What Is a Buruli Ulcer?

Medically Reviewed by Jabeen Begum, MD on October 13, 2022
5 min read

You may dismiss it as an insect bite when bumps or bites appear on your body. But when those bumps grow, become tender, or damage your skin, you may question what caused the spots.

A skin disease caused by a bacteria called Mycobacterium ulcerans, known as Buruli ulcer, can start as a small bump and then start damaging your skin quickly if left untreated. The toxin from the bacteria can cause skin loss. Early detection and antibiotics are crucial for treating Buruli ulcers.

When you become infected by the bacteria, your skin gets destroyed by a toxin called mycolactone. What starts as a small bump becomes an ulcer that can look similar to leprosy. 

The World Health Organization (WHO) created the Global BU Initiative in 1998 to raise awareness and control Buruli ulcer outbreaks. From 2002 to 2016, there were over 58,000 cases reported around the world. WHO started the initiative to assess Buruli ulcer cases at local, national, and global levels. 

Buruli ulcer has immunosuppressive properties and is toxic to your skin. Buruli ulcers cause chronic, ulcerative skin lesions that kill your skin cells. There are multiple strains of Buruli ulcers. The bacteria, Mycobacterium ulcerans, can evolve into different strains with different transmission patterns. 

Buruli ulcer requires quick action after you become infected. Without antibiotic treatment, Buruli ulcers can lead to lifelong ailments. These problems include: 

  • A skin deformity
  • Functional disability or limited movement 
  • Bone infection
  • More bacterial infections within your skin lesion

A painless, nonsensitive lesion could be the first sign of Buruli ulcer. Sometimes, you may think the spot is nothing more than a mosquito or spider bite. Over time, the lesion can become more prominent or become an ulcer. Other symptoms may begin to appear.

After about one to two months, the bump on your arm may change shape or feel different. Buruli ulcer symptoms include: 

  • Skin swelling
  • Damaged skin
  • Damaged soft tissue
  • Growing ulcers 

As the ulcer progresses, you may see other symptoms happening around the affected spot. Your ulcer may become crusty and form a scab that doesn’t heal. Then your scab will disintegrate into your ulcer. After that, the ulcer keeps growing with or without infection. 

Buruli ulcer may be painless or have pain associated with an infection. If your skin becomes infected, you may experience the following: 

  • Fever
  • Swelling and raised lumps
  • Thickened flat areas on your skin
  • Localized pain

The first case of Buruli ulcer was reported in the 1930s in Australia. Since then, there have been reports of the disease in over 30 countries around the world. Buruli ulcer isn’t contagious, but that doesn’t mean people of all ages can’t become infected. 

Atypical mycobacteria called Mycobacterium ulcerans cause Buruli ulcers. This bacteria is in the same family as leprosy and tuberculosis. Buruli ulcer is a severe condition that can leave your skin permanently damaged without the proper treatment.

The exact cause of how people get Buruli ulcer is unknown. Buruli ulcer transmission can happen in a few ways. Mosquito bites can spread the ulcer. But other animals like possums and mice can also host the disease.

There's a possibility that the disease passes from insects found in water to humans. But no evidence shows an infected animal giving the condition to people. Lab testing in Australia showed that horses, alpacas, koalas, possums, and dogs could get Buruli ulcers.

Buruli ulcer is typically diagnosed with lab testing. Diagnosis and treatment happen once tissue from the ulcer gets tested. Doctors will take a direct swab from the necrotic base of your ulcer. They’ll run lab testing to confirm the presence of Mycobacterium ulcerans.

When getting a diagnosis, your doctor will ask questions about where you live and where you have traveled recently. They do this to see if you’ve been in an area known for Buruli ulcer. Your doctor might request a biopsy of the lesion to test specifically. 

You’ll need an early diagnosis and an aggressive treatment plan to minimize tissue loss. This will also help speed up your ulcer healing time.

The WHO has created a recommended treatment plan for people diagnosed with Buruli ulcer. They made this plan to help reduce and manage your Buruli ulcer. 

Antibiotics. These are your best options for healing smaller lesions. Early antibiotic treatment works against the disease to protect your skin and heal any damage.

Surgery. In cases of severe damage to your skin, you may need dead tissue removed. Surgery can also cover skin defects or correct deformities.

Wear proper clothing. When using tools like gardening outside, ensure you’ve got gloves, a long-sleeved shirt, and pants. This can help you prevent cutting yourself or coming in contact with Buruli ulcer. 

Wash your cuts and scratches. Don’t let potential bacteria into your bloodstream. If you accidentally cut yourself while working outside, wash the area thoroughly.

Identify the lesion. Confusing or misdiagnosing your skin legion can occur. You may confuse Buruli ulcer with skin conditions like boils, lipomas, tuberculosis, or deep fungal infections. Your doctor may order labs that include a polymerase chain reaction, direct microscopy, histopathology, and culture to identify and treat Buruli ulcer.  

Permanent damage to your skin is a significant risk factor for Buruli ulcer. Damage can involve up to 15% of your skin surface, and a second infection can happen. Other problems coming from a Buruli ulcer include your wounds spreading to other areas or, worse, infection of the bone.

Other risk factors of Buruli ulcer include extensive scarring, swelling from fluid retention, and trouble moving your joints. Long-term effects of Buruli ulcer include permanent disability or disfigurement.

Ultimately, it’s best to take precautions against getting Buruli ulcer. Taking care of yourself outside can help tremendously. Wearing gloves, and long-sleeved shirts, protecting cuts, and washing any wound can help protect your body from this condition.