Provisional guidance on the role of specific antibiotics in the management of Mycobacterium ulcerans disease (Buruli ulcer)
When to suspect M. ulcerans disease
In a known endemic area, an experienced health worker can usually diagnose M. ulcerans disease on clinical grounds. The following clinico-epidemiological features are important diagnostic clues:
- most patients live in or have travelled to a known endemic area;
- most patients are children under 15 years of age;
- about 85% of lesions are on the limbs;
- lower-limb lesions are twice as common as upper-limb lesions;
- non-ulcerative lesions are almost painless or minimally painful (although ulcers may be painful in the presence of secondary bacterial infection);
- in the absence of secondary bacterial infections or other coinfections in ulcerative lesions, there are often no constitutional symptoms (such as fever);
- enlarged lymph nodes are not a feature of M. ulcerans disease.