Transcript Buruli Ulcer Mycobacterium ulcerans Infection Prepared by

Buruli Ulcer
Mycobacterium ulcerans
Infection
Prepared by: A. Elkader Y. Elottol
Supervisor: Prof M. Shubir
Disease caused by Mycobacterium
ulcerans.
First described by MacCallum in 1948, but
the name came from Buruli country in
Uganda.
The third most common Mycobacterium ,
that affected more than 30 countries .
Mode of transmission
Mode of transmission is not entirely
known evidence suggest that insects
are aquatic bugs belong to the genus
Noucaris and Diplonychus may
transmit the microbe.
Person to person transmission are
not clearly supported .
Trauma during swimming.
Pathogenesis
Once inoculated into the subcutaneous tissue
the organisms proliferates and elaborates a
toxin that has affinity for fat cells.
The toxin called Mycolactone which cause local
immunosuppression in infected tissue.
The most affected are children under the age of
15 years, mortality is low but disability is
high(66%) affected region mostly the upper
extremities.
The resulting necrosis then provides a favorable
milieu for further proliferation of the organisms.
Clinically the disease manifests as Papules,
Nodules, Plaques, Odematous Forms and
Ulcers.
Mycolactone toxin
Diagnosis
Clinical: depending on the clinical ground
Laboratory: any two of the following finding are
required:
Acid fast bacilli in a smear stained with Ziehl
Neelsen .
Positive culture of M.ulcerans ( required 6-8
weeks or longer at 30-33ċ, produce Rough
domed, lemon yellow colony on L.J medium)
Histopathological study of excisional biopsy
specimen.
Positive PCR for DNA from M. ulcerans.
PCR
Treatment
Drug treatment: several antimicrobial
agent have in vitro activity , but no single
agent has been proven to regularly useful
in treatment.
Agent used include Rifampicin, Rifabutin,
Clarithromycin,Azithromycin,Streptomycin,
and Amikacin.
Combination therapy are mostly used.
Surgical treatment: need prolong hospital
stay (100 days).
Prevention
No available Vaccine, used BCG give immunity
to about 47%.
Referances
World HealthOrganization.
Center for Desease Control
TANKS