Symptoms of Ulcer Buruli
Symptoms of Buruli ulcer most often begin with the appearance on the ground, as a rule, of the previous skin injury of the dense subacute-inflammatory painless infiltrate (tubercle, papule), most often in the legs, thighs, forearms and less often in other parts of the body. As it ripens through the central softening stage, the tubercle transforms into a painless ulcer, which, without treatment, occurs in the vast majority of cases. Much less frequently (10%), the decomposition of the tubercle without opening occurs in the direction of the underlying tissues, up to the destruction of the bones and the development of osteomyelitis. Very typical symptoms of the Buruli ulcer are more pronounced hyperpigmentation of the skin in the palpable infiltrate region, which is due not so much to the local disturbance of the melanogenesis function as to the stagnant-cyanotic color and partly the development of hemosiderosis. In the stage of infiltrate formation, general phenomena are usually absent, patients can feel only a feeling of tension in the area of the lesion.
In a week or two (less often before), as a result of central softening, decay and opening of the focus, one, sometimes several ulcers, typical features of which are noticeable depth, up to the subcutaneous fat, unevenly covered with fetid purulent-necrotic masses, seal in the base of the ulcer. The reaction of the regional lymph nodes and the more so the phenomena of periadenitis and lymphangitis are extremely rare and occur only in cases of stratification of the secondary pyococcal flora.
The dynamics of the development of the Buruli ulcer is characterized by peripheral growth and at times a migrating character. As the tendency to scarring on one side of the ulcerative defect, it continues to develop in a different direction. Sometimes, as a result of inoculation near the main, "maternal" ulcers, small, "daughter" foci may form, while their course becomes more torpid, often they are connected along the surface or in the depth, forming fistulous movements and bridges.
The process in many cases lasts from 2 months to 6 months or more and sometimes, even without treatment, is completed by complete scarring of ulcerative defects and deep tissue damage by coarse tightening and deforming scars, which subsequently limit the amount of movement in the affected limb.