Buruli Ulcer


(Mycobacterium ulcerans infection)

Buruli ulcer is caused by a germ that mainly affects the skin but which can also affect the bone. The causative organism is called Mycobacterium ulcerans, which although different, belongs to the same family of organisms that cause leprosy and tuberculosis.

Buruli ulcer has been reported in over 30 countries with tropical and subtropical climates, but it may also occur in some countries where it has not yet been recognized. Limited knowledge of the disease, its focal distribution and the fact that it affects mainly poor rural communities contribute to low reporting of cases. Progress is being made now to develop tools for early diagnosis, to understand exactly how infection is transmitted and to improve treatment.


Buruli ulcer often starts as a painless, mobile swelling in the skin called nodule. Infection often leads to extensive destruction of skin and soft tissue with the formation of large ulcers usually on the legs or arms. If patients seek treatment at the early stage, antibiotics can prove to be successful. Delayed treatment may cause irreversible deformity, long-term functional disability such as restriction of joint movement, extensive skin lesions and sometimes life-threatening secondary infections.

Early diagnosis and treatment are vital.

Prevention and Treatment

Research for a vaccine to treat Buruli ulcer is continuing, although the current Bacille Calmette-Guérin (BCG) vaccine appears to offer some short-term protection. A safe and effective vaccine may be the most effective way to combat Buruli ulcer in the long term.

Current WHO recommendations for treatment are as follows:

  • A combination of rifampicin and streptomycin/amikacin for eight weeks as a first-line treatment for all forms of the active disease. Nodules or uncomplicated cases can be treated without hospitalization.
  • Surgery mainly to remove necrotic tissue, cover skin defects and correct deformities.
  • Interventions to minimize or prevent disabilities.

For more information, see Buruli ulcer project on WHO