Buruli is a county in Uganda where large numbers of cases occurred in the 1950's.
Distribution: mainly in equatorial Africa (Benin, Cote d'Ivoire, Ghana, Uganda), but also occurs in Mexico, South America, Australia ("Barnsdale ulcer"), Malaysia, Papau New Guinea, India, China and Japan.
Clinical criteria suggestive of Buruli ulceration:
(1) travel to or living in an endemic area
(2) onset of lesions < 15 years of age (if present in an endemic region)
(3) ulcerations usually on a limb (85%), with involvement of a lower limb about twice as frequent as involvement of an upper limb
(4) no other diagnosis that can better explain the findings
Laboratory criteria - 2 or more of the following:
(1) positive acid fast smear (Ziehl-Neelsen)
(2) positive culture for M. ulcerans (slow grower)
(3) histopathologic examination of a biopsy, with demonstration of acid fast bacilli
(4) positive PCR reaction for DNA from M. ulcerans
where:
• Laboratory criteria 1 and 3 seem similar. Thus, it would seem that diagnostic patterns are (1/3) + 2 or (1/3) + 4. or 2 + 4.
A new case is one that involves a patient with no previous history of Buruli ulcer.
A recurrent case is one that involves a patient within 1 year, either at the previous site or at a different site.
An inactive site shows a depressed, stellate scar.
