See also: [[Aboriginal health]], [[Infectious Diseases#Important tropical diseases table|tropical diseases]] ***Guidelines:*** - [Management of Mycobacterium ulcerans infection (Buruli ulcer) in Australia: consensus statement. MJA 2025](https://onlinelibrary.wiley.com/doi/10.5694/mja2.52591?af=R) - [bookends](bookends://sonnysoftware.com/ref/DL/272158) - [Buruli ulcer - AJGP 2024](https://www1.racgp.org.au/ajgp/2024/september/an-overview-of-buruli-ulcer-in-australia) Buruli ulcer (BU) is caused by Mycobacterium ulcerans, an environmental pathogen that causes severe skin and soft-tissue necrosis. In Australia, cases of BU are acquired in endemic regions, which include Victoria and Far North Queensland, but those who have visited these regions can present to health practitioners anywhere. ![[Pasted image 20250616212041.png]] > [!caption]- > A. early/pre-ulcerative lesions. > B. shows progression, with typical undermined edges, surrounding induration and central necrosis. > C. Lesions heal slowly and may leave an area of scarring. > [!key points] > - Buruli ulcer is a notifiable disease in Victoria, the Northern Territory and QLD. > - Diagnosis using PCR is sensitive and specific if performed correctly; a dry swab under the undermined edge of ulcers or a tissue sample via punch biopsy if the lesion is not ulcerated is recommended. If swabs are incorrectly performed or performed on non-ulcerated skin, they can give a false negative result. > - **Treatment:** eight weeks’ duration using rifampicin-based dual oral antibiotic therapy, in combination with clarithromycin or a fluoroquinolone. > - Relapse is very rare but can occur in people with risk factors. > - There is emerging evidence for shorter durations of treatment (six weeks) in individuals with small lesions who are at low risk of relapse and in those who have undergone surgical excision of the lesion (four weeks). > - Patients should be warned that ulcers typically enlarge with antibiotic treatment, will not have healed by completion of antibiotics, and take a **median of four to five months to heal.** > - Surgical management is usually not required, but may be beneficial to reduce healing times, avoid or reduce the duration of antibiotics, and manage paradoxical reactions. > - Early identification and treatment of paradoxical reactions is important, as they are associated with increased tissue necrosis and delayed wound healing. > - Good **wound care** is critical in successful treatment of Buruli ulcer, as it enhances healing and prevents secondary bacterial infection. > - Compared with adults, children have a higher proportion of non-ulcerative and severe lesions, are less likely to experience adverse antibiotic effects, but have higher rates of paradoxical reactions; specialist referral is recommended.