Buruli ulcer (BU), caused by Mycobacterium ulcerans, is a neglected tropical disease characterized by chronic and debilitating skin lesions. Despite its public health relevance, BU remains under-recognized and frequently misdiagnosed in Nigeria. This study aimed to determine the proportion of PCR-confirmed Buruli ulcer cases among patients with chronic wounds and identify associated risk factors.
A cross-sectional study was conducted from February to October 2024 among 300 participants aged ≥15 years with wounds persisting for at least four weeks. Data were obtained using structured questionnaires. Laboratory confirmation of BU was performed using IS2404 real-time polymerase chain reaction (PCR), with smear microscopy and histopathology used as supportive diagnostic methods. Multivariable logistic regression analysis was employed to identify independent predictors of BU.
Buruli ulcer was PCR-confirmed in 75 of 300 participants (25.0%). The highest burden occurred among individuals aged 30–59 years. A substantial proportion of participants (70.0%, 210/300) reported prior exposure to freshwater environments. Lesions were predominantly located on the lower limbs and typically measured 5–15 cm along the longest axis, with symptom duration ranging from 6 to 24 weeks prior to presentation. Multivariable analysis identified freshwater exposure (adjusted odds ratio [aOR] = 3.25, 95% CI: 1.78–5.93), lower limb involvement (aOR = 2.80, 95% CI: 1.52–5.17), and symptom duration >12 weeks (aOR = 4.10, 95% CI: 2.21–7.60) as independent predictors of Buruli ulcer. Although smear microscopy and histopathology demonstrated moderate sensitivity, PCR showed superior diagnostic performance.
Buruli ulcer represents a significant yet under-recognized cause of chronic non-healing wounds in southeastern Nigeria, with a substantial proportion of cases among patients with chronic wounds confirmed by PCR. Targeted screening, improved access to reliable diagnostics, and coordinated public health interventions are imperative to reduce the disease burden.
}, year = {2026}, journal = {Clinical Epidemiology and Global Health}, volume = {40}, pages = {1 - 8}, month = {07/2026}, publisher = {Elsevier BV}, issn = {2213-3984}, url = {https://www.sciencedirect.com/science/article/pii/S2213398426001211/pdfft?md5=8dfd719637db71ff71a50e7cb698214e&pid=1-s2.0-S2213398426001211-main.pdf}, doi = {10.1016/j.cegh.2026.102406}, language = {ENG}, }