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Publications

Journal Article Review Epublish 1 citation

PubMed: 41413430 DOI: 10.1038/s41572-025-00672-9

Buruli ulcer.

Nat Rev Dis Primers 11(1):89

Authors: Rie R Yotsu, Rachel E Simmonds, Dziedzom K de Souza, Richard Odame Phillips, Yaw Ampem Amoako, Shashikant Srivastava, Kingsley Asiedu, Sara Eyangoh, Paul D R Johnson, Gerd Pluschke

Affiliations

  • Department of Tropical Medicine and Infectious Disease, Celia Scott Weatherhead School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
  • Department of Dermatology, National Center for Global Health and Medicine, Tokyo, Japan.
  • Discipline of Microbes Infection & Immunity, School of Biosciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
  • Department of Parasitology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon-Accra, Ghana.
  • Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
  • School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
  • Division of Infectious Diseases, Department of Medicine, University of Texas at Tyler School of Medicine, Tyler, TX, USA.
  • Department of Cellular and Molecular Biology, University of Texas Health Science Center at Tyler, Tyler, TX, USA.
  • Department of Malaria and Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland.
  • Centre Pasteur du Cameroun, Yaoundé, Cameroon.
  • Department of Infectious Diseases and Immunology, Austin Health and University of Melbourne, Melbourne, Australia.
  • Swiss Tropical and Public Health Institute, Allschwil, Switzerland.
  • University of Basel, Basel, Switzerland.

Abstract

Buruli ulcer is a slowly progressive necrotizing disease of the skin caused by Mycobacterium ulcerans, recognized by WHO as a neglected tropical disease. Around 2,000 cases are reported annually, but underdiagnosis and under-reporting probably obscure the true burden. A major advance in the understanding of Buruli ulcer pathogenesis was the discovery that mycolactone, a lipid-like exotoxin secreted by M. ulcerans, inhibits the Sec61 translocon, driving tissue destruction and immune suppression. M. ulcerans is an opportunistic environmental pathogen; however, its mechanisms of transmission remain unclear in most regions. PCR is the current gold standard for diagnosis, but its cost and technical demands limit use in resource-limited settings. Treatment is available with an oral regimen of rifampicin plus clarithromycin for 8 weeks, but further research is in progress to explore alternative drugs, optimized dosing and duration, and improved affordability. Adjunctive wound care, management of paradoxical reactions and rehabilitation, including physiotherapy and psychosocial support, are essential components of Buruli ulcer management. Future efforts should focus on elucidating transmission pathways to inform prevention, developing rapid diagnostics, refining and adapting drug regimens for diverse clinical presentations and patient groups, and advancing wound care. Strengthening healthcare worker training and integrating Buruli ulcer control with that of other skin diseases will enhance accessibility to early diagnosis and treatment, prevent disabilities and deformities, and reduce stigma, ultimately ensuring better quality of life for affected individuals worldwide.

MeSH

Buruli Ulcer, Skin, Pharmaceutical Preparations, Ulcer, Diagnosis

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