Observational studyPLoS neglected tropical diseases2014
Clinical features and risk factors of oedematous Mycobacterium ulcerans lesions in an Australian population: beware cellulitis in an endemic area.
Observational study in PLoS neglected tropical diseases, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it, 38 citations in OpenAlex.
- Drugs for treating Buruli ulcer (Mycobacterium ulcerans disease).The Cochrane database of systematic reviews · 2018Pooled it
- Management of Mycobacterium ulcerans infection (Buruli ulcer) in Australia: consensus statement.The Medical journal of Australia · 2025Article
- AtypicalJournal of clinical medicine · 2025Review
- Buruli ulcer surveillance in south-eastern Australian possums: Infection status, lesion mapping and internal distribution of Mycobacterium ulcerans.PLoS neglected tropical diseases · 2024Article
- A human model of Buruli ulcer: The case for controlled human infection and considerations for selecting a Mycobacterium ulcerans challenge strain.PLoS neglected tropical diseases · 2023Review
- The Clinical Utility of Maceration Dressings in the Treatment of Inpatient Hand Infections: An Evaluation of Treatment Outcomes Compared to Standard Care.Hand (New York, N.Y.) · 2021Article
- Delays in Patient Presentation and Diagnosis for Buruli Ulcer (Tropical medicine and infectious disease · 2019Article
- The changing epidemiology worldwide ofEpidemiology and infection · 2018Article
- Wound healing: Natural history and risk factors for delay in Australian patients treated with antibiotics for Mycobacterium ulcerans disease.PLoS neglected tropical diseases · 2018Article
- Increased Severity and Spread of Mycobacterium ulcerans, Southeastern Australia.Emerging infectious diseases · 2018Article
- Overrepresentation of Diabetes in Soft Tissue Nontuberculous Mycobacterial Infections.The American journal of tropical medicine and hygiene · 2016Article
- Clinical Features of Spontaneous Partial Healing During Mycobacterium ulcerans Infection.Open forum infectious diseases · 2016Article
- Pre-emptive steroids for a severe oedematous Buruli ulcer lesion: a case report.Journal of medical case reports · 2015Article
- Clinical Epidemiology of Buruli Ulcer from Benin (2005-2013): Effect of Time-Delay to Diagnosis on Clinical Forms and Severe Phenotypes.PLoS neglected tropical diseases · 2015Article
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Authors and funding
6 authors at 1 institution in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionOedematous lesions are a less common but more severe form of Mycobacterium ulcerans disease. Misdiagnosis as bacterial cellulitis can lead to delays in treatment. We report the first comprehensive descriptions of the clinical features and risk factors of patients with oedematous disease from the Bellarine Peninsula of south-eastern Victoria, Australia.
methodsData on all confirmed Mycobacterium ulcerans cases managed at Barwon Health, Victoria, were collected from 1/1/1998-31/12/2012. A multivariate logistic regression model was used to assess associations with oedematous forms of Mycobacterium ulcerans disease.
resultsSeventeen of 238 (7%) patients had oedematous Mycobacterium ulcerans lesions. Their median age was 70 years (IQR 17-82 years) and 71% were male. Twenty-one percent of lesions were WHO category one, 35% category two and 41% category three. 16 (94%) patients were initially diagnosed with cellulitis and received a median 14 days (IQR 9-17 days) of antibiotics and 65% required hospitalization prior to Mycobacterium ulcerans diagnosis. Fever was present in 50% and pain in 87% of patients. The WCC, neutrophil count and CRP were elevated in 54%, 62% and 75% of cases respectively. The median duration of antibiotic treatment was 84 days (IQR 67-96) and 94% of cases required surgical intervention. On multivariable analysis, there was an increased likelihood of a lesion being oedematous if on the hand (OR 85.62, 95% CI 13.69-535.70; P<0.001), elbow (OR 7.83, 95% CI 1.39-43.96; p<0.001) or ankle (OR 7.92, 95% CI 1.28-49.16; p<0.001), or if the patient had diabetes mellitus (OR 9.42, 95% CI 1.62-54.74; p = 0.02).
conclusionsIn an Australian population, oedematous Mycobacterium ulcerans lesions present with similar symptoms, signs and investigation results to, and are commonly mistakenly diagnosed for, bacterial limb cellulitis. There is an increased likelihood of oedematous lesions affecting the hand, elbow or ankle, and in patients with diabetes.
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