Imagine a skin infection that spreads quietly, causes little or no pain, and yet eats away flesh and bone if left untreated.
That’s Buruli ulcer — one of the world’s most neglected tropical diseases.

Though rare, this slow-moving yet destructive infection has affected thousands across Africa, Australia, and parts of Asia, including India. Its deceptive nature—painless, progressive, and easily ignored—makes awareness crucial. At Nellikka.life, we break down what this disease really is, why it’s often missed, and how modern medicine can help stop it in time.

What Exactly Is Buruli Ulcer?

Buruli ulcer is a chronic skin and soft-tissue infection caused by Mycobacterium ulcerans — a cousin of the bacteria that cause tuberculosis (TB) and leprosy.

But unlike its relatives, this bacterium releases a unique toxin called mycolactone, which destroys skin, fat, and sometimes bone tissue — all without triggering pain or inflammation. That’s why many patients only notice the disease after significant damage has already occurred.

Where Does It Occur?

Buruli ulcer primarily affects rural, tropical, and subtropical regions near slow-moving rivers, wetlands, and swamps.
It’s most common in:

• West and Central Africa (Ivory Coast, Ghana, Benin, Cameroon)
• Australia (Victoria and Queensland)
• Southeast Asia, including a few reported cases from India

The World Health Organization (WHO) classifies Buruli ulcer as a Neglected Tropical Disease (NTD) because it mainly impacts poor, rural communities with limited access to healthcare.

How Does It Spread?

Scientists are still studying the exact transmission route.
What’s known so far:

• It does not spread person to person.
• It’s believed to be transmitted through environmental exposure — possibly via insect bites, minor skin wounds, or contact with contaminated water or soil.
• Aquatic insects, mosquitoes, and snails may serve as carriers in some regions.

Essentially, spending time near contaminated water sources increases the risk — which is why people involved in fishing, farming, or washing clothes in rivers are more vulnerable.

Symptoms: Why It’s So Often Missed

Buruli ulcer begins innocently — just a small, painless nodule, lump, or swelling, often mistaken for an insect bite or boil.

Over days to weeks, this lump breaks down into an open ulcer with undermined edges and dead tissue beneath.
In advanced cases, it can destroy deep layers of skin and even bone, leading to severe deformities or disabilities.

Common signs include:

• A painless swelling (on limbs, face, or trunk)
• A slowly enlarging ulcer with yellowish base and edges that overhang
• Little to no fever or pain even in large ulcers
• Scarring, contractures, or limb deformities in late stages

Without early treatment, the infection can cause permanent disfigurement, loss of mobility, or even amputation.

Diagnosis: How Doctors Confirm It

Doctors rely on a combination of:

• Clinical examination — typical painless ulcers in endemic regions
• PCR test (Polymerase Chain Reaction) to detect M. ulcerans DNA
• Microscopy or culture (though the bacteria grow slowly)
• Histopathology for advanced cases

In India, diagnostic confirmation may be done through reference laboratories supported by WHO or the Indian Council of Medical Research (ICMR).

Treatment: The Good News

Once feared as a condition requiring surgery, Buruli ulcer can now be effectively treated with antibiotics if detected early.

Standard WHO regimen:

• Rifampicin (10 mg/kg once daily)
• Clarithromycin (7.5 mg/kg twice daily)
  Duration: 8 weeks

Additional care includes:

• Wound dressing and cleaning
• Surgical debridement for large ulcers
• Reconstructive surgery or skin grafting when necessary
• Physiotherapy to prevent contractures and restore mobility

When treated early, most patients heal completely without disability.

Prevention: What We Know So Far

Because the exact mode of transmission is unclear, prevention focuses on reducing environmental exposure and early detection:

• Avoid swimming or wading in stagnant or swampy waters in endemic areas.
• Wear protective clothing (long sleeves, boots) while farming or fishing.
• Keep minor wounds clean and covered.
• Report painless skin swellings or ulcers early to a healthcare center.

Health education and community awareness remain the strongest weapons against this silent disease.

Buruli Ulcer in India

While cases in India are rare, sporadic reports have come from Kerala, Tamil Nadu, and Maharashtra. The symptoms can easily be mistaken for tuberculosis of the skin or chronic ulcers, making awareness among clinicians vital.
With India’s tropical climate and widespread freshwater ecosystems, understanding this infection is crucial for early detection and public health surveillance.

Living Beyond the Ulcer

Recovery from Buruli ulcer is more than just healing the wound — it’s about regaining confidence, mobility, and dignity. Many survivors face social stigma due to scarring or deformity.
That’s why WHO-backed programs now emphasize holistic rehabilitation — physical therapy, mental health support, and community reintegration.

At Nellikka.life, we believe awareness can heal more than antibiotics ever will. Knowing the signs, acting early, and breaking the stigma around neglected diseases can save not just limbs, but lives.

References (Science-Backed Sources)

1. World Health Organization (2024). Buruli ulcer (Mycobacterium ulcerans infection) — WHO Fact Sheet.
2. Johnson, P. D. R. et al. (2005). Buruli Ulcer (M. ulcerans Infection): New Insights, New Hope. Journal of Clinical Microbiology.
3. Global Buruli Ulcer Initiative, WHO. Treatment and Management Guidelines (2019).
4. Yotsu, R. R. (2018). Buruli Ulcer: Review of Current Knowledge and Research Needs. Tropical Medicine and Infectious Disease.
5. Indian Council of Medical Research (ICMR) Reports

In Essence

Buruli ulcer reminds us that some diseases don’t roar — they whisper.
But silence can be deadly.
Recognizing those quiet signs early — that small, painless bump — can mean the difference between a scar and a lost limb.

At Nellikka.life, our goal is to ensure that no disease, however rare, hides behind ignorance. Because awareness, after all, is the first medicine.