċ, produce Rough domed, lemon yellow colony on L.J medium) • Histopathological study of excisional biopsy specimen. • Positive PCR for DNA from M. ulcerans.
Treatment • Drug treatment: several antimicrobial agent have in vitro activity , but no single agent has been proven to regularly useful in treatment. • Agent used include Rifampicin, Rifabutin, Clarithromycin,Azithromycin,Streptomycin, and Amikacin. • Combination therapy are mostly used. • Surgical treatment: need prolong hospital stay (100 days).
Prevention • No available Vaccine, used BCG give immunity to about 47%. Referances • World HealthOrganization. • Center for Desease Control