Endemic areas include much of Central and West Africa, such as Zaire, Congo, Cameroon, Nigeria, Benin, Ghana, Liberia and Ivory Coast. Cases of Buruli ulcer have been reported in contiguous countries completely across Africa from Uganda to Guinea. Other involved geographic areas include Australia, Southeast Asia and sporadic cases in Central and South America. Tissue necrosis may extend to muscle or bone, and metastatic bone lesions can develop. Healing with fibrosis may lead to significant deformity, with lymphedema, scarring, and contractures.
Subclinical infections are common, as demonstrated by a positive burulin skin test.
There is no specific race predilection. There are no differences in rates of infection among males and females. Lesions usually begin as singular, painless, occasionally pruritic, subcutaneous nodules, which appear approximately 7-14 days after trauma to the overlying skin. Suppuration and ulceration occur within 1 or 2 months. Characteristic lesions have a scalloped border and a sloughing, necrotic base.