Precise incidence is unknown. It is the 3rd human mycobacterial disease in importance after tuberculosis and leprosy. It is possible that ethnic endogamy is a promoting factor. This endemic infectious disease is caused by an atypical Mycobacteria, mycobacterium ulcerans, that produces a lipid exotoxin that destroys tissue and decreases immunity. The disease occurs mainly in marshy areas in humid tropical regions (Africa, Asia, South America).
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Epidemiology: high (red), moderate (yellow) or low (green) endemicity. (*) isolated cases
The infection arises either by direct contact (skin breakdown) or by the bite of a vector such as the water bug Naucoris cimicoid.
Three evolutionary stages are described:
1: non-ulcerated lesion:
- nodule: subcutaneous, firm, painless, adhering to the skin
- plate: indurated and elevated, painless, dry, discolored skin
- edematous lesion: diffuse nonpitting swelling, painless, non-inflammatory
2: ulcerated lesion: more or less extensive, painless, yellowish background and detached edges
3: scarring lesions: atrophic scars; sometimes periarticular flanges.
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Single lesion, multifocal and osteoarticular forms can be encountered. The lesions may present at different clinical stages.
Treatments:
- local care of the necrotic lesions: painless, rarely requiring anesthesia
- medical treatment: rifampicin, oxoflacine with or without subcutaneous heparin
- surgical treatment: resection of nodules, excision of necrotic areas with delayed skin graft, surgical repair of the periarticular flanges
Anesthetic implications:
malnutrition and anemia due to chronic infection
References :
- Casanova J.L.
Mendelian predisposition to mycobacterial infections in humans.
J Soc. Biol 2000; 194 : 25-8.
- Lehman L, Simonet V, Saunderson P, Agbenorku P .
Ulcère de Buruli.
OMS 20016
- Kouame K, Kacou DE, Kanga JM.
L’ulcère de Buruli chez l’enfant.
In Les plaies de l’enfant, éditeurs: R Vanwijck et L Forest-Lalande, Sauramps, 2009: 201-11.
Updated: January 2018