Diagnostic Work-up of Buruli Ulcer

Abstract

Abstract Buruli ulcer (BU), caused by Mycobacterium ulcerans, is a neglected tropical disease with polymorphic skin manifestations. The great variability in clinical presentation and the broad range of similar conditions makes management difficult, especially in developing countries, where clinicians often have to work with limited laboratory support. Trained nurses at peripheral health care centres rely on key epidemiological and clinical criteria. In case of doubt, medical doctors from reference hospitals at the district level confirm the diagnosis. Diagnosis requires careful skin and general clinical examination of the patient. The diagnostic approach is conducted in three-steps: history, clinical examination of the skin and general clinical examination. BU presents in two standard clinical forms: non-ulcerated and ulcerated forms. Less commonly, BU can present as osteomyelitis, scars, mixed forms and multifocal lesions. Each clinical form has a number of differential diagnoses, which can often be confirmed or ruled out by combining with other symptoms, signs, or laboratory examinations. There are five laboratory methods available to support or confirm a diagnosis of BU. Ideally, two positive results are required to confirm the BU diagnosis and, in most places, PCR remains the most common and practical diagnostic test.